Debra Hector

Dairy consumption and overweight and obesity: a systematic review of prospective cohort studies

A comprehensive literature search was undertaken to examine the relationship between dairy consumption and overweight/obesity in prospective cohort studies. A literature search from 1980 through to April 2010 was conducted. Nineteen cohort studies met all the inclusion criteria and were included in the systematic review. Of the 19 cohort studies, 10 were among children and adolescents (aged 2 to 14 years, n = 53 to 12 829, follow‐up 8 months to 10 years) and nine among adults (aged 18 to 75 years, n = 248 to 42 696, follow‐up 2 years to 12 years). A range of dairy food exposure measures were used. Eight studies (three out of 10 studies involving children and five out of nine studies involving adults) showed a protective association against increasing weight gain (measured in various ways); one reported a significant protective association only among men who were initially overweight; seven reported no effect; one reported an increased risk (among children), and two reported both a decreased and increased risk, depending on the dairy food type. The evidence from prospective cohort studies for a protective effect of dairy consumption on risk of overweight and obesity is suggestive but not consistent, making firm conclusions difficult.

Consumption of 'extra' foods by Australian children: types, quantities and contribution to energy and nutrient intakes

Objective:To measure the types and quantities of energy-dense, nutrient-poor ‘extra’ foods consumed by Australian children and adolescents and their contribution to total energy and nutrient intakes.Design, setting and subjects:We used data from 3007 children, aged 2–18 years, who participated in the nationally representative 1995 National Nutrition Survey. Intake was determined by 24-h recall and ‘extra’ foods were defined using principles outlined in the Australian Guide to Healthy Eating (AGHE) and by applying cut points for maximum amounts of fat and sugar within each food category.Results:All children (99.8%) consumed at least one ‘extra’ food and the most commonly consumed were margarine, sugar-sweetened soft drinks, cordials and sugar. ‘Extra’ foods contributed 41% of daily energy intake. Those foods contributing most to energy intake were fried potatoes (4.2%), sugar-sweetened soft drinks (3.3%), ice cream/ice confection (3.1%) and cordials (2.7%). Age and sex were important determinants of ‘extra’ food intake, with males and older children generally consuming more and different types of, ‘extra’ foods than females and younger children. ‘Extra’ foods contributed 19% protein, 47% total fat, 47% saturated fat, 54% sugar, and approximately 20–25% of selected micronutrients to the diet. Calcium and zinc intakes from core foods were below 70% of the recommended dietary intakes for adolescent girls.Conclusions:‘Extra’ foods are over-consumed at two to four times the recommended limits and contribute excessively to the energy, fat and sugar intakes of Australian children, while providing relatively few micronutrients. This is of concern in terms of childrens weight and nutrient status.Sponsorship:DR was on placement at NSW Centre for Public Health Nutrition as part of the NSW Health Biostatistical Officer Trainee Program.

The association between infant feeding practices and subsequent atopy among children with a family history of asthma.

Background Although longer duration of breastfeeding and later introduction of solid foods are both recommended for the prevention of asthma and allergic disease, evidence to support these recommendations is controversial.

Consumption of ‘extra’ foods by Australian adults: types, quantities and contribution to energy and nutrient intakes

Objectives:To identify the types and quantities of ‘extra’ foods, or energy-dense, nutrient-poor foods, consumed by Australian adults, and assess their contribution to total energy and nutrient intakes.Subject/Methods:We used 24-h recall data from 10 851 adults, aged 19 years and over, who participated in the nationally representative 1995 National Nutrition Survey. ‘Extra’ foods were defined using principles outlined in the Australian Guide to Healthy Eating and by applying cut points for maximum amounts of fat and sugar within each food category.Results:‘Extra’ foods contributed to 36% of daily energy intake with the highest contributors being fried potatoes (2.8%), margarine (2.6%), cakes and muffins (2.5%), beer (2.4%), sugar-sweetened soft drinks (2.4%), and meat pies (2.2%). Both age and sex were important determinants of ‘extra’ foods intake; younger adults were more likely to consume sugar-sweetened soft drinks, fried potatoes, meat pies and savoury pastries, pizza, crisps, lollies and chocolate; whereas older adults were more likely to consume sweet and savoury biscuits, cakes and muffins, margarine and butter. In all age groups, ‘extra’ foods contributed more to energy intake for men than women. Overall, ‘extra’ foods contributed 16% protein, 41% total fat, 41% saturated fat, 47% sugar and approximately 20% of selected micronutrients to the diet.Conclusions:‘Extra’ foods contribute excessively to the energy, fat and sugar intakes of Australian adults, while providing relatively few micronutrients. This is of concern for the increasing risk of overweight and chronic disease and poor micronutrient status.

Effectiveness of a multi-strategy intervention in increasing the implementation of vegetable and fruit breaks by Australian primary schools: a non-randomized controlled trial.

