Ten-year changes in positive and negative marker food, fruit, vegetables, and salad intake in 9-10 year olds: SportsLinx 2000-2001 to 2010-2011.

BACKGROUND: To investigate changes in intakes of 'negative' and 'positive' foods, fruit, vegetables, and salad in serial cohorts of 9-10-year-old children from 2000-2001 to 2010-2011. METHODS: For this serial, cross-sectional study, children in school year 5 (9-10 years of age) completed the SportsLinx Lifestyles Survey [n = 30,239 (15,336 boys and 14,903 girls)]. Changes in positive and negative food scores, and the proportion of boys and girls reportedly consuming fruit, vegetables and salad on the previous day to surveying, were investigated annually from 2000 to 2011. RESULTS: The consumption of negative foods declined and positive foods increased significantly compared to baseline. Positive changes in fruit, vegetables and salad consumption were observed over time, with the most recent cohort more likely to consume fruit, vegetables and salad compared to the 2000-2001 baseline. Girls displayed more favourable positive and negative food scores and were more likely to consume fruit, salad and vegetables across several study years compared to boys. CONCLUSIONS: The consumption of negative and positive foods, fruit, vegetables, and salad has improved over the last 10 years. In addition, girls appear to have better positive and negative food scores, and were more likely to consume fruit, vegetables and salad, across a number of study years or cohorts compared to boys. These encouraging findings suggest that children's food intake has improved since 2000. Furthermore, the data indicate that boys and girls may require separate or different healthy eating messages to further improve food intake.

Changes in fitness, body mass index and obesity in 9-10 year olds.

BACKGROUND: The prevalence of obesity in children has increased substantially in recent years and, paediatric obesity and poor fitness are risk factors for disease. The present study aimed to assess changes in body mass index (BMI), the prevalence of obesity and changes in aerobic endurance over time in 9-10-year-old schoolchildren. METHODS: Participants were recruited by the SportsLinx project from primary schools across Liverpool. Height and weight data were used to calculate BMI. The prevalence of obesity and overweight were estimated using age- and sex-specific cut-off points. Performance on the 20-m multi-stage shuttle runs test (20 mMST) was used as a marker of aerobic endurance. Data were available for 13,418 (6572 boys, 6846 girls) 9-10-year-old children. Analysis of covariance was completed to assess year-on-year changes in BMI controlling for deprivation (IMD) and 20 mMST performance, and 20 mMST performance controlling for IMD and BMI. RESULTS: No significant changes in BMI from baseline were observed (P > 0.05). Obesity prevalence reduced in girls (2005 = 10.3%, 2008 = 8.52% in 2008). The data for boys showed no reductions in prevalence (2005 = 6.77%, 2008 = 7.87%). The most recent cohort for boys and two most recent cohorts for girls had lower levels of aerobic endurance than baseline (2004-2005) (P

Coping mechanisms used by women in an attempt to avoid symptoms of chronic radiation enteritis.

BACKGROUND: Approximately 12,000 individuals undergo pelvic radiotherapy in the UK every year and up to 50% may develop symptoms of chronic radiation enteritis (CRE). Health professionals often give inappropriate dietary advice to patients in an attempt to avoid CRE symptoms, such as avoiding fibre, despite a lack of evidence to support this. METHODS: The present study aimed to explore dietary advice and changes made to the diet by women treated with pelvic radiotherapy. A questionnaire was distributed to 117 women attending Liverpool Women's Hospital, exploring symptoms of CRE and asking questions about diet and medication advice received, as well as changes made to the diet. RESULTS: Ninety-five (87.2%) women completed the questionnaire and 47% had changed their diet. No significant relationship was observed between receiving dietary advice and making changes to the diet (P > 0.05), although those advised by a dietitian were more likely to be taking regular anti-diarrhoeal medication (P < 0.05) and those taking regular medication found that it helped most/all of the time (P < 0.001). CONCLUSIONS: CRE sufferers should be dissuaded from unnecessarily restricting their diet, which may result in malnutrition. Regular follow-up screening should lead to the identification of sufferers and the offer of individual advice if necessary.

Identification of 'hot spots' of obesity and being underweight in early pregnancy in Liverpool.

