Katrine I. Baghurst

Public health implications of dietary differences between social status and occupational category groups.

STUDY OBJECTIVE--As there is a social status gradient in chronic disease mortality in Australia, this study aimed to establish whether there were substantial differences among socioeconomically defined groups with respect to food choice and nutrient intake, in the context of risk of nutrition related chronic diseases. DESIGN AND PARTICIPANTS--Cross sectional data were collected from a randomly selected population sample of 1500 urban Australian adults. Data were collected by postal questionnaire, which included an assessment of dietary intake and questions on sociodemographic details. Three measures of social position were collected: occupation, educational status, and income status. Occupation was interpreted both on a continuous, prestige scale, and also as categorical occupational groupings. MAIN RESULTS--The study achieved a 70% response rate. Higher social status was generally associated with healthier dietary intakes, with lower fat and refined sugar densities, and higher fibre densities, but also with higher alcohol density. No differences were found in salt, polyunsaturated fat, protein, or complex carbohydrate densities across groups. Food intake differences were also found between occupational status groups, with the upper social groups tending to consume more wholegrain cereal foods, low fat milk, and fruit, and less refined cereal foods, full cream milk, fried meat, meat products, and discretionary sugar; but also more cheese and meat dishes. CONCLUSIONS--Although this study did show statistically significant differences across social status groups in relation to nutrient and food intakes, these differences were small compared to the disparity between intakes of all groups and the recommended patterns of intake, and did not appear to be great enough to be a major explanatory variable in differences in disease risk across groups.

Demographic and dietary profiles of high and low fat consumers in Australia.

STUDY OBJECTIVE--To determine the socio-demographic, attitudinal, and dietary correlates of high and low fat consumption in the community. DESIGN--The study was undertaken using a postal survey format. A questionnaire was sent for self completion to a randomised sample of the adult population of two Australian states. PARTICIPANTS--Adult participants were selected randomly from the Electoral Rolls of the states of Victoria and South Australia. As voting at elections is compulsory in Australia, these rolls contain the names of all Australian citizens over the age of 18 years. Altogether 3209 respondents completed the survey giving a response rate of 67%. MAIN RESULTS--Lower than average fat consumption was more common in women. Age was a significant factor only in men. Occupation was not related to lower than average fat consumption but manual work and low occupational prestige were linked to higher than average consumption in men. People with a history of conditions related to heart disease were more likely to be low consumers but medical history did not distinguish high from average consumers. Low fat consumption was linked to higher refined and natural sugar consumption and higher alcohol consumption, but protein and complex carbohydrate consumption did not vary with fat consumption. Low fat diets also had higher densities of fibre and most vitamins and minerals, the exceptions being retinol, zinc, and vitamin B12, nutrients generally linked to meat and dairy consumption. Of the latter, only the low zinc concentrations, which are already borderline in the community, pose a potential nutritional problem. CONCLUSIONS--This study showed very strong links between dietary fat intake and the intake of nearly all other nutrients in the diet. The results highlight the need to consider relationships between nutrients not only for purposes of nutrition education but also in relation to nutritional epidemiology studies.

Socioeconomic status and personal characteristics as predictors of dietary change

Abstract An understanding of personal and socioeconomic predictors of dietary change is necessary for the development of effective public health nutrition education programs. Four hundred and eighty-seven volunteers were recruited from the electoral rolls of higher and lower socioeconomic status (SES) suburbs in an Australian city to take part in a 3-month, personalized, one-to-one nutrition education program. This study reports on predictors of dietary behavior change in the 249 volunteers assigned to the intervention condition. Change in usual food intake, change in nutrition knowledge, diet-related beliefs, confidence about making dietary changes, dietary stage of change and SES were assessed. The belief that diet has a causative role in the development of high blood cholesterol level, obesity and heart disease, nutrition knowledge, and interviewer-assessed confidence about making dietary changes were all predictive of change in this sample of volunteers. Improvements in knowledge about food selection and how to apply this knowledge to personal dietary habits were also associated with dietary change. Dietary stage of change was found to be associated with dietary intake, but did not predict behavior change. This study has shown that food selection knowledge, belief about diet-disease relationships, and attitudes toward dietary change goals may usefully be addressed in nutrition education programs that occur in public health, community health, or work-site settings.

