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ISSN 0034-6659

Volume 36 Number 5 2006

Nutrition & Food Science
Children and young people

www.emeraldinsight.com

Nutrition & Food Science
Children and young people
Editor Dr Mabel Blades

ISSN 0034-6659 Volume 36 Number 5 2006

Access this journal online___________________________ Editorial board ______________________________________ Editorial ____________________________________________ Gaps in the awareness of current nutrition issues as dependent on age
Melanie S. Adams _________________________________________________

283 284 285

CONTENTS

286

Prevalence of dieting, overweight, body image satisfaction and associated psychological problems in adolescent boys
Abdulbari Bener, Abdulaziz Kamal, Ihab Tewfik and Osman Sabuncuoglu _______________________________________________

295

Generating effective change in school meals: a case study
Claire Seaman and Julia Moss ______________________________________

305

Breakfast frequency and fruit and vegetable consumption in Belgian adolescents: a cross-sectional study
P. Mullie, P. Clarys, D. De Ridder, P. Deriemaeker, N. Duvigneaud, M. Hebbelinck, A.R. Grivegne ´ e and P. Autier__________________________

315

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CONTENTS
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Impact of household food security and nutrition programme on the nutritional status of children in Oyo state, Nigeria
B.O. Lawal and A.A. Jibowo ________________________________________

327

Habitual dietary calcium intake and body weight in 7–10 year old children
Amy Jennings, V. Costarelli, G.J. Davies and P.W. Dettmar _____________

337

Nutritional knowledge and dietary intakes of young professional football players
Sue Murphy and Yvonne Jeanes _____________________________________

343 349

Probiotic acidophilus milk for infants and children
S. Sarkar and A.K. Misra __________________________________________

Cultured milk products for lactose-intolerant recipients
S. Sarkar _________________________________________________________

357 365 381 382

Food facts ___________________________________________ Book reviews _______________________________________ Conference reports __________________________________

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B. Vrije Universiteit Brussels. DrPH MPH FACSM Professor. Ninewells Medical School. UK Dr Wendy Wrieden Centre for Public Health Nutrition Research. Appalachian State University. MIFST University of Ulster at Jordanstown. SRD Lecturer on Food Studies. PhD. USA Claire Seaman.5 EDITORIAL BOARD John J. Edinburgh. BSc. UK Professor Winston Craig Andrews University. Northern Ireland Margaret Thorogood. Nieman. 2006 p. PhD RD FADA Nutrition Advisor.NFS 36. USA Nutrition & Food Science Vol. 5. PhD Senior Lecturer. MI. USA David C. USA Marcel Hebbelinck. 36 No. Queen Margaret College. London School of Hygiene and Tropical Medicine. Belgium Ann Reed Mangels. UK 284 Dr Margaret Ashwell OBE Ashwell Associates (Independent Scientific Co-ordinators & Consultants) Ashwell. UK Christopher Strugnell. Anderson. BSc. Vegetarian Resource Group. MPhil. Berrien Springs. PhD Professor of Nutrition. Dundee. 284 # Emerald Group Publishing Limited 0034-6659 . University of Carolina School of Public Health and School of Medicine. Laboratory Human Biometry. PhD Professor.

Editorial Good nutrition is important at whatever age and in this edition of Nutrition and Food Science. The competition was held at the East of England Show in Peterborough. 2006 p. The standard was extremely high and it was excellent to see young people involved in enjoying cooking as well as doing it to such a high standard. there is a focus on nutrition particularly of young people. Mabel Blades Editorial 285 E Nutrition & Food Science Vol. All too often children and young people make less prudent choices with over consumption of fat and sugar and too little fruit and vegetables. Recently. Most of the entrants to the competition were cooking for elderly. here in the Western countries. the whole matter is getting children to eat good food. This was open to cooks who are involved in preparing food for those they care for in residential care homes and day centres. Also I was delighted to be asked to judge a competition called Care Cook of the Year on behalf of the National Association of Care Caterers. 5. enabling children to get enough food is the main problem. Again the standard was extremely high. Real attention to the food and suitability of it for the group catered for had been made. I was asked to judge a Food In Schools competition for those attending secondary schools. While in developing countries. The schools had been through a number of stages before the final day’s competition. good nutrition has an impact not only on their daily well-being but also on their growth and future health. nutritious and varied food. 36 No. 285 Emerald Group Publishing Limited 0034-6659 . At this stage. These competitions and the high standard achieved by the participants show how one can tempt people of whatever age into enjoying good.

2006 pp. Dr William Adams III. Colorado. Responses were collected in December 2005 from 171 well-educated male and female respondents ranging from 18–70 years of age. Public health. the participants of ages 18–30 were significantly less well informed about the effect of diet on cancer. This information should be used as the basis for an education program to improve public health and that should target younger people. Important gaps in their knowledge included a low level of awareness of the health effects of canola and corn oil. for his advice on survey design and statistical evaluation. Health education Paper type Research paper 286 Introduction Over the past few decades. and the effect of diet on diabetes and cancer. 5. I am grateful to Dr Barbara Demmig-Adams for her guidance during the planning of this study and writing of the manuscript. the high calcium content of several vegetables. to Dr William Adams.com/0034-6659. intelligence and disruptive behavior than the older participants. However. In several of these latter cases. respectively. Dr James Adams. vs about two-thirds in the 31–70 years old age group.The current issue and full text archive of this journal is available at www. Originality/value – This study provides new information about current. Design/methodology/approach – A questionnaire was designed to assess public awareness of a range of important findings uncovered by recent scientific research on nutrition.5 Gaps in the awareness of current nutrition issues as dependent on age Melanie S. the calcium content of dairy products.1108/00346650610703135 E . research has made rapid progress in uncovering the mechanisms of how food affects all aspects of human health. USA Abstract Purpose – The goal of this study is to identify important current topics in nutrition that may be poorly understood by the public. Adams Summit Middle School. important issues in nutrition that are poorly understood even by an educated sample audience. 36 No. it was the group of younger participants who had the lowest level of awareness.emeraldinsight. Boulder. to Dr Volker Ebbert for making the figures and to Dr Kristine Mueh. access to the original scientific studies is limited and much of the information of the public is obtained from the mass media. women were found to be better informed than men on the issue of vegetables with high calcium content. Only about one-third of the 18–30 years old participants were well informed about canola/corn oil and the calcium content of green vegetables. the effect of diet on mental processes and the power of the Mediterranean diet in preventing heart attacks. Jr. Diet. the recommendations concerning saturated fat and olive oil. particularly by younger participants. 286-294 Emerald Group Publishing Limited 0034-6659 DOI 10. Likewise. Keywords Nutrition.htm NFS 36. Findings – The highly educated group of respondents surveyed with respect to their awareness of nutrition was well informed on the importance of a balanced diet. Ms Haydee Phelps and Mr Peter Teasdale for their help in administering the surveys. This study identifies important issues in nutrition that are well documented in the original scientific literature but poorly recognized by the public. A questionnaire was designed and responses collected from 171 male and female participants ranging in age from 18–70 years. Research limitations/implications – The number of male respondents was lower than that of female respondents and this may have limited the identification of additional cases where genderrelated differences in awareness exist. In addition. Nutrition & Food Science Vol.

Because the age profile showed two natural peaks. other issues were included for which public awareness was unknown. 26–35 (8 per cent).Several questions were included for which a reasonably good public awareness was expected. Results and discussion Awareness of ‘‘good’’ and ‘‘bad’’ fats The typical American diet is excessively high in saturated fat and corn oil. (D) questions on the effect of diet on a range of diseases and disorders. The data were collected in December 2005. the role of diet in diabetes and the adverse effects of excess saturated fat consumption. with the best (or ‘‘correct’’) answer as based on current scientific literature emphasized in black. male. top: saturated fat) and be replaced by oils such as olive oil (Figure 1. and 56+ (3 per cent) showed insufficient statistical power to allow the detection of significant differences among these subgroups. which should be consumed in similar proportions. (C) questions on overall diet composition. (E) questions on the calcium content of different food groups and (F) questions about the benefit obtained from the Mediterranean diet. such as the high calcium content of various vegetables. old and combined total participants that gave a particular answer were determined using the formula S5[(Q6P)/N]1/2. Vegetable oils contain two types of polyunsaturated fats. 1991). Results were graphed as pie diagrams showing the percentage of participants who gave the different answers. 46–55 (26 per cent). only two groups of ages 18–30 and ages 31–70 were therefore analyzed for the final comparison. The answers from the surveys were tabulated and significant differences in the percentage of female. top: olive oil). A large percentage of the participants were aware that the level of saturated fats should be reduced in the typical American diet (Figure 1. (B) questions on different groups of dietary fats. The survey questions were designed to minimize guessing or arbitrary choices on part of the respondents by offering a range of answers including ‘‘haven’t seen any information on this’’. the role of diet in mental disorders and other conditions. contains them in a ratio 50:1. Corn oil. the value of different types of unsaturated fats and the remarkable power of the Mediterranean diet in preventing heart attacks. Respondents included parents of the 7th and 8th Graders from two schools in the Boulder Valley School District (Summit Middle School and Centennial Middle School) as well as college students (University of Colorado and Dalton College. P is the percent calculated. Canola oil contains these two kinds of fats in similar proportions (2:1). surveys were collected from college students as a group younger in age but well matched in education level. The questionnaire included (A) demographic questions. young. Many participants did not know that canola oil The awareness of current nutrition issues 287 . GA). Only significantly different results are shown for the two gender and age groups (Figures 1–5). Q is 100–P and N is the total sample size (Babbi. Initial analysis of the full age profile with narrower brackets of ages 18–25 (38 per cent of participants). however. which can induce cancer and other chronic diseases (Simopoulos. In addition. omega-6 and omega-3 fats. Because 90 per cent of the parents had college degrees. where S is the sampling error at the 95 per cent confidence level. such as the high calcium content of dairy products. Methodology A questionnaire was designed to gauge awareness of a range of current issues in nutrition (see Appendix). Participants included a total of 49 men and 122 women with 67 participants of the ages 18–30 and 101 participants of the ages 31–70. 2004). 36–45 (26 per cent).

.2 (saturated).5 per cent. bottom: corn oil).8 (corn) Figure 2. ±3.6 per cent.0 per cent. ±2. ±1.3 per cent. a significantly higher percentage of older participants were aware of the correct information for canola and olive oil compared to younger people. Awareness of ‘‘good’’ and ‘‘bad’’ fats Notes: Percentages for correct answer (in black) and sampling error at 95 per cent confidence respectively for all participants were: 97. ±1.9 (canola) and 52. ±1.5 per cent. Awareness of sensible diet composition Notes: Percentages for correct answer (in black) and sampling error at 95 per cent confidence respectively for all participants were: 67. However. ±3. bottom: canola oil) and that corn oil consumption should be reduced in the American diet (Figure 1.7 per cent.9 (right) consumption should not be reduced (Figure 1.5 288 Figure 1. 58.2 (olive).NFS 36. 85.6 (left) and 93.

The awareness of current nutrition issues 289 Notes: Percentages for correct answer (in black) and sampling error at 95 per cent confidence respectively for all participants were: 94.7 (yogurt).0 per cent.8 per cent. ±2.0 per cent.8 (broccoli) and 46. ±3.1 (beans).3 (cottage cheese).0 per cent.8 (kale/collard greens) Figure 3. ±3. 47. ±1. ±3. 90. Awareness of foods that are good calcium sources . 21.7 per cent.

The .8 per cent.9 per cent.6 (mental disorders) Awareness of sensible diet composition Well-designed scientific studies with many participants show that diets aimed at weight loss and weight maintenance that are very low in fat and diets low in ‘‘carbs’’ (carbohydrates) work only for a small percentage of dieters (Tsai and Wadden. 74. ±3.0 per cent. 2005).3 per cent. ±1.2 (cancer).8 (intelligence).3 (disruptive behavior) and 34.5 290 Figure 4.NFS 36.3 (diabetes).0 per cent. 77. ±3. ±3. 45. Awareness of diet impact on various conditions Notes: Percentages for correct answer (in black) and sampling error at 95 per cent confidence respectively for all participants were: 97. ±3.

