Relationships between social class, nutrient intake and dietary patterns in Edinburgh schoolchildren

Oral Health Impact of Sugar-Sweetened Beverage Consumption among Korean Adolescents

OBJECTIVES

This study aimed to investigate the association between the frequency of SSB consumption and the prevalence of oral symptoms in adolescents.

METHODS

We analyzed the data collected from the 2017 (13th) Korea Youth Risk-Behavior Web-based Survey (KYRBWS). KYRBS collected beverage consumption data from 64,991 Korean adolescents. Self-reported oral symptoms including sensitivity to food, sharp aches and pains in the teeth, and painful or bleeding gums were also collected. Multivariable logistic regression modeling was used to test the Association between the frequency of SSB consumption and oral symptoms groups.

RESULTS

It was found that Korean adolescents who consumed SSB at least once a week(94.4%) experienced more subjective oral symptoms (46.5%) even after controlling for confounding variables. In addition, as the frequency of SSB intake in adolescents increased, the subjective oral symptoms increased.

CONCLUSIONS

The results of this study clearly revealed that the SSB consumption impacted adolescents' subjective oral symptoms. Compared to those who did not consume SSBs, those who consumed SSBs showed increased for developing subjective oral symptoms.

Dietary patterns of 5-year-old children and their correlates: findings from a multi-ethnic Asian cohort

There is limited data on the dietary patterns of 5-year-old children in Asia. The study examined childhood dietary patterns and their maternal and child correlates in a multi-ethnic Asian cohort. Based on caregiver-reported 1-month quantitative FFQ of 777 children from the Growing Up in Singapore Towards healthy Outcomes cohort, cluster analysis identified two mutually exclusive clusters. Children in the 'Unhealthy' cluster (43·9 %) consumed more fries, processed meat, biscuits and ice cream, and less fish, fruits and vegetables compared with those in the 'Healthy' cluster (56·1 %). Children with mothers of lower educational attainment had twice the odds of being assigned to the 'Unhealthy' cluster (adjusted OR (95 % CI) = 2·19 (95 % CI 1·49-3·24)). Children of Malay and Indian ethnicities had higher odds of being assigned to the 'Unhealthy' cluster (adjusted OR = 25·46 (95 % CI 15·40, 42·10) and 4·03 (95 % CI 2·68-6·06), respectively), relative to Chinese ethnicity. In conclusion, this study identified two dietary patterns in children, labelled as the 'Unhealthy' and 'Healthy' clusters. Mothers' educational attainment and ethnicity were two correlates that were associated with the children's assignments to the clusters. These findings can assist in informing health promotion programmes targeted at Asian children.

Sugar-sweetened beverage consumption frequency in Korean adolescents: based on the 2015 Youth Risk Behavior Web-Based Survey

INTRODUCTION

The purpose of the present study was to investigate current sugar-sweetened beverage consumption habits in Korean adolescents in conjunction with their demo-socioeconomic characteristics, and to identify variables that affect such behaviours.

MATERIALS AND METHODS

The study was conducted via secondary analysis of data from the 2015 Youth Risk Behavior Web-Based Survey (the 11th survey). The dependent variable in the current study was the combined consumption frequency of three types of sugar-sweetened beverages (carbonated beverages, highly-caffeinated beverages, sugary beverages), and demographic (gender, academic grade, residence), sociological (father's education level, mother's education level, having experienced depression within the last 12 months) and economic (subjective economic status, weekly allowance) factors constituted the independent variables.

RESULTS

Our results showed that the amount of weekly allowance had the greatest impact on adolescents' beverage consumption of more than seven times a week. Increases in experiencing a depressed mood and allowance were associated with an increased tendency to consume ≥ 7 sugar-sweetened beverages per week.

CONCLUSION

The results of the current study suggest that families and society should work collectively to motivate adolescents to consciously choose and buy healthy snacks. Furthermore, society should reach a consensus and invest effort to resolve this issue continuously and gradually, such as by presenting a standard for consumption of sugar-added drinks and implementing regulations to ban sales to adolescents.

What factors are associated with frequent unhealthy snack-food consumption among Australian secondary-school students?

OBJECTIVE

To examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption.

DESIGN

Cross-sectional survey of students' eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire.

SETTING

Australian secondary schools across all states/territories.