Financial costs of healthful eating: A comparison of three different approaches

Abstract In the last decade, governments of most developed countries have established dietary guidelines for their populations in an effort to lower the incidence and prevalence of chronic diseases such as coronary heart disease, hypertension, certain cancers, and diabetes. However, although little quantitative analytical work has been undertaken, concern has been expressed about the potential increases in the financial costs of following a diet that complies with these dietary guidelines. To determine whether it is necessarily more expensive to follow a healthful diet, three pricing analyses were undertaken. An analysis of the potential cost of direct substitution of healthful alternatives for less healthful food choices (e.g., product-by-product substitution through the use of fat, fiber, or salt-modified alternatives, etc.) indicated that this approach would result in a more costly diet, while providing limited nutritional improvement at the population level. Pricing of self-selected diets of people whose diets currently comply with the dietary guidelines and targets for healthful eating showed that these people are currently paying more per megajoule for their diet. However, costing of diets that conformed to a new healthful eating plan, designed to produce eating patterns that meet both the dietary goals set for components of the food supply such as dietary fat, refined sugars or fiber, and the recommended daily intakes for energy, protein, vitamins, and minerals showed that healthful eating need not be more expensive and indeed, for most people, would bring cost savings. This study highlighted the need to consider the cost implications of recommendations made in nutrition education material and dietary guidelines, and to promote readjustment in the balance of foods in the diet rather than direct substitution of one particular food, or group of foods, by a “healthier” alternative.

Dietary fats, marbling and human health

This paper provides a description of dietary fats, including saturated, monounsaturated and polyunsaturated fats, as well as trans fatty acids and dietary cholesterol. The main concerns about dietary fats for human health are discussed, with particular reference to obesity, coronary heart disease and cancer. In relation to obesity, concern is with total fat intake in relation to excess energy intake; for heart disease this is also an issue but perhaps more important is the issue of the type of fats consumed, notably the role of saturated v. polyunsaturated and monounsaturated fats. For cancer, evidence suggests few links with either total or type of fat in the diet. The paper then reviews red meat as a source of dietary fat, concentrating on Australian beef and the types of fat found in the beef. In the USA, current data tables indicate fat levels from 3.7% for the leanest cuts with most cuts being at least 6–7% fat. In Australia, analyses show lower fat levels with between 1.6 and 6.5% fat for pasture-fed beef and 1.6 and 6.5% for grain-fed beef. Generally, the fatty acid composition of marbling fat is similar to subcutaneous fat from the same animal. Contrary to some commonly held beliefs it does not, therefore, confer any health benefit but merely contributes to the overall fat level.

Demographic and nutritional profiles of people consuming varying levels of added sugars

Abstract Sociodemographic characteristics and dietary intake of high and low consumers of added sugars, was assessed on a random sample of the Australian adult population using a postal, quantified food frequency approach. People with a higher percentage of energy coming from added sugars in their diet had higher energy and fibre intakes, but lower % energy from fat, complex carbohydrates, protein and alcohol. They also had lower intakes of a range of micronutrients despite having a higher energy intake. However, the form of the relationship between % added sugars and micronutrient intake varied. For some there was a strong linear trend across deciles of added sugars intake with vitamin B6, beta-carotene, folate and magnesium showing the strongest inverse linear trends in both men and women. In women, there was also a strong trend for niacin and weaker but still significant inverse linear trends for retinol, vitamin C, vitamin B12, potassium and zinc. In men, weaker trends were evident for vitamin B12, sodium, calcium and zinc. There were no significant linear trends for thiamine, riboflavin or iron in either sex, nor for retinol, vitamin C or potassium in men and sodium and calcium in women. For some of the micronutrients however, the relationship between % added sugars and micronutrient intake was not strictly linear, with lower nutrient intakes occurring at either end of the % added sugars intake range. High consumers of added sugars were found in all sociodemographic sectors but more particularly so in men and amongst smokers. For women, younger respondents and those in the paid workforce were more likely to be high consumers and, for men, consumption was more likely to be high in those who had never married.