Two-thirds of participants knew that the most successful diet for the long-term maintenance of a healthy weight consists of healthful choices rather than low fat and/ or low ‘‘carb’’ fad diets (Figure 2. individuals on low fat diets may be deficient in healthful fats and individuals on low ‘‘carb’’ diets (such as the Atkins diet that restricts fruits and vegetables) may suffer from vitamin deficiencies and other problems. due to their restrictive nature.. diabetes..majority of dieters abandon such diets sooner or later. right pie diagram). While a truly balanced diet is the recommended option. There is evidence that a truly balanced diet is the best way to provide an optimal vitamin supply. 2000. Furthermore. intelligence. broccoli and kale/collard greens. an increasing number of studies with good controls also show a strong impact of dietary factors on mood and behavior (Bryan et al. Dani et al. 2004. Awareness of the power of the Mediterranean diet in preventing heart attacks Notes: Percentages for correct answer (in black) and sampling error at 95 per cent confidence respectively for all participants were 22. disruptive behavior and mental disorders) are affected by dietary factors. not many respondents knew that vegetables. are similarly good sources of calcium as dairy products (Farnham et al. A large percentage of participants were aware of the The awareness of current nutrition issues 291 Figure 5. top). 2003).2 .. is the recommended option. Some supplements contain excessively high concentrations of vitamins. bottom). ±3. Kale and collard greens actually have more calcium than milk on an equal volume basis (Mangels. which have been shown to cause harmful effects.2 per cent. 2000. scientific studies have shown that consuming excessive amounts of most vitamins is equally undesirable as consuming insufficient quantities (Pryor et al. While this is well studied for cancer and diabetes. Mangels. Awareness of foods that are good calcium sources A very large percentage of participants knew that dairy products (like yogurt and cottage cheese) are a good source of calcium (Figure 3. it is difficult for individuals with a busy lifestyle to achieve this and a number of participants commented on that. 2005). bottom). 2005). Awareness of diet impact on various conditions All five of the conditions included in the questionnaire (cancer. The best option for long-term weight maintenance is to change poor dietary habits and consume a balanced diet with healthful choices. left pie diagram). Pham and Plakogiannis. such as beans. A significantly higher percentage of women were aware of the calcium content of all of these vegetables and a significantly higher percentage of the older respondents were found to have better information in the case of kale and collard greens than younger participants (Figure 3. The answer of taking a regular multivitamin was therefore counted as a ‘‘correct’’ answer as well. Only a very small percentage of the participants favored the use of high dose ‘‘megavitamins’’ (Figure 2. 2003) (Figure 3. However. A majority of the participants was furthermore aware of the fact that a balanced diet with a resulting balanced vitamin intake.. In addition.

may reveal additional instances of gender-related differences in awareness. older participants were better informed than younger people. women were better informed than men.. 2001). 2001). Once again. the present survey is unique in that it targets specific current issues that are not widely recognized by the public. the effect of diet on several mental processes and the power of diet in preventing heart attacks. . Awareness of the power of the Mediterranean diet in preventing heart attacks A rigorously designed scientific study testing the effect of the Mediterranean diet (rich in vegetables. bottom). such as less awareness of the health effects of canola and corn oil. the high calcium content of several vegetables. disruptive behavior and mental disorders (Figure 4. Other published surveys have targeted issues that have been discussed for decades. However. olive oil. In a number of these cases.. This outcome is much better than that of currently prescribed medications. Discussion While there is much discussion about appropriate nutrition. While the highly educated group of individuals targeted in the present survey was well informed in a number of issues.NFS 36. women were better informed than men and older participants were better informed than younger people. Conclusions The highly educated group of respondents surveyed with respect to their awareness of nutrition was well informed in many issues. seafood and lean meat) found that this diet prevented 72 per cent of second heart attacks in a large group of men (de Lorgeril et al. however. Only a very small percentage of participants knew about the effectiveness of the Mediterranean diet (22 per cent). fruit. In contrast. In the case of cancer. such as the importance of a balanced diet. even this group had important gaps in their knowledge. 1996. A greater nutrition awareness of women has also been noted in other nutrition surveys (Variyam et al. i. This may not be surprising because older individuals are likely to worry more about getting cancer. and 78 per cent of the participants either marked the wrong answer (33 per cent) or marked that they had not heard of this diet (45 per cent) (Figure 5).. which is demonstrated by the fact that the original study by de Lorgeril has been cited 485 times by other original peer-reviewed studies (as of January 2006) since it was published in 1999. the calcium content of dairy products and the effect of diet on diabetes and cancer. the older participants were better informed than the younger group in the cases of intelligence and disruptive behavior. it was again found that a significantly higher percentage of older participants had better information than younger respondents.e. top). and particularly a larger male group. even this select group showed important gaps in their knowledge.. the recommendations concerning saturated fat and olive oil. In the case of vegetables with high calcium content. In a number of these cases. 1999). The present results apply only to the highly educated group studied and additional work with less well educated participants may show even wider gaps of awareness in these other populations. intelligence. There were no significant differences in awareness among groups. However. Repetition of the present survey with a larger number of participants. Girois et al.5 292 effect of diet on diabetes and cancer (Figure 4. this diet and its ability to prevent heart attacks are widely acknowledged among scientists. a much lower percentage of participants were aware of the effect of nutrition on the other three conditions. such as the concern about excessive salt intake and cholesterol-increasing foods (Girois et al.

W. A. Vol. Nutrition Reviews. age (in years). 1. 23–35. J. S. (1999). Baghurst. J. 77–90.P. (2005). pp. (1991). The awareness of current nutrition issues 293 B. . Nutrition & Food Science. (2004). ‘‘Calcium in the vegan diet’’. C. Nutrition Reviews..L. Kumanyika. Statistics in Medicine.B.N. Annals of Pharmacotherapy. ‘‘Modelling nutrition knowledge. 39–53. Mangels..org/nutrition/calcium. E. attitudes. ‘‘Mediterranean diet. K. Vol. pp. N. 295–306.. A. pp. the highest level of education obtained. ‘‘Vitamin E supplementation in cardiovascular disease and cancer prevention: Part 1’’. and Smallwood. E.R.. Demographic questions (1) (2) (3) gender. Vol. pp. W. pp. Farnham. Journal of the American Society for Horticultural Science. ‘‘Calcium and magnesium concentration of inbred and hybrid broccoli heads’’. (2003). 99. Vol. and Demmig-Adams. CA. A31. 91 No.vrg. Grusak. Girois.htm (accessed 12 November 2005). B. J. p. pp. and Rock. D. The Practice of Social Research. References Babbi. 15 No.A. 779–85. ‘‘Systematic review: an evaluation of major commercial weight loss programs in the United States’’. Martin. and van Klinken.. Circulation. Switzerland’’. ‘‘A comparison of knowledge and attitudes about diet and health among 35. and Wang.. J.W. (2005). R. Dani.A.K. Appendix A. traditional risk factors. Vol. (2004). S. pp.. 258–63. Appendix G. (2001). P.M. Morabia. Simopoulos. animal fats.. S. Vol. M. I.. and Wadden. 4. ‘‘The remarkable role of nutrition in learning and behaviour’’. 3. and diet-disease awareness: the case of dietary fibre’’.W.. (2000).Q. The Vegetarian Resource Group. Variyam. Burrill. (1996). Monjaud. 20. Questions related to dietary fats (should be reduced/should not be reduced/haven’t seen any information on this) (4) (5) olive oil.. de Lorgeril. 62.to 75-year-old adults in the United States and Geneva. ‘‘Beta carotene: from biochemistry to clinical trials’’. American Journal of Public Health. Bryan. (2005). and Mauger. and Plakogiannis. Pham. 58. and the rate of cardiovascular complications after myocardial infarction – Final report of the Lyon Diet Heart Study’’. Annals of Internal Medicine. available at: www.L. Hughes. J. Vol. Wadsworth. and Mamelle. pp. Tsai.. Blaylock.A. E. 125. J. pp. Osendarp. T. C. 6th ed.. Stahl. Vol. J. ‘‘Omega-6/omega-3 essential fatty acid ratio and chronic diseases’’.. 56–66. ‘‘Nutrients for cognitive development in school-aged children’’. Pryor. pp.In several of the above cases where there were gaps. Calvaresi. Belmont. 35 No. one may speculate that this is related to the fact that common advertisements focus on different and more profitable treatments..G. Vol. A. D. 142. 418–24. 39. Vol. Food Reviews International. D. 344–49. (2000). 1870–8. M. R. Salen. Delaye. M. M.

no supplements are needed/none of these choices reflect my opinion/haven’t seen any information on this). (14) broccoli. (16) diabetes. how many second heart attacks do you think were prevented by the Mediterranean diet over the next 5 years? (10%/20%/40%/60%/80%/haven’t seen any information on this) Corresponding author Melanie S. Questions on what food are good calcium sources (good source of calcium/not a good source of calcium/haven’t seen any information on this) (10) yogurt. Adams can be contacted at: Barbara. (18) intelligence (IQ).com Or visit our web site for further details: www. (11) beans. Based on what you have heard or read. Questions on diet composition 294 (9) D.emeraldinsight. F. which one of the following do you think would be most likely to help you reach and maintain a healthy weight? [Eat healthy choices/eat a diet low in fat/eat a diet low in ‘‘carbs’’ (carbohydrate)/eat a diet low in fat and low in ‘‘carbs’’ (carbohydrates)/none of these reflect my opinion/haven’t seen any information on this].5 (6) (7) (8) canola oil.edu To purchase reprints of this article please e-mail: reprints@emeraldinsight. Based on what you might have heard about the effect of diet on heart disease. corn oil. (12) cottage cheese. what do you think is the best way to get your vitamins and minerals? (It is best to add a regular multi-vitamin/multi-mineral supplement to one’s diet/it is best to add vitamin/mineral supplements to one’s diet with higher amounts than suggested by the current guidelines because these are not high enough/it is enough to eat a balanced diet. E. (19) disruptive behavior. Based on what you have heard or read.NFS 36. (13) collard greens/kale. C. Question on Mediterranean diet (20) In a large experiment.com/reprints . Questions on which of conditions are affected by eating habits (affected by eating habits/not affected by eating habits/haven’t seen any information in this) (15) cancer. men in their mid-50s who had suffered a heart attack either continued eating the same diet as before or were put on the Mediterranean diet. (17) mental disorders.Demmig-Adams@colorado.

Keywords Diet. overweight. tired all the time (53. Marmara University. Nutrition & Food Science Although dieting among boys are less common when compared with girls. dieting as a method of weight control has been a common behaviour . University of Qatar.. The extreme dieters experienced more psychological problems than the intermediate dieters and non-dieters.4 per cent were intermediate dieters.3 per cent). Obesity. 5. body image satisfaction and associated psychological problems in adolescent boys Abdulbari Bener Department of Medical Statistics and Epidemiology. Design/methodology/approach – A representative sample of 800 boys in the age group of 14–19 in Qatar was approached during the period from October to December. Adolescents.1108/00346650610703144 attractive. 33. Doha. Dieting was more likely in subjects who practiced exercise and who were perceived by peers or themselves as overweight. 34 per cent were overweight.1 per cent were overweight. UK Osman Sabuncuoglu Department of Child and Adolescent Psychiatry. Originality/value – The present study findings provide a strong evidence for the association between frequent dieting and overweight. In complying with the demands of being socially E Emerald Group Publishing 0034-6659 DOI 10. Qatar Paper type Research paper Introduction Adolescence is a time when social demands influence the individual and when ‘‘others’’ perceptions become very significant to the individual adolescent (Hill. State of Qatar Ihab Tewfik School of Biosciences. Capacity and competence in adolescent boys are complex issues. Findings – Of the studied subjects. Self-reports were obtained from 593 teenage boys using the adolescent dieting scale (ADS). University of Westminster. Turkey Abstract Purpose – The aim of the present study is to examine the severity of dieting and its association with obesity. Boys. 2006 studies have shown the prevalence of eating disorders among boys cannot be taken pp. Among the dieters. State of Qatar Dieting. 36 No. body satisfaction and psychological problems in adolescent boys. some Vol. Extreme dieters reported sleeping problems (58. overweight and body image 295 Abdulaziz Kamal Department of Psychology.1 per cent. 2004 and 593 boys gave consent to participate in this study.1 per cent were extreme dieters and 37. thus giving a response rate of 74. 1999).3 per cent) and felt like crying more than usual (50 per cent). Hamad General Hospital and Hamad Medical Corporation.emeraldinsight. because adolescents have a tendency to make treatment decisions by themselves (Tan and Fegert. London. Self-esteem. 295-304 Limited too lightly (Braun et al.com/0034-6659. 2004). 1989). body image dissatisfaction and psychological problems. Television was the main source of information on diet (61.7 per cent).htm Prevalence of dieting. 10. and the self-reporting questionnaire (SRQ-20) for psychopathology.The current issue and full text archive of this journal is available at www. Istanbul.

Methods Qatar is an independent state occupying the Qatar Peninsula. 2002).. but the annual rainfall is scarce. The population of Qatar is 724125 (Annual Health Report. Usually.. The study was conducted from October to December 2004. many of the adolescent boys who dieted are of normal weight for their height.5 296 particularly in Western culture and within particular groups such as adolescents (Swadi et al. the occurrence of psychiatric symptoms in association with dieting seems to be an indication that dieting is not necessarily a healthy method of weight control. 1997) who found that psychiatric morbidity was clearly associated with extreme dieters reported high levels of depression and anxiety. A representative sample of 800 adolescent boys aged 14–19 was included in this study. While the definition of ‘‘dieting’’ includes weight reduction efforts generally considered to be healthy (e. While dieting efforts among average weight or underweight individuals are most often considered negative. dieting efforts among overweight individuals have been viewed more positively (Ackard et al. at least in some to support this view as recently highlighted by Patton (Patton et al... On its southern side it is bordered by Saudi Arabia. A multistage stratified sampling design was developed. There are issues of concern over the practice of dieting among boys. jutting into the Persian Gulf from the eastern coast of the Arabian Peninsula. many individuals also consider ‘‘dieting’’ to include unhealthy weight control behaviours such as fasting. The population were derived from secondary and high schools in Qatar. 2000). An extremely hot. 2002). In order to secure a representative sample of the . 2003) and 30 per cent of the total population constitutes Qatari nationals. Swadi et al. modest weight reduction (10–15 per cent of individual body weight) achieved by the combination of calorie reduction and exercise implementation was associated with positive changes in cardiovascular risk factors. Dieting as part of an eating disorder has been well documented and accepted in Western culture. For example. Wing and Jeffery (1999) found that among overweight individuals. The aim of the present study was to examine the severity of dieting and its association with obesity. Despite a large body of literature on emotional and behavioural factors associated with dieting. Humidity is high during the summer. Brownell and Rodin. 1989. First... yet they use unhealthy weight control behaviours such as fasting and use appetite suppressants. adolescents are using unhealthy weight control measures (Neumark-Sztainer et al. While dieting may be viewed as a useful exercise in body weight control.g. To our knowledge. no studies reported the prevalence of obesity or dieting behaviour among adolescent boys neither in Qatar nor in the region. arid climate prevails. 1994). but it was only recently that eating disorders began to be viewed as cross-cultural phenomena with reports of clinical eating disorders in the Arab World (Hill. body image satisfaction and psychological problems in adolescent boys in the State of Qatar. The land is stony and largely barren. increased fruit and vegetable intake and decreased fat and sugar intake).NFS 36. skipping meals and eliminating food groups (Ackard et al. Qatar has an area of 11493 km2.. we are unaware of any studies that have looked at these associations independent of body mass index (BMI). rather than healthier weight loss practices such as reducing intake of fat and sweets and increasing physical activity (Ackard et al. 2000). 2002. 1999).

