Validation of model-based estimates (synthetic estimates) of the prevalence of risk factors for coronary heart disease for wards in England

Several sets of model-based estimates (synthetic estimates) of the prevalence of risk factors for coronary heart disease for small areas in England have been developed. These have been used in policy documents to indicate which areas are in need of intervention. In general, these models have not been subjected to validity assessment. This paper describes a validity assessment of 16 sets of synthetic estimates, by comparison of the models with national, regional and local survey-based estimates, and local mortality rate estimates. Model-based estimates of the prevalence of smoking, low fruit and vegetable consumption, obesity, hypertension and raised cholesterol are found to be valid.

Family circumstance and adolescent dietary behaviours

The available information on the contribution of family circumstance to adolescent dietary behaviours is inconsistent. Indicators of family circumstance may impact adolescent behaviours by influencing their daily home environment. This study examined cross-sectional and longitudinal relationships between indicators of family circumstance and (i) breakfast skipping and (ii) consumption of snack food, fast food, fruits and vegetables among adolescents. Dietary behaviour was assessed using a web-based survey completed by 1884 adolescents from years 7 and 9 of secondary schools in Victoria, Australia, at baseline and 2 years later. Five indicators of family circumstance (parental marital status, maternal education, maternal employment status, number of brothers and number of sisters) were assessed with a questionnaire completed by parents at baseline only. Logistic regression was used to examine cross-sectional associations between indicators of family circumstance and dietary behaviours. Multinomial logistic regression was used to examine associations between indicators of family circumstance and 2-year change in dietary behaviours. Individual indicators of family circumstance were differentially associated with adolescent dietary behaviours. Cross-sectional and longitudinal associations differed for adolescent boys and girls highlighting the importance of assessing specific dietary behaviours and food types individually by gender. This study highlights the complexity of the relationships between family circumstance and adolescent dietary behaviours. Future research needs to assess the efficacy of strategies promoting maternal nutritional knowledge on the dietary behaviours of adolescents.

Family influences on children's physical activity and fruit and vegetable consumption

Background : There is evidence of a clustering of healthy dietary patterns and physical activity among young people and also of unhealthy behaviours. The identification of influences on children's health behaviors, particularly clustered health behaviors, at the time at which they develop is imperative for the design of interventions. This study examines associations between parental modelling and support and children's physical activity (PA) and consumption of fruit and vegetables (FV), and combinations of these behaviours.

Methods : In 2002/3 parents of 775 Australian children aged 10–12 years reported how frequently their child ate a variety of fruits and vegetables in the last week. Children wore accelerometers for eight days during waking hours. Parental modelling and parental support (financial and transport) were self-reported. Binary logistic and multinomial logistic regression analyses examined the likelihood of achieving ≥ 2 hours of PA per day (high PA) and of consuming ≥ 5 portions of FV per day (high FV) and combinations of these behaviors (e.g. high PA/low FV), according to parental modelling and support.

Results : Items of parental modelling and support were differentially associated with child behaviours. For example, girls whose parents reported high PA modelling had higher odds of consuming ≥ 5 portions of FV/day (OR = 1.95, 95% CI = 1.32–2.87, p < 0.001). Boys whose parents reported high financial support for snacks/fast foods had higher odds of having 'high PA/low FV' (OR = 2.0, 95% CI = 1.1–3.7).

Conclusion : Parental modelling of and support for physical activity and fruit and vegetable consumption were differentially associated with these behaviours in children across behavioural domains and with combinations of these behaviours. Promoting parents' own healthy eating and physical activity behaviours as well encouraging parental modelling and support of these behaviours in their children may be important strategies to test in future research.

Modelling income group differences in the health and economic impacts of targeted food taxes and subsidies

Objective : To examine the effects, by income group, of targeted food taxes and subsidies on nutrition, health and expenditure in the UK.

Methods : A model based on consumption data and demand elasticity was constructed to predict the effects of four food taxation-subsidy regimens. Resulting changes in demand, expenditure, nutrition, cardiovascular disease (CVD) and cancer mortality were estimated.