SUBJECTS

Secondary-school students aged 12-17 years participating in the 2009-10 National Secondary Students' Diet and Activity (NaSSDA) survey (n 12 188).

RESULTS

Approximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week ('frequent snackers'). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m² were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers.

CONCLUSIONS

Frequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.

Family sociodemographic characteristics as correlates of children’s breakfast habits and weight status in eight European countries. The ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project

Objective

The purpose of the present study was to investigate the associations of family sociodemographic characteristics with children’s weight status and whether these potential associations are mediated by children’s breakfast habits.

Design

A school-based survey among 10–12-year-old children was conducted in eight European countries. Children’s weight and height were measured and breakfast habits and family sociodemographic characteristics were self-reported by 5444 children and their parents. International Obesity Task Force cut-off points were used to categorize children as overweight/obese or normal weight. Mediation analyses were used to test the potential mediating effect of children’s breakfast consumption on the associations between family sociodemographic characteristics and children’s overweight/obesity.

Setting

Schools in eight European countries participating in the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project.

Subjects

Children aged 10–12 years and their parents (n 5444).

Results

Children’s reported daily breakfast consumption varied from 56 % in Slovenia to 92 % in Spain on weekdays and from 79 % in Greece to 93 % in Norway on weekends. Children of native parents, with both parents employed and with at least one parent having more than 14 years of education were more likely to consume breakfast daily and less likely to be overweight/obese. Finally, mediation analyses revealed that the association of parental nationality and parental educational status with children’s overweight/obesity was partially mediated by children’s daily breakfast consumption.

Conclusions

The study shows that the lower likelihood of being overweight/obese among 10–12-year-old children of native background and higher parental educational status was partially mediated by children’s daily breakfast consumption.

Meal frequencies in early adolescence predict meal frequencies in late adolescence and early adulthood

Background

Health and risk behaviours tend to be maintained from adolescence into adulthood. There is little knowledge on whether meal frequencies in adolescence are maintained into adulthood. We investigated whether breakfast, lunch and evening meal frequencies in early adolescence predicted meal frequencies in late adolescence and in early adulthood. Further, the modifying effect of gender and adolescent family structure were investigated.

Methods

National representative sample of 15-year-olds in Denmark with 4 and 12 year follow-up studies with measurement of breakfast, lunch and evening meal frequencies. A total of 561 persons completed questionnaires at age 15 years (baseline 1990, n=847, response rate 84.6%), age 19 years (n=729, response rate 73.2%) and age 27 years (n=614, response rate 61.6%).

Results

Low meal frequencies at age 15 years was a significant predictor for having low meal frequencies at age 19 years (odds ratio (OR, 95% CI)) varying between 2.11, 1.33-3.34 and 7.48, 3.64-15.41). Also, low meal frequencies at age 19 years predicted low meal frequencies at age 27 years (OR varying between 2.26, 1.30-3.91 and 4.38, 2.36-8.13). Significant predictions over the full study period were seen for low breakfast frequency and low lunch frequency (OR varying between 1.78, 1.13-2.81 and 2.58, 1.31-5.07). Analyses stratified by gender showed the same patterns (OR varying between 1.88, 1.13-3.14 and 8.30, 2.85-24.16). However, the observed predictions were not statistical significant among men between age 15 and 27 years. Analyses stratified by adolescent family structure revealed different lunch predictions in strata.

Conclusions

Having low meal frequencies in early adolescence predicted low meal frequencies in late adolescence and early adulthood. We propose that promotion of regular meals become a prioritised issue within health education.

Changes in intake of milk and dairy products among elementary schoolchildren following experiential studies of dairy farming

This study intends to clarify the effects of hands-on dairy farming experience on the consumption of milk and dairy products. A survey was conducted on 474 elementary schoolchildren and their parents at eight elementary schools that offered hands-on dairy farming experience at four dairy farms in Hokkaido, Japan. In the survey, questionnaires were used to inquire about the children's milk and dairy product intake before and after the hands-on experience. In addition, milk intake at school was investigated weekly for 3 months after the hands-on experience. The parents were asked about the children's intake of milk and dairy products at home before and after the hands-on experience. Analysis of the survey results indicated a significant increase in the amount and frequency of milk consumed and the frequency of yogurt consumed at home by the children immediately after the hands-on experience. Accordingly, the study suggested that the hands-on dairy farming experience had the effect of increasing children's milk and dairy product consumption at home.