5E…6A. almost and always’’. the feasibility of quantification of dieting and understand ability and acceptability of this questionnaire. We therefore did a translation into Arabic with back translation by a non-clinician who was fluent in both Arabic and English. We piloted the questionnaire on a small Dieting. heredity.g. sometimes. Three bands of dieting. On that basis. 1.83 and it had two principal components with an Eigen value of 3. The authors identified behaviours typical of dieting but did not include the extreme weight control strategies that are characteristics of clinical eating disorders. The alpha coefficient for the eight items scale was 0. The sample size was determined with the a priori knowledge that the prevalence rate of dieting in the State of Qatar is more or less similar to UAE and Western countries. Instruments Self-reports were obtained by using adolescent dieting scale (ADS) (Patton et al.study population. Three bands of dieting were in a non-clinical population. 6C. 1994) for psychopathology. Allowing an error of 2.. Moreover. the sampling plan was stratified with proportional allocation according to stratum size. Two hundred and seven boys were excluded from the study due to incomplete questionnaire or did not give their consent or did not want to respond to the questionnaire due to lack of time. 5C. The unidimensionality of the ADS was assessed by using a principal component analysis which showed that. However. Because of the ease of administration. they considered the eight item ADS a suitable scale for measuring dieting in a non-clinical population. half of the classes were chosen (e. overweight and body image 297 . or that it may be affected by parity. 1997) and self-reporting questionnaire (SRQ-20) (El-Rufaie and Absood. for the nine item scales. Schools were then selected according to geographical location. 5A. there were two main components. it was believed that a sample size of 800 is adequate to achieve a high degree of precision in estimating the true prevalence rate of dieting in the general population. etc. it seems to be culture free since it inquires about specific behaviours rather than concepts. The ADS (Patton et al.5 per cent and level of significance (Type-1 error) of 1 per cent. 2 and 3 respectively. there are four possible answers ‘‘seldom or never. they found that one of the items ‘‘skipping breakfast’’ has a low item correlation and therefore carried out a separate analysis without that item.4 and the other with a much smaller Eigen value of 1. The anthropometrics measures of adolescent boys were measured and collected by qualified nurses. reducing food quantity and meal skipping). They attracted a score of 0. intermediate (total score 7–14) and extreme (total score more than 15) were identified using data obtained from their study. 6E. climate and sociodemographic and environmental factors.0. we decided to use it in our survey.5 and the other component had an Eigen value of 1. which covered three broad dieting strategies (calorie counting. Of the schools selected. one with an Eigen value of 5. In those classes. minimal (total score 1–6). A total of 800 boys were approached and 593 expressed their consent to participate in this study. They identified nine behaviours.. 1997) The ADS consists of eight items and for each question. The ADS is based on a refinement of a number of other scales for measuring dietary restraint. which may be influenced by cultural factors. half of the students were chosen on the basis of alternate names according to the class registration list.). Questionnaire including the general demographic variables and dieting information was filled out by the research assistants.2.

49 per cent were dieters. Among the overweight boys. Dieting was most likely to be practiced among subjects who had a family history of arthritis (P50. Statistical methods and analysis The statistical package for social sciences (SPSS) (Norusis.001). Table III shows the comparison of dieting severity by ADS. In 2 6 2 tables. 1994) This is a screening instrument for identifying potential psychiatric cases in community settings and is not designed for diagnostic purposes.0). The mean BMI for the studied population was 23.8 per cent)..1 per cent were extreme dieters. Extreme dieting was higher among the subjects whose family members practiced dieting. among the dieters. Almost 90 per cent were dieting mostly on a minimal or moderate basis. There were minimal changes in the wording following the piloting process. The Arabic version of the SRQ (El-Rufaie and Absood. Dieting was clearly associated with 298 . It has been found to have a fairly good sensitivity and specificity and has been successfully used in adolescent populations (Feijo et al.0. El-Rufaie and Absood (1994) validated the SRQ-20 in a primary care sample in the United Arab Emirates and found it to be a valid instrument for detecting minor psychiatric morbidity. Chi-square analysis was performed to test for differences in proportions of categorical variables between two or more groups. 1998) was used for statistical analysis. the fisher’s exact text (two tailed) replaced the chi-square test if the assumptions underlying chi-square violated. Body mass index was calculated as the weight in kilograms (1 kg subtracted to allow for clothing) divided by height squared in meters.NFS 36. But. Of the total respondent population. Data were expressed as mean and standard deviation (SD) unless otherwise stated. 34 per cent were overweight. 1993).9) (with range of 15. Only a small minority of the adolescent boys were non-dieters (11.05 was considered as the cutoff value for significance. BMI calculation showed that 196 (33. However. Subjects were classified into three categories: acceptable weight (BMI. Results A total of 593 of 800 enrolled school boys participated in this study.0. The level p. The prevalence of dieting did not show great variations in the two age groups of 14–16 and 17–19. overweight (BMI 25–29.2 (SD 3. 1997). Table II shows the adolescent dieting score and BMI by age group. namely in case of small sample size and where the expected frequency is less than 5 in any of the cells. Student-t test was used to ascertain the significance of differences between mean values of two continuous variables.5 number of adolescents who reported that the questionnaire was understandable and easy to answer. however no significant difference was found. Each item would attract a score of 1 for a ‘‘yes’’ response and 0 for a ‘‘no’’ response. thus giving a response rate of 74.9 kg m22) and obese (BMI 30+ kg m22) (Garner. 10. The original version (Harding et al. Table I shows the sociodemographic characteristics of the studied subjects.1 per cent. One way analysis of variance (ANOVA) was employed for comparison of several group means and to determine the presence of significant differences between group means of continuous variables. For the above reasons.6–34. we did not feel that a full validation study of the ADS in this culture was not necessary and was not carried out..1 per cent) fell above the 25 kg m22.008) and heart disease (P.25 kg m22). 1980) consists of 20 items designed to detect non-psychotic symptoms.

3) 38(11.25 90(34.8) 60(19.3) 41(13.5) Intermediate dieters ADS57–14 98(37.4) 63(20.6) 63(22.3) Extreme dieters ADS515–24 21(8.9) Table II.4) Minimal dieters ADS51–6 110(42.7) 169(54.0) 39(11.9) Non-dieters N5311 n(per cent) 142(45.037). overweight and body image NS* NS NS 299 NS NS Table I.6 Note: *NS5Not significant Dieters N5282 n(per cent) 119(42.1) 131(39.7) 43(15. Self-perception and peers perception of body weight also contributed heavily to the boys ADS score (P. Adolescent dieting score and BMI by age group exercise showing that those who diet more often also practiced exercise regularly (P50. Television and magazines were the main sources of information for the extreme dieters on dieting and have shown a significant association.Variables Age (years) 14–16 17–19 BMI (kg m22) #25 Normal .9) 180(57.2) 39(13.3) 81(28.3 per cent of extreme dieters got their information on dieting from school friends compared with 12.8) 186(66.3) 82(26.0) 111(39.4) 171(60.2) 163(57. The other significant psychological problems among the extreme dieters were that sleeping problems (58. Discussion The rate of overweight among children continues to increase in every society. Overweight and distorted body perception can both lead to serious physical and .1) 121(42.8) 100(32.2) 183(58.3 per cent).1) P value Dieting. Table IV shows the association between the dieting behaviour and psychological factors in studied adolescent boys.002). The self-reported questionnaires revealed that poor appetite (45 per cent) was more common among the extreme dieters.5) 106(31.3) 211(67.9) 131(42.2) 65(20.001) in both cases.1) .7 per cent). Television was the main source of information on diet for all subjects and again the extreme dieters were more influenced by the information through television (61.5) 124(37. crying more than usual (50 per cent).5 per cent of non-dieters and 18.7) BMI groups (kg m22) #25 171(65.2) 128(41.25 Overweight Education Intermediate Secondary Living condition Excellent Above average Average Below average Poor No of siblings #6 .5) 226(68.0.9) 161(57.0) 96(34.3 per cent) and feeling tired all the time (53.8) 56(19. About 23.9 per cent of intermediate dieters (P50. Sociodemographic characteristics of the studied subjects by gender Age group 14–16 N5261 17–19 N5332 Non-dieters ADS50 32(12.

2) 137(37.6) 67(40.0) 57(42.8¡3.8) 28(6.7) 17(42.1¡4.5) 21(7.6) 70(51.9) 39(10.3 46(11.0.9) 101(36.0) 7.6) 14(7.6) 75(51.0) 167(38.1) 39(12.9) 87(42.7) 105(68.4¡3.1) 28(10.3) 82(41.4) 8(5.3) 27(9.9) 91(33.25 Dieting in family Yes No Obesity in family Yes No Family history of diabetes Yes No Family history of high blood pressure Yes No Family history of Arthritis Yes No Family history of mental disorders Yes No Family history of heart diseases Yes No Dieting friends Yes No Practice exercise Yes No Satisfied with own body Yes No Peer’s perception of respondent’s figure Overweight Average Underweight Self-perception of figure Overweight Average Underweight SRQ (Mean¡SD) 22 Non-/minimal dieters ADS50–6 23.1) 6(5.5) 241(52.7) 169(53.4) 32(19.0) 8(20.5) 33(10.6) 101(41.7) 121(37.9) 87(37.001 NS psychological problems (Strauss. 1999).9) 131(40.3) 148(46.8) 118(37.5) 52(11.1) 142(51.8) 104(37.2) 24(16. Specific risk factors of eating disorders are body dissatisfaction.002 NS 300 .008 NS .6¡3.8) 33(13.6) 123(53.7) 236(52.2) 75(46.9) 41(12.2) 81(66.7) 21(9.0) 52(9.1) 100(51.8 Intermediate dieters ADS57–14 23.0) 155(49.7) 34(28.8) 165(51.7 Extreme dieters ADS515–24 22.8) 19(7.7) 21(9.7) 215(55.8) 105(38.9 140(35.0.5) 33(21.9) 188(51. .0 211(53.0) 111(40.4¡3. 1993).6) 36(8.0.3) 15(37.001 Table III.0) 37(9.6) 23(11.7) 24(8.6) 107(44.9 p value NS NS NS NS NS NS 0.5 Variable BMI. low self-esteem.3) 236(54.7) 156(55.2) 46(31.6¡3.7) 146(53.1) 117(36. kg m22 #25 . kg m (Mean¡SD) BMI group.1) 6.0) 165(36.8) 15(9.2) 32(10.2) 78(47. It is interesting to point out that their actions are focused on diet without paying much attention to other aspects of life style including physical activity and even psychosocial problems.4) 123(53.7) 176(39.6) 85(37.5) 207(37.6) 96(46.NFS 36.3) 163(59.3) 135(34.5) 294(53.2) 21(12. Comparison of dieting severity by ADS .4) 139(50. high need for social approval and history of physical abuse among adolescents (Garner.001 NS 0.9) 6.4) 55(34.