BackgroundLimited evidence exists describing the effectiveness of strategies in facilitating the implementation of vegetable and fruit programs by schools on a population wide basis. The aim of this study was to examine the effectiveness of a multi-strategy intervention in increasing the population-wide implementation of vegetable and fruit breaks by primary schools and to determine if intervention effectiveness varied by school characteristics.MethodsA quasi-experimental study was conducted in primary schools in the state of New South Wales, Australia. All primary schools in one region of the state (n = 422) received a multi-strategy intervention. A random sample of schools (n = 406) in the remainder of the state served as comparison schools. The multi-strategy intervention to increase vegetable and fruit breaks involved the development and provision of: program consensus and leadership; staff training; program materials; incentives; follow-up support; and implementation feedback. Comparison schools had access to routine information-based Government support. Data to assess the prevalence of vegetable and fruit breaks were collected by telephone from Principals of the intervention and comparison schools at baseline (2006–2007) and 11 to 15 months following the commencement of the intervention (2009–2010). GEE analysis was used to examine the change in the prevalence of vegetable and fruit breaks in intervention schools compared to comparison schools.ResultsAt follow-up, prevalence of vegetable and fruit breaks increased significantly in both intervention (50.3 % to 82.0 %, p < 0.001) and comparison (45.4 % to 60.9 % p < 0.001) schools. The increase in prevalence in intervention schools was significantly larger than among comparison schools (OR 2.36; 95 % CI 1.60-3.49, p <0.001). The effect size was similar between schools regardless of the rurality or socioeconomic status of school location, school size or government or non-government school type.ConclusionThe findings suggest that a multi-strategy intervention can significantly increase the implementation of vegetable and fruit breaks by a large number of Australian primary schools.

A comparison of two nutrition signposting systems for use in Australia

Consumers are interested in making healthier food choices but the mandatory nutrition information panel currently in use in Australia is not easily understood or interpreted by most consumers. A simple nutrition signpost would be valuable. This paper reviews two nutrition signposting systems currently being considered for adoption in Australia. The authors conclude that a system similar to the colour-coded Traffic Light System is likely to be most useful.

A fizzy environment: availability and consumption of sugar-sweetened beverages among school students.

OBJECTIVE Reducing sugar-sweetened beverage (SSB) consumption has been targeted in obesity prevention strategies internationally. This study examined associations between SSB availability at school and in the home, and consumption among Australian school students. METHOD Secondary analysis of the 2010 New South Wales Schools Physical Activity and Nutrition Survey (n=8058) was conducted. Logistic regression analyses tested the impact of SSB availability at school and in the home on consumption category (low, ≤1 cup/week; moderate, 2-4 cups/week; high, ≥5 cups/week). RESULTS Students in years K-10 (ages 4-16years) who usually purchased sugar-sweetened soft drinks or sports drinks from their school canteen were almost three times as likely to be high consumers (AOR 2.90; 95%CI 2.26, 3.73). Students in years 6-10 (ages 9-16years) were almost five times as likely to be high consumers if soft drinks were usually available in their home (AOR 4.63; 95%CI 3.48, 6.17), and almost ten times as likely to be high consumers if soft drinks were usually consumed with meals at home (AOR 9.83; 95%CI 6.06, 15.96). CONCLUSION Limiting the availability of SSBs in the home and school environments is a prudent response to address high SSB consumption among school students, albeit only part of the solution for obesity prevention.

Socio-cultural differences in Australian primary school children's weight and weight-related behaviours.

To examine whether there are socio‐cultural differences in overweight/obesity and weight‐related behaviours of Australian primary school children.

Weight status and weight-related behaviors of children commencing school

OBJECTIVE To describe the weight status and weight-related behaviors of children commencing school. METHODS This study is a representative cross-sectional survey of Australian children in their first year of schooling (n=1141) in 2010. Height and weight were measured, and parents reported their childs diet, physical activity and screen-time. RESULTS 18.7% of children were overweight/obese. Compared with non-overweight/obese peers, overweight/obese boys were 1.73 times (95% CI 1.08, 2.79) as likely to exceed recommended screen time and 2.07 times (95% CI 1.11, 3.87) as likely to eat dinner three or more times/week in front of the TV. Overweight/obese girls were twice as likely to have a TV in their bedroom (OR 2.00, 95% CI 1.12, 3.59) and usually be rewarded with sweets for good behavior (OR 1.96, 95% CI 1.09, 3.51) and were 1.65 times as likely to be inactive (95% CI 1.08, 2.55). CONCLUSION We showed that many children begin school with established weight-related behaviors that occur in the home environment. The inclusion of parents and the home environment in intervention strategies will be important to support changes to reduce childhood obesity. The weight status and weight-related behaviors of children entering school may potentially be a general indicator of the overall effectiveness of obesity prevention interventions among preschool-aged children.

Temporal trends in weight and current weight-related behaviour of Australian Aboriginal school-aged children

Objectives: To report 13‐year trends in weight status of Australian Aboriginal children, and to describe weight‐related behaviour in children in 2010, by Aboriginality.