Celia J. Prynne

Food and nutrient intake of a national sample of 4-year-old children in 1950: comparison with the 1990s.

OBJECTIVE To evaluate the food and nutrient intake of members of a birth cohort study when young children in 1950 and investigate differences from present-day childrens diets. DESIGN One-day recall diet records from the MRC National Survey of Health and Development (NSHD) (1946 Birth Cohort) at age 4 years were analysed for energy and selected nutrients and compared to the published results for 4-year-olds in the 1992/93 National Diet and Nutrition Survey (NDNS). SETTING England, Scotland and Wales in 1950 and 1992/93. SUBJECTS 4,599 children in 1950 and 493 children in 1992/93. RESULTS Mean (SD) daily intakes in 1950 were energy 1,445 (343) kcal, or 6.1 (1.4) MJ, protein 46 (11)g, fat 64 (20)g, starch 117 (33)g, sugar 62 (24)g, unavailable carbohydrate 13 (4)g, calcium 736 (230) mg, iron 7.7 (2.1) mg, retinol 738 (1,273) microg, carotene 1,049 (1,130) microg and vitamin C 40 (26) mg. Compared to 1992/93, the 1950 diet contained substantially more bread and vegetables and less sugar and soft drinks, giving it a higher starch and fibre content and making it more in line with current recommendations on healthy eating. However, fat provided 40% of energy in 1950, compared to 35% in 1992/93. In 1950, red meat was an important source of iron, but by 1992 most iron came from fortified breakfast cereals. Vitamin C came mainly from vegetables in 1950, but from soft drinks in 1992. CONCLUSIONS The relative austerity of post-war food supplies resulted in food and nutrient intakes in 1950 which in many respects may well have been beneficial to the health of young children, despite fat intake being higher than present-day recommendations.

Consumption of red or processed meat does not predict risk factors for coronary heart disease; results from a cohort of British adults in 1989 and 1999

Objectives:To investigate whether a high consumption of red or processed meat is associated with increased risk of coronary heart disease (CHD).Subjects/Methods:The subjects were 517 men and 635 women, who were members of the Medical Research Council National Survey of Health and Development, 1946 birth cohort. Assessment of diet was carried out at two time points 1989 and 1999 with outcome measures collected in 1999. Food intake data were recorded in 5-day diaries. Meat consumption was estimated by adding individual meat portions to the meat fractions of composite dishes.Results:There was no significant association between red or processed meat consumption in 1989 and 1999 and serum cholesterol concentrations and blood pressure measured in 1999. The combined intake of red and processed meat in 1999 had a significant positive association with blood pressure in men only. Red and processed meat intakes in 1989, separately and combined, had a significant positive association with waist circumference in 1999: a 10 g increase in red meat consumption accounted for a 0.3 cm increase in waist circumference; P=0.04 (men), 0.05 (women).Conclusions:Consumption of red or processed meat assessed separately was not related to the major risk factors for CHD but contributed to increased waist circumference that has also been identified as a risk factor.

Dietary acid-base balance and intake of bone-related nutrients in Cambridge teenagers.

Objectives: To evaluate the diet of 16–18-y-old boys and girls with particular reference to intakes of nutrients believed to affect bone health and dietary acid–base balance.Design: A 7-day food diary was completed between the months of October and December.Setting: Cambridge, UKSubjects: A total of 111 boys and 101 girls aged 16–18 y who were recruited into the Cambridge Bone Studies.Main outcome measures: Mean daily intakes of foods and selected nutrients (protein, calcium, phosphorus, magnesium, potassium, vitamins C and K) were calculated. Two estimates of acid–base balance were calculated from the diet using the formulae of Remer (net acid excretion, estimated indirectly; NAEind) and Frassetto (protein/potassium ratio).Results: Mean calcium and phosphorus intakes were above the UK Reference Nutrient intake (RNI). In all, 39% of the boys and 36% of the girls had vitamin K intakes lower than 1 μg/kg body weight/day. Calcium intake was positively correlated with all other nutrients except vitamins C and K. Boys had a significantly higher estimated net acid excretion (NAEind) than girls (P<0.001). Although a strong correlation (r=0.76, P<0.001) was found between the two methods, at higher acid levels a divergence was observed. A significant positive correlation was found between NAEind and the weight consumed per day of milk, cheese, meat and cereal foods and a negative correlation was found with the weight of potatoes and fruit. Diet composition is such that a lower NAEind is accompanied by a lower calcium intake.Conclusions: The interpretation of the effects of calcium and other nutrients on bone cannot be considered in isolation from the other components of the diet. These results challenge some of the accepted perceptions about what constitutes an optimal diet for the promotion of bone health in adolescents.Sponsorship: Medical Research Council, Department of Health/Medical Research Council Nutrition Research Initiative and Mead Johnson Research Fund.

Daily profiles of energy and nutrient intakes: are eating profiles changing over time?