Variable Source of information on dieting School TV Magazine Radio Often has headache Has poor appetite Sleeping badly Are you easily frightened Sometimes hand shakes Feel tensed..7) 90(40. 2003) found that 17.7) 22(36.0) 21(9.1) 84(37.014 NS NS NS 0.1 per cent were extreme dieters which is quite higher than the rate found in an Australian study (Patton et al.7) 17(28.4) 77(34.7) 22(36.0) 18(30.3) 37(61.2) 93(41.009 NS NS NS 0.0) 55(24.8) 67(21.5) 130(41. nervous or worried Poor digestion Having trouble thinking clearly Feeling unhappy Crying more than usual Difficulty in enjoying daily activities Difficulty in making decisions Daily work is suffering Unable to play useful part in life Lost interest in things Feeling worthless person Thought of losing life in mind Feeling tired all the time Uncomfortable feeling in stomach Easily tired Non-/minimal dieters ADS50–6 (n5311) 39(12.7) 15(25. The rate reported in our study was higher than these studies that 33.2) 97(31.4) 75(24.3) 24(40. First. Both studies indicated that a significant proportion of males (adults and adolescents) were overweight.035 NS NS 0.0) 12(20.. Two relevant studies have been recently carried out.6) 110(35. a cross-sectional study (Bener and Kamal) involving a sample of 8566 secondary and high school students boys aged from 14 to19 found that 11.7) 27(45.5) Extreme dieters ADS515–24 (n560) 14(23. More recently.1) 36(11. Musaiger (Musaiger et al.48) 123(39.9) 116(52..9) 107(48.7) 25(41.5) 62(27.041 NS NS NS NS Ns NS NS NS NS NS Dieting. several Western studies indicated that dieting (of varying severity) is a common behaviour .1) 93(29.4 per cent were grossly obese.9 per cent.7) 25(41.9) 28(12.2) 91(41.7) 27(45.5) 81(36. but their main focus was on obesity.0) 35(58. Despite differences in methodology.3) 32(53.7) 21(35.1) 87(39.1 per cent of male students were overweight and 8.7) 31(14.4) Intermediate dieters ADS57–14 (n5222) 42(18.2) 61(27.4 per cent were intermediate dieters and 10. But.0) 10(16.4) 146(46.0) 6(10.9) 111(35.9 per cent of boys were at a risk of being overweight.3) 19(31.3) 49(22.7) p value 0.7) 82(26. overweight and body image 301 Table IV.5) 140(45.2) 107(34. 1997) that 12 per cent of boys and 38 per cent of girls were categorised as ‘‘intermediate dieters’’ and 1 per cent of boys and 7 per cent of girls were ‘‘extreme dieters’’.7) 31(51.5) 31(10.0) 101(32.2) 77(34.6) 88(39. 37. Of the studied adolescent boys in the current study.1) 156(50.3) 16(26.6) 58(26. the overweight rate of Qatari adolescent boys were very similar to the rate found in a study of Fonseca (Fonseca et al.5) 42(7.1) 106(34.037 0.0) 16(26.1 per cent of the adolescent boys were overweight.0) 20(33.7) 89(28.4) 56(25.009 0.9) 120(38.6) 183(58.6) 78(25.5) 47(21. Association between dieting severity and psychological factors There are very few studies on dieting and eating behaviour conducted in other Arab countries.0) 22(36.8) 81(36.8) 92(41. 2002) that the proportion of overweight individuals among boys (BMI greater than 90th percentile of the Brazelian population) was 23.0) 111(35.

P. A study from Portugal (Fonseca et al. could consider them to be overweight or obese. Weight concern develops among girls in all weight spectrum but among the boys it is strongly related to BMI (Field et al. nutrition and exercises using culturally appropriate materials. 369–76. pp. Conclusion The present study findings revealed a strong evidence for the association between frequent dieting and eating disorders. and Musaiger. D. A. Journal of Psychosomatic Research. Croll. In our study.NFS 36. Vol. 2001). sleeping problems (58. 1998) also reported that among boys the main factors for dieting were parental supervision and BMI.001) in dieters. The only factors which contribute to starting dieting among Qatari boys are self-perception and peer’s perception of their own figure.M. Environmental influences particularly peer group’s perceptions and attitudes. Extreme dieters were under stress like they felt like crying more than usual. Steen (Steen et al.. role models and learned behaviour seem to be influential in this respect.5 302 even among young people of normal weight range. body image dissatisfaction and psychological problems in adolescent boys in Qatar. Also a report from Latin America (McArthur et al. The use of problematic weight loss tactics were significantly higher among students who are involved in substance misuse reported by several studies (Garry et al.M. 30 No. 129–36. On the contrary.0... which was especially noteworthy among the overweight and obese.. Durant et al. References Ackard. But.3 per cent) and feeling tired all the time (53. There was a tendency for teenagers to underestimate their weight status. ‘‘Dieting frequency among college females: association with disordered eating. half of the extreme dieters had significant psychological problems like crying more than usual (50 per cent).. A study on body weight perception among Bahraini adolescents (Al Sendi et al. . Vol. (2004).3 per cent). 2004) revealed a significant discrepancy between adolescents’ perception of body weight and actual BMI. Al Sendi. 2001) found that the adolescents are very interested in learning more about obesity and weight loss methods. 2003) done by the Institute for Health Promotion and Disease Prevention in California documented that perceived overweight boys and girls were more likely to experience anxiety and depression than perceived normal and underweight subjects. One third of the adolescent boys thought that their parents and their peers respectively. We have not covered these factors in our study. but their impact on boys has not been investigated earlier. 1999). A research (Xie et al. ‘‘Body weight perception among Bahraini adolescents’’. pp. J. (2002). Wooley and Wooley (1984) estimated that 72 per cent of adolescents and young adults were dieting.. body image.K. Data revealed in our study that self-perception and peers perception of body weight also contributed heavily to the boys ADS score (P..O. Child Care Health and Development.. and related psychological problems’’. 2003. Shetty. 52.. 1996) reported in their study that the obese boys perceived themselves to be less overweight and happier with their looks than obese girls. A... could not sleep well and felt tired all the time. 4. 1999). Half of the overweight boys were dieters. Special attention needs to be directed toward teenagers for educating them about a healthy weight. our results showed that there is no association of dieting with BMI. A. The mass medical are believed to encourage girls to form unrealistically think body ideals (Field et al. and Kearney-Cooke. body image.

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. Design/methodology/approach – The current study uses a case study approach to examine food provision and education within a primary school in Edinburgh. tending to be high in fat and sugar and lacking in essential nutrients. UK Abstract Purpose – Obesity among primary school children is an area of current concern throughout the UK. established that there was confusion over what constitutes healthy eating (Health Pro. 2003). where lessons might be learned for future campaigns and areas where further research would be useful. Health education.com/0034-6659. Primary schools. Research limitations/implications – The study was carried out in one school where the school meals were prepared on an in-house basis. United Kingdom Paper type Case Study Generating effective change in school meals 305 Introduction In Britain. Among other factors. and sugary meal options (Department of Education and Skills. looking at ways in which effective change in children’s eating habits and food choices can be achieved on a small scale provides some useful pointers for future research with schools where meals are prepared by contract caterers. 5. 36 No.htm Generating effective change in school meals: a case study Claire Seaman and Julia Moss Queen Margaret University College. 2001). Edinburgh. current dietary advice in Nutrition & Food Science Scotland). Nonetheless. 2002) and currently a third of twelve year olds in Scotland are classed as overweight. including semistructured interviews. Children (age groups). particularly those in poorer areas where the children were shorter E 0034-6659 DOI 10.1108/00346650610703153 and thinner than those in more privileged areas (Alexander et al. Vol. alongside much discussion surrounding the opportunities and challenges of effecting change. it has been suggested by many authors that unhealthy school meals are contributing to the problem. children are reaching their teens a stone heavier than previous generations (Yapp. 2006 The irony is that school meals were introduced in 1900 due to the anxiety over the pp. 2004). Within the case study. one in five children is currently estimated to be overweight and 2. On average. The manner in which change can most effectively be implemented is explored and some indicators for future work highlighted. children in Britain are more likely to be overweight and to suffer the associated health and social problems.5 per cent are classed as obese. both quantitative and qualitative methods were used.emeraldinsight. In addition. The primary purpose of this study is to investigate the success of a healthy eating programme and to examine the work that had been done to identify areas where further work was required. 1997. Obesity among children is reported as having risen continuously for around two decades (Reilly. results indicate that slow subtle change will be more effective than well intentioned attempts to achieve the ideal in a peremptory manor and that persistence is likely to play a key role. Originality/value – The paper focuses on a healthy eating programme. Findings – Results indicate some considerable success has been achieved and more ways in which healthy eating can be promoted within the school have been identified. Menus in school canteens have been reported to regularly feature high fat. 2004). In addition. recent studies of children aged between 11 and 12. School meals may contribute to obesity. 305-314 Emerald Group Publishing Limited health of children. In Britain approximately four million school meals are prepared daily providing for 45 per cent of school children (Eves et al. At a time when the country has never had more nutritional information.. which adopts a healthy eating programme based on the guidelines of Hungry for Success. recipe analysis and observational research. During the .The current issue and full text archive of this journal is available at www. Keywords Nutrition.

providing recommendations for radical improvements in the school meals service (BNF. 2004). Nutrient standards for school meals were established by the government during the Second World War. In an attempt to combat the problem. N The School Nutrition Action Group (SNAG). small. Healthy eating habits established in childhood are likely to influence food consumption over the lifespan and form a key part of strategies to tackle obesity in the UK. only meal of the day. 2001). 2004.5 306 Boer war it was brought to the attention of the government. 2002). but lapsed over time. 1997). school is an influential time for children in relation to moulding their dietary preferences. ‘‘Hungry for Success – A Whole School Approach to School Meals’’ was published. Price and budget in relation to school meals are also an issue. A survey by the DHSS. sugar and salt (Bunker and Burgess. However. There was also an absence of nutritional information.. The standards for school meals became very relaxed and the Local Education Authorities (LEA’s) were only obliged to provide school meals to those children entitled (Church.. The rational behind the idea was also that if the children were hungry it would affect their studies (Learning Curve. Noble and Kipps. In April 2001 minimal nutritional standards. Many cafeterias are ‘‘Free Choice’’ and need to generate business. 1994. based on government advice on healthy eating were introduced by the Caroline Walker Trust (Harvey. This development aimed to provide a meal during the day to children from less privileged backgrounds. Caraher et al. Various bodies have become involved with schools throughout the UK in a bid to improve school meals: N The Food Standards Agency (FSA). These groups regularly carry out surveys. The budget delegated to a school. Church.NFS 36. Therefore. using dietary reference values. There was no specific costing of meals and no statutory requirement to meet nutritional guidelines. focussing primarily on studies that indicate that current school meals lack nutritional balance and contain excess fat. 2004). Caterers are now provided with a guide with which they can compare the nutritional content of the school meals they produce (Bunker and Burgess. 2004). In addition to the problems associated with being overweight during childhood itself. 2004). 2001). 1997. In 2002 a report. 2003). 2004). reports and studies into school meals in an attempt to solve current problems. Eves et al. none of which have been adopted formally. . 1997. N The European Network of Health Promoting Schools (ENHPS). popular options such as burgers and chips feature prominently (Health Pro. 1997). DoH 1989. For many children the school meal is their main or in some cases. that the young men being recruited were. Attempts have been made to reintroduce national guidelines for schools. 1996. 2002. This provided the opportunity for choice but not necessarily for the good (Adams et al. MAFF. ‘‘The Diets of British School-Children’’ revealed that around 30 per cent of a child’s energy intake is derived from school meals (Health Pro. Recent concern has been mounting over the nutritional content of school meals. the London School Board offered cheap or free school dinners. Free meals are provided for eligible pupils whose families receive certain benefits (SPEC. allowing a great change in school meal provision. the meals that are provided are not required to meet a nutritional standard. can limit the food that is served (FSA.. In 1980 with the revision of the Education Act they were withdrawn formally. Blades. undernourished and unwell.

semistructured depth interviews were carried out with the head of the kitchen staff. both quantitative and qualitative methods were used. their food choices might have been affected. Researchers observe the activities and interact with the subjects (Schutt. The foods available within the meal and the quantities provided were noted and the nutritional analysis was carried out using Comp-Eat. Each alternate child’s meal [in queuing order] was noted for analysis. The three categories in which data were collected were an nutritional analysis of the meals served. Therefore the observer stood to the side of the cash desk. With this type of observational study White (2002) states that it is important to blend into the background and not cause an obstruction. During participant observations. 1998). A different day of each week was selected to ensure menu variety. Non-participant observations require the researcher to play a passive role in avoiding the direct influencing of events (Grix.Methodology The primary methodology for this study involves a case study carried out within a primary school. however. The observations were applied to sittings of 120 primary three and four children aged between seven and nine. the opinions of those schoolchildren who regularly ate the meals and of their parents would form a fascinating piece of supplementary research. While the choice of those individuals who were to take part in the interviews was naturally affected by the availability and willingness of the participants. Three mealtimes were observed and anonymous records of the actual food choices made by children were kept to facilitate practical suggestions for future development work. natural science processes are studied as they happen. participant and non-participant observation are in current general use (Sarantakos. 1999). Three observational studies of the food choices of 180 children took place over a period of three weeks. it is important to note that all those interviewed had had direct contact with the project. A nutritional analysis of four popular meal choices was made to allow comparisons with the Caroline Walker Trust guidelines. including an analysis of the nutritional content of the school meal served. In addition. interviews with staff associated with food provision and a small observational study of the food choices that individuals pupils made. involvement and experience of each staff member and are listed in Table I. at the best vantage point without being obtrusive. Within this case study. 2001). A major concern was that if the children had known that they were being analysed. both for ethical reasons and to avoid distracting or influencing the children. The questions asked within the interviews varied slightly according to the focus. The study was repeated three times to get as much information as possible and to improve the reliability of the results. Two types of observational techniques. providing a comparison with the guidelines published by the Caroline Walker Trust. which was carried out using Comp-Eat Software and three observational studies carried out during the serving period for lunch. Generating effective change in school meals 307 . To explore the wide range of issues. Non-participant observations were used for this study. the methodology that was developed in three parts to cover the span of data that it was perceived would offer a useful perspective both on the participants understanding of the school meals project and on the actual changes identified. the member of staff who had organised the healthy eating project and a PE teacher who was also a parent of children within the school. The results obtained should therefore be viewed as the views of those staff involved in the project. the head teacher.