Data : Expenditure data were taken from the Expenditure and Food Survey; estimates of price elasticities of demand for food were taken from a report based on the National Food Survey 1988–2000. Estimates of effect on CVD and cancer mortality of changing fat, salt, fruit and vegetable intake were taken from previous meta-analyses.

Results : (i) Taxing principal sources of dietary saturated fat is unlikely to reduce cardiovascular disease (CVD) or cancer mortality. (ii) Taxing ‘less healthy’ foods (defined by the WXYfm nutrient profiling model) could increase CVD and cancer deaths by 35–1300 yearly. (iii) Taxing ‘less healthy’ foods and subsidising fruits and vegetables by 17.5% could avert up to 2900 CVD and cancer deaths yearly. (iv) Taxing ‘less healthy’ foods and using all tax revenue to subsidize fruits and vegetables could avert up to 6400 CVD and cancer deaths yearly. Few obesity-related CVD deaths are averted by any of the regimens. All four regimens would be economically regressive and positive health effects will not necessarily be greater in lower-income groups where the need for dietary improvement is higher.

Conclusions : A targeted food tax combined with the appropriate subsidy on fruits and vegetables could reduce deaths from CVD and cancer.

Dietary fiber, potassium, magnesium and calcium in relation to the risk of preeclampsia

To explore the relation between preeclampsia risk and maternal intake of dietary fiber, potassium, magnesium and calcium. STUDY DESIGN: We conducted a case-control study of 172 preeclamptics and 339 normotensive controls. Maternal dietary intake was assessed using a food frequency questionnaire. Logistic regression procedures were used to estimate the association between each dietary factor and preeclampsia risk. RESULTS: Fiber intake was inversely associated with the risk of preeclampsia. When extreme quartiles of total fiber intake were compared, the odds ratio (OR) for preeclampsia was 0.46 (95% confidence interval [CI] 0.23-0.92). The multivariate OR for preeclampsia for women in the top quartile of potassium intake (>4.1 g/d) versus the lowest quartile (<2.4 g/d) was 0.49 (95% CI 0.24-0.99). There was some evidence of a reduced risk of preeclampsia with a high intake of magnesium and calcium, though these results were not statistically significant. Intake of fruits and vegetables, low-fat dairy products, total cereal and dark bread were each associated with a reduced risk of preeclampsia. CONCLUSION: Our results support previous reports that suggest that diets high in fiber and potassium are associated with a reduced risk of hypertension. Maternal intake of recommended amounts of foods rich in fiber, potassium and other nutrients may reduce the risk of preeclampsia.

Family food environments as determinants of children's eating : implications for obesity prevention