BACKGROUND: Obesity and being underweight in pregnancy are related to an increased risk of maternal and foetal morbidity, yet their prevalence is often unknown. The present study aimed to identify neighbourhoods with a higher than average prevalence or 'hot spots' of obesity and/or being underweight among first trimester pregnant women. METHODS: A database was compiled consisting of postcode, height and weight for 7981 women who had booked-in for antenatal care between July 2004 and June 2005 at Liverpool Women's Hospital. Body mass index (BMI) was calculated and women were categorised accordingly. Postcodes for 6865 cases across Merseyside were converted to geolocations (pin-points on a map) using conversion software (http://www.census.ac.uk/cdu/). RESULTS: There was a very high prevalence of being overweight (27%) and obesity (17%); 3.8% of women were underweight and probably malnourished (BMI < 18.5 kg m(-2)); and a further 10.7% of women were possibly malnourished (BMI < 20.0 kg m(-2). Deriving case density from the geolocations allowed visualisation and identification of six neighbourhoods with above average levels of obesity and three neighbourhoods had marked concentrations of both being underweight and obesity. CONCLUSIONS: These neighbourhoods, particularly those identified as 'hot spots' for both being underweight and obesity, include some of the most deprived wards in the UK. As dietetic intervention may help to promote optimal weight gain during pregnancy and improve dietary intake for pregnant women and their families, primary health care providers should target these localities with a high prevalence of low and high BMI as a priority.

Interpreting the correlation coefficient when one of the variables is discrete.

The effect on the correlation coefficient of discretizing data was investigated in two ways. First, the theoretical effect of dichotomizing data was calculated, and it was shown that the resulting correlation coefficient is considerably less than that between the underlying bivariate normally distributed variables. Second, computer simulations were performed of a model in which a continuous variable (measured with some error) gives rise to a counting variable through a mechanism in which the count is zero below a certain threshold value for the continuous variable and then increases linearly as the continuous variable increases. It was shown that the correlation coefficient between the observed values of the continuous and counting variables decreased as (a) the measurement error increased, (b) the slope of the relationship decreased, and (c) the number of counts decreased. It is concluded that caution is required when interpreting correlation coefficients when one or both of the variables consist of a few (say only four or five) discrete scores.

A longitudinal study of the growth of matched pairs of vegetarian and omnivorous children, aged 7-11 years, in the north-west of England.

OBJECTIVE: To assess the ability of a meat free diet to support normal growth of children. DESIGN: A one year longitudinal observational case--comparison study of growth. SETTING: Children were recruited mainly through schools from Merseyside and all measurements were taken in their homes. SUBJECTS: Fifty 'free-living' children following meat free diets, aged 7-11 y (expected to be pre-pubertal), were compared with a control group of 50 omnivores matched for age, sex and ethnic group. INTERVENTION: None. MAIN OUTCOME MEASURES: Height, weight, upper arm skinfold thicknesses and mid-upper arm circumference measurements were taken at baseline and one year later. The increments over one year were each analysed using a multiple stepwise regression model which derived predicted increments controlled for a variety of factors other than the diet factor. RESULTS: Of all the anthropometric measurements examined only the predicted height increment of the vegetarians was slightly greater than that of the omnivores (difference in predicted height increment = 0.47 cm, P = 0.05). This difference was only apparent after allowing for father's height, maternal smoking habit and number of siblings. A tendency for the vegetarians to be leaner than the omnivores was not significant at the 5% level and both the vegetarian and omnivorous groups lay close to the 50th percentiles for both height and weight (Child Growth Foundation, 1994). CONCLUSIONS: The results suggest that these children who followed a meat free diet and conventional lifestyles grew at least as well as children who ate meat.

Children with diabetes mellitus: perception of their behavioural problems by parents and teachers.

The behaviour of 127 children with diabetes mellitus aged 8-16 years was assessed by their parents and teachers using a well established screening device and compared to that of 51 non-diabetic children. Twenty five per cent of the diabetics were perceived by their parents to be disturbed compared to only 14% of the controls. The proportion perceived to be disturbed by their teachers was similar in the two groups but more diabetics than controls were perceived by both parents and teachers to be disturbed. No relationship was found between the extent of the behaviour problems recorded and the control of the diabetes, as measured by glycosylated haemoglobin, the child's age, the child's age at diagnosis or the duration of the diabetes. However, the children with the younger parents at diagnosis tended to be perceived by their parents as having more behaviour problems, as were the diabetics from families facing the most social problems. The families more knowledgeable about diabetes were less likely to have disturbed children.