There have been various changes within the canteen over the last fifteen years. What changes have been made. Initially set meals were served but due to the amount of waste. Traffic light system. the caterers were selling . Increase in obesity. Availability of confectionary. Advice given by a parent. Nutritional background. Changes in the food served over the years. The main aims. Should the children be educated on healthy eating earlier on in the curriculum. Why the programme for healthy eating was introduced. the school brought in outside caterers. What changes were made. Satisfaction with the schools efforts. Budget. The importance of integrating a healthy eating programme. N Reduced the amount of fast food served.5 Head of Canteen 308 Head Master The importance of integrating a healthy eating programme. Should the children be educated on healthy eating earlier on in the curriculum. How the programme has affected the children. Other reasons for healthy eating. N Encouraged the children to drink water throughout the day in order to aid their ability to study and to control their appetite. Project Leader PE teacher and Parent Table I. Should the children be educated on healthy eating earlier on in the curriculum. Guidelines. Monitoring choice. Changes in the food served over the years. If children at p3 and p4 level are too young to make food choices. Use of support groups. Surveillance of the children’s eating habits. Results and discussion The healthy eating programme As part of the programme the school: N Integrated healthier meals into the mainstream food service. How easy it is to follow the advice provided. This was also recognised as a problem in schools by Coles and Turner (1993). How lunch is organised. Budget.NFS 36. Should the children be educated on healthy eating earlier on in the curriculum. Children’s reactions to the programme. Waste. The success of the project. Levels of physical education. However. providing the children with a wide choice. Availability of advice.

in line with current dietary advice in Scotland. In primary one the children spend a lesson making up a lunch box and deciding what healthy foodstuffs it should contain. This has been a positive move. which state that a good atmosphere in the canteen is essential. Children are not allowed to use the confectionary machines provided for the senior school which is based on the same sight. Although food such as pizza.a lot of fast food products which were not of an acceptable quality supporting the research of Ruxton et al. However. such as slicing them and cooking them with stock. Although none of the staff actually have a background in nutrition. Within the school. was that the teachers were stopped from giving sweets as rewards at primary level. they have been able to follow the guidelines from ‘‘Hungry for Success’’ fairly easily. due to an unfriendly atmosphere the children were being deterred from eating there. Initially. to establish a basis for the provision of healthier food. They are however. which sounds like an unhealthy option is still served in the canteen. Chips are only served once a week. there has been no move up to now to monitor the snacks that children bring in at break time. Three years ago the school employed an individual with experience on healthy eating and running a school canteen. a change in staff and attitude has altered this ensuring that it is an inviting and friendly place to be. At lunch time children are not allowed to purchase any confectionary from the counters except fudge bars. However. A number of substantive changes have occurred. it was ascertained that the pizzas are made in on site. corresponding closely with recommendations within Hungry for Success (2002). Another recent change with regard to confectionary within the school. 2005). It could be argued that a chocolate bar may be less harmful to a child nutritionally than a doughnut. Sugar free flavoured waters and fruit juices were introduced as an alternative to the more sugary beverages available previously. although the differences are likely to be very small. This is perceived as being the parent’s decision and confirms the importance of parental education. This was a move to reduce the amount of crisps and sweets that they were eating previously. including the introduction of healthier recipes. The project leader was also involved with the Health Promoting Schools programme. (1993). The school also used information from the Health Education Board of Scotland’s programme called. Over the years the ambience of the canteen has also changed. able to choose a cake such as a doughnut as desert. salad bowls and fresh and dried fruit as an alternative to confectionary. The school have done this by locking the machines during their play time and lunch time. it is perceived that while the kitchen is running at a minor budgetary deficit the quality of the food has greatly improved. The staff have devised other ways to cook potatoes which seem fairly popular. the children are taught all the way through the school but in more depth within primary six and seven. Healthy eating education With regards to education on healthy eating. ‘‘Healthy for Life’’ which they found very useful. This has been successful to a point as the children have Generating effective change in school meals 309 . Therefore the bases are baked and not fried and can also be made with wholemeal flour providing a healthier fast food option. Many vending machines are now being removed from schools by the Food and Drink Federation (FDF) when requested by the school or the LEA due to dietary reasons (FDF.

the pasta seemed to be the most popular dish. notably the pizza and the hot dogs (Table II). For example. out of the healthy options. Results indicated overwhelmingly that the salad boxes were unpopular. This information could be built on and the sausage selections could be made healthier. the kitchen staff could begin to infiltrate more healthy ingredients into the sauces such as more vegetables or more lean meat which would benefit the children nutritionally. he did not allow his own children to eat within the school refectory. the results from the observational study indicate that the unhealthier options on the menu or those options that appeared to be unhealthy were the most popular. Given the lack of enthusiasm for the salad boxes. and provides an interesting insight. The school recognises the importance of parental input and is aware that there is more that could be done to encourage parents to become involved. was very content and positive about the programme. the head of the catering staff and the project leader. more work to increase the popularity of this group of foods would be required before this became a sensible option. This revealed a pattern whereby sausages were revealed as the main choice throughout the study whether they occurred in a ‘‘healthy’’ or ‘‘unhealthy’’ option. but decided that there would be too much waste. this appears to have been a sensible decision. Findings and discussion from the observational study In general. A key area for future work will be the development of more and even more popular recipes that also happen to be healthy. These participants were more directly involved with the introduction of the programme which may have introduced bias but which may also have provided a useful perspective about the amount of change which had actually been achieved. It would beneficial to go into more depth at this point in order to make the children more aware of the food choices they are making. as pasta in particular is such a popular option. By developing on this information. perhaps by using leaner sausages. Findings and discussion from the interviews The initial observation made during the headmaster. perhaps by adding cheese or pasta. who is also a parent. Almost all of the children accompanied their meal with a cake. The best alternative. The portion of salad could be slowly increased as the children became ‘‘acclimatised’’ to it. There was a day within the three monitored when the majority of the children selected the ‘‘healthier choice’’ sausage casserole.NFS 36. While the numbers of people interviewed are too small to draw any firm conclusions. This may suggest that he doubts the success of the healthy eating programme and is an area where future research might focus. the school could advise the parents on giving the children healthy snacks for break time. (1998) who have focused on the importance of nutritional education and its advantages. Adding to the current salad box to make it more popular might provide a reasonable way forward. would be to serve a small portion of salad with more of the main meals for example the burgers. This supports the view of Bowker et al. the importance of liaison with parents is highlighted.5 310 been found to discuss and in some cases even advise their parents as to what they should have in their lunchboxes. Throughout the study only four fruit box selections were . Though he did not state doubts as to the effectiveness of the food improvements. The person that questioned the effectiveness of the programme was actually the physical education teacher. Each day. however. The school had previously considered installing a salad bar. The healthier options were not selected.

Findings and discussion from the Comp-Eat analysis The nutritional analysis work carried out to estimate the nutritional content of the dishes routinely provided as part of the school lunch is summarised in Table III. As the unhealthy options tend to be very similar each day this task would be simple and effective.Healthy option Day 1 Fish cakes Pasta and tomato sauce Baked potato Sandwich Salad Total Per cent Day 2 Roast beef. The healthier options seemed to be based on more traditional meal choices such as casseroles. Kitchen staff at the school may find it useful to investigate which are the more popular healthy options and build on this information. This will also encourage the children to select the healthier options.6 1 7 5 7 20 33. The unhealthier options could then be reduced gradually.3 2 16 17 2 3 0 0 40 66. This suggests that the school do not take into consideration the fact that there are two snack breaks per day and most of the children will have sweets or crisps provided by the parents for both breaks. The menu varied more for the healthier options but the unhealthy options generally stayed constant. A way to combat this unhealthy routine could be to restrict the cakes to once or twice a week. yorkshire pudding and stovies Sausage casserole Pasta and tomato sauce Baked potato Sandwich Salad Green split pea soup Total Per cent Day 3 Turkey and stuffing Pasta and tomato sauce Baked potato Sandwich Salad Mushroom soup Total Per cent 3 7 7 3 0 20 33. thus undermining calculations on sugar and fat consumption. In relation to the children choosing cakes as desert options the view of the school is that they are happy for the children to reward themselves with something sweet after their meal. The results indicate that the main meals were reasonably healthy and fell more or less into . This would move the healthy eating programme onto another level.6 3 7 4 6 0 1 21 35 Unhealthy option Pastry Pizza Sausage roll Burger Waffles Sausage sandwich 1 4 7 10 10 8 40 66.3 Hot dog Pizza Sausage roll Pie 29 2 6 2 39 65 Generating effective change in school meals 311 Burger Pizza Sausage roll Pie Sausage sandwich Table II. Interview schedules made. The observational study showed that what the children chose varied with the menu.

Research in other countries has indicated that limiting food choice has improved dietary habits of children (current dietary advice in Scotland). Conclusions and recommendations for further research Throughout this study the commitment and enthusiasm of staff within the individual school has been apparent and is likely to have been the key factor for success in this project. The pizza which could be perceived as an unhealthy meal actually had a lower fat content than the sausage casserole. Booth et al. As doughnuts were the most popular choice. In addition. Comp-Eat nutritional analysis .45 1085 Chocolate iced doughnut 250 1047 33 3 12 100 Table III. Staff enthusiasm. However.76 16.5 312 the Caroline Walker Trust guidelines. This illustrates the contribution that can be made by nutritional analysis software to the identification of food choices that fall within the golden ideal of a healthy and popular dish! The sodium content for each savoury dish exceeded the recommended daily amount (RDA) of 5 g (CASH.15 10.71 664 Chicken casserole 226 1115 11. It has been recognised that salad boxes have not been popular. A doughnut contributes half of the recommended energy intake and almost all of the recommended fat content that a midday meal should have for a child. It was noted that there was a great variety of choice for the children which was possibly daunting for them. the average nutritional content of chocolate iced doughnuts were analysed against the Caroline Walker Trust guidelines in order to see what contribution they make to the average school meal. An effective move for the school involved with the study may be to reduce the unhealthier options further in favour of the healthier options. improvements could be made by simply reducing the more unhealthy meals and developing the more popular healthy dishes. Instead of the school just reducing the amount that they produce.38 29 12 1233 Sausage casserole 230 960 11. almost all of the children accompanied their meal with a cake. they should try to find new ways of introducing salad. More recipes could be developed such in a similar way suggested for the pizza in order to make them more nutritious. 2004) and is a cause for concern. Most children chose a doughnut or something similar thus exceeding the guidelines with regard to fat and protein. If the meals were combined with yoghurt or with fruit for desert they would fit in with the guidelines. the sausage casserole was found to have a high fat content. In a canteen run establishment there is often a wide choice for children.NFS 36.07 17. If a doughnut is selected as a desert this will cause all menu combinations to exceed the recommendations for fat. alongside parental involvement and the involvement of the Pizza Energy (Kcal) (KJ) Carbohydrate (g) Protein (g) Fat (g) Sodium (mg) 404 1700 54. (1990) suggested that too much variety may have a negative effect on children’s food choice. Pureeing more vegetables into dishes such as the pasta sauces where they will be concealed may be effective as children may not be aware that they are eating them. From the popularity of some of the healthy dishes served at the school.25 14.

org. The enthusiasm of the children was also notable and.uk (accessed 29 March 2004). is likely to be a key to the success of future projects and generating this atmosphere remains a key goal and a vital area for future research. Bowker. Mock. Health Education Authority. A.. 1. ‘‘Salt and children information’’. ‘‘Nutritional standards for school lunches’’. Griffiths. E. (2001). (1993). Report of an Expert Working Group. Caraher. facilitating trying out simple. Nonetheless. and Burns. S. (1997). Baker. pp. Nutrition & Food Science.turning the tide’’. pp. Mcguffin.gov. J. R. but this is an area that would merit further research. 6. Vol. Bunker.L. 98 No.nutrition. the benefits of change and the ways in which it can most effectively be achieved are substantial and would merit further investigation. British Food Journal. 4. M. V. pp. pp. The Caroline Walker Trust. 22–31. but there is little doubt that the changes made are positive and are likely to make a long term contribution to health and wellbeing. H. 1. Vol. pp. pp. available at: www. Health Education. 117–25. (1990). British Food Journal. References Adams. Generating effective change in school meals 313 .. pp. Nutrition & Food Science. and Tudor-Smith.ac. small changes relatively quickly and funding is perhaps easier than in some areas of the UK. S. Cole. and Tilston. Consensus Action on Salt and Health.J. 31 No. Throughout the interviews it was clear that the school has found it very difficult to measure what difference the healthy eating regime is making to the diets of the school children. Department of Education and Skills (2004). ‘‘An investigation of school meals eaten by primary schoolchildren’’. ‘‘The healthy option – a review of activity on food and nutrition by UK schools involved in the European network of health promoting schools’’. a very positive factor. Further research would be required to investigate the long term impact of decreasing food choices in a school canteen situation. London.a commitment to healthy choice’’.. BNF (2003). Nutritional Guidelines for School Meals. in itself.. Crosswaite. and Lyon. and Burgess. H. Caroline Walker Trust (1992). British Food Journal. ‘‘Feeding minds and bodies: the Edwardian context of school meals’’. 4. Nutrition & Food Science. L. L. 12–19. 92 No. 4.uk (accessed 19 October 2004). (2004). 255–75. Booth. 3.hyp. P. available at: www. Department of Education and Skills. A.H.. 189–93. S. (1997).. Colquhoun. pp. 99 No. ‘‘Catering for young people in schools’’. 97 No. Vol. Vol. CASH (2004). ‘‘School food. BNF Healthy Schools. Neale. 106 No. M. 104 No. Vol. Catering for Healthy Eating in Schools. London. The school in which this study was carried out has a number of advantages in terms of making change happen. A. (1998). 31 No. (2001). available at: www.P. Blades. S. Vol. British Food Journal.W. C. C. (2002). ‘‘The consumer survey of school meals’’. alongside recipe modification work to establish versions of current dishes that are healthier but retain their popularity. it has in-house catering.uk (accessed 6 March 2005). 705–12. 135–41. M.dfes.children themselves. ‘‘Children’s views of cooking and food preparation’’. and Snowdon. Vol. Vol. ‘‘Food in schools. 20–2. A. and Turner. 9. C.. Church. Alexander. ‘‘Nutritional analysis of mid-day meals provided for 5–11 year old schoolchildren’’.

