Secular trends in under-reporting in young people

Metabolic Risk Factors in Young Men With Healthy Body Fat But Different Level of Physical Activity

The study was performed to evaluate metabolic risk in young lean individuals characterized by different physical activity. A total of 194 students (93 active with 5–7 h weekly physical activity and 101 inactive) were accepted for the study. The following percentages of body fat were accepted as characteristic for lean men: 14% to 17% in active and 18% to 24% in inactive participants. Circulating glucose, insulin, triacylglycerols (TG), total cholesterol (TC), and high-dendity lipoprotein (HDL)-cholesterol (HDL-C) were assayed. Daily intake of energy and macronutrients was briefly assessed from 24 h food records collected over 4 days preceding blood collection. Insulin and TG differed with respect to physical activity and was lower by 37.5% and 12.5%, respectively, in active versus inactive participants. In active students with upper quartile of body fat percentage, the only significant difference was found between circulating insulin (by 28%, p < .04). In inactive participants with upper quartile of body fat, significant differences were found between levels of insulin and TG (by 25% and by 37.5%, respectively). Diet composition did not differ with respect to the percentage of energy derived from protein, fat, and carbohydrates. An inverse association between insulin level and the percentage of body fat seems to be physiological one because it has been noted in both active and inactive individuals. On the contrary, elevation in circulating TG found exclusively in inactive subjects seems to be secondary to the changes in adiposity and circulating insulin and is followed by tendency to higher levels of TC.

Associations of Nutrient Intake Changes During Childhood with Adolescent Hepatic Fat: The Exploring Perinatal Outcomes Among CHildren Study

OBJECTIVE

To examine associations of dietary changes from childhood to adolescence with adolescent hepatic fat and whether the PNPLA3 rs738409 risk allele, a strong genetic risk factor for hepatic fat, modifies associations.

STUDY DESIGN

Data were from 358 participants in the Exploring Perinatal Outcomes among CHildren (EPOCH) study, a longitudinal cohort in Colorado. Diet was assessed by food frequency questionnaire in childhood (approximately 10 years of age) and adolescence (approximately 16 years of age) and converted to nutrient densities. Hepatic fat was assessed in adolescence by magnetic resonance imaging. Linear regression was used to test associations of dietary changes from childhood to adolescence with adolescent hepatic fat.

RESULTS

Increases in fiber, vegetable protein, and polyunsaturated fat intake from childhood to adolescence were associated with lower adolescent hepatic fat, and increases in animal protein were associated with higher hepatic fat (β per 5-unit increase on log-hepatic fat: -0.12 [95% CI, -0.21 to -0.02] for ▵fiber; -0.26 [95% CI, -0.45 to -0.07] for ▵vegetable protein; -0.18 [95% CI, -0.35 to -0.02] for ▵polyunsaturated fat; 0.13 [95% CI, 0.04-0.22] for ▵animal protein). There was evidence of effect modification by PNPLA3 variant, whereby inverse associations of ▵fiber and ▵vegetable protein and positive associations of ▵saturated fat with adolescent hepatic fat were stronger in risk allele carriers. Most conclusions were similar after adjusting for obesity in adolescence, but associations of ▵saturated fat with hepatic fat were attenuated toward the null.

CONCLUSIONS

Our results suggest that nutrient intake changes between childhood and adolescence, particularly decreases in fiber and vegetable protein and increases in saturated fat intake, interact with the PNPLA3 variant to predict higher hepatic fat in adolescence, and may be targets for reducing hepatic fat in high-risk youth.

Determinants of Portion Size in Children and Adolescents: Insights from the UK National Diet and Nutrition Survey Rolling Programme (2008-2016)

Large portion sizes have been identified as contributing to overweight and obesity, particularly in children and adolescents. This study examined predictors of portion sizes of high energy snack foods eaten by children aged 1.5–18 years. Specifically, we examined whether portion sizes were adjusted for age, and what external features of the environment might be linked to large portion sizes. Portion sizes were derived from four-day food diaries that form the UK National Diet and Nutrition Survey. Diaries from 5942 children were examined and multilevel models were used to discover whether age, gender, location, time of day, household income, and watching TV while eating predicted portion sizes of savoury snacks, chocolate, confectionery and biscuits. Portion sizes of all the target foods were predicted by age. Boys had larger portions, and portion sizes were larger when target foods were consumed later in the day. Portion sizes were larger outside the home, for example in leisure venues, but the target foods were eaten more frequently in the home. As dietary patterns change to include more snack intake outside the home, these locations could be an important space to target for interventions for portion control.

Effects of a 3-month vigorous physical activity intervention on eating behaviors and body composition in overweight and obese boys and girls

PURPOSE

This study aims to analyze the effects of a 3-month vigorous physical activity (VPA) intervention on eating behavior and body composition in overweight and obese children and adolescents.

METHODS

Forty-seven participants (7-16 years) took part in the study: 28 were assigned to the intervention group (IG) (10 boys and 18 girls) and 19 in a control group (CG) (8 boys and 11 girls). Body composition (dual-energy X-ray absorptiometry), anthropometrics (body mass, height, and body mass index (BMI)), and eating behavior traits (Three-Factor Eating Questionnaire-R21C) were determined before and after the VPA intervention.

RESULTS

A decrease in the percentage of body fat and BMI (-2.8% and -1.8%, respectively), and an increase in most lean mass variables were found in the IG (all p ≤ 0.05). In relation to the eating behavior traits, IG subjects showed a 14% reduction in the Emotional Eating score (p = 0.04), while Cognitive Restraint score did not change after the VPA intervention. The baseline factors of the questionnaire predicted changes in body mass and fat mass variables only in the CG.

CONCLUSION

A 3-month VPA intervention influenced eating behaviors of overweight or obese young, especially the Emotional Eating factor, in the presence of favorable body composition changes.

Cross-sectional survey of the amount of sugar and energy in cakes and biscuits on sale in the UK for the evaluation of the sugar-reduction programme

OBJECTIVES

To investigate the variation in sugar and energy content of cakes and biscuits available in the UK.

DESIGN

We carried out a cross-sectional survey in 2016 of 381 cakes and 481 biscuits available in nine main UK supermarkets.

METHODS

The sugar and energy content was collected from product packaging and nutrition labelling of cake and biscuit products.

RESULTS

The average sugar content in cakes and biscuits was 36.6±7.6 and 30.0±9.2 g/100 g, respectively. The mean energy content was 406±37 for cakes and 484±38 kcal/100 g for biscuits. There was a large variation in sugar and energy content between different cake and biscuit categories and within the same category. 97% of cakes and 74% of biscuits would receive a 'red' (high) label for sugar.

CONCLUSIONS

This research makes available baseline data of the cakes and biscuits market in the UK for future evaluation of the recently launched sugar-reduction programme. The study showed that reductions in sugar and energy content of cakes and biscuits are possible, since there was a large variation in sugar and energy content between different cake and biscuit categories and within the same category. A reduction in sugar and energy content, and overall cake and biscuit consumption, can help reduce overall sugar and energy intake in the UK and thus reduce the risk of obesity and dental caries.

Associations between nutritional quality of meals and snacks assessed by the Food Standards Agency nutrient profiling system and overall diet quality and adiposity measures in British children and adolescents

OBJECTIVE

This cross-sectional study examined how the nutritional quality of meals and snacks was associated with overall diet quality and adiposity measures.

METHODS

Based on 7-d weighed dietary record data, all eating occasions were divided into meals or snacks based on time (meals: 06:00-09:00 h, 12:00-14:00 h, and 17:00-20:00 h; snacks: others) or contribution to energy intake (meals: ≥15%; snacks: <15%) in British children aged 4-10 (n = 808) and adolescents aged 11-18 (n = 809). The nutritional quality of meals and snacks was assessed as the arithmetical energy intake-weighted means of the Food Standards Agency (FSA) nutrient profiling system score of each food and beverage consumed, based on the contents of energy, saturated fatty acid, total sugar, sodium, fruits/vegetables/nuts, dietary fiber, and protein.