BACKGROUND/OBJECTIVES:Associations between timing of eating occasions and their nutrient composition and health have been described in interventional and cross-sectional studies. However, data from longitudinal data are limited. This study examined 17-year changes in energy and macronutrient intake across eating occasions in the 1946 British birth cohort.SUBJECTS/METHODS:Data were obtained from the 1946 British birth cohort. Cohort members completed 5d-estimated diaries at ages 36 (1982), 43 (1989) and 53 years (1999). Data from subjects who provided dietary data at all three time points were analysed (n=1253). Repeated-measures analysis of variance with post hoc Bonferronis adjustment was used to examine changes in energy and macronutrient at breakfast, mid-morning, lunch, mid-afternoon, evening and extra meal slots between 1982 and 1999. Analyses were stratified by sex and social class.RESULTS:The proportion of energy and macronutrients consumed at lunch declined between 1982 and 1999, which was compensated by a greater intake in the mid-afternoon and evening. This trend was seen across sex and social class, although women and adults with a non-manual occupation reported greater energy, carbohydrate and non-starch polysaccharide intake at breakfast in 1982 and had a higher protein intake in the evening compared with men and adults with a manual occupation.CONCLUSIONS:The timing of energy and nutrient intake has shifted slightly over time, with a greater proportion of intake later in the day. The association between the observed sex and occupational social class differences in eating profiles and chronic disease warrants investigation.

Disaggregating composite food codes in the UK National Diet and Nutrition Survey food composition databank

Objective:To disaggregate composite food codes used in the UK National Diet and Nutrition Survey (NDNS) into their individual food components in order to provide a more complete estimate of intake at the individual food level.Methods:A total of 3216 composite food codes from the NDNS food composition databank were subject to disaggregation. The main food components used were meat, fish, fruit, vegetables and cheese, which were further divided into 26 subcategories.Results:It was shown that previous determination of meat containing composite food codes provided an overestimate of meat intake and underestimate of additional components such as fruit and vegetables.Conclusions:By incorporating disaggregated data into NDNS, variations will be seen in consumption of some main food groups, but these variations may be also attributable to trends in consumption.

Time-of-day and nutrient composition of eating occasions: prospective association with the metabolic syndrome in the 1946 British birth cohort

Background:Diet is a key modifiable factor in the prevention and treatment of the metabolic syndrome. However, few studies have examined the prospective association between time-of-day of nutrient intake and the metabolic syndrome.Objective:To examine the association between time-of-day and nutrient composition of eating occasions and the long-term development of metabolic syndrome in the Medical Research Council (MRC) National Survey of Health and Development (NSHD; 1946 British birth cohort).Methods:The analysis comprised 1488 survey members who completed at least 3 days of estimated diet records at age 43 years (1989) and for whom data on metabolic syndrome at age 53 years (1999) were available. Dietary records were divided into seven meal slots: breakfast, mid-morning, lunch, mid-afternoon, dinner, late evening and extras. Metabolic syndrome was defined by the criteria of the adult treatment panel (ATPIII8), and was modified to include glycosylated haemoglobin instead of fasting glucose. Associations between time-of-day of nutrient intake at age 43 years and prevalence of metabolic syndrome at age 53 years were assessed using multivariate nutrient density logistic models after adjustment for sex, social class, smoking status, region, alcohol intake and recreational physical activity.Results:There were 390 cases of metabolic syndrome at age 53 years. Substituting 5% of energy from carbohydrate for a similar amount of energy from fat at breakfast (odds ratio=0.93; 95% confidence interval=0.89–0.98; P=0.002) and mid-morning at age 43 years (odds ratio=0.96; 95% confidence interval=0.93–0.99; P=0.011) was associated with lower odds of the metabolic syndrome at age 53 years. Carbohydrate intake at breakfast or mid-morning was particularly protective against abdominal obesity (P⩽0.001). Increasing carbohydrate intake at breakfast while simultaneously decreasing fat intake was also negatively related to triacylglycerols (P⩽0.001).Conclusions:Increasing carbohydrate intake in the morning while simultaneously reducing fat intake could be protective against long-term development of the metabolic syndrome and its components.

Intake and sources of phylloquinone (vitamin K(1)) in 4-year-old British children: comparison between 1950 and the 1990s.

OBJECTIVES To compare dietary intake and sources of phylloquinone (vitamin K1) in 4-year-old British children between 1950 and the 1990s, and report their variation by sociodemographic factors. DESIGN Nationally representative samples of 4-year-olds from the longitudinal Medical Research Council National Survey of Health and Development (NSHD) (1950) and the cross-sectional National Diet and Nutrition Surveys (NDNS, 1992/93 and 1997). SETTING Great Britain. SUBJECTS Subjects were 4599 children born on 3-9 March 1946 (NSHD) and 307 children in the 1990s (NDNS). RESULTS Geometric mean dietary phylloquinone intake was significantly higher in 1950 (39 mug day(-1), 95% confidence interval (CI) 37, 40) compared with the 1990s (24 mug day(-1), 95% CI 22, 25) (P<0.001). This difference remained when intake was expressed per MJ energy intake and per kilogram body weight, and after accounting for sex, region and occupational social class of the family. In 1950, phylloquinone intake in Scotland was significantly lower than in the rest of Britain. By the 1990s these regional differences had disappeared. Food sources of phylloquinone intake changed significantly between 1950 and the 1990s, with fats and oils contributing more and vegetables less, although vegetables contributed most (60% and 48%, respectively) to phylloquinone intake in both surveys. CONCLUSIONS Phylloquinone intakes of children have decreased significantly since 1950. With the suggested need for adequate phylloquinone intake for optimal development and maintenance of bone and the cardiovascular system, the substantially lower phylloquinone intakes reported in children of the 1990s, compared with 1950, may have implications for the health of these two systems in later adulthood.