Relationship between dietary habits and caries increment assessed over two years in 405 English adolescent school children.

The study was conducted in seven schools on children initially aged 11.5 years. They recorded their diet on five occasions, each of three days, and received an annual dental examination, including radiography. Caries increments were low, mostly (58 per cent) in fissure surfaces. Correlations between caries increment and dietary factors were low due to the low caries increments observed and the large error associated with dietary data where analyses attempt to discriminate between individuals. The highest correlation was between caries increment and weight of daily intake of sugars (+0.143, p less than 0.01). Multivariate analyses revealed that this relationship could not be explained by differences in sex, social class, tooth-brushing habits or level of plaque as measured by gingival inflammation. Weight of sugar intake appeared to be more strongly correlated to caries than frequency of intake; concentration of sugars in foods was positively related, and sugars in snacks were more strongly related to caries than total dietary sugars. The 31 children who consumed most sugar (greater than 163 g/day) developed 5.0 DMFS during the 2 years, 0.9 DMFS per year more than the 31 children (3.2 DMFS during 2 years) who had the lowest sugar intake (less than 78 g/day).

Changes in water intake of Northumbrian adolescents 1980 to 2000.

OBJECTIVES: To determine: total water intake in young English adolescents; the relative importance of sources of water intake; and changes in water intake and sources of water between 1980 and 2000. DESIGN: A cross-sectional observational study of the diets of 11-12-year-old children attending seven schools in south Northumberland, UK. The information obtained was compared with results from a similar survey carried out 20 years previously. METHODS: All children attending these schools were invited to participate. They completed a three-day diet diary with an interview on the fourth day, on two occasions during the school year. Standard UK food composition tables were used and water intake from various sources calculated. Anthropometric and social class information was obtained. RESULTS: Four hundred and twenty-four children completed all aspects of the study (64% of those eligible). The mean total water intake was 1,130 g d(-1), approximately the same as that recorded 20 years before. Water intake in relation to energy intake: water intake was 139 g MJ(-1) in boys and 143 g MJ(-1) in girls. Sixty-five per cent of water came from drinks and 35% from foods; very similar to proportions 20 years before. The sources of water in drinks had changed considerably, with a marked increase in consumption of soft drinks (especially carbonated drinks) and a decrease in consumption of hot drinks and milk. There were a few differences between sexes but little difference between social groups. CONCLUSIONS: Total water intake was similar to that recorded 20 years previously and lower than intakes reported in other countries. Changes in the sources of water meant that less water consumed was likely to come from the tap in the house and more from drinks made elsewhere, than 20 years previously. These changes have implications for estimating fluoride intake in fluoridated areas.

Sugars consumption of Northumbrian children aged 11-14 years.

In order to investigate the relationships between diet and tooth decay the authors recently completed the first longitudinal study of diet and dental caries increment in children. 405 children initially aged 11.5 years each recorded their intake of foods and drinks for a total of 15 days over a period of 2 years. This is a review of some of the findings.

Dietary intake and the extraction of third molars: a potential problem.

The most common form of oral surgery is extraction of impacted third molars. The patient may suffer a period of impaired food intake before extraction because of the discomfort caused by the impacted tooth. This may compound poor intake for other reasons, for example poverty. After surgery, the patient undergoes several days of pain and swelling, which delays a return to normal eating. The relationship between surgery for impacted third molars and diet has not been documented, nor is dietary advice routinely offered. The aim of this study was to describe the diet of patients before and after extraction of third molars. Patients recorded everything they ate for 7 days before and after surgery. These records were converted into estimates of nutrient intake. A substantial fall in energy intake occurred which had not been corrected even a week after surgery. The nutritional implications of this are not yet clear. Practitioners are strongly advised to warn patients of the likelihood of serious disturbance to their lifestyle and to offer them simple dietary advice.