Nutrient intakes in relation to health-related aspects of personality

Abstract Previous research has indicated that various aspects of eating behavior are related to personality. However, few studies have involved random samples of the general adult population or a broad assessment of nutrient intakes. The present study used a random postal survey of adults ages 18 to 70 years in Perth, Western Australia, to investigate the relationships between nutrient densities (relative intake, assessed using a dietary questionnaire) and relevant personality variables. The latter included the three dimensions from the Eysenck Personality Questionnaire (EPQ) and two measures of locus of control. For both men and women, the food-related internal locus of control correlated positively with fiber density and negatively with refined sugar density. The significant correlations with EPQ variables were gender-specific. For males, N (neuroticism) correlated negatively with fiber density and positively with cholesterol density; P (toughminded unconcern) correlated negatively with complex carbohydrate density. On the other hand, for females, P correlated negatively with both protein density and sodium density, and positively with refined sugar density; E (extraversion) correlated positively with sodium density. It is concluded that several features of dietary intake are related to personality factors considered relevant to psychological well-being. Regression analyses showed that these personality factors were generally stronger predictors of nutrient intake than the more frequently considered demographic variables, age, education and occupational status.

Zinc and magnesium status of australian adults

Abstract A national random survey of Australian adults showed that the daily intakes ofzinc and magnesium in the population were marginal with the diets of 67% of men and 85% of women being below the RDA for zinc, and those of 50% of men and 39% of women, below the RDA for magnesium. There were few differences across state of residence, metropolitan or country, age gender or occupational status and where such differences did exist, these were related almost entirely to differences in total food or energy intake. The major source of zinc in the diets of participants were steak, bread, milk, cheeses, minced meat and breakfast cereals and, for magnesium, bread, milk, breakfast cereals, bananas and beer (in men). Biochemical assessments were also made on a random sample of the South Australian population whose sociodemographic and dietary profile matched closely that of the national sample. Measures of plasma and urinary zinc and magnesium, appeared to confirm a high level of risk for magnesium but not for zinc. Interpretation of these data are however difficult because of uncertainty about plasma magnesium standards and, for zinc, the ability of plasma measures, alone, to detect marginal deficiencies.

The development of a simple dietary assessment and education tool for use by individuals and nutrition educators

Abstract Many of the major food guidance systems in use in western countries are based primarily on minimal nutrient requirement standards. In the last decade, increasing knowledge about the nutritional correlates of chronic disease have refocussed the nutrition debate to include concerns related to dietary excesses. The purpose of the research outlined in this paper was to develop a quantified and nutritionally-assessed food guidance system that was in line not only with current recommended minimal intake standards but also with the more recently developed national dietary guidelines designed to improve chronic disease risk profile. The system was devised using a computer simulation and analysis process. Foods and portion sizes used in modeling the diets were based on extensive nutrient intake data sets from random samples of the population. The system has been termed the 12345(+) nutrition plan, the numeric descriptor refering to the recommended servings or portions per day from the various food groups. The system is adaptable to varying energy and nutrient needs, and educational materials are being developed to detail its use in individual counselling and group settings with subjects of varying social and ethnic backgrounds.

Consumption of beef/veal/lamb in Australian children: Intake, nutrient contribution and comparison with other meat, poultry and fish categories

Aim To describe reported consumption of meat for children using the 2007 Australian National Childrens Nutrition and Physical Activity Survey. Methods One-day, weighted data are described for consumption of meat, poultry and fish consumed as ‘cuts’ and from mixed dishes. Data are presented for all children by age groups (2–3 years, 4–8 years, 9–13years, 14–16 years) and gender. Trimming practices, time and place of consumption, and nutrient contributions are described. Results Ninety per cent of children reported consuming meat, poultry or fish on the day surveyed. Reported mean consumption of all beef/veal/lamb, pork/ham/bacon, poultry and fish ranged from 52 g in 2 to 3-year-old boys to 161 g in 14 to 16-year-old boys; and was lower in 9 to 16-year-olds girls; 98 g. Mean reported consumption of beef/veal/lamb was 21–64 g for boys and 23–36 g for girls, depending on age group. For meals where the meat, poultry or fish were identified individually, meals with beef/veal/lamb contained more vegetables (159 g) than pork/ham/bacon (50 g) and poultry (110 g). The beef/veal/lamb was fully (20%) or semi-trimmed (58%), and 49% of minced beef/veal/lamb was lean. Sixty-eight per cent of respondents reported eating poultry with the skin removed. Across all age groups, beef/veal/lamb in cuts and mixed dishes contributed 4% of total energy, 6% of total fat, 5% of saturated fat, 46% of haem iron, 18% of zinc and 21% of long-chain omega-3 fatty acid intake. Conclusions These findings help to inform evidence-based individual or population-level recommendations.