Socioeconomic status and the health of youth: a multilevel, multidomain approach to conceptualizing pathways

Previous research has clearly established associations between low socioeconomic status (SES) and poor youth physical health outcomes. This article provides an overview of the main pathways through which low SES environments come to influence youth health. We focus on 2 prevalent chronic health problems in youth today, asthma and obesity. We review and propose a model that encompasses (a) multiple levels of influence, including the neighborhood, family and person level; (b) both social and physical domains in the environment; and finally (c) dynamic relationships between these factors. A synthesis of existing research and our proposed model draw attention to the notion of adverse physical and social exposures in youth's neighborhood environments altering family characteristics and youth psychosocial and behavioral profiles, thereby increasing youth's risk for health problems. We also note the importance of acknowledging reciprocal influences across levels and domains (e.g., between family and child) that create self-perpetuating patterns of influence that further accentuate the impact of these factors on youth health. Finally, we document that factors across levels can interact (e.g., environmental pollution levels with child stress) to create unique, synergistic effects on youth health. Our model stresses the importance of evaluating influences on youth's physical health not in isolation but in the context of the broader social and physical environments in which youth live. Understanding the complex relationships between the factors that link low SES to youth's long-term health trajectories is necessary for the creation and implementation of successful interventions and policies to ultimately reduce health disparities.

Social, economic and demographic correlates of overweight and obesity in primary-school children: preliminary data from the Healthy Growth Study

OBJECTIVE

To record the prevalence of overweight and obesity in urban primary-school children in relation to several socio-economic and demographic factors.

DESIGN

Cross-sectional.

SETTING/SUBJECTS

A representative sample of 729 schoolchildren (379 male and 350 female), aged 9-13 years, stratified by parental educational level, was examined in the urban region of Athens. Weight and height were measured using standard procedures. The International Obesity Task Force thresholds were used for the definition of overweight and obesity. Several socio-economic and demographic data and the child's 'popularity' score were also recorded with specifically designed standardized questionnaires.

RESULTS

The prevalence of overweight and obesity was 29·6 % and 11·1 %, respectively. Annual family income of € 12,000-20,000 (OR = 1·58), residence ownership (OR = 1·63) and the grandmother as the child's primary caregiver (OR = 1·38) were significantly associated with higher odds of childhood overweight and obesity. Non-Greek parental nationality (OR = 0·72) and higher 'popularity' scores of children (OR = 0·42) were significantly associated with lower odds of overweight and obesity. The grandmother as the child's primary caregiver and an annual family income of € 12,000-20,000 remained significantly associated with childhood overweight and obesity after adding all significant correlates of childhood overweight and obesity observed at the bivariate level in a multivariate regression model (OR = 1·51 and 1·61, respectively).

CONCLUSIONS

Among family income, residence ownership, child's primary caregiver, parental nationality and popularity scores that were identified as significant correlates of childhood overweight and obesity at the bivariate level, lower family income and grandmother as the child's primary caregiver were the only factors that remained significantly associated with childhood overweight and obesity at a multivariate level.

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.

Unfavourable family characteristics and their associations with childhood obesity: a cross-sectional study

OBJECTIVE

This cross-sectional study explores the influence of multiple familial factors on children's weight status and the interaction between parenting stress and unfavourable family characteristics.

METHODS

A total of 197 families with children between 6 and 14 years participated in this study. Of this group, 97 families had a child with normal weight and 100 families had a child with overweight. Parents reported on seven family factors (maternal BMI, number of children, family structure, socioeconomic position, life events, parental psychopathology and parenting stress).

RESULTS

Families with overweight children experience more parenting stress. A regression analysis revealed that familial factors explain 27% in the variance in child's weight status. The hypothesis that a combination of familial factors will be more able to explain child's adiposity could not be confirmed.

CONCLUSIONS

Familial factors have moderate ability to predict children's weight status. There is a need to identify other familial mechanisms taking into account developmental and temporal evolutions over the past decade.

What maternal factors influence the diet of 2-year-old children living in deprived areas? A cross-sectional survey

Objective

To investigate the maternal factors associated with poor diet among disadvantaged children.

