Michael Gracey

Historical, cultural, political, and social influences on dietary patterns and nutrition in Australian Aboriginal children

Before permanent European colonization 2 centuries ago, Australian Aborigines were preagriculturalist hunter-gatherers who had adapted extraordinarily well to life in a variety of habitats ranging from tropical forests, coastal and riverine environments, savannah woodlands, and grasslands to harsh, hot, and very arid deserts. Colonization had serious negative effects on Aboriginal society, well-being, and health, so much so that Aborigines are now the unhealthiest subgroup in Australian society. The change from active and lean hunter-gatherers to a more sedentary group of people whose diet is now predominantly Westernized has had, and continues to have, serious effects on their health, particularly in relation to cardiovascular disease and type 2 diabetes mellitus, which are highly prevalent among Aborigines. The contemporary diets of Australian Aborigines are energy rich and contain high amounts of fat, refined carbohydrates, and salt; they are also poor in fiber and certain nutrients, including folate, retinol, and vitamin E and other vitamins. Risks of development of cardiovascular disease and type 2 diabetes in this population probably develop during late childhood and adolescence. This indicates a need for greater emphasis on health promotion and disease prevention than at present and a need to plan these in culturally sensitive, secure, and appropriate ways. Most information about Aboriginal diets is anecdotal or semiquantitative. More effort needs to be invested in studies that more clearly and precisely define dietary patterns in Aboriginal people, especially children, and how these patterns influence their growth, nutritional status, and health, prospectively.

Child health in an urbanizing world.

The aim of this study is to document and comment on the effects of urbanization on child health, internationally, using published reports and the authors personal experience. Urbanization is having profound effects on the health and well‐being of infants and children in industrialized and developing countries. This will affect generations into the future. The changes are not confined to cities and large towns; they rapidly influence transitional societies in remote and rural areas, because globalization is changing infant feeding practices and childrens diets and lifestyles. In developing countries, overcrowding and environmental pollution are massive problems made worse by undernutrition and infections, particularly respiratory and diarrhoeal diseases. In developed societies there are many other problems, e.g. injuries, poisonings, violence, drug abuse, exposure to industrial and atmospheric pollutants, including pesticides, sexually transmissible diseases, and “lifestyle”, diseases including obesity and cardiovascular disease risk. There is an urgent need for paediatricians, health planners, policy‐makers, governments and the community to understand these issues and work towards minimizing their harmful effects on children.

The CUPDAY Study: prebiotic‐probiotic milk product in 1–3‐year‐old children attending childcare centres

Aim: The aim of the study was to evaluate the efficacy of a milk product containing probiotics and prebiotics (CUPDAY Milk) on the incidence of diarrhoea in children attending daycare centres.

NEW WORLD SYNDROME IN WESTERN AUSTRALIAN ABORIGINES

1. It has become clear over the past 25 years that Aborigines in Western Australia (WA) now experience very high rates of type 2 diabetes mellitus and its complications as well as hypertension and cardiovascular disease; these disorders are often associated with obesity and abnormalities of plasma lipids.

Nutritional effects and management of diarrhoea in infancy

The interactions between diarrhoeal disease and nutritional status are complex and synergistic. These are serious issues globally because they affect hundreds of millions of young children and annually cause >3 million deaths in children aged under 5y. Despite intensive field‐based and laboratory studies over three decades, many questions remain unanswered about the causes, pathophysiology and best approaches to management and prevention of this “diarrhoea‐malnutrition” syndrome. Oral rehydration therapy (ORT) has been a major advance and has saved many lives from acute diarrhoea. However, persistent diarrhoea is now a major problem and is very significant because of its strong negative impacts on nutritional status and because persistent diarrhoea and dysentery are now major causes of infant and young child deaths. ORT provides clear and practical methods for replacement of fluid and electrolyte losses during diarrhoea. Rehydration salts can be made available as (i) a simple, easy‐to‐use package, complete with user instructions; (ii) cereal‐based formulae based on widely available ingredients that can be prepared domestically or commercially; and (iii) home‐made mixtures of sugar and salt which should be simple to prepare but are risky because of inadequate understanding about their preparation at home and the chance of mixing the ingredients inaccurately and giving them wrongly. Continuation and encouragement of breastfeeding is an important strategy to prevent and control diarrhoea and as part of its management. Early refeeding during diarrhoea is another important principle to help to reduce its duration, severity and its nutritional impacts. Supplementation with specific dietary ingredients, such as vitamin A, zinc and folate, is rather contentious and drug therapy is of little value unless specifically indicated. Some patients may require enteral nutrition or parenteral nutrition but these require specialized equipment and skills that are usually beyond the reach of developing countries and infants and children who live in remote areas.