RESULTS

Regardless of the definition of meals and snacks, higher FSA score (lower nutritional quality) of meals was inversely associated with overall diet quality assessed by the Mediterranean diet score in both children and adolescents (P <0.0001), whereas the inverse associations for the FSA score of snacks did not reach statistical significance. The FSA score of meals based on time was inversely associated with body mass index z-score only in children, whereas that of snacks based on time showed a positive association.

CONCLUSION

Lower nutritional quality of meals, but not snacks, assessed by the FSA score was associated with lower overall diet quality, whereas no consistent associations were observed with regard to adiposity measures.

Yogurt consumption is associated with higher nutrient intake, diet quality and favourable metabolic profile in children: a cross-sectional analysis using data from years 1-4 of the National diet and Nutrition Survey, UK

PURPOSE

Yogurt consumption has been associated with higher nutrient intakes, better diet quality and improved metabolic profiles in adults. Few studies have investigated these associations in children. This study investigated the association of yogurt consumption with nutrient intakes, diet quality and metabolic profile in British children.

METHODS

Data from  1687 children aged 4-10 and 11-18 years of the National Diet and Nutrition Survey (NDNS) years 1-4 were analysed. Yogurt consumption was determined using a 4-day diet diary. Diet quality was assessed by the Healthy Eating Index 2010 (HEI-2010). Anthropometric measures, blood pressure, pulse pressure, plasma glucose, HbA1c, C-reactive protein, triacylglycerol, total cholesterol, high-and low-density cholesterol from NDNS were used.

RESULTS

The highest tertile of yogurt consumption (T3) was associated with higher nutrient intakes, particularly for calcium (children 4-10 years: P < 0.0001; children 11-18 years P = 0.001), iodine (both age groups P < 0.0001) and riboflavin (both age groups P < 0.0001), and HEI-2010 score (both age groups P < 0.0001) in children aged 4-10 years (mean ± SD: 98.4 ± 35.7 g yogurt/day) and 11-18 years (mean ± SD: 105.4 ± 37.5 g yogurt/day) compared with non-consumers (0 g yogurt/d). Yogurt consumption was associated with significantly lower pulse pressure in children aged 4-10 years and lower HbA1c concentration, being shorter and having a larger hip circumference in children aged 11-18 years, compared with non-yogurt consumers.

CONCLUSION

This study suggests that British children who are yogurt consumers (> 60 g/day) have higher overall diet quality, nutrient intakes and adequacy, lower pulse pressure (children aged 4-10 years) and HbA1c concentrations (children aged 11-18 years), were shorter and had a smaller hip circumference (children aged 11-18 years).

Salt and sugars content of breakfast cereals in the UK from 1992 to 2015

OBJECTIVE

To study the salt and sugars content of breakfast cereals sold in the UK between 1992 and 2015.

DESIGN

Cross-sectional surveys on salt and sugars content collected from the nutrition information panel of breakfast cereals in 1992, 2004, 2006, 2009, 2012 and 2015.

SETTING

All major UK retailers operating at that moment in time (approximately ten).

SUBJECTS

The salt and sugars content was collected from product packaging and the nutrition information panels.

RESULTS

Cereals consistently surveyed across all five years (n22) showed a significant reduction in salt content of 47 % (P<0·001). Sugars content of breakfast cereals (n 15), however, did not show a significant change; 25·65 g/100 g in 1992 and 22·45 g/100 g in 2015 (P=0·170). There was a large variation in salt and sugars content between different categories and within the same type of category.

CONCLUSIONS

The study shows the progressive reduction in salt content of breakfast cereals in the UK since 2004 as a result of the successful salt reduction programme, particularly the setting of incremental salt targets. Further reductions in salt content need to be made as cereals remain a major contributor to salt intake. Sugars content, however, has been consistently high due to the lack of a sugar reduction strategy. The research demonstrates that the sugars content of breakfast cereals in the UK is of concern, particularly in children's breakfast cereals, with a typical serving (30 g) containing a third of a 4-6-year-old's maximum daily recommendation (19 g/d) for free sugars intake in the UK. More can and should be done to reformulate, with an urgent need to set incremental sugar reduction targets.

Associations between energy density of meals and snacks and overall diet quality and adiposity measures in British children and adolescents: the National Diet and Nutrition Survey

This cross-sectional study examined how energy density (ED) of meals and snacks are associated with overall diet quality and adiposity measures in 1617 British children aged 4-18 years from the 1997 National Diet and Nutrition Survey. On the basis of data from 7-d weighed dietary record, all eating occasions were divided into meals or snacks on the basis of time (meals: 06.00-09.00, 12.00-14.00 and 17.00-20.00 hours; snacks: all others) or contribution to energy intake (EI) (meals: ≥15 %; snacks: <15 %). ED of meals and snacks was calculated on the basis of food only. Overall diet quality was assessed using the Mediterranean diet score (range 0-8). Irrespective of the definition of meals and snacks, ≥67 % of EI was derived from meals, whereas ED of meals was lower than ED of snacks (mean: 8·50-8·75 v. 9·69-10·52 kJ/g). Both ED of meals and ED of snacks were inversely associated with total intakes of vegetables, fruits, dietary fibre and overall diet quality and positively associated with total intakes of fat. However, the associations were stronger for ED of meals. The change in the Mediterranean diet score with a 1-unit increase of ED (kJ/g) was -0·35 to -0·30 for ED of meals and -0·09 to -0·06 for ED of snacks (all P<0·0001). After adjustment for potential confounders, all measures of ED of meals and snacks did not show positive associations with adiposity measures. In conclusion, although both ED of meals and ED of snacks were associated with adverse profiles of overall diet quality (but not adiposity measures), stronger associations were observed for ED of meals.

Cross-sectional survey of the amount of free sugars and calories in carbonated sugar-sweetened beverages on sale in the UK

OBJECTIVES

To investigate the free sugars and calorie content of carbonated sugar-sweetened beverages (CSSB) available in the main UK supermarkets.

STUDY DESIGN

We carried out a cross-sectional survey in 2014 of 169 CSSB.

METHODS

The free sugars (sugars g/100 mL) and calorie (kcal/100 mL) were collected from product packaging and nutrient information panels of CSSB available in 9 main UK supermarkets.

RESULTS

The average free sugars content in CSSB was 30.1±10.7 g/330 mL, and 91% of CSSB would receive a 'red' (high) label for sugars per serving. There was a large variation in sugars content between different flavours of CSSB and within the same type of flavour ranging from 3.3 to 52.8 g/330 mL. On average, ginger beer (38.5±9.9 g/330 mL) contained the highest amounts of sugars and ginger ale (22.9±7.7 g/330 mL) contained the lowest. Cola flavour is the most popular flavour in the UK with an average free sugars content of 35.0±1.1 g/330 mL. On average, the supermarket own brand contained lower levels of sugars than branded products (27.9±10.6 vs 31.6±10.6 g/330 mL, p=0.02). The average calorie content in CSSB was 126.1±43.5 kcal/330 mL. Cola flavour had a calorie content of 143.5±5.2 kcal/330 mL. Among the 169 products surveyed, 55% exceeded the maximum daily recommendation for free sugars intake (30 g) per 330 mL.

CONCLUSIONS

Free sugars content of CSSB in the UK is high and is a major contributor to free sugars intake. There is a wide variation in the sugars content of CSSB and even within the same flavour of CSSB. These findings demonstrate that the amount of free sugars added to CSSB can be reduced without technical issues, and there is an urgent need to set incremental free sugars reduction targets. A reduction in sugars content and overall CSSB consumption will be very beneficial in reducing obesity, type 2 diabetes and dental caries.

Systematic review of the literature on the effectiveness of product reformulation measures to reduce the sugar content of food and drink on the population's sugar consumption and health: a study protocol

INTRODUCTION

Obesity, type 2 diabetes and dental caries are all major public health problems in the UK, with significant costs to the healthcare service. We aim to conduct a systematic review to summarise the evidence on the effectiveness of product reformulation measures to reduce the sugar content of food and drink on the population's sugar consumption and health.