Design

Survey of 300 mothers of 2-year-old children from areas of high deprivation in Scotland (response rate 81 %). A diet quality score was derived from reported consumption of carbohydrates, protein, fruit and vegetables, dairy products and restriction of sugary fatty foods.

Results

Most children (85 %) were classified as having a poor quality diet (low diet quality score). Mothers’ general knowledge about healthy eating was high, but did not predict the quality of the children’s diet. Lower frequencies of food preparation and serving, such as cooking with raw ingredients, providing breakfast daily and the family eating together, were also associated with a poorer diet. Regression modelling identified five significant factors. An increased risk of a poor diet was associated with mothers being unlikely to restrict sweets (OR = 21·63, 95 % CI 2·70, 173·30) or finding it difficult to provide 2–3 portions of fruit daily (OR = 2·94, 95 % CI 1·09, 7·95). Concern that the child did not eat enough increased the risk of a poor diet (OR = 2·37, 95 % CI 1·09, 5·16). Believing a healthy diet would help the child eat more reduced the risk of having a poor diet (OR = 0·28, 95 % CI 0·11, 0·74), as did providing breakfast daily (OR = 0·22, 95 % CI 0·05, 0·99).

Conclusions

Interventions to improve children’s diet could promote more positive intentions about preparing and serving of foods, particularly of specific meals at which the family eats together. The benefits of these behaviours to the child (improved diet, weight control) should be emphasised.

A review of family and social determinants of children's eating patterns and diet quality

With the growing problem of childhood obesity, recent research has begun to focus on family and social influences on children's eating patterns. Research has demonstrated that children's eating patterns are strongly influenced by characteristics of both the physical and social environment. With regard to the physical environment, children are more likely to eat foods that are available and easily accessible, and they tend to eat greater quantities when larger portions are provided. Additionally, characteristics of the social environment, including various socioeconomic and sociocultural factors such as parents' education, time constraints, and ethnicity influence the types of foods children eat. Mealtime structure is also an important factor related to children's eating patterns. Mealtime structure includes social and physical characteristics of mealtimes including whether families eat together, TV-viewing during meals, and the source of foods (e.g., restaurants, schools). Parents also play a direct role in children's eating patterns through their behaviors, attitudes, and feeding styles. Interventions aimed at improving children's nutrition need to address the variety of social and physical factors that influence children's eating patterns.

Welfare babies: poor children's experiences informing healthy peer relationships in Canada

Positive peer relationships among children living in poverty are important for their well-being, resiliency and mental and physical health. This paper explicates the 'felt experience' of children living in poverty, and the implications of these experiences for healthy peer relationships, from a re-analysis of two qualitative research studies in Canada examining children living in food insecure circumstances. Poor children feel deprived, part of the 'poor group', embarrassed, hurt, picked on, inadequate and responsible. Poor children internalize their own lack of social resources in feelings of deprivation. They experience negative feelings relative to their peers-inadequacy, embarrassment and hurt. Children do identify group membership but it is not used as a social resource, as it could be, but rather as a symbol of social segregation. Children also feel responsible for ameliorating some of the effects of their poverty and this seems to strengthen their relationship with their mothers. This could equally be translated into peer-related support, such as standing up to poor bashing, or engaging constructively with higher social class peers. Health promotion strategies that seek to foster positive peer relationships and enhance children's sense of belonging should offer novel social environments in which poor children can engage a variety of peers.

Changes over 20 years in macronutrient intake and body mass index in 11- to 12-year-old adolescents living in Northumberland

Monitoring adolescent diets over time enables the assessment of the effectiveness of public health messages which are particularly important in vulnerable groups such as adolescents. In 2000, 424 children aged 11-12 years old completed two 3 d estimated dietary records. On the fourth day one nutritionist interviewed each child to clarify the information in the diary and foods were quantified with the aid of food models. Nutrient intake was calculated using computerised food tables. These children attended the same seven schools in the same Northumberland area as the 11- to 12-year-old children who recorded their diet using the same method in 1980 (n 405) and 1990 (n 379), respectively. Height and weight, and parental occupation were recorded in all three surveys for each child. Height and weight were used to calculate BMI, weight was used to estimate BMR and parental occupation was used to determine social class. Comparing the macronutrient intakes in 2000 with 1980 and 1990, energy intakes (EI) fell in boys (to 8.45 MJ) and girls (to 7.60 MJ). This fall may, at least in part, be due to an increase in low energy reporting. For 1980, 1990 and 2000 the percentage of boys with EI:BMR below 1.1 was 6, 15 and 23 %, respectively; for girls, 3, 14 and 18 %, respectively. Percentage energy from fat was unchanged between 1980 and 1990 but fell to 35 % (about 76 g/d) in 2000, alongside a 3 % increase in percentage energy from starch (30 %). Percentage energy from non-milk extrinsic sugars remained above recommendations (16 %; about 82 g/d). The number of overweight and obese children increased from 11 % to 30 % between 1980 and 2000. Positive changes have occurred in the Northumbrian adolescent diet but social inequalities, reported in previous surveys, remain.