The impact of inter-generational social and regional circumstances on dietary intake patterns of British adults: results from the 1946 British Birth Cohort

OBJECTIVES (1) To determine the extent to which an individuals childhood social circumstances and region of residence influence their dietary pattern at age 43 years and (2) to establish the extent to which an individual adopts the dietary pattern of their social and regional circumstances at age 43 years. DESIGN Longitudinal study of a social class stratified, random sample of all legitimate, singleton births in the week of 3-9 March 1946. SETTINGS England, Scotland and Wales. SUBJECTS The 3187 survey members who provided sociodemographic information at age 4 years in 1950 and sociodemographic and dietary data (48-hour dietary recall) at 43 years in 1989. RESULTS People who remained in the non-manual social class consumed significantly higher amounts of food items correlated with the factor health aware (items include high-fibre breakfast cereals, wholemeal breads, apples and bananas) than those who remained in the manual social class. Those who made the transition from manual social class in childhood to non-manual social class at age 43 years partly adopted the distinctive dietary patterns of the non-manual social classes. Consumption of items in the factors refined (items include whole-fat milk, white bread, sugar and butter) and sandwich (items include tomatoes, lettuce, onions, bacon and ham) did not differ by social class or regional mobility. CONCLUSIONS This work suggests that although adult dietary patterns are developed as a result of childhood influences, these patterns can be modified as a result of social and regional transitions. Such changes in dietary patterns may influence susceptibility to disease.

Meat consumption after disaggregation of meat dishes in a cohort of British adults in 1989 and 1999 in relation to diet quality

Background/Objectives:The aim of the study was to quantify more precisely the meat intake of a cohort of adults in the UK by disaggregating composite meat dishes.Subjects/Methods:Subjects were members of the Medical Research Council National Survey of Health and Development, 1946 birth cohort. Five-day diaries were collected from 2256 men and women in 1989 and 1772 men and women in 1999. From the details provided, composite meat dishes were broken down into their constituent parts and the meat fraction was added to meat portions only. Meat intake was classified as red meat, processed meat and poultry.Results:Meat consumption without disaggregation of meat dishes resulted in a mean overestimation of 50% in men and 33% in women. Red meat consumption fell between 1989 and 1999 from 51.7 to 41.5 g per day in men and 35.7 to 30.1 g per day in women. Poultry consumption rose from 21.6 to 32.2 g per day in men and 18.2 to 29.4 g per day in women. Re-calculating red meat intakes resulted in the percentage of subjects in 1999 consuming more than the recommendation of the World Cancer Research Fund falling from 30 to 12%. Increasing consumption of red and processed meat was associated with increased intakes of energy, fat, haem iron, zinc and vitamin B12, and lower intake of fibre. Increased sodium intake was associated with increased consumption of processed meat.Conclusions:Disaggregation of meat dishes provided a more precise estimate of meat consumption. The quantity of red or processed meat in the diet was reflected in the nutrient content of the entire diet.

Development of the Eating Choices Index (ECI): a four-item index to measure healthiness of diet.

OBJECTIVE Current indices of diet quality generally include intakes of specific foods or nutrients. We sought to develop an index that discriminates healthy and unhealthy eating choices for use in large surveys as a short questionnaire and as a measure in existing studies with adequate dietary data. DESIGN The Eating Choices Index (ECI) score included four components: (i) consumption of breakfast, (ii) consumption of two portions of fruit per day, (iii) type of milk consumed and (iv) type of bread consumed, each providing a score from 1 to 5. In analysis of 5 d food records, the ECI score was examined in relation to macronutrients, fibre, vitamin C, Fe, Ca and folate using Pearson correlations. Variation with sex, BMI, socio-economic status, marital status, smoking status and physical activity were also investigated. SETTING Medical Research Council National Survey of Health and Development. SUBJECTS Individuals (n 2256) aged 43 years. RESULTS The ECI score (mean 12·3 (sd 3·5)) was significantly positively associated with protein, carbohydrate, fibre, vitamin C, Fe, Ca and folate (r = 0·2-0·5; P < 0·001) and significantly negatively associated with fat intake (r = -0·2; P < 0·001); ECI scores were not correlated with total energy intake. Individuals with a lower ECI score were more likely to be men (P < 0·001), overweight or obese (P < 0·001), have lower socio-economic status (P < 0·001), smoke more (P < 0·001) and be less physically active (P < 0·001). CONCLUSIONS ECI scores correlated with nutrient profiles consistent with a healthy diet. It provides a simple method to rank diet healthiness in large observational studies.