METHODS AND ANALYSIS

Electronic database will be systematically searched using a combination of terms, tailored to optimise sensitivity, specificity, and the syntax and functionality of each database. The databases searched will include the Cochrane Library, EMBASE, MEDLINE (Ovid) and Scopus. The bibliographies of those papers that match inclusion criteria will be searched by hand to identify any further, relevant references, which will be subject to the same screening and selection process. The database search results will be supplemented by hand searches. In addition to the peer-reviewed literature, a number of grey literature searches will be undertaken using the broad search terms 'sugar' and 'food' or 'drink' and 'reduction', these searches will include key government and organisation websites as well as general searches in Google. The selection of the studies, data collection and quality appraisal will be performed independently by 2 reviewers. Data will be initially analysed through a narrative synthesis method. If a subset of data we analyse appears comparable, we will investigate the possibility of performing a meta-analysis.

ETHICS AND DISSEMINATION

Ethics approval will not be required as this is a protocol for a systematic review. The findings will be disseminated widely through conference presentations and published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42016034022.

Protein intake and obesity in young adolescents

The abundance of protein and its functional diversity in living systems makes it essential for virtually all life processes. Dietary protein and amino acid requirements are affected by age, body size, body composition, physiological state, and the level of energy output. The requirement for dietary protein is based on the indispensable amino acids under all conditions and under specific physiological and pathological conditions as well as the synthesis of dispensable amino acids and other nitrogen-containing compounds. Previous findings have shown the influence of early intake of proteins on the development of overweight in healthy children. The present review focused on the possible association (if any) between protein intake and later development of obesity. The aim is to benefit physicians, dieticians as well as parents to understand future consequences of incorrect dietary habits in young adolescents and encourage healthy dietary habits to avoid obesity.

Decreasing the number of small eating occasions (<15 % of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity: a cross-sectional study in British children and adolescents

Evidence of associations between meal frequency (MF) and snack frequency (SF) and diet and obesity in young populations is limited. This cross-sectional study examined MF and SF in relation to dietary intake and adiposity measures in British children aged 4-10 years (n 818) and adolescents aged 11-18 years (n 818). Based on data from a 7-d weighed dietary record, all eating occasions were divided into meals or snacks on the basis of contribution to energy intake (≥15 or <15 %) or time (06.00-10.00, 12.00-15.00 and 18.00-21.00 hours or others). All measures of MF and SF showed positive associations with energy intake, except for MF based on energy contribution in children. Irrespective of the definition of snacks, SF was associated with higher intakes of soft drinks, confectionery and total sugar, lower intakes of cereals, fish, meat, protein, PUFA, starch and dietary fibre, and a lower diet quality (assessed by the Mediterranean diet score, except for SF based on energy contribution in adolescents). MF based on time, but not based on energy contribution, was associated with higher intakes of confectionery and total sugar, lower intakes of fish, protein, PUFA and starch, and, only in children, a lower diet quality. All measures of MF and SF showed no association with adiposity measures. In conclusion, this cross-sectional study in British children and adolescents suggests that decreasing the number of small eating occasions (<15 % of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity.

Prevalence and characteristics of misreporting of energy intake in US children and adolescents: National Health and Nutrition Examination Survey (NHANES) 2003–2012

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003–2012, we investigated the prevalence and characteristics of under- and over-reporting of energy intake (EI) among 14 044 US children and adolescents aged 2–19 years. For the assessment of EI, two 24-h dietary recalls were conducted with the use of the US Department of Agriculture Automated Multiple-Pass Method. Under-, plausible and over-reporters of EI were identified using two methods: based on the 95 % confidence limits (1) for agreement between the ratio of EI:BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI:estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield’s equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming ‘low active’ level of physical activity. The risk of being an under- or over-reporter compared with a plausible reporter was analysed using multiple logistic regression. Percentages of under-, plausible and over-reporters were 13·1, 81·5 and 5·4 %, respectively, based on EI:BMR and 18·8, 72·3 and 8·8 %, respectively, based on EI:EER. Under-reporting was associated with older age, non-Hispanic blacks (compared with non-Hispanic whites) and overweight and obesity (compared with normal weight). Over-reporting was associated with younger age, lower family poverty income ratio, normal weight and the first survey cycle. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999–2012 (n 22 949). In conclusion, we found that EI misreporting remains prevalent and differential in US children and adolescents.

Secular changes in intakes of foods among New Zealand adults from 1997 to 2008/09

OBJECTIVE

To examine changes in the food choices of New Zealand (NZ) adults, between the 1997 National Nutrition Survey (NNS97) and the 2008/09 NZ Adult Nutrition Survey (2008/09 NZANS).

DESIGN

The 2008/09 NZANS and the NNS97 were cross-sectional surveys of NZ adults (aged 15 years and over). Dietary intake data were collected using a computer-based 24 h diet recall. Logistic regression models were used to examine changes over time in the percentage reporting each food group, with survey year, sex and age group (19-30 years, 31-50 years, 51-70 years, ≥71 years) as the variables.

SETTING

NZ households.

SUBJECTS

Adults aged 19 years and over (NNS97, n 4339; 2008/09 NZANS, n 3995).

RESULTS

In the 2008/09 NZANS compared with NNS97, males and females were less likely to report consuming bread, potatoes, beef, vegetables, breakfast cereal, milk, cheese, butter, pies, biscuits, cakes and puddings, and sugar/confectionery (all P<0.001). In contrast, there was an increase in the percentage reporting rice and rice dishes (P<0.001), and among females a reported increase in snacks and snack bars (e.g., crisps, extruded snacks, muesli bars; P=0.007) and pasta and pasta dishes (P=0.017). Although food choices were associated with sex and age group, there were few differential changes between the surveys by sex or age group.

CONCLUSIONS

For all age groups there was a shift in the percentage who reported consuming the traditional NZ foods, namely bread, beef, potatoes and vegetables, towards more rice and rice dishes. Declines in the consumption of butter, pies, biscuits, cakes and puddings are congruent with current dietary guidelines.

Anthropometric, lifestyle and parental characteristics associated with the prevalence of energy intake misreporting in children: the GRECO (Greek Childhood Obesity) study

The objectives of the present study were to identify childhood energy misreporting, and evaluate characteristics that are associated with its prevalence in a nationwide cross-sectional sample of Greek schoolchildren. Under the context of the GRECO (Greek Childhood Obesity) study, data from a total of 4547 children aged 10-12 years and 2318 parents were included in the analysis. Anthropometric, lifestyle and parental characteristics plus psychological concerns were investigated in relation to the prevalence of energy misreporting. Of the included children, 36 % were classified as energy under-reporters and 16 % as over-reporters. Multinomial logistic regression analysis revealed that the most important predictors of energy under-reporting (URP) were children's BMI (OR 1·11, 95 % CI 1·09, 1·14) and weight satisfaction (OR 0·87, 95 % CI 0·78, 0·97). In the case of energy over-reporting (ORP), children's BMI (OR 0·87, 95 % CI 0·84, 0·90), meal and snack consumption frequency (OR 1·52, 95 % CI 1·32, 1·75), female sex (OR 0·65, 95 % CI 0·45, 0·90), and maternal education (OR 0·95, 95 % CI 0·91, 0·99) remained as significant predictors. Additionally, parental perception that the body weight of their children was normal reduced the odds of URP (OR 0·69, 95 % CI 0·48, 0·99) and ORP (OR 0·53, 95 % CI 0·31, 0·93). In conclusion, the present study confirms that the issue of URP and ORP in childhood populations is evident and quite serious. Although there are no definite guidelines on how to use data obtained from misreporters in an epidemiological dataset, validity of reported energy intake seems to be influenced by children's BMI and weight satisfaction, as well as by parental perceptions regarding their children's weight.

Obscurity on obesity

Much research is underway on the links between diet and obesity. So too are long-running disputes among nutritionists on core questions about the relationship. This editorial reviews the state-of-play on four issues: what makes people fat, how to lose weight, how much do we eat, and what policies to adopt towards obesity. The practical consequence is that, at present, frontline health professionals will not find in nutrition science agreed, actionable solutions to assist overweight patients. But research and debate continues actively.

Is there an association between food portion size and BMI among British adolescents?