Health Pro (2004). Noble. A. (1994).pro. Noble. Corney.uk (accessed 19 October 2004). (2002). London. ‘‘Food and health manifesto’’. M. Diets of British Schoolchildren.J. Belton.society. The Process and Practice of Research.uk. Harvey. Vol. 8. The University of Birmingham Press. and Holmes. C. J. National Food Survey 1995. ‘‘Primary children’s school meal choices.emeraldinsight.co. Guardian Unlimited. T.guardian. and Kipps. ‘‘Food in schools: the chips are down’’. was the professional concern justified?’’. Ruxton. C. available at: www.. Learning Curve (2003). ‘‘Education committee’s starter paper on school meals bill’’.org.uk (accessed 10 October 2004). Hungry for Success (2002). ‘‘School meals research project’’. London.ac. pp. White. Yapp. Tuesday 17 September. London. Writing your MBA Dissertation. Vol.nutritional implication’’. pp. Kipps. London. available at: www. Ministry of Agriculture. Schutt.K..org Corresponding author Claire Seaman can be contacted at: CSeaman@qmuc. 36. (2002). (1998). ‘‘School dinners. British Nutrition Foundation. 2nd ed.com (accessed 11 October 2004). Food and Drink Federation. Food Standards Agency. FDF (2005).uk (accessed 8 November 2003).R. ‘‘A whole school approach to school meals in Scotland’’. ‘‘School meals and the 1980 Education Act.R. (1999). E.gov. ‘‘School meals’’.uk (8 November 2004). C.. Kirk. MAFF (1996).gov. M. B. Vol. Learning Curve. Social Research. Hygiene and Nutrition in Foodservice and Catering.govanlc. Hygiene and Nutrition in Food Service and Catering. School Meals Guide. Eves. (2001). 245–57. (2001).. www. Scottish Executive. M. Birmingham. 301–3. HMSO.org.M. British Food Journal.gov.com/reprints . pp. and Lumbers.H. N.. 1 No.uk.S.NFS 36. available at: www. Demystifying Postgraduate Research from MA to PhD.healthpro. Department of Health.com Or visit our web site for further details: www. 26. (2003). Reilly. FSA (2004).A. 9–12. SPEC (2004). ‘‘Childhood obesity at ‘epidemic levels’’’. (1993). London.fdf...uk To purchase reprints of this article please e-mail: reprints@emeraldinsight. Report on Health and Social Subjects No. available at: www. Macmillan Press Ltd. pp. J.5 314 DoH (1989). Vol. Why were school dinners brought in?’’. 2nd ed. S. available at: www. Sage Publications Ltd.food. Nutrition Bulletin. Bindles Ltd. M.eatrightnebraska.learningcurve.scotland. available at: www. J. (1997). 95 No. Sarantakos. 1. Fisheries and Food HMSO. Grix. M. available at: www. 21–32. R. 1. ‘‘Diet or disease? The case for school meals guidelines’’.

Vrije Universiteit Brussel. Fruits. Brussels. These habits are influenced by age. P. Findings – Socio-economic status significantly influenced breakfast frequency with differences between the highest educational programme (general) and the lower technical. In conclusion. Belgium Paper type Research paper Nutrition & Food Science Vol. This research was E made possible due to the unconditional financial support of Proctor and Gamble. technical and occupational programme). 36 No. Grivegne ´e and P. Duvigneaud and M. Belgium. Jules Bordet Institute.The current issue and full text archive of this journal is available at www. Belgium Fruit and vegetable consumption 315 A.emeraldinsight. Fruit and/or vegetable intake was influenced significantly by the educational programme and by the educational level of the mother. They would also like to thank Martine Mullie-Devos who coded and entered the records in the database. healthy eating habits among girls and boys in Belgium (as estimated by breakfast frequency and fruit and/or vegetable intake) are rather poor. In this respect healthy eating habits such as regular breakfast and a sufficient intake of fruit and vegetables are two important items to prevent childhood and adolescent obesity. Design/methodology/approach – A cross-sectional study using pupils contacted by nurses in schools during an information session about female hygiene. The purpose of this study is to determine the breakfast frequency and the fruit and vegetable consumption in Belgian adolescents. Adolescents. For both sexes breakfast frequency decreased when comparing age groups from 12 with 15 years of age respectively from 67 to 55 per cent for the boys and from 61 to 47 per cent for the girls. Originality/value – In the light of these findings action should be taken to improve the eating habits among Belgian children to prevent childhood obesity. . educational programme. 5. Autier Unit of Epidemiology and Prevention. Department of Human Biometry and Biomechanics.R.1108/00346650610703162 The authors would like to thank the nurses for their participation. Belgium Abstract Purpose – Several cross-sectional studies reported that breakfast skipping and a poor consumption of fruits and vegetables are associated with overweight and obesity-related morbidities. Deriemaeker. For the girls the reported intake of one or less than one portion of fruit and/or vegetables was respectively 20 and 16 per cent.htm Breakfast frequency and fruit and vegetable consumption in Belgian adolescents A cross-sectional study P.and occupational programmes. 2006 pp. Hebbelinck Faculty of Physical Education and Physiotherapy. Keywords Diet. 315-326 Emerald Group Publishing Limited 0034-6659 DOI 10. On that occasion all pupils (boys and girls) completed a questionnaire concerning their eating habits. Subjects were boys (n51390) and girls (n53610) between 12 and 15 years of age from the main three educational programmes (general. De Ridder. Half of the subjects who declared to have overweight (selfimage) did not take breakfast at a regular base. N. self-image and educational level of the mother. Vegetables. The use of daily breakfast was respectively 67 versus 49 and 48 per cent for the boys and 60 versus 42 and 39 per cent for the girls). D. Nutrition. The percentage of girls reaching an intake of four or more a day was 15 per cent for the two language regions. Clarys.com/0034-6659. P. Only 13 per cent of the French speaking boys and 10 per cent of the Flemish speaking boys reported an intake of four or more fruits and/or vegetables a day. Twenty six per cent of the boys of the French speaking part and 19 per cent of the boys of the Flemish speaking part of Belgium declared to take only one or less than one portion of fruit and/or vegetables a day. Mullie.

. 2004). 1997). Skipping breakfast increased the risk for overweight in adolescents (Berkey et al.5 316 Background As several other behaviours. Especially maternal education is considered as an important determinant of dietary intake (North and Emmett. It was equally the aim to . (2003) for example suggests that television viewing may contribute to a decline in fruit and vegetable consumption among adolescents. The health aspects of daily fruit and vegetable intake are sustained by several epidemiological studies. 2003). healthy eating habits at younger age may be an important factor for healthy eating habits in later live. Lack of regular breakfast influences cognition and learning in a negative way (Pollitt and Mathews. The aim of this study was to evaluate the breakfast frequency and the fruit and vegetable intake in adolescents between 12 and 15 years. In the Unites States less than 20 per cent of the children between 2 and 18 years eat the recommended 5 portions of fruit and vegetables a day (Krebs-Smith et al. increasing the consumption of fruit and vegetable may be a useful approach for nutritional change in obese individuals. 2004).1998.. (2004).. lack of time. 1998). However. these well documented positive health outcomes of regular fruit and vegetable consumption do not lead to a sufficient intake in the major part of the population... 2004. 2003. The study of Boynton-Jarett et al. The consumption of fruit and vegetables is influenced by several social and environmental factors. poor consumption of fruit and vegetable has been associated with obesityrelated morbidities (Bowman et al. Fruit and vegetables may protect against excessive weight gain because of their low energy density.NFS 36. In addition. 1997). It was estimated that a daily intake of more than 400 g of fruit and vegetables may decrease cancer incidence by 20 per cent (World Cancer Research Fund. Pollitt and Mathews. especially during growth stages (Nicklas et al. Regular breakfast and a sufficient intake of fruit and vegetables are two important items of a healthy eating pattern to prevent childhood obesity.. 2003). Keski-Rahkonen et al. Reported reasons for poor breakfast habits are stress. By consequence. Consumption of fruit and vegetables was more likely as the education level of the responsible adult increased (Lowry et al.. Again. 2000). lack of parental control (outdoor working or divorced parents).. or it may be a part of the individualisation process (Nicklas et al. In a recent study of Tylavsky et al. 2003). breakfast skipping in adolescents has been associated with several health compromising behaviours and unhealthy lifestyles (Keski-Rahkonen et al. 1996). There is also epidemiological evidence that sufficient intake of fruit and vegetables protects against cardiovascular and other prosperity diseases (World Cancer Research Fund. The regular intake of breakfast increases the possibility of a balanced diet improving the overall nutritional status and the nutrient density. (2001) increasing fruit and vegetable intake should help to decrease the consumption of high-fat and high-sugar foods among obese parents and their children. Moreover... an intake of over 400 g a day decreases the risk for cardiovascular diseases between 20 and 40 per cent. Berkey et al. 1996). Keski-Rahkonen et al. Skipping breakfast has also been associated with poor eating habits and multiple snacking during the reminder of the day. According to the study of Epstein et al. 2003. high fiber content and low glycemic index. Different studies showed that the consumption of fruit and vegetables is low among adolescents. three or more servings of fruit and vegetables a day resulted in a better bone mineral density and a lower urinary calcium output in early pubertal girls compared with girls with a low fruit and vegetables consumption.

School directions over the country (the French and Flemish region) could invite a team of nurses to give these information sessions for female adolescents between 12 and 15 years. pupils were contacted in the school setting during an information session about female hygiene. The questionnaire was designed in two languages (French and Dutch). For all questions the option ‘‘I do not know’’ was a possible answer.390) of different educational programmes (general. 1. One portion of fruit was defined as a medium sized apple while a portion of vegetables was defined as a quarter of a plate. Subjects could report breakfast frequency during a 1 week period ranging from never over once a week (1) to all days of the week (7). 317 . thin. The questionnaire was not validated against other research methods.. Intake of fruit juice. 2000). The following levels were possible for the educational level of the mother: lower grade (up to 12 years). technical or occupational programme. For vegetable intake answer possibilities ranged from none to . living environment and their self image with regard to their body weight. education of the mother and self image of the adolescent. Answering possibilities for educational programme were from high to low level: general. higher grade (up to 18 years). chips) was not considered as fruit or vegetables (Cullen et al. potatoes and potatoes derived products (French fries. During this 1 hour session the girls completed a short questionnaire concerning their eating habits. gender. educational programme of the respondent and educational level of the mother. The results of this study may help to give direction to health education projects for adolescents. Between September 1999 and May 2000. No distinction was made between week and weekend days. too thick. Breakfast was defined as all food used between 5 and 10 am (without inclusion of drinks) (Siega-Riz et al. Possibilities for daily fruit portions ranged from none with half of a portion interval to 4 portions. foot). non university higher education. educational programme.610) and boys (n51. Since not all schools/teachers agreed to participate in this procedure the group of questioned boys was smaller compared with the group of the girls. car. train. The subjects indicated their living environment (town versus rural). technical. fruit and vegetable consumption. university degree. boys completed the same questionnaire in a separate classroom under supervision of a teacher. After a validation try-out on 200 pupils. Self-image concerning body weight was reported using the following classification: too thin.5. bike. Daily fruit and vegetable intake was assessed by the use of portions a day. Fruit and vegetable consumption Methods Subjects/setting Subjects were girls (n53. 2 or more than 2 portions. and occupational level) aged between 12 and 15 years.evaluate these two aspects of healthy eating habits in function of age. 1998). time to reach the school (in 10 minute intervals) and mode of transportation (bus.1. thick.. 1. Measures A closed questionnaire was developed to assess breakfast frequency. satisfied. self-image in relation to body weight. corrections were made to improve the comprehensibility. During the same hour.