Aboriginal mothers, breastfeeding and smoking

Objective: To document the smoking practices of Aboriginal mothers living in Perth during pregnancy and during the subsequent year while feeding their infants.

Persistent growth faltering among Aboriginal infants and young children in north-west Australia: a retrospective study from 1969 to 1993

The objective was to examine long‐term changes in the growth of Aboriginal infants and young children in the Kimberley region in the far northwest of Australia from 1969 to 1993. A retrospective analysis of anthropometric data (weight and length) routinely collected on 0–5‐year‐old children in 5‐year cohorts from 1969 to 1993 was carried out. From 1974‐78 to 1989‐93 there has been a significant increase in mean birthweight (ANOVA p < 0.05). The percentage of low birthweight infants (<2500g) declined from 14% in 197983 to 10% in 1989‐93 (p < 0.001). There were no consistent improvements in the growth patterns of infants from birth to 60 months. All cohorts displayed pronounced growth faltering in weightforage and heightforage from 6 to 12 months of age and fell significantly below both the NCHS reference values and mean values for healthy breastfed infants. In conclusion, reductions in Aboriginal infant mortality and infectious disease rates over the past 20 years have not been accompanied by improved growth. The persistence of child malnutrition in these communities may warrant a shift in attention from disease treatment and prevention to a better understanding of nutritional influences, particularly weaning practices, during infancy and early childhood.

Hospitalisation for gastroenteritis in Western Australia

Aims: To document gastroenteritis hospitalisations of the 1995–96 cohort of infants born in Western Australia to mid-2002, and to assess factors associated with their hospitalisations and readmissions. Methods: Retrospective analysis of the State’s hospitalisation data, Midwives’ Notification of Births data, the Australian Bureau of Statistics mortality data and clinical and demographic information. Results: Aboriginal infants were hospitalised for gastroenteritis eight times more frequently than their non-Aboriginal peers, and were readmitted more frequently and sooner for diarrhoeal illnesses than the other group. They also stayed in hospital for twice as long and many Aboriginal patients were hospitalised on numerous occasions. Hospitalisation rates were higher in remote areas and were significantly associated with co-morbidities such as undernutrition, anaemia, co-existing infections, and intestinal carbohydrate intolerance. Conclusions: Gastroenteritis is very prevalent in Australian Aboriginal infants and children and is a major cause of their hospitalisation in Western Australia. It is often associated with undernutrition, anaemia, intestinal parasitic infestations, other infections, intestinal carbohydrate intolerance, and, in some instances, with low birth weight. This is often due to unhygienic living conditions and behaviours and presents major challenges to public health, health promotion, and clinical personnel, particularly paediatric services. Childhood diarrhoeal diseases occur commonly in other indigenous groups but have not received the attention that they deserve.

Persistent childhood diarrhoea: Patterns, pathogenesis and prevention

Abstract With improved management of acute episodes of infectious diarrhoea, increased attention is now being given to persistent diarrhoea and its nutritional consequences and associated mortality. Risk factors for the development of persistent diarrhoea include young age, malnutrition, impaired immune function, recent introduction of milk feedings, prior antimicrobial therapy and infection with pathogenic strains of Escherichia coli. Descriptive epidemiology indicates that 3–20% of episodes of acute diarrhoea in children in developing countries become persistent and cause about one‐third to one‐half of all deaths from diarrhoea. Environmental factors may be very important in causing persistent diarrhoea: these include undernutrition combined with the impact of living in highly contaminated environments and their effects on gastrointestinal microecology. Development of effective preventive strategies will depend on improved understanding of causes and pathogenesis of persistent diarrhoea.

Differences in growth among remote and town‐dwelling Aboriginal children in the Kimberley region of Western Australia

This paper documents the growth of Aboriginal children in remote communities and gazetted towns of the Kimberley region in the far north of Western Australia over the past 20 years. The studys specific aim was to compare the height and weight growth of children in different environments from birth to five years of age. From 1979 to 1983, children living in towns were significantly taller and heavier than their counterparts in remote communities. From 1984 to 1988 and thereafter, there were no significant differences in the growth patterns of children in towns and remote communities. Overall, weight‐for‐age and height‐for‐age of children in remote communities has improved since the 1970s relative to their town‐dwelling counterparts. These changes in growth shed light on the quality of the social and physical environment over the past 20 years and may assist with the development of future programs for child health.