The prevalence of obesity has increased simultaneously with the increase in the consumption of large food portion sizes (FPS). Studies investigating this association among adolescents are limited; fewer have addressed energy-dense foods as a potential risk factor. In the present study, the association between the portion size of the most energy-dense foods and BMI was investigated. A representative sample of 636 British adolescents (11–18 years) was used from the 2008–2011 UK National Diet and Nutrition Survey. FPS were estimated for the most energy-dense foods (those containing above 10·5 kJ/g (2·5 kcal/g)). Regression models with BMI as the outcome variable were adjusted for age, sex and misreporting energy intake (EI). A positive association was observed between total EI and BMI. For each 418 kJ (100 kcal) increase in EI, BMI increased by 0·19 kg/m2(95 % CI 0·10, 0·28;P< 0·001) for the whole sample. This association remained significant after stratifying the sample by misreporting. The portion sizes of a limited number of high-energy-dense foods (high-fibre breakfast cereals, cream and high-energy soft drinks (carbonated)) were found to be positively associated with a higher BMI among all adolescents after adjusting for misreporting. When eliminating the effect of under-reporting, larger portion sizes of a number of high-energy-dense foods (biscuits, cheese, cream and cakes) were found to be positively associated with BMI among normal reporters. The portion sizes of only high-fibre breakfast cereals and high-energy soft drinks (carbonated) were found to be positively associated with BMI among under-reporters. These findings emphasise the importance of considering under-reporting when analysing adolescents' dietary intake data. Also, there is a need to address adolescents' awareness of portion sizes of energy-dense foods to improve their food choice and future health outcomes.

Associations of eating frequency with adiposity measures, blood lipid profiles and blood pressure in British children and adolescents

Several epidemiological studies in adults have suggested a favourable effect of frequent eating on blood lipid profiles, but evidence in younger populations is lacking. In the present cross-sectional study, we examined the associations of eating frequency (EF) with metabolic risk factors in British children aged 4-10 years (n 818) and adolescents aged 11-18 years (n 818). Dietary intake was assessed using a 7 d weighed dietary record. EF was calculated based on all eating occasions, except for those providing < 210 kJ of energy. Metabolic risk factors examined were total, HDL-cholesterol and LDL-cholesterol concentrations, TAG concentration, BMI z-score, waist:height ratio (WHtR; only adolescents), and systolic and diastolic blood pressures. Adjustment was made for age, sex, social class, physical activity levels, intakes of protein, fat, total sugar and dietary fibre, ratio of reported energy intake to estimated energy requirement (EI:EER) and BMI z-score (except for BMI z-score and WHtR). In children, EF was inversely associated with total cholesterol and LDL-cholesterol concentrations (n 324, P= 0·01 and 0·04, respectively). Conversely, EF was positively associated with BMI z-score in adolescents (P= 0·004). There were no associations between EF and other metabolic risk factors. In analyses in which only plausible energy reporters (EI:EER: 0·72-1·28) were included, similar results were obtained, except for an inverse association between EF and diastolic blood pressure in children. In conclusion, a higher EF is associated with lower total cholesterol and LDL-cholesterol concentrations in children but with a higher BMI z-score in adolescents.

The proportion of excessive fast-food consumption attributable to the neighbourhood food environment among youth living within 1 km of their school

The study objective was to estimate the proportion of excessive fast-food consumption by youth that is attributable to living and attending school in a neighbourhood with a moderate or high density of fast-food restaurants. This was a cross-sectional study of 6099 Canadian youths (aged 11-15 years) from 255 school neighbourhoods. All participants lived within 1 km of their school. The density of chain fast-food restaurants within a 1-km circular buffer surrounding each school was determined using geographic information systems. Excessive fast-food consumption (≥2 times per week) was assessed by questionnaire. Multilevel logistic regression analysis was used to examine associations. The population attributable risk estimates of excessive fast-food consumption due to neighbourhood exposure to fast-food restaurants were determined based on the prevalence of exposure and the results from the logistic regression. Eight percent of participants were excessive fast-food consumers. After adjusting for sociodemographic factors (i.e., gender, race, and socioeconomic status), it was found that youths from neighbourhoods with a moderate (odds ratio (OR), 1.68; 95% confidence interval (CI), 1.11-2.54) or high (OR 1.70; 95% CI 1.12-2.56) density of chain fast-food restaurants were more likely to be excessive fast-food consumers than were youths from neighbourhoods with no chain fast-food restaurants. Approximately 31% of excessive consumption was attributable to living in neighbourhoods with a moderate or high density of fast-food restaurants. Thus, the fast-food retail environment within which youth live and go to school is an important contributor to their eating behaviours.

Adolescent dietary patterns in Fiji and their relationships with standardized body mass index

Background

Obesity has been increasing in adolescents in Fiji and obesogenic dietary patterns need to be assessed to inform health promotion. The objective of this study was to identify the dietary patterns of adolescents in peri-urban Fiji and determine their relationships with standardized body mass index (BMI-z).

Methods

This study analysed baseline measurements from the Pacific Obesity Prevention In Communities (OPIC) Project. The sample comprised 6,871 adolescents aged 13–18 years from 18 secondary schools on the main island of Viti Levu, Fiji. Adolescents completed a questionnaire that included diet-related variables; height and weight were measured. Descriptive statistics and regression analyses were conducted to examine the associations between dietary patterns and BMI-z, while controlling for confounders and cluster effect by school.

Results

Of the total sample, 24% of adolescents were overweight or obese, with a higher prevalence among Indigenous Fijians and females. Almost all adolescents reported frequent consumption of sugar sweetened beverages (SSB) (90%) and low intake of fruit and vegetables (74%). Over 25% of participants were frequent consumers of takeaways for dinner, and either high fat/salt snacks, or confectionery after school. Nearly one quarter reported irregular breakfast (24%) and lunch (24%) consumption on school days, while fewer adolescents (13%) ate fried foods after school. IndoFijians were more likely than Indigenous Fijians to regularly consume breakfast, but had a high unhealthy SSB and snack consumption.

Regular breakfast (p<0.05), morning snack (p<0.05) and lunch (p<0.05) consumption were significantly associated with lower BMI-z. Consumption of high fat/salt snacks, fried foods and confectionery was lower among participants with higher BMI-z.

Conclusions

This study provides important information about Fijian adolescents’ dietary patterns and associations with BMI-z. Health promotion should target reducing SSB, increasing fruit and vegetables consumption, and increasing regularity of meals among adolescents. Future research is needed to investigate moderator(s) of inverse associations found between BMI-z and consumption of snacks, fried foods and confectionery to assess for potential reverse causality.

Dietary glycaemic index and glycaemic load in relation to food and nutrient intake and indices of body fatness in British children and adolescents

The diversity of the associations of dietary glycaemic index (GI) and glycaemic load (GL) with dietary intake and body fatness observed in epidemiological studies may be partly due to the differences in underlying dietary intake patterns. We examined the cross-sectional associations of dietary GI and GL with food and nutrient intakes and indices of body fatness in 818 children aged 4–10 years and 818 adolescents aged 11–18 years in Britain, based on the data from the National Diet and Nutrition Survey. Dietary intake was assessed using a 7 d weighed dietary record. Overweight was defined as BMI ≥ 85th percentile of the age- and sex-specific British growth reference data. Central obesity was defined as waist:height ratio (WHtR) ≥ 0·5 (adolescents only). Breads, breakfast cereals and potatoes were the positive predictive food groups for dietary GI, while dairy products, fruit juice, other cereals and fruit were the negative predictors. Dietary GL was closely correlated with carbohydrate intake. Dietary GI showed no associations with overweight or central obesity. Conversely, dietary GL showed an independent association with a higher risk of overweight in children and a higher risk of central obesity (but not overweight) in adolescents. However, dietary GI and GL were not associated with BMI z-score in children and adolescents or WHtR in adolescents. In conclusion, the present study showed that dietary GL was independently associated with overweight in children and with central obesity in adolescents. Nevertheless, given no associations when body fatness measures were treated as continuous variables, the results must be interpreted cautiously.

Energy underreporting in African-American girls: a longitudinal analysis

BACKGROUND

The objective of this study was to determine the longitudinal prevalence and predictors of dietary underreporting in African-American preadolescent girls and the association of baseline dietary underreporting with changes in BMI over a 2-year period as part of the Girls health Enrichment Multi-site Studies (GEMS).