3 per cent for the girls (n52.108 213 69 100.5 9.05) more girls and boys from the Flemish speaking region (respectively 59.5 62. The data collection procedure (on invitation with the target age for the information session at the onset of girl’s puberty) provoked an uneven distribution between girls and boys and between the different age groups.7 15.0 38. followed general education. five to six times a week and every day.9 per cent).5 tot 3. The representation of the girls was comparable for technical (12.8 per cent) consumed breakfast compared with their counterparts in the French speaking region (respectively 52. More girls (n53. region and education programme) used for the analysis. Results Table I gives an overview of the subjects and the different groups (sex.3 56.0 11.3 20.5 Statistics The fruit and vegetable consumption and breakfast frequency were analysed using the Mantael–Haenstzel x2 for trends. Significantly (p .0 13. There was an overrepresentation of pupils from the general programme: three out of four respondents.353 2.5 portions a day and more than 4 portions a day.742 457 411 100.0 12. and this for both sexes.4 per cent) while there was an under representation for the boys from the occupational programme (5. The level of significance was set at 0.1 22.NFS 36.069 721 494 2. Fruit and vegetable portions were summed and subjects were divided in three categories: 0 to 1 portion a day.0 37.1 per cent (n5780) for the boys. For both sexes an overrepresentation was noticed for the age group of 13 years: 57.610 1.05) less girls consumed breakfast compared with the boys. 1.0 57. Distribution of the 5000 male and female adolescents .9 9.257 326 2.05.7 76.069) and 56.6 and 58.0 per cent) compared with the technical programme (15 per cent). More subjects from the French speaking region (62 per cent) completed the questionnaire compared with the Flemish speaking region (38 per cent).6 79.610) than boys (n51. Data concerning breakfast frequency are represented in Tables II and III. 318 Male adolescents n Per cent Total group Regions Flemish speaking French speaking Age 12 years 13 years 14 years 15 years School programme General Technical Occupational 1. Breakfast frequency was divided into four categories: never.0 Female adolescents n Per cent 3. Influence of independent variables was assessed using multilinear regression.4 Table I.7 per cent) and occupational programme (11.0 62. Significantly (p . 0. 0. age. Breakfast frequency for both sexes differed when comparing the two language regions.7 11.3 5. The latter was independent of the language region.9 and 71.390) completed the questionnaire.390 528 862 157 780 319 134 1. one to four times a week.

7 12.3 379 12.7 54.1 6.2 7.2 5.2 11.5 3.3 50.9 57.2 6.5 8.8 1.0 47.9 14.3 61.5 12.4 22.6 4.9 6.4 13.6 8.2 83 13.2 508 12.8 4.7 4.9 15.6 3.0 6.3 47.0 18.0 12.4 5.202 58. region. age and self-image of 5.8 2.1 12. Over 45 per cent of the female adolescents of 15 years of age had a breakfast frequency of four times or less a week.8 10.7 19.2 213 11.3 11.9 201 62.2 Fruit and vegetable consumption 319 10.8 3.0 10.3 66. When comparing age 13 with age 14 percentages decreased from 61.6 49.0 7.4 1.5 11.8 9.One to four Five to six Never breakfast(s) breakfasts Every day Do not a week a breakfast know breakfast a week n per cent n per cent n per cent n per cent n per cent Region – male Flemish speaking French speaking Region – female Flemish speaking French speaking Age – male 12 years 13 years 14 years 15 years Age – female 12 years 13 years 14 years 15 years Self-image – male To thin + thin Good Overweight + obesity Self-image – female To thin + thin Good Overweight + obesity School programme – male General Technical Occupational School programme – female General Technical Occupational Travel time to school 10 to 20 min 30 to 40 min 50 and more min Education mother Lesser than six years Six years Twelve years Higher non-university University Unknown 16 55 57 179 6 29 26 10 6 107 50 73 4 40 27 21 80 135 45 18 8 137 48 51 204 73 30 13 19 81 23 36 135 3.2 17.0 6.6 7.8 58.2 10.9 11.9 1.1 48.138 62.8 3.5 to 54.0 5.7 3.6 811 11.7 22.8 12.2 4.4 5.3 183 9.9 3.5 30. .4 19.2 8.5 7.4 1187 11.4 105 8.9 59 154 261 521 10 107 72 24 52 362 211 157 17 143 53 48 325 409 152 41 20 508 140 134 726 202 67 14 54 272 77 131 447 11.7 1.7 8.7 5.6 65 105 170 257 18 96 41 15 43 246 82 56 16 107 47 35 216 176 129 35 6 337 55 35 456 113 28 6 28 151 62 87 263 12.8 Table II.6 2.5 per cent for the boys.1 6.5 61.3 13.8 5.5 4.5 54.2 29.9 19.5 161 39.0 64.6 17.0 5.3 23.4 3.4 340 11.9 19.2 37.000 male and female adolescents The use of a daily breakfast decreased as a function of age and this for both sexes.4 24.5 4.5 15 108 642 325 474 1.7 9 40 54 113 12 29 6 2 12 92 38 25 3 36 10 16 73 78 33 14 2 116 21 30 151 49 16 5 4 42 19 26 120 1.9 52.3 4.9 3.1 13.8 179 55.9 4.1 659 45.1 8.5 14.9 15.4 9.0 to 47.4 25.8 5.3 31.2 62.3 5.7 66.9 1.644 60.0 5.6 19.2 12.7 28. Breakfast frequency in function of gender.4 4.9 65.9 26.5 20.321 28.1 635 17.9 12.9 3.9 59.6 11.262 11.1 1.2 17.0 17.6 32.4 5.0 4.5 4.9 16.4 21.5 11.6 749 16.6 130 71.0 75.0 9.6 70.3 4.9 122 11.0 504 53.5 3.1 12.0 193 42.0 17.5 29.6 5.2 2.9 174 11.5 111 12.3 1.2 7.7 33 67.3 519 12.7 4.5 1.2 per cent for the girls and from 66.

380 0. Lower breakfast frequencies were noticed for adolescents reporting thick or too thick for their self-image compared with those reporting to be satisfied of their self-image and those reporting to be thin or too thin. Results for fruit and vegetable consumption are represented in Table IV.649 Ref. 0.0 per cent of the girls and 67.924 1.842 21. Time to reach the school in the morning did not influence the breakfast frequency.856 0.3 of the pupils reporting their mother to have the lowest educational level consumed breakfast every day compared with 62.628 1.125 1.43 0. Only 28.121 0.775 2.0001 .671 to to to to to to to to 0.0001 95% Confidence interval 20.038 Ref.747 20. school programme.0001 0.788 Ref.080 to 20.238 0.026 20.008 0. The educational programme had a significant impact on the breakfast frequency.380 21. self-image and education of the mother and the dependant variable breakfast frequency 1.8 and 49.5 Variable Sex Male Female Age 12 years 13 years 14 years 15 years Region Flemish speaking French speaking School programme General Technical Occupational Self-image To thin Thin Good Overweight Obesity Education mother Lesser than six years Six years Twelve years Higher non-university University Coefficient Ref. 0. 0. Educational level of the mother significantly (p .113 0. age.212 0. For the adolescents from the categories thick or too thick less than 50 per cent consumed daily breakfast.335 0. 0.06 . 20. region.0001 .634 20.759 20.146 0.05) influenced the breakfast frequency with breakfast frequency increasing as a function of the educational level of the mother.330 to 20.186 Ref. 0.01 0.496 20. Only a very low percentage of girls and boys reached the recommended intake of fruit and vegetables.0001 0.256 20. 20.352 0. 0.11 0.380 1. The pupils from the general education programme consumed more regularly breakfast compared with pupils from the technical and occupational programme: 60.555 21.123 20.331 SE 0.231 0.329 to 0. 0. 20.511 20.500 0. 0.042 20.710 0.576 320 Table III.2 and 42.475 0.0001 .102 0.6 per cent of the boys from the general education level consume breakfast every day compared with respectively 47.888 to 20. 0. More girls than boys reached the recommended intake: for the girls respectively 15 per cent from the Flemish speaking region and 14.069 0. breakfast frequency was influenced by the self-image of the respondents.0001 .103 20.0001 .963 to 20.3 per cent for the technical programme and 39.0005 .220 0. 20.408 21.168 20.6 per cent from the .787 to 20.989 Ref. 0.330 p value 0.5 per cent for the occupational programme.217 0.991 For girls and boys.9 per cent of the pupils of which their mother obtained a university degree. 0.127 0.050 1.325 0.36 . Multilinear regression analysis of the independent variables gender.NFS 36.072 0.231 to 20.096 20.592 0.

00019 Ref.6 10.8 14.6 17.2 13 years 158 20.2 14 years 142 19.7 64.0 67.8 60.50 0.5 55. Fruit and vegetable consumption in function of gender.5 Six years or lesser 13 25.84 0.4 Education – male – French speaking General Education School 150 21.1 64.4 Age – female 12 years 55 16.0001 Ref.4 69.0001 Ref.062 0.0 14.21 321 0.6 8. 0. age and school programme of 5.0 67.6 14.7 15 years 143 28.0 9.0 13.00086 Ref.4 61.9 9.8 70.6 16.000 male and female adolescents .5 Professional Education School 76 26.9 13 years 315 15.9 More than 12 years 30 10.8 67.9 Education – male – Flemish speaking General Education School 72 17.9 25.3 14 years 94 29. 0.6 15.2 Education – female – Flemish speaking General Education School 93 11.2 64.4 64. 0.2 68.3 70.2 15.0028 Ref. 0.8 Education mother – male – French speaking Unknown 123 32.5 Age – male 12 years 38 24.0035 0.9 33.7 Education mother – male – Flemish speaking Unknown 56 22.7 Education mother – female – Flemish speaking Unknown 129 19.7 Education mother – female – French speaking Unknown 220 22.3 Region – female Flanders 216 16. 0.5 15 years 38 28.60 0.8 70.1 Professional Education School 54 32.3 1.9 64.1 Six years or lesser 11 17.6 58.5 More than 12 years 16 11.7 Professional Education School 6 21.9 72.1 Wallonia 227 26.0001 Ref.5 to 3.1 53 114 203 329 13 99 42 13 55 304 113 60 38 12 3 97 6 11 131 39 33 293 22 14 17 7 9 20 45 5 24 40 86 9 52 56 128 12 89 100 10.5 6.5 10.0 to 1 portion a day n per cent Region – male Flanders 101 19.2 12 years 108 19.0468 Ref.5 67.0015 Ref.029 0.2 12.7 Technical Education School 46 42.1 14.307 0.5 Twelve years 41 21.5 54.489 106 523 183 83 216 1.6 67.3 58.9 73.7 14.872 0.2 16.9 73.42 0.9 13.7 16.4 14.95 0.6 15.6 57.797 Ref.7 More than 12 years 86 14.7 66.1 14.6 Professional Education School 31 49.042 0.5 16.1 69.0 Wallonia 439 19.5 More than 12 years 50 20.4 69.0 62.7 16.1 15.8 Education – female – French speaking General Education School 338 17.0001 Table IV.2 9. 0. 0.6 70. 0.6 Fruit and vegetable consumption 0.3 51. 0.0 5.1 57.0 66.2 12 years 23 19.092 0. 0.7 11.4 51.7 12.4 Technical Education School 47 31.9 61.001 0.5 4 and more portions a day portions a day x2 for trend n per cent n per cent p value 374 521 934 1.2 9.7 13.6 12.2 12 years 46 13.9 66.450 466 291 307 48 19 444 56 21 577 182 175 1.3 Technical Education School 23 27.7 68.7 19.66 0.033 0.9 7.077 0.7 Six years or lesser 6 22.68 Ref. region.7 14.6 Technical Education School 47 17.8 12.4 Six years or lesser 25 20.3 72.6 11.310 82 97 174 14 86 100 211 33 126 151 462 44 233 195 635 87 351 416 70.

2 per cent at the age of 15 years while the number of girls reporting an intake between 0 and 1 portion a day increased from 16.4 per cent of the boys reported an intake between 0 and 1 portion of fruit and vegetables a day while only 9. 2001)..2 per cent for the French speaking region for the boys. This trend was significant (p . Percentages for boys were respectively 3 per cent for the Flemish region and 6. Discussion The method used for data collection (collection during information sessions about female hygiene) provoked an uneven distribution between girls and boys. 1985). The girls reaching the recommended intake decreased from 16. They equally shed some light on the particular situation in Belgium as several inequalities between the two main language regions were detected. . Our study indicates that these differences in health and socio-economic status result already at young age in poorer nutritional habits for the adolescents from the French speaking region. educational level of the mother. 1995..9 per cent over that age period. Fruit and vegetable consumption decreased as a function of age. 2003. 0. 1998. Krebs-Smith and Kantor. language region. 1985.. A study carried out among 7600 Swedish youngsters of 15 years of age revealed that 27 per cent of the girls and 17 per cent of the boys never consumed breakfast (Skinner et al. Due to the uneven distribution of participants and because of the distribution in several categories (age. Discrepancies between the language regions were less pronounced compared with the results of the breakfast frequency. Skinner et al. Gleason.4 per cent for the French region. 1997.9 per cent of the French speaking region. Educational level of the mother influenced the fruit and vegetable intake.05) for the girls and the boys in the French speaking region and for the girls in the Flemish speaking region. National statistics point to a weaker health and socio-economic status in the French compared with the Flemish speaking region of Belgium (Center for Operational Research in Public Health. However.0 per cent for the Flemish speaking region and 13. Considering all age groups we found that 4.5 322 French speaking region versus 10. Hoglund et al.9 to 28.NFS 36. 0. education programme. some categories are underrepresented. with more girls than boys in the analysis. Prevalence of no breakfast at all for the group of 15 years of age was lower in our study with a prevalence of 14.05) for the girls and boys of the Flemish speaking region and for the boys of the French speaking region. our results on breakfast frequency and fruit and vegetable intake corroborate the findings of several other studies carried out on adolescents in affluent countries (Keski-Rahkonen et al. These trends were significant (p .8 per cent at the age of 12 years to 12. 28.2 per cent of the girls of the Flemish speaking region never took breakfast versus 7.05) for the girls but not for the boys. time used for travelling to school).. The number of pupils reporting an intake from 0 to 1 portion a day decreased with increasing educational level of the mother.7 per cent of the boys reached the recommended intake at that age.5 per cent for the boys. The educational programme of the respondents influenced the fruit and vegetable consumption with lowest intakes for the lowest educational programme. At the age of 15 years. The latter was significant (p . Frost-Anderson et al. 1997a). 0.8 per cent for the girls and 7.. while an intake of 4 and more portions a day increased with increasing educational level of the mother.