The prevalence of childhood obesity is escalating rapidly and it considered to be a major public health problem. Diet is a recognised precursor of fatness, and current evidence supports the premise that in Westernised countries, the dietary intakes of children are likely to be important in obesity genesis. However, we have a relatively poor understanding of the environments in which a child’s eating is learnt and maintained. Much of the existing work in this area is based on small-scale or experimental studies, or has been derived from homogeneous populations within the USA. Despite these limitations, there is evidence that aspects of the child’s family environment are likely to be important in determining obesity risk in children. This thesis examines the impact of the family food environment on a child’s eating through two related studies. The first study, titled the Children and Family Eating (CAFÉ) study comprised three phases. Phase one involved qualitative interviews with 17 parents of 5-6 year-old children to explore parental perceptions regarding those factors in a child’s environment believed to influence the development of their child’s eating habits. These interviews were used to inform the development of quantitative measures of the family food environment. The second phase involved the development of a Food Frequency Questionnaire (FFQ) to assess dietary intake in 5-6 year-olds. The FFQ was informed by analysis of 1995 Australian National Nutrition Survey data. In the final phase the relationships between dietary intakes of 5-6 year-old children, and potential predictors of dietary intake were examined in a cross-sectional study of 560 families. Predictors included measures of: parental perceptions of the adequacy of their child’s diet; food availability and accessibility; child-feeding; the opportunities for parental modelling of food intake; a child’s television exposure; maternal Body Mass Index; and maternal education. Analysis of the CAFÉ data provides unique information regarding the relationships between a child’s family food environment and their food consumption. Models developed for a range of dietary outcomes considered to be predictive of increased risk for obesity, including total energy and fat intakes, vegetable variety, vegetable consumption, and high-energy (non-dairy) fluid consumption, explained between 11 and 20 percent of the variance in dietary intake. Two aspects of the family food environment, parental perception of a child’s dietary adequacy, and the total minutes of television viewed per day, were frequently found to be predictive of dietary outcomes likely to promote fatness in these children. The second study, titled the Parent Education and Support (PEAS) Feeding Intervention Study, was a prospective pre/post non-randomised intervention trial that assessed the impact of a feeding intervention to 240 first-time mothers of one-year-old children. This intervention focused on one aspect of the family food environment, child-feeding, which has been proposed as influential in the development of obesogenic eating behaviours. In this study, Maternal and Child Health Nurses (MCHNs), using a ‘Division of Responsibility’ model of feeding, taught parents to provide nutritious food at regular intervals and to let children decide if to eat and how much to eat. Thus parents were encourages to food their child without exerting pressure, or employing coercion or rewards (controlling behaviours). The aim was to influence parental attitudes and beliefs regarding child-feeding. Through the use of these feeding techniques, this intervention also aimed to increase the variety of fruits and vegetables a child consumed by teaching parents to persist with offering these foods, over the year of the intervention, in non-emotive environments. Fruits and vegetables were chosen in this intervention because they are likely to be protective in the development of obesity. Analysis of the PEAS data suggests that this low-level feeding intervention, delivered through existing Maternal and Child Health services, was modestly effective in changing parental attitudes and beliefs regarding the feeding of young children. Further, the validity of fruits offered to intervention group children increased. This thesis expands the existing knowledge base by providing a comprehensive analysis of the relative impact of aspects of the family environment on dietary intakes of 5-6 year-olds. Further, the analysis of a feeding intervention in first-time parents provides important insights regarding the potential to influence child-feeding and the impact this may have on the promotion of eating behaviours protective against obesity.

History of contact and change in the Goroka Valley, Central Highlands of New Guinea, 1934-1949

The thesis traces the interaction of the Goroka Valley people with European and coastal New Guinean intruders during the pacification stage of contact and change. In this 15 year period the people moved from a traditional subsistence culture to the threshold of a modern, European-influenced technological society. The contact experiences of the inhabitants of the Valley and the outsiders who influenced them are examined, using both oral and documentary sources. A central theme of this study is the attempts by Europeans and their coastal New Guinean collaborators to achieve the pacification of a people for whom warfare has been described as 'the dominant orientation'. The newcomers saw pacification as being inextricably linked with social, economic and religious transformation, and consequently it was pursued by patrol officers, missionaries and soldiers alike. Following an introductory chapter outlining the pre-contact and early-contact history of the Goroka Valley people, there is a discussion of the causes of tribal fighting in Highlands communities and two case studies of violent events which, although occurring beyond the Goroka Valley, had important consequences for those who lived within its bounds. The focus then shifts to the first permanent settlement of the agents of change -initially these were coastal New Guinean evangelists and policemen - and their impact on the local people. A period of consolidation is then described, as both government and missions established a permanent 'European presence in the Valley'. This period was characterised by vigorous pacification coupled with the introduction of innovations in health and education, agriculture, technology, law and religion. The gradual transformation of Goroka Valley society as a result of the people's interaction with the newcomers was abruptly accelerated in 1943, when many hundreds of Allied soldiers occupied the Valley in anticipation of a threatened Japanese invasion. Village life was disrupted as men were conscripted as carriers and labourers and whole communities were obliged to grow food to assist the Allied war effort. Those living close to military airfields-and camps were subject to Japanese aerial attacks and the entire population was exposed to an epidemic of bacillary dysentery introduced by the combatants. However the War also brought some positive effects, including paradoxically, the almost total cessation of tribal fighting, the construction of an ail-weather airstrip at Goroka which ensured its future as a town and administrative and commercial centre, and the compulsory growing of vegetables, coffee, etc, which laid the foundations for a cash economy and material prosperity. The final chapter examines the aftermath of military occupation, the return of civil administration and the implementation of social and economic policies which brought the Goroka Valley people into the rapid-development phase of contact. By 1949 Gorokans were ready to channel their aggressive energies into commercial competitiveness and adopt a cash-crop economy, to accept the European rule of law, to take advantage of Western innovations in medicine, education, transport and communications, to seek employment opportunities at home and in other parts of the country and to modify their primal world view with European religious and secular values. A Stone Age people was in process of being transformed into a modern society.