METHODS

Energy was summarized at baseline, 12 months, and 24 months and computed as a 3-day average of 24-hour dietary recalls. Physical activity was assessed by accelerometer, basal metabolic rate was estimated using the World Health Organization's prediction equation, and caloric underreporting was based on the Goldberg equation.

RESULTS

We classified 48% of the girls at baseline as underreporters; with underreporting increasing over time (61% at 12 months; 66% at 24 months). Intervention treatment assignment did not affect the prevalence of underreporting over time. The consistency of underreporting (or not) stayed stable over time. Across all three time points, a higher BMI predicted underreporting. Baseline dietary underreporting and baseline BMI were found to be the major predictors of change in BMI, whereas baseline dietary variables did not predict change in BMI.

CONCLUSIONS

Dietary underreporting was extremely common in this sample of AA preadolescent girls and predictive of change in BMI. Given the magnitude and consistency of dietary underreporting along with the fact that no dietary variables predicted change in BMI, measurement of dietary intake in preadolescents, even with sophisticated measurement methodologies, appears biased. The best use of dietary recalls may not be to estimate dietary intake but rather to determine underreporting.

Differences in food consumption according to weight status and physical activity levels among Greek children between 1992/93 and 2006/07

BACKGROUND

There is a lack of data in Greece on trends in food intake according to weight status and physical activity (PA), despite the high prevalence of obesity. The present study aimed to examine differences in these parameters among first-grade children from Crete, Greece, over a 15-year period.

METHODS

Children (aged 5.9-7.6 years) from two representative cross-sectional studies participated during 1992/93 (n = 245) and 2006/07 (n = 257). Estimated 3-day food records were used to assess food consumption and energy-density (ED) [kJ g(-1) (kcal g(-1) )]. Moderate-to-vigorous-PA (MVPA) and cardiorespiratory-fitness were assessed by questionnaires and the 20-m shuttle-run test (20mSRT), respectively.

RESULTS

In 2006/07, compared to 1992/93, both sexes had a significantly higher intake of dairy products and snacks (P < 0.001), a lower intake of cereals (P < 0.001) and higher cardiorespiratory fitness levels (P < 0.001). Among girls, fruit/vegetable consumption was higher (P < 0.05), although legume intake was lower (P < 0.005). Among overweight/obese (OW/OB) children, ED significantly decreased (P < 0.05) and the mean consumption of fruits/vegetables was higher (P < 0.001). The percentage of OW/OB boys was significantly higher (P < 0.001); however, MVPA was significant higher in this group compared to 1992/93 (P < 0.001). During the two time-periods, active children in 2006/07 appeared to have a lower ED than active ones in 1992/93 (P < 0.001).

CONCLUSIONS

Several differences in food intake were observed among first-grade children of Crete between 1992/93 and 2006/07, as characterised by significant increases in the consumption of dairy products and snacks and a decrease in the intake of cereals, among both sexes. Future school-based interventions in this population should emphasise the need to increase fruit/vegetable, unrefined cereal and legume consumption.

Intakes and adequacy of potentially important nutrients for cognitive development among 5-year-old children in the Seychelles Child Development and Nutrition Study

OBJECTIVE

To assess the nutritional adequacy of Seychellois children in relation to nutrients reported to be important for cognitive development.

DESIGN

Dietary intakes were assessed by 4 d weighed food diaries and analysed using dietary analysis software (WISP version 3·0; Tinuviel Software, UK). Individual nutrient intakes were adjusted to usual intakes and, in order to investigate adequacy, were compared with the UK Estimated Average Requirements for children aged 4-6 years.

SETTING

Children 5 years old were followed up as part of the Seychelles Child Development Nutrition Study (SCDNS), located in the high-fish-consuming population of Mahé, Republic of Seychelles.

SUBJECTS

Analysis was carried out on a sample of 229 children (118 boys, 111 girls).

RESULTS

Children consumed a diet of which fortified cereal and milk products contributed the most to nutrient intakes. The majority (≥80 %) of children met requirements for several nutrients important for child development including Fe, folate and Se. Adjusted dietary intakes of Cu, Zn, iodine, niacin and vitamin A were below the Estimated Average Requirement or Recommended Nutrient Intake. Mean adjusted energy intakes (boys 4769 kJ/d (1139·84 kcal/d), girls 4759 kJ/d (1137·43 kcal/d)) were lower than the estimated energy requirement (boys 5104 kJ/d (1220 kcal/d), girls 5042 kJ/d (1205 kcal/d)) for 88 % of boys and 86 % of girls.

CONCLUSIONS

Nutrition was adequate for most children within the SCDNS cohort. Low intakes of some nutrients (including Zn, niacin and vitamin A) could reflect nutritional database inaccuracies, but may require further investigation. The study provides valuable information on the adequacy of intakes of nutrients which could affect the growth and development of Seychellois children.

Patterns and trends of beverage consumption among children and adults in Great Britain, 1986-2009

Many dietary recommendations include reduction of excessive intake of sugar-sweetened beverages (SSB) and other energy-rich beverages such as juices and alcohol. The present study examines surveys of both individual dietary intake data and household food expenditure surveys to provide a picture of patterns and trends in beverage intake and purchases in Great Britain from 1986 to 2009, and estimates the potential for pricing policy to promote more healthful beverage purchase patterns. In 2008-9, beverages accounted for 21, 14 and 18 % of daily energy intake for children aged 1·5-18 and 4-18 years, and adults (19-64 years), respectively. Since the 1990s, the most important shifts have been a reduction in consumption of high-fat dairy products and an increased consumption of fruit juices and reduced-fat milk among preschoolers, children and adolescents. Among adults, consumption of high-fat milk beverages, sweetened tea and coffee and other energy-containing drinks fell, but reduced-fat milk, alcohol (particularly beer) and fruit juice rose. In testing taxation as an option for shifting beverage purchase patterns, we calculate that a 10 % increase in the price of SSB could potentially result in a decrease of 7·5 ml/capita per d. A similar 10 % tax on high-fat milk is associated with a reduction of high-fat milk purchases by 5 ml/capita per d and increased reduced-fat milk purchase by 7 ml/capita per d. This analysis implies that taxation or other methods of shifting relative costs of these beverages could be a way to improve beverage choices in Great Britain.

National Diet and Nutrition Survey: fat and fatty acid intake from the first year of the rolling programme and comparison with previous surveys

High saturated fat intake is an established risk factor for several chronic diseases. The objective of the present study is to report dietary intakes and main food sources of fat and fatty acids (FA) from the first year of the National Diet and Nutrition Survey (NDNS) rolling programme in the UK. Dietary data were collected using 4 d estimated food diaries (n 896) and compared with dietary reference values (DRV) and previous NDNS results. Total fat provided 34-36 % food energy (FE) across all age groups, which was similar to previous surveys for adults. Men (19-64 years) and older girls (11-18 years) had mean intakes just above the DRV, while all other groups had mean total fat intakes of < 35 % FE. SFA intakes were lower compared with previous surveys, ranging from 13 to 15 % FE, but still above the DRV. Mean MUFA intakes were 12·5 % FE for adults and children aged 4-18 years and all were below the DRV. Mean n-3 PUFA intake represented 0·7-1·1 % FE. Compared with previous survey data, the direction of change for n-3 PUFA was upwards for all age groups, although the differences in absolute terms were very small. Trans-FA intakes were lower than in previous NDNS and were less than 2 g/d for all age groups, representing 0·8 % FE and lower than the DRV in all age groups. In conclusion, dietary intake of fat and FA is moving towards recommended levels for the UK population. However, there remains room for considerable further improvement.

Do trends in physical activity, sedentary, and dietary behaviors support trends in obesity prevalence in 2 border regions in Texas?

OBJECTIVE

The aim of the study was to compare the change in energy balance-related behaviors from 2000-2002 to 2004-2005 between 2 Texas regions with distinct patterns in obesity prevalence (decrease in the El Paso region [EP] and leveling off in the Rio Grande Valley region [RGV]) and to determine the role of the behaviors in the difference in obesity prevalence between the regions.

DESIGN

Cross-sectional measurements of the School Physical Activity and Nutrition Study.

SETTING

Elementary schools.