Does temporomandibular disorder pain dysfunction syndrome affect dietary intake?

Temporomandibular disorder pain dysfunction syndrome (TDPDS) is the most common cause of facial pain after toothache. The symptoms are varied but are likely to affect the choice, intake and enjoyment of food. This has not been previously investigated. In this paper a preliminary study of 35 patients attending a department of oral and maxillofacial surgery at a general hospital is presented. Thirty-one subjects reported that eating was a problem; 15 prepared food differently and 24 considered that their choice of food was limited. Four of the five foods most often reported to be difficult to eat are valuable in the diet: meat (22), apples (20), bread (13), toast (7) and toffees (6). Twenty-three subjects reported eating a softer diet. Most (25) reported pain when eating. Such circumstances make it harder for TDPDS sufferers to meet current nutritional guidelines, especially, perhaps, for some to achieve an adequate intake of iron.

Trends in fruit, vegetable and salad intakes in 9-10-year-old schoolchildren living in Liverpool, 2000-2005.

OBJECTIVE: To report on the fruit, vegetable and salad intakes of Liverpool schoolchildren aged 9-10 years over a 5-year period (2000-2005). DESIGN: Cross-sectional observational study. SETTING: Between 75 and 100 Liverpool primary schools took part in each survey year. SUBJECTS: Subjects consisted of five separate cohorts of 9-10-year-old children from all areas of the city. MAIN OUTCOME MEASURES: Number and proportion of boys and girls who reported eating fruit, vegetables and salad on the previous day. RESULTS: There was an upward trend in the reported intake of fruit between 2002 and 2005. Girls were more likely than boys to report eating fruit (P < 0.001). The trend in salad intake was positive. Between 2000 and 2005 there were significant increases in the number of boys (chi2 = 17.57, P = 0.001) and girls (chi2 = 80.56, P = 0.001) eating salad. Girls were significantly more likely to eat salad than boys in all years (chi2 = 58.75, P = 0.001). Trends in vegetable intake were similar to those for salad, with both sexes reporting yearly increases over the 5-year period. The increase in the number of boys who reported eating vegetables between 2000 and 2005 was 23.5% (chi2 = 32.9, P = 0.000). In girls there was a 44.8% increase over the same period (chi2 = 110.3, P < 0.000). CONCLUSIONS: The data reveal positive trends in the fruit, vegetable and salad intakes of Liverpool schoolchildren between 2000 and 2005. Further research is needed to elucidate the specific factors that have enabled the changes to take place.

Sugars consumption by 379 11-12-year-old English children in 1990 compared with results in 1980.

The amount of sugars consumed by young adolescents was assessed in 1990 using the same methods as those employed in a similar survey in 1980. The children were the same age (mean 11 years 6 months) and from the same seven schools in both survey. In 1980, 405 children completed the study and 379 in 1990. Information was collected using two 3-day dietary diaries, each child being interviewed by a dietitian upon completion of a diary. The dietitian in this study was calibrated closely with the dietitian who undertook the 1980 study so as to ensure comparable diet evaluation methods. Total sugars consumption was unchanged (117 g/day in 1980, 118 g/day in 1990) but consumption of non-milk extrinsic sugars increased (83 g/day in 1980, 90 g/day in 1990) and milk and intrinsic sugars decreased (34 g/day in 1980, 28 g/day in 1990) between the two surveys. In 1990, non-milk extrinsic sugars contributed 17% to total dietary energy intake, while milk and intrinsic sugars contributed 5%. There was little difference in percent contributions between the sexes, but some social-class trends were apparent. Confectionery provided 33% and soft drinks provided 27% of non-milk extrinsic sugars, these two dietary sources providing 60% of non-milk extrinsic or 46% of total sugars intake. These levels of consumption are considerably higher than those currently recommended in the UK.

Cardiorespiratory fitness and body mass index of 9-11-year-old English children: a serial cross-sectional study from 1998 to 2004.