Diet, Obesity and Education in Three Age Groups of Saskatchewan Women

Research on relationships between socioeconomic status and Canadians’ diet is limited. The current study investigated differences by education in dietary variables shown to be related to obesity; it included three age groups of Saskatchewan women who participated in the 1992 to 1993 Heart Health Intervention Evaluation baseline study. Multistage sampling was used to select randomly from the Saskatchewan Health Insurance Registration File. The overall response rate was 42.6%; a sample representative of the general Saskatchewan population was obtained. Three-day estimated food records and demographic information from 396 women aged 18 to 74 years were subdivided into three age categories: 18 to 34 years, 35 to 54 years, and 55 to 74 years. For the 18- to 34-year group, obesity was significantly more prevalent with lower education; trends were similar for the older age groups. Under-reporting of energy intake (indicated by an energy intake:basal metabolic rate ratio of <1.1) was related to obesity but not to education. The greatest differences in diet between educational groups were observed in the 18- to 34-year group; fewer differences existed in the 35- to 54-year group, and none in the 55- to 74-year group. Health promotion efforts need to be targeted appropriately, and based on differences in dietary intakes by socioeconomic group. Research should help promote an understanding of the reasons for differences in diet by socioeconomic status.

Effects of ethnicity, family income, and education on dietary intake among adolescents

BACKGROUND

The aim of the study is to describe the overall diet and potential effects of gender, ethnicity, family income, and parents' education on dietary patterns in adolescents aged 11 to 20 years who participated in a cohort study in 12 Southern California communities.

METHODS

A validated 131-item youth/adolescent food frequency questionnaire was administrated among 3,201 participants in the Children's Health Study at follow-up visits between 1998 and 2000. Sociodemographic characteristics included ethnicity, family income, and parents' education. Stratified analysis and analysis of covariance were used to describe the intakes of selected nutrients and food groups.

RESULTS

Mean intakes for all nutrients except calcium met 100% of the Recommended Dietary Allowances. Average daily food intakes were below the minimum recommended number of servings for all major food groups. The majority of subjects had an excessive intake of added sugar. A gender difference was found in intakes of energy, total fat (TF), saturated fat (SF), monounsaturated fat (MUSF), and calcium (P < 0.05). Non-Hispanic Whites had the lowest intakes of fruits while Blacks and Asians had significantly higher intakes of vegetables (P < 0.05). Subjects from higher income families had significantly higher intakes of polyunsaturated fat, protein, calcium, and folate and more frequently consumed dairy products. Intakes of TF, SF, MUSF, and cholesterol decreased as parents' education levels increased. Subjects from families with parents who had higher educational attainment were more likely to meet the recommendations of dairy products, fruits, and vegetables.

CONCLUSION

Overall, subjects in our study did not have healthy eating habits. Dietary patterns varied by sex, ethnicity, income, and education.

Short stature and coronary heart disease: a 35-year follow-up of the Finnish cohorts of The Seven Countries Study

OBJECTIVES

To examine whether short stature is associated with an increased risk of coronary heart disease.

DESIGN

Follow-up study.

SETTING

Two geographically defined areas in eastern and western Finland.

SUBJECTS

A total of 1441 men who were free of coronary heart disease at the start of the follow-up.

MAIN OUTCOME MEASURES

Hazard ratios for fatal and non-fatal coronary heart disease

RESULTS

Height was inversely related to fatal coronary heart disease and incident non-fatal coronary heart disease during the follow-up. These relationships persisted after adjusting for other major cardiovascular risk factors. Comparing the high-risk area in eastern Finland with the low-risk area in south-western Finland, no difference in fatal coronary heart disease and cumulative incidence of non-fatal coronary heart disease was seen in tall men. The increase in risk of coronary heart disease death was 19% for a 10 cm decrease in height (OR = 0.81, 95% CI = 0.68-0.95).