Provision of meals on wheels to the elderly : case studies in the era of local government reform

Australia’s ageing population is on the increase. It is predicted that by 2021 one quarter of Victoria’s elderly population will be aged 60 and over. Not only are people living longer, but they also wish to remain living in the community. The Home and Community Care (HACC) Program was established in 1985 to facilitate and assist the elderly and disabled to remain in their home. In Victoria around 51% of HACC funds are managed by local governments, a level of government that has recently undergone major reforms, which ultimately impacted on the manner in which services were provided. The HACC program funds Meals on Wheels, a service that provides meals for those elderly who no longer can prepare their own meals. The aim of this study was to assess the Meals on Wheels service provided by two Melbourne councils with different service philosophies. The study has four main components: (1) Menu analysis by food and variety; (2) Analysis of actual meals; (3) Clients assessment of Food Services; and (4) Client assessment of the organoleptic qualities of Meals on Wheels. Two Melbourne councils were chosen for their different approaches to service delivery. The City of South tendered out both meal production and delivery, while the City of North maintained its MOW service in-house. The case study method of research allowed for each council’s service to be assessed objectively and without comparison. Several methodologies were used for collecting data in this study. Menu analysis was carried out by comparing the MOW menus with the HACC menu planning guidelines together with general menu planning principles. Analysis of actual meals was in two stages. The weights of the meals were recorded and compared with the HACC recommended food serving portions and meal combinations over a five-day period were analysed for their nutrient contents. Face to face interviews were conducted with clients for their assessment of MOW and the assessment of the organoleptic qualities of the meals was carried out over a five-day period. The results concluded that both councils menus were based on sound menu planning principles, but did not conform with Home and Community Care menu planning guidelines fully and did not include a serve of bread, fruit and milk. The weight analysis of the meal combinations revealed some discrepancies between actual meals and Home and Community Care guidelines by not meeting the recommended serving sizes. Meal combinations generally met Home and Community Care standard for kilojoule and protein, but other nutrients, such as thiamin, riboflavin, magnesium, calcium and zinc were generally below the recommended levels for Meals On Wheels. The majority of study group lived alone and received four to five meals per week. Delivery times of meals, selective menus and food quality were issues raised by clients. Whilst the quality and variety of vegetables was raised by clients they generally rated the organoleptic qualities of the meals as satisfactory. This study examined the four components of the service. A simple method of evaluation the service was developed, which highlight discrepancies with HACC standards and encouraged the councils to set a customer satisfaction standard. A number of recommendations are made to ensure that meals are aesthetically pleasing, including a list of different methods for preparing vegetables. The provision of additional foods, such as a “snack pack” is recommended to improve the supply of essential nutrients that were below the Home and Community Care standards. Meals on Wheels is a vital support service for the elderly living in the community and as such should aim to provide a high quality service that meets the needs of its clients.

Family correlates of fruit and vegetable consumption in children and adolescents : a systematic review

Objectives To review associations between the family environment and young people’s fruit and vegetable consumption.

Design A systematic review. Published English-language (n 60) papers were identified using electronic databases and manual searches of personal files and reference lists. Observational research reporting a measure of fruit/vegetable intake for children (aged 6–11 years) and/or adolescents (aged 12–18 years) and at least one potential family correlate of dietary intake was included.