PARTICIPANTS

3,949 children (9-10 years).

VARIABLES MEASURED

Body mass index (objectively measured) and behaviors (self-assessed).

ANALYSIS

Probability and post-stratification weighting procedures and mediation analysis.

RESULTS

Compared to students in the RGV, students in the EP experienced a smaller decrease in sports team participation, an increase in regular meal consumption, and an increase in the frequency of milk/yogurt, cereal, sweet snacks, and frozen dessert consumption between measurement periods. Prevalence of frequent television viewing was lower in the EP. The lower body mass index in the EP was associated with regular meal consumption, and higher milk/yogurt and sweet snack consumption.

CONCLUSIONS AND IMPLICATIONS

Improvement of physical activity, sedentary behaviors, and healthful diet, but not unhealthful diet like sweet snack consumption, seem to be related to the decrease in obesity in the EP.

Weight control beliefs, body shape attitudes, and physical activity among adolescents

BACKGROUND

Relatively little is known about how perceived weight controllability influences important psychological health factors among adolescents. Thus, the purpose of this study is to explore adolescents' weight controllability beliefs and how those beliefs influence weight-related attitudes and behaviors.

METHODS

Adolescents (N = 369, mean age = 13.14, SD = 0.95) enrolled in physical education completed a survey packet, which included demographic questions and items targeting obesity, body shape, and weight controllability beliefs.

RESULTS

Participants believed that fat children have weight problems because they consume too many calories, are lazy, have access to junk food, and lack self-control. Those who endorsed high weight controllability beliefs were more likely to indicate that a thin person, as compared to a fat person, would enjoy physical activity and be coordinated, have higher levels of personal weight and body shape satisfaction, and engage in vigorous physical activity more days per week.

CONCLUSIONS

Perceived weight controllability may be an important construct to study further, particularly in relationship to health- and weight-related attitudes and behaviors.

Characteristics of energy under-reporting in children and adolescents

Under-reporting (UR) of food intake is an issue of concern, as it may distort the relationships studied between diet and health. This topic has been scarcely addressed in children. The objective of the study was to assess the extent of UR in French children and investigate associated covariates. A total of 1455 children aged 3-17 years were taken from the nationally representative cross-sectional French étude Individuelle Nationale des Consommations Alimentaires (INCA2) dietary survey (2006-7). Food intake was reported in a 7 d diet record. Socio-economic status, sedentary behaviour, weight perception variables and food habits were collected by questionnaires. Weight and height were measured. Under-reporters were identified according to the Goldberg criterion adapted to children. Multivariate logistic regressions investigated the associations between UR and covariates. Rates of under-reporters were 4·9 and 26·0 % in children aged 3-10 and 11-17 years, respectively (P < 0·0001), without significant differences between boys and girls. Overall, UR was positively associated with a lower socio-economic status, overweight, skipping breakfast and dinner, a higher contribution of proteins to energy intake (EI), and a lower contribution of simple carbohydrates to EI. Under-reporters aged 3-10 years also had a higher sedentary behaviour and a lower snack-eating frequency. In adolescents, UR was also associated with a less-frequent school canteen attendance, a perception of being overweight, a wish to weigh less, and current and past restrictive diets. In conclusion, under-reporters differ from plausible reporters in several characteristics related to diet, lifestyle, weight status and socio-economic status. Therefore, it is important to consider this differential UR bias when investigating diet-disease associations in children.

Increased hepatic fat in overweight Hispanic youth influenced by interaction between genetic variation in PNPLA3 and high dietary carbohydrate and sugar consumption

BACKGROUND

Recently, a genetic variant (rs738409; C→G) of the PNPLA3 gene was identified to be associated with increased hepatic fat deposition, and the effect was more pronounced in Hispanics. Animal models have also shown that PNPLA3 expression can be regulated by dietary carbohydrate.

OBJECTIVE

The aim of this study was to examine whether the influence of PNPLA3 genotype on hepatic fat is modulated by dietary factors in Hispanic children.

DESIGN

PNPLA3 was genotyped in 153 Hispanic children (75% female, ages 8-18 y) by using the TaqMan method. Dietary intake was assessed by using three 24-h dietary recalls or diet records. Visceral adipose tissue (VAT), subcutaneous abdominal adipose tissue (SAAT), and hepatic fat fraction (HFF) were assessed in multiple abdominal slices by magnetic resonance imaging. Analysis of covariance was used to assess the diet × genotype interaction in liver fat, with the following a priori covariates: sex, age, energy, VAT, and SAAT.

RESULTS

HFF was influenced by a significant interaction between genotype and diet (genotype × carbohydrate, P = 0.04; genotype × total sugar, P = 0.01). HFF was positively related to carbohydrate (r = 0.31, P = 0.04) and total sugar (r = 0.34, P = 0.02) intakes but only in the GG group, independent of covariates. Dietary variables were not related to HFF in the CC or CG group or to other fat depots in all genotype groups.

CONCLUSIONS

These findings suggest that Hispanic children carrying the GG genotype are susceptible to increased hepatic fat when dietary carbohydrate intake, specifically sugar, is high. Specific dietary interventions based on genetic predisposition in this population may lead to more effective therapeutic outcomes for fatty liver. This trial was registered at clinicaltrials.gov as NCT00697580, 195-1642394A1, and NCT00693511.

Energy intake misreporting among children and adolescents: a literature review

While adults' energy intake misreporting is a well-documented phenomenon, relatively little is known about the nature and extent of misreporting among children and adolescents. Children's and adolescents' dietary reporting patterns are likely to be distinct because of their ongoing cognitive and social development. These developmental differences present unique challenges to aspects of dietary reporting, such as food knowledge, portion size estimation and response editing. This review of 28 articles describes energy intake misreporting among children and adolescents. Like adults, children and adolescents tended to underreport energy, with the largest biases observed with food records. Even when mean reported energy intake was close to its expected value, approximately half of all individuals were classified as misreporters, and overreporting appeared to be more common than it is among adults. Associations between numerous characteristics and misreporting were explored in the literature, with the most consistent findings for age and adiposity. Two predictors for adults, gender and social desirability, were not consistent factors among children and adolescents. The review concludes by highlighting knowledge gaps and recommendations for future research and practice.

Validity and reproducibility of the FFQ (FFQW82) for dietary assessment in female adolescents

OBJECTIVE

To assess the validity and reproducibility of a self-administered FFQ with eighty-two food items (FFQW82) for assessing the habitual diet in female adolescents.

DESIGN

The validity of the FFQW82 for assessment of nutrient intake was evaluated by comparison with a 7 d weighed food record (7d-FRRI) reported as 'gold standard'. Reproducibility of the FFQW82 was assessed at an interval of 1 month (test-retest method). The first survey (FFQW82 and 7d-FRRI) was conducted in April 2007 and the second FFQW82 survey was conducted in May 2007. Daily consumption of energy from eleven food groups and nine nutrients were calculated from both instruments for breakfast, lunch, dinner and the whole day. Crude and energy-adjusted Pearson correlation coefficients were calculated using log-transformed data.

SETTING

Middle school, Tokyo, Japan.

SUBJECTS

Female adolescents aged 12-13 years.

RESULTS

Sixty-three female adolescents completed both surveys. The relative difference between the energy intake calculated by the FFQW82 and the 7d-FRRI for the whole day, breakfast, lunch and dinner was 8 %, 10 %, 15 % and 10 %, respectively. As for validity, the correlation coefficient of total energy intake for the whole day was 0·31. The result for breakfast was relatively higher (0·59) compared with that for lunch (0·40) and dinner (0·32). For macronutrients, the energy-adjusted correlation coefficient ranged from 0·28 (carbohydrates) to 0·53 (protein). Reproducibility of total energy intake was 0·62 and ranged from 0·46 (fat) to 0·69 (carbohydrate) for macronutrients.

CONCLUSIONS

These results suggest that the FFQW82 has proved to have some potential with regard to reproducibility among our study population.