CONCLUSIONS

Our results show that short stature is an independent risk factor for coronary heart disease. Differences in stature partly explain the Finnish east-west difference in the incidence of coronary heart disease.

Childhood nutrition and poverty

One in three children in Britain lives in poverty (households whose income was less than 50% average earnings). Low income is associated with poor nutrition at all stages of life, from lower rates of breast-feeding to higher intakes of saturated fatty acids and lower intakes of antioxidant nutrients. Moreover, there is increasing evidence that poor nutrition in childhood is associated with both short-term and long-term adverse consequences such as poorer immune status, higher caries rates and poorer cognitive function and learning ability. These problems arise primarily because parents do not have enough money to spend on food, not because money is being spent unwisely. Policy options to improve the dietary health of poor children include: giving more money to the parents by increasing Income Support (social security) payments, providing food stamps or vouchers, and using food budget standards to inform the levels of income needed to purchase an adequate diet; feeding children directly at school (not only at lunchtime but also at breakfast or homework clubs), by providing free fruit at school, and by increasing entitlement to free food amongst children living in households with low incomes; improving access to a healthy and affordable diet by first identifying 'food deserts' and then considering with retailers and local planners how best to provide food in an economical and sustainable way. The value of using food budget standards is illustrated with data relating expenditure on food to growth in children from 'at-risk' families (on low income, overcrowded, headed by a lone parent or with four or more children under 16 years of age) living in a poor area in London. Lower levels of expenditure are strongly associated with poorer growth and health, independent of factors such as birth weight, mother's height, or risk score. The present paper provides evidence that supports the need to review Government legislation in light of nutrition-related inequalities in the health of children.

The remedying of iron deficiency: what priority should it have?

Fe deficiency is considered to be the commonest of nutritional deficiencies worldwide. Adverse effects are stated to include lower growth rate and impaired cognitive scores in children and poor pregnancy outcome and lower working capacity in adults. In the present review, Fe intake, stores of the element, the magnitude of deficiencies and the benefits from interventions, as reflected in the results of clinical trials, are discussed. Because of inadequacies of knowledge in numerous respects, more information is needed regarding the extent to which clinical trials relate to public health realities, before introducing regional or national supplementation programmes. While Fe supplements are needed in certain groups, and in particular regions, increased dietary intakes could be supplied by food fortification, as well as by individual improvements in intake.

The contribution of breakfast to the diets of a sample of 136 primary-schoolchildren in Edinburgh

The contribution of breakfast to mean daily energy and nutrient intakes was investigated in a sample of 7-8-year-old children recruited by letter from five Scottish schools. After eighteen families dropped out of the study and three dietary records were discarded, the final sample numbered 136 (51%). Dietary data were collected using the 7 d weighed inventory, while a questionnaire was used to classify children into manual or non-manual social class groups. Mean daily energy intakes were close to estimated average requirements (Department of Health, 1991), while intakes of most micronutrients were in excess of reference nutrient intakes (RNI; Department of Health, 1991). The most popular breakfast consumed by the children was one including a ready-to-eat breakfast cereal (RTEBC). Differences in macronutrient content were seen between breakfasts of boys and girls, while manual-social-class children ate breakfasts which were lower in energy, NSP and certain micronutrients than those of non-manual-class children. Breakfast contributed 14% of energy and 9-36% of micronutrient intakes to the overall diets. Breakfasts including RTEBC contributed significantly more energy and nutrients than other types of breakfast. Children who ate RTEBC nearly every day had overall diets which had a higher nutrient density and were lower in fat than those of children who ate RTEBC less frequently or not at all. Intakes of most micronutrients were above the RNI in both these groups, with the exception of folate, Fe and vitamin A, which were below the RNI for those consuming RTEBC infrequently. However, the type of breakfast eaten did not appear to influence energy and nutrient intakes at other meals during the day. Nevertheless, it was concluded that breakfast, particularly one containing RTEBC, had a strong influence on the daily energy and nutrient intakes of 7-8-year-old children, particularly by reducing the proportion of energy from fat.