Results Parental modelling and parental intake were consistently and positively associated with children’s fruit and fruit, juice and vegetable (FJV) consumption. There were also positive associations between home availability, family rules and parental encouragement and children’s fruit and vegetable consumption. Parental intake was positively associated with adolescents’ fruit and vegetable consumption. There were also positive associations between parental occupational status and adolescent fruit consumption and between parental education and adolescents’ FJV consumption.

Conclusions Our findings highlight the importance of targeting the family environment for the promotion of healthy eating behaviours among children and adolescents. Future interventions should encourage parents to be positive role models by targeting parental intake and to create a supportive home environment through increased encouragement and availability of fruits and vegetables and employing rules to govern eating behaviours. For adolescents, indicators of family circumstances (e.g. parental education) should be used to identify target groups for interventions aimed at promoting healthy eating.

Dietary resistant starch interacts with non-starch polysaccharide and protein to influence colonic protein fermentation, with possible implications for colon cancer risk in humans

Resistant starch is dietary starch that passes undigested into the colon where it can have effects similar to non-starch polysaccharide (dietary fibre). The results support the potential health benefits of incorporating foods containing high levels of both resistant starch and non-starch polysaccharide, such as whole grain breads and legumes, as part of well balanced diets containing fruit, vegetables, cereals, meat/alternatives and dairy foods.

Level of urbanization and noncommunicable disease risk factors in Tamil Nadu, India

Objective To investigate the poorly understood relationship between the process of urbanization and noncommunicable diseases (NCDs) through the application of a quantitative measure of urbanicity.

Methods We constructed a measure of the urban environment for seven areas using a seven-item scale based on data from the Census of India 2001 to develop an “urbanicity” scale. The scale was used in conjunction with data collected from 3705 participants in the World Health Organization’s 2003 STEPwise risk factor surveillance survey in Tamil Nadu, India, to analyse the relationship between the urban environment and major NCD risk factors. Linear and logistic regression models were constructed examining the relationship between urbanicity and chronic disease risk.

Findings
Among men, urbanicity was positively associated with smoking (odds ratio, OR: 3.54; 95% confidence interval, CI: 2.4–5.1), body mass index (OR: 7.32; 95% CI: 4.0–13.6), blood pressure (OR: 1.92; 95% CI: 1.4–2.7) and low physical activity (OR: 3.26; 95% CI: 2.5–4.3). Among women, urbanicity was positively associated with low physical activity (OR: 4.13; 95% CI: 3.0–5.7) and high body mass index (OR: 6.48; 95% CI: 4.6–9.2). In both sexes urbanicity was positively associated with the mean number of servings of fruit and vegetables consumed per day (P < 0.05).

Conclusion
Urbanicity is associated with the prevalence of several NCD risk factors in Tamil Nadu, India.

Association of western and traditional diets with depression and anxiety in women

Objective: Key biological factors that influence the development of depression are modified by diet. This study examined the extent to which the high-prevalence mental disorders are related to habitual diet in 1,046 women ages 20–93 years randomly selected from the population.

Method: A diet quality score was derived from answers to a food frequency questionnaire, and a factor analysis identified habitual dietary patterns. The 12-item General Health Questionnaire (GHQ-12) was used to measure psychological symptoms, and a structured clinical interview was used to assess current depressive and anxiety disorders.

Results: After adjustments for age, socioeconomic status, education, and health behaviors, a "traditional" dietary pattern characterized by vegetables, fruit, meat, fish, and whole grains was associated with lower odds for major depression or dysthymia and for anxiety disorders. A "western" diet of processed or fried foods, refined grains, sugary products, and beer was associated with a higher GHQ-12 score. There was also an inverse association between diet quality score and GHQ-12 score that was not confounded by age, socioeconomic status, education, or other health behaviors.

Conclusions: These results demonstrate an association between habitual diet quality and the high-prevalence mental disorders, although reverse causality and confounding cannot be ruled out as explanations. Further prospective studies are warranted.