The Three-Factor Eating Questionnaire and BMI in adolescents: results from the Québec family study

Eating behaviour traits are associated with body weight variations in adults. The Three-Factor Eating Questionnaire (TFEQ) measures cognitive restraint, disinhibition and hunger, as well as their corresponding subscales, e.g. rigid and flexible control. The TFEQ has not been widely used in adolescents to investigate eating behaviour traits associated with body weight. The aim of the present study was to assess whether eating behaviour traits were associated with BMI in male and female adolescents. Sixty adolescents (thirty females and thirty males; mean age 15.0 (sd 2.4) years) from the Québec Family Study completed the TFEQ and 3 d dietary records. There were no sex differences in the TFEQ scores. Rigid control, disinhibition and emotional susceptibility (to overeat) were positively related to BMI z-scores for the entire sample (r 0.3, P < 0.05). There was a positive relationship between BMI z-scores and rigid control (r 0.39, P < 0.05) in females, while BMI z-scores were positively related to emotional susceptibility (r 0.42, P < 0.02) and disinhibition (r 0.41, P < 0.03) in males. Adolescents characterised by both high disinhibition and high rigid control had significantly higher BMI z-scores than those by both low disinhibition and low rigid control. There were no significant differences in BMI z-scores between the flexible control categories. Dietary macronutrient content was not consistently related to eating behaviour traits. These results show that the eating behaviour traits of disinhibition and rigid control are independently related to BMI z-scores in this group of adolescents.

Trends in energy and sugar intakes and body mass index between 1983 and 1997 among children in Great Britain

BACKGROUND

It has been suggested that rising obesity among children is partly attributable to sugary foods and soft drinks driving an increase in energy intake (EI). Yet historical data on sugar intake are sparse. The present study calculated total sugar intake de novo among 3296 children aged 10-11 and 14-15 years in 1983 and compared EI, macronutrients and sugar sources with data from 459 children of same age in the 1997 National Diet and Nutrition Survey.

METHODS

Secondary analysis of 7-day weighed diet records and anthropometric data from two British surveys. Compositional data on sugars applied to individual food codes to calculate sugar intake and sources for 1983. Trends examined before/after adjustment for low/high energy reporting (LHER) defined as EI : basal metabolic rate <1.16 or >2.65.

RESULTS

Mean EI (kJ day(-1)) was 7% lower in 1997 than in 1983, mainly as a result of lower fat intake. After excluding LHER, mean EI was 3% lower in 1997. Mean body mass index (BMI) increased by 0.7-1 kg m(-2) (2-3 kg). Total sugar intake averaged 115 g day(-1) in 1983 and 113 g day(-1) in 1997 (122 versus 127 g day(-1) excluding LHER, P = 0.08). Excluding LHER, fat energy was lower in 1997 (35.4% versus 37.8%) and sugars slightly higher (23.6% versus 22.3%). Sugar sources showed a marked shift away from table sugar with smaller falls in milk, biscuits and cakes, counterbalanced by an significant increase in sugar from soft drinks and, to a lesser extent, fruit juice and breakfast cereals.

CONCLUSIONS

Although the study design precludes drawing causal inferences regarding nutrient intake and obesity, a higher prevalence of under-reporting and lower levels of physical activity in 1997 could explain the paradox of lower reported EI and rising BMI.

Sugar and fat intake among children in Scotland: what is needed to reach the dietary targets?

OBJECTIVE

To assess the intake and sources of non-milk extrinsic sugars (NMES) and fat among children in Scotland in relation to socio-economic status, and to estimate the changes in diet required to achieve recommended levels of intake.

DESIGN

Cross-sectional survey with diet assessed by semi-quantitative FFQ.

SETTING

Eighty postcode sectors across Scotland.

SUBJECTS

Children (n 1398) aged 3-17 years recruited from the Child Benefit register (76 % of those contacted).

RESULTS

The mean intake of NMES of 17.4 (95 % CI 17.0, 17.8) % food energy was considerably higher than the UK recommended population average of 11 % food energy. The mean intake of total fat of 32.9 (95 % CI 32.7, 33.2) % food energy met the recommended population average of no more than 35 % food energy, while the mean intake of SFA of 13.8 (95 % CI 13.7, 14.0) % food energy was above the recommended population average of no more than 11 % food energy. Despite clear socio-economic gradients in the mean daily consumption of many 'healthy' and 'unhealthy' food groups, socio-economic differences in NMES as a percentage of food energy were limited and there was no significant variation in the intake of total fat or SFA as a percentage of food energy with socio-economic status. Modelling of the data showed that removing sugar-sweetened soft drinks and increasing fruit and vegetable intake by 50 % would not restore the intake of NMES and SFA to recommended levels.

CONCLUSIONS

Major changes in the intake of many food groups will be required to bring the NMES and saturated fat intake in line with current dietary recommendations.

Trends in food intake in French children from 1999 to 2007: results from the INCA (étude Individuelle Nationale des Consommations Alimentaires) dietary surveys

The objectives of the present study were to assess the intake of different food groups in French children aged 3–17 years (n 1455), and to analyse trends since a dietary survey undertaken 8 years ago. Dietary intake was evaluated using data from the 2006–7 cross-sectional INCA2 national dietary survey (étude Individuelle Nationale sur les Consommations Alimentaires), based on a 7 d food record. Dietary intake (percentage of subjects consuming the food group and amount eaten) was assessed for thirty-nine food categories. We observed variations in food consumption by age, sex, North–South regional gradient, seasonal period and educational level of the responding parent. Trends in dietary intake between 1999 and 2007 were determined by comparing the INCA1 (n 1126) and the INCA2 surveys. Both surveys had been carried out using the same methodology. The findings showed a decrease in energy intake in children aged 3–14 years, due to a reduction in the consumption of foods of animal origin and sweetened products. In adolescents aged 15–17 years, energy intake remained rather stable; during this 8-year period, the consumption of meat decreased, whereas the consumption of savoury snacks such as sandwiches and hamburgers significantly increased. These trends occurred during a time of growing concern about overweight and the associated co-morbidities in France. A number of public health measures were implemented over this period to improve dietary habits and physical activity patterns in children and adults. The periodic monitoring of dietary patterns through the INCA surveys is an essential part of the surveillance network in France.

Trends in child overweight rates and energy intake in France from 1999 to 2007: relationships with socioeconomic status

Our objectives were (i) to assess the current prevalence of childhood overweight (including obesity) (OWOB) in France and its relationship with comprehensive socioeconomic status (SES) indicators and (ii) to examine trends in OWOB prevalence and changes in energy intake (EI) and sedentary behavior (SED) based on the previous INCA 1 (Individuelle Nationale des Consommations Alimentaires) data (1998-1999). A representative sample of children aged 3-14 (n = 1,030) was taken from the 2006-2007 cross-sectional INCA 2 food consumption survey. Weight and height were measured. The prevalence of OWOB was estimated according to the IOTF (International Obesity Task Force) definition. Average daily EI was evaluated using a 7-day food record. SED (screen time) and SES were reported by answering questionnaires. SES indicators included the occupation and level of education of the head of the household (HH), and variables describing household wealth. Composite indices of SES were computed by correspondence analysis, and relationships with OWOB were explored by logistic regression analysis. In total, 14.5% (95% CI: 12.1-17.0) of the children were OWOB. All SES indicators were inversely correlated to OWOB. Average EI was equal to 1,739 kcal/day. Daily, children spent 113.5 min watching television, and 38.5 min playing video games or using a computer. Compared to the INCA 1 study, OWOB prevalence was not significantly different, EI was lower, and SED was higher. These trends were the same across all occupational categories of heads of household. Although overall rates of childhood OWOB are currently stabilizing, no change was observed in the strong inverse socioeconomic gradient of OWOB between the two studies.

Under-reporting of gravidity in a rural Malawian population

BACKGROUND

Mis-reporting of data by study participants in a questionnaire-based study is an important source of bias in studies.

OBJECTIVE

To determine the prevalence and factors influencing mis-reporting of gravidity among rural women in Malawi.

MATERIALS AND METHODS

Data from cross sectional study conducted in 2004 were analysed using logistic regression analysis and the logit modeling.