OBJECTIVE: To examine the changes over time in cardiorespiratory fitness and body mass index (BMI) of children. DESIGN: Serial cross-sectional, population-based study. SETTING: Primary schools in Liverpool, UK. PARTICIPANTS: A total of 15,621 children (50% boys), representing 74% of eligible 9-11-year olds in the annual school cohorts between 1998/9 and 2003/4, who took part in a 20m multi-stage shuttle run test (20mMST). MAIN OUTCOME MEASURES: Weight, height, BMI (kg/m(2)) and obesity using the International Obesity Taskforce definition. RESULTS: Median (95% confidence interval) 20mMST score (number of runs) fell in boys from 48.9 (47.9-49.9) in 1998/9 to 38.1 (36.8-39.4) in 2003/4, and in girls from 35.8 (35.0-36.6) to 28.1 (27.2-29.1) over the same period. Fitness scores fell across all strata of BMI (P<0.001). Moreover, BMI increased over the same 6-year period even among children in fittest third of 20mMST. CONCLUSION: In a series of uniform cross-sectional assessments of school-aged children, BMI increased whereas cardiorespiratory fitness levels decreased within a 6-year period. Even among lean children, fitness scores decreased. Public health measures to reduce obesity, such as increasing physical activity, may help raise fitness levels among all children - not just the overweight or obese.

Changes in consumption of sugars by English adolescents over 20 years.

OBJECTIVE: Dietary surveys of 11- to 12-year-old Northumbrian children in 1980 and 1990 revealed that consumption of non-milk extrinsic sugars (NMES) was 16-17% of energy intake. This study reports dietary sugars consumption in 2000 and compares it with data collected in 1980 and 1990, using identical methods. DESIGN: A repeat cross-sectional dietary survey of children aged 1-12 years attending the same schools as in the 1980 and 1990 surveys. SETTING: Seven middle schools in south Northumberland. SUBJECTS: All children aged 11-12 years old attending the seven schools. METHOD: Food consumption was recorded using two 3-day diet diaries. Food composition tables were used to calculate energy and nutrient intakes. NMES, and milk and intrinsic sugars were calculated using previously described methods. RESULTS: The numbers of children completing the surveys in 1980, 1990 and 2000 were 405, 379 and 424, respectively; approximately 60-70% of eligible children. Total sugars provided 22% of energy consistently over the three surveys. NMES consumption in 2000 provided 16% of energy compared with 16% in 1980 and 17% in 1990. Sources of NMES changed over the three surveys. NMES from soft drinks doubled from 15 to 31 g day(-1), and from breakfast cereals increased from 2 to 7 g day(-1) over the 20 years. Confectionery and soft drinks provided 61% of NMES. Over 20 years, the proportion of energy from fat decreased by 5% and from starch increased by 4%, creating a welcome tilt in the fat-starch see-saw, without an adverse effect on sugars intake. CONCLUSIONS: Consumption of NMES in 2000 was substantially higher than recommended, and there has been little change over 20 years. Continued and coordinated efforts are required at a national, community and individual level to reduce the intake of NMES.

Dietary intake of 9-10-year-old and 11-12-year-old children in Liverpool.

OBJECTIVE: To describe the eating habits of children in Liverpool and compare two age groups that bridge the transition from primary to secondary school. DESIGN: Two cross-sectional studies carried out one year apart using a food intake questionnaire that records whether or not each child claims to have eaten specific marker foods on the previous day. SETTING: Primary and secondary schools in Liverpool. SUBJECTS: Six hundred and forty-nine children aged 11 or 12 years and 3556 children aged 9 or 10 years. RESULTS: Fewer older children ate breakfast (68-82%), especially the girls, and not eating breakfast was associated with eating on the way to school in the younger children. More of the older girls ate nothing at breakfast or on the way to school. Overall, the less desirable foods were reported to have been eaten by more children, of both ages, than the more desirable foods. Fruit, however, was mentioned by most children (69-77%) but the next 10 foods mentioned by most children were all less desirable ones. Only 31% of primary and 21% of secondary children ate both fruit and vegetables but 23% of primary and 26% of secondary children ate neither fruit nor vegetables. Overall, more of the girls of both age groups claimed to have eaten foods that would normally be encouraged. CONCLUSIONS: Food choice changes appreciably between primary and secondary school and, in some key respects, for the worse. In particular, far more children of both age groups need to be eating fruit and vegetables every day.