The relevance of the Heart Foundation of Australia's dietary recommendations for adult Australians : a comparison of views of general practitioners, cardiologists and dietitians

PURPOSE: To compare the views of general practitioners, cardiologists and dietitians about the relevance of the Heart Foundation of Australia's dietary recommendations for adult cardiac patients.

BASIC PROCEDURES: Quantitative-cross sectional study. Postal questionnaires were self-completed by 248 Victorian general practitioners (30% response), 189 Australia-wide cardiologists (47% response) and 180 Victorian dietitians (45% response). Responses were represented as percentages and analyses of variance were conducted to explore the impact of the independent variables: age, work status and gender on the dependent variable: dietary recommendation.

MAIN FINDINGS: Approximately half of the recommendations were viewed as strongly important to implement; these related to lean meats, limiting takeaways and cakes/biscuits, and adjusting energy intake. Others of importance were eating fruits, vegetables and fish. However, most of these goals were seen as difficult to achieve. Dietitians appeared to share responses of doctors, except for greater importance of eating fruit and vegetables and a greater difficulty in limiting cakes and biscuits. There was a high level of agreement among the three groups (mean 87%) about patients having difficulty implementing adjusting energy intake.

CONCLUSIONS: There is agreement amongst these professionals that many of the recommendations lack importance, specifically those pertaining to unsaturated oils, low fat dairy products, cholesterol rich foods, intake of legumes and grains and the restriction of salt. This may reflect a need for further nutrition education.

Why do some socioeconomically disadvantaged women eat better than others? An investigation of the personal, social and environmental correlates of fruit and vegetable consumption

The purpose of this paper was to examine the contribution of individual, social and environmental factors to predicting fruit and vegetable consumption among women of low socioeconomic position (SEP). An Australian community sample of 355 women of low SEP provided survey data on sociodemographic information, diet (fruit and vegetable consumption), and various cognitive, behavioural, social and perceived environmental influences on healthy eating. Information on the availability and accessibility of major chain supermarkets and fruit and vegetable stores from participant's residence was collected through objective audits. Women who were older, dieting to lose weight, had a greater taste preference for fruit and perceived the cost of fruit to be lower were more likely to be high fruit consumers. Women who had a high BMI were more likely to be high vegetable consumers. Women who perceived a greater availability of healthy foods in their neighbourhoods were more likely to be high fruit and vegetable consumers. Strategies aimed at increasing fruit and vegetable consumption among low SEP women should focus on modifying perceptions about the cost, availability and taste of fruits and vegetables. Tailoring nutrition interventions to accommodate differences in age, weight-control practices and weight status may also prove beneficial.

Major dietary patterns of young and middle aged women : results from a prospective Australian cohort study

Objective: The aim of this study was to assess the major dietary patterns of two age cohorts of women, to determine to the extent to which the dietary patterns differ between the cohorts and to assess whether they vary according to sociodemographic and behavioural characteristics and patterns of nutrient intake.

Method: Dietary intake was assessed using an 80-item food frequency questionnaire for women aged 50–55 years (n=10 150; ‘middle age’) in 2001 and aged 25–30 years (n=7371; ‘young’) in 2003, from the Australian Longitudinal Study on Women's Health. Factor analysis using principal component extraction was used to identify dietary patterns, and a pattern score was calculated from the consumption of the food items identified with each dietary pattern. Associations between the dietary pattern scores and sociodemographic and behavioural characteristics and nutrient intakes were investigated using regression analysis.

Results: Six dietary patterns were identified and were labelled: cooked vegetables; fruit; Mediterranean-style; processed meat, meat and takeaway; reduced fat dairy; and high-fat and sugar foods. Regression analysis revealed that healthier dietary patterns were significantly associated with other favourable health-related behaviours, higher socioeconomic status and living in urban areas (P-values <0.05).

Conclusions: In spite of differences in the level of consumption of individual food items, the similarity in dietary patterns across two generations of women suggests that policies and interventions to improve diet should focus on social and economic factors and general health-related behaviour rather than different age groups.