RESULTS

7118 women were in the reproductive age group, 2387(33.5%) had ever attended school, 4556 (64.0%) had never and results for 175 (2.5%) were missing. Of those who attended school, 94.9% (2297) had attained a maximum primary level, 5.04% (122) secondary level and 0.08% (2) tertiary level. 81.6% of the women were aged between 12 and 36 years of age, mean was 26.1 years (SD 10.05 years). The remaining 18.4% were aged between 37 and 49 years of age. The mean number of pregnancies attained was 4.0 (SD 3.4), live births was 3.0 (SD 3.2), mean number of stillbirths was almost zero (SD 0.9) and the mean number of children alive was 2.0 (SD 2.3). The prevalence of mis-reporting of gravidity was 7.9%. Factors influencing the risk of under-reporting gravidity were: previous experience of a still-birth, young age, not being married and having ever attended some level of education.

CONCLUSIONS

We suggest that women who perceived that the community expected them, or they expected themselves to have fewer or no pregnancy at all, censured themselves in reporting low number of pregancies. Researchers using questionnaires should keep in mind possibility of mis-reporting of number of pregnancies among women as this may introduce error in research results. Incorporating multiple questions asking the same thing but in a different way has potential to identify biases as these other questions serve as consistency checks.

Are eating occasions and their energy content related to child overweight and socioeconomic status?

The objectives of this study were: (i) to assess the relationships between childhood overweight (OW) and four eating behaviors: daily eating frequency, and the relative contribution of breakfast, main meals (lunch and dinner), and snacks to total daily energy intake (EI); (ii) to explore whether these eating behaviors are involved in the negative association between socioeconomic status (SES) and OW. A representative sample of French children aged 3-11 years (n = 748) was taken from the 1998-1999 cross-sectional French INCA1 (Enquête Individuelle et Nationale sur les Consommations Alimentaires) food consumption survey. Food intake was reported in a 7-day food record, and SES, physical activity, sedentary behavior (SED), weight, and height were reported by answering face-to-face questionnaires. After adjusting for EI, physical activity, and SED, OW was positively associated with the contribution of the main meals to EI (P = 0.03), not significantly associated with the contribution of breakfast to EI, and inversely correlated to the number of eating episodes (P = 0.009) and to the contribution of snacking episodes to EI (P = 0.007). Our data suggest that a combination of more frequent intake occasions and lower contribution of the main meals to total daily EI is associated with a smaller risk of OW in children. However, eating frequency was the only eating behavior that played a slight mediation role (contributing approximately 8%) in the inverse relationship between SES and OW.

Associations between the portion sizes of food groups consumed and measures of adiposity in the British National Diet and Nutrition Survey

The objective of the present study was to examine the associations between the portion sizes of food groups consumed with measures of adiposity using data from the National Diet and Nutrition Survey of British adults. Seven-day weighed dietary records, physical activity diaries and anthropometric measurements were used. Foods eaten were assigned to thirty different food groups and analyses were undertaken separately for men and women. The median daily portion size of each food group consumed was calculated. The potential mis-reporting [corrected] of dietary energy intake (EI) was identified using the following equation: EI--estimated energy requirements/EER [corrected] x 100 = percentage of under-reporting (UR) of energy needs. Multinomial logistic regression (adjusted for age, social class, physical activity level and UR) was used to determine the portion sizes of food groups most strongly associated with obesity status. Few positive associations between the portion sizes of food groups consumed and obesity status were found. However, UR was prevalent, with a median UR of predicted energy needs of 34 and 33 % in men and women, respectively. After the adjustment was made for UR, more associations between the food groups and obesity status became apparent in both sexes. The present study suggests that the true effect of increased portion size of foods on obesity status may be masked by high levels of UR. Alternatively, these data may indicate that an increased risk of obesity is not associated with specific foods/food groups but rather with an overall increase in the range of foods and food groups being consumed.

Snacking patterns among adolescents: a comparison of type, frequency and portion size between Britain in 1997 and Northern Ireland in 2005

Despite the potential link between snack food intake and obesity and the reportedly high prevalence of snacking among adolescents, adolescent snack food patterns (types of foods consumed, frequency and portion size) have not been extensively examined. This study examines these issues using data on the snacking patterns of adolescents aged 13–16 years who took part in the 1997 National Diet and Nutrition Survey (NDNS) and that from a Northern Irish (NI) cohort of adolescents collected 8 years later, in 2005. Overall energy intake was significantly higher in the NI adolescents in 2005 compared with the NDNS adolescents in 1997 (P < 0·01). Consequently, energy intake from snacks was significantly higher in the NI cohort (P < 0·01) and a trend for a higher % energy intake from snacks compared with the NDNS group was observed (median 32·5 % v. 29·8 %, respectively). Sugar-sweetened carbonated and soft drinks remained the most popular choice of snack over this 8-year period; however, both the portion size consumed and frequency of consumption were significantly higher among the adolescents in 2005 compared with those in 1997 (P = 0·022 and P = 0·014, respectively). Despite the lower popularity, and correspondingly lower frequency of milks and beverages, the portion size of both food groups was significantly higher among the adolescents in 2005 compared with those in 1997 (P < 0·001 and P = 0·007, respectively). These findings may provide scope for policy interventions to place particular emphasis on reducing typical portion sizes consumed of popular snack choices, in particular high-energy carbonated and soft drinks, among UK adolescents.

High sucrose intake is associated with poor quality of diet and growth between 13 months and 9 years of age: the special Turku Coronary Risk Factor Intervention Project

BACKGROUND

Previous studies have suggested that interventions to lower dietary fat content and improved fat quality lead to a compensatory increase in sucrose content.

OBJECTIVE

The purpose of this work was to determine what associations exist between sucrose intake and intake of nutrients, intake of specific foods, and growth in children aged 13 months to 9 years of age in the prospective, randomized Special Turku Coronary Risk Factor Intervention Project.

SUBJECTS AND METHODS

Nutrient intake and food consumption were evaluated annually at ages 13 months through 9 years by using food records. Altogether, 543 children were divided into 3 groups according to mean sucrose intake: constantly high sucrose intake (highest 10%), constantly low sucrose intake (lowest 10%), and average sucrose intake (80%). Absolute and relative weights and heights were recorded at 7, 13, and 24 months of age and annually thereafter until 9 years old.

RESULTS

The high sucrose-intake group exceeded the recommended sucrose intake (<10% of energy intake, World Health Organization) already at the age of 2 years. Energy and total fat intake did not differ between the sucrose-intake groups. Children with low and average sucrose intake consumed more protein and had a better dietary fat quality than children with high sucrose intake. They also tended to receive more vitamin E, niacin, calcium, iron, zinc, and dietary fiber than children who consumed a high sucrose diet. Children in the low sucrose-intake group consumed more grains, vegetables, and dairy products than the other children. Sugar intake had no direct association with obesity, but weight, height, and BMI of children differed between the sucrose-intake groups between 7 months and 9 years of age.

CONCLUSIONS

In children aged 13 months to 9 years, long-term low sucrose intake is associated with better nutrient intake and growth than high sucrose intake.

Energy density of the diet and change in body fatness from childhood to adolescence; is there a relation?

BACKGROUND

The contribution of energy density (ED) of the total diet to increased risk of obesity from childhood into adolescence is unclear.

OBJECTIVE

We assessed the relation between the ED of the diet in childhood, calculated in a number of ways, and change in adiposity from childhood to adolescence.

DESIGN

In a prospective study, 48 children (30 boys, 18 girls) were initially studied at age 6-8 y (baseline) and followed up at age 13-17 y. Daily ED, energy intake, and food intake were assessed at baseline by 7-d weighed food records concurrent with estimates of total energy expenditure (TEE) by doubly labeled water. ED was calculated with the use of 5 published methods. Obesity risk was defined with the use of body fat from total body water by isotope dilution. Body fat was normalized for height and expressed as fat mass index (FMI). Change in adiposity was calculated as follow-up FMI minus baseline FMI.

RESULTS

Misreporting of energy intake at the group level at baseline was low relative to the TEE. ED of the total diet at baseline by the 3 methods for calculating ED that excluded all or most beverages was prospectively associated with change in FMI. However, ED of the total diet by any of the methods was not associated with change in the percentage body fat, body mass index, or waist circumference z scores.

CONCLUSION

The methods used to calculate ED and to assess obesity risk lead to different conclusions about the relation between the ED of the diet in childhood and gain in fat into adolescence.