In any case. (1986) breakfast frequency decreases significantly during puberty. (2003) suggested that overweight children who never ate breakfast had lower daily energy intakes and may lose body fat. On the other hand. (1997) on Flemish primary school children are in good agreement with our study. normal weighted children who never ate breakfast tended to gain weight. (1998) demonstrated that breakfast frequency among children increased during holidays compared with school days. a part of the French speaking region of Belgium. According to Keski-Rahkonen et al. (1997) towards older adolescents. In their study 9 per cent of the girls and 5 per cent of the boys did take less than two times breakfast a week. (2001). Ortega et al. They studied eating habits in 1.526 adolescents between 12 and 17 years of age living in the province of Luxemburg. Using semi-quantitative food frequency questionnaires they revealed that 59 per cent of the respondents did not consume vegetables on daily basis while 17 per cent of them reported to eat only one serving of vegetables a week.4 per cent of the children did not take breakfast or less than 420 kJ during breakfast. The latter was noticed especially for girls fearing an increase in body mass. In contrast. Data on breakfast frequency were obtained with the 24 h food recall method on 1. The increasing trend of skipping breakfast in function of age was equally reported by Frost-Anderson et al. (1998). In their study differences in fruit and vegetable intake were more pronounced when comparing girls and boys. 1997) and general health. but also as a function of the selfimage of their body: subjects with a self-image related with overweight skipped breakfast more frequently compared with subjects classifying their self-image concerning body weight as normal or as thin and too thin. several crosssectional studies have consistently reported that skipping breakfast tended to increase snacking and the risk of overweight among children and adolescents. Our results indicate indeed a decreased breakfast frequency at that age.8 per cent for the girls and 7. Of the girls 15 per cent from the Flemish speaking Fruit and vegetable consumption 323 . In our study the critical age for a significant decrease in breakfast frequency was between 13 and 14 years of age. pointing to the possible influence of stress and lack of time as possible reasons for skipping breakfast.. The finding in our study that time to school does not influence the breakfast frequency is in contradiction with the stress hypothesis as postulated by Ortega et al.8 per cent for the girls and 3. The data indicate a further increase of the breakfast skippers up to 15 years (respectively 14. They observed that 4. this was respectively 47 and 35 per cent for the boys. However. skipping breakfast is not an adequate method to reduce energy intake given its adverse effects on academic performance (Wyon et al.5 per cent for the boys).321 Flemish children between 6 and 12 years old. In our study the prevalence of children taking no breakfast at all at 12 years of age was 1. Similar findings were reported for fruit intake: 54 per cent reported an intake of one portion of fruit per day while 10 per cent of the respondents consumed only 1 portion of fruit per week. Moreover. (1997). the longitudinal study of Berkey et al. Fruit and vegetable consumption was evaluated in the study of Paulus et al. These percentages increased to respectively 12 and 15 per cent at the age of 18. when considering the recommended intake we also found a better profile for the girls compared with the boys.8 per cent for the boys. (2003) dieting and body shape ideals are the strongest determinants for the eating pattern amongst teenage girls. Our study extends the data obtained by De Henauw et al. Sixty one per cent of the girls reported a daily intake of at least 1 portion of fruit whilst 46 per cent of the girls reported an intake of minimum 1 portion of vegetables a day.The results obtained by De Henauw et al. According to Morgan et al.

Obe.4 per cent) declared to eat 1 or less than 1 portion of fruit and vegetables a day. at the age of 15. Other similarities between the study of Paulus et al. and Colditz. Again.W.s Relat. Field.5 324 region and 14. H. In our study. one out of three female and male adolescents (respectively 28. In the light of these findings action should be taken to improve the eating habits among Belgian children to prevent childhood obesity. (2003). Hence they advice to address breakfast endorsing progammes to the entire family with sufficient attention for the influence of peers and other health behaviours related with regular breakfast eating. Metab. The fruit and vegetable consumption among most Belgian adolescents is insufficient and should be encouraged to protect against weight gain and obesity-related morbidities such as cardiovascular disease and diabetes. . 1258–66. Breakfast intake has been identified as an important factor in nutritional well-being. breakfast skippers tend to have more health compromising behaviors and unhealthy lifestyles compared with the regular breakfast eaters. 2003). References Berkey..E. In our study fruit and vegetable consumption was not different when comparing girls and boys while breakfast frequency was significantly higher for the boys compared with the girls. Indeed.A. The study of Lien et al. they reported a decrease in the consumption of 1 portion of fruit from 59 per cent at 14 years of age to 29 per cent at 21 years of age for the girls and a decrease from 53 to 20 per cent for the boys. The latter finding may be an indication that healthy nutritional habits are not always interrelated.R. improved understanding of the determinants of adolescents dietary behaviors is critical for the promotion of healthy dietary habits. 10. especially during growth (Berkey et al..The downward trend in these eating habits as a function of age should receive uttermost attention. Gillman. Rockett.NFS 36. 27 No. carried out on 885 Nordic subjects between 15 and 21 years also indicated a decrease of fruit and vegetable consumption as a function of age. pp. (2003). As mentioned by Keski-Rahkonen et al. Their family study indicates equally that parental breakfast eating was the most significant factor associated with adolescent breakfast eating. (2001) and ours were the decreasing trend of the daily intake of fruit and vegetables in function of age as well as the influence of the educational programme of the respondents.. Int. M. Conclusions Our results indicate alarming trends for unhealthy eating habits such as skipping daily breakfast and insufficient intake of fruit and vegetables.6 per cent of the French speaking region reached the recommended intake compared with respectively 10 and 13. From a public health perspective. J. G.. A. Our study indicated also different healthy eating patterns as a function of the language region (the French versus the Flemish speaking region). Disord. this should be taken into account when designing health promotion campaigns. The type of educational programme followed by the adolescent and the educational level of the mother were found to be strong determinants for healthy eating habits.9 and 28. C.S. (2001). Their sample is indeed somewhat older compared with ours. These unhealthy eating habits increase the risk of overweight and obesity among adolescents.. but their results are alarming since they indicate a continuous decrease also after the age of 15. Vol. ‘‘Longitudinal study of skipping breakfast and weight change in adolescents’’.2 per cent of the boys.

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Norwood. Nutr. M. D. (1997). Int.B.. Clin. pp. Nutr. Nutr. J. ‘‘Appalachian adolescents’ eating patterns and nutrient intakes’’.. 1093–9. L. Saint-Remy. American Institute for Cancer Research. J. 55. Abrahamsson L. Clin. E. J. 76. N. ‘‘Fruit and vegetables . and Jeanjean. Mullie can be contacted at: patrick. Assoc. 311–7. M.. World Cancer Research Fund (1997). Vol.. DC. Jartelius. Salvetti. J. J. J.D.P. 5–12. Nutr. (2004). and Carbone. (2002).. C.. 748S–56S. J. Siega-Riz. M.A.. D. (1998).be To purchase reprints of this article please e-mail: reprints@emeraldinsight.com Or visit our web site for further details: www. T. Diet. Food. Am. 67. Sci. and Costello. Ezell. Food. Penfield.. Rimm. Pollitt.. 130–6. 1–2. Am.emeraldinsight. E. 2. Vol. Danish. J. and Mathews. Am.com/reprints ..building a solid foundation’’. 67. A.5 326 Paulus. Nutr. pp.. R. Tylavsky.. pp.. Womack. Nutr.mullie@skynet. ‘‘Fruit and vegetable intakes are an independent predictor of bone size in early pubertal children’’.. Am. Clin. J. 79 No. ‘‘An experimental stuty of the effects of energy intake at breakfast on the test performance of 10-year-old children in school’’.. B. Vol. ‘‘Dietary habits during adolescence . J. J. Popkin.N. Clin. Holliday. Vol. pp.P. Wyon.M.M. Washington. Vol.NFS 36. F. K. Corresponding author P. pp. Skinner. 85. R. and Fletcher R. ‘‘Breakfast and cognition: an integrative summary’’. (2001).results of the Belgian Adolux Study’’.. A.. C. Am. Clin. Vol. (1998). Vol. pp.A. 804S–13S. pp. and Carson. 48.M. Nutrition and the Prevention of Cancer: A Global Pperspective. Eur. (1985).. ‘‘Trends in breakfast consumption for children in the Unites States from 1965–1991’’.

Jibowo Department of Agricultural Extension and Rural Sociology. Obafemi Awolowo University. Nigeria B. Ile-Ife. lack . which became real in many households with effects on women and children. Ibadan. Malnutrition is a serious problem. that is about 40 per cent of all children in the developing world. 2006 is a consequence of poverty and low food production. Health education. Nigeria Food security and nutrition programme 327 A.htm Impact of household food security and nutrition programme on the nutritional status of children in Oyo state. agricultural extension and education departments in providing women farmers with the education and training needed to reduce the incidence of malnutrition and food insecurity. Increasing malnutrition and household food insecurity are related human welfare problems heightened in the last few decades by economic recession (Akinyele.The current issue and full text archive of this journal is available at www. These effects are visible in the living conditions of the people especially those residing in rural and peri-urban areas. The participants who are farmers were selected using systematic random sampling technique from each of the six local government areas covered by the programme.com/0034-6659. Keywords Nutrition. Children (age groups). It has also been recognized that malnutrition Vol. 36 No. 327-336 Emerald Group Publishing Limited that poverty is one of the causes of malnutrition. and it is also increasingly clear pp. Also. About 200 million children under the E 0034-6659 DOI 10. Descriptive statistics such as frequency counts. causing morbidity and mortality among young Nutrition & Food Science children and women of childbearing age.emeraldinsight. Nigeria Abstract Purpose – The purpose of this paper is to assess the impact of household food security and nutrition programme (HFSN) on the nutritional status of children (0–5 years) in Oyo state.O. 1993). This led to poverty. Such conditions cause high levels of mortality and morbidity and spread of ill health and malnutrition. percentages and means were used to describe the findings while analysis of variance (ANOVA) was used to determine the significant difference in the nutritional status of the children of the two groups. while non-participants were selected using simple random sampling technique.1108/00346650610703171 age of five. The participants utilized most of the prograrmme recommendations and significant differences existed in the weight for age and height for age indices of their children. Findings – The results show that the women farmers who participated in programme activities possessed some personal and household characteristics which influenced the nutritional status of the children. Originality/value – The results indicate the need for constant surveillance and collaborative effort of the health. Design/methodology/approach – Pre-tested structured and unstructured questionnaires were used to elicit information from 201 programme and 201 non-programme women participants. Obafemi Awolowo University. Nigeria Paper type Research paper Introduction Nigeria is still faced with the problem of equating the supply of food with the everincreasing demand for it four decades after attaining her independence. Institute of Agricultural Research and Training. anthropometry technique was used to assess the nutritional status of the children of both groups.A. 5. Diet. Nigeria. Lawal Farming Systems Research and Extension Programme.

improved feeding practices and child care which are being promoted among households in Nigeria especially through nutritional education. The main target in each . These LGAs were purposively selected for the study. N Determine the utilization of the various household food security and nutrition Programme’ recommendations by the women. while 36 per cent were underweight and 9 per cent wasted. 43 per cent of Nigerian children under the age of five years were stunted. To understand the present situation therefore.1 square kilometers out of which 27. this study embarked on the assessment of the impact of the household food security and nutrition programme on the nutritional status of children in the target area. Oyo. UNICEF recognized the fact that women are the driving force in achieving project effectiveness and reducing poverty and also the key to addressing the household food security and nutrition goals. N Assess the impact of the programme on the nutritional status of children. 2001) reveal high prevalence of malnutrition among the same group of children in Nigeria. The programme of intervention covered the four agricultural zones to which the state was divided. 1992) showed that in 1990. The programme however covered six local government areas (LGAs) in all the four zones. This problem of malnutrition had led to embarking on strategies of direct intervention in form of agricultural and rural development programmes to alleviate the problem.. time and labour saving devices. 1997. Methodology The study was carried out in Oyo state. 2001). The specific objectives are to: N Identify the personal and household characteristics of women in the study area. an indication of the prevalence of malnutrition and chronic household food security. Ogbomoso and Saki. Objectives of the paper The general objective of the paper is to assess the effect of household food security and nutrition programme on the nutritional status of the children in the study area.249. The aim of the programme is to increase the availability of staple foods throughout the year and also to promote the nutritional well-being of household members especially women and children. Also. The land area covers a vast landmass of 32.NFS 36. For non-programme communities non-participants were selected through random sampling technique from communities similar to the programme areas in ecology and socio-economic background. The need to enhance food security and nutrition at the household level has led to the development of improved technologies in the area of farming. which is one of the states in the South Western Nigeria. nutritional surveys conducted in Nigeria (Adelekan et al.93 km2 is cultivable (OYSADEP. The state is predominantly agrarian with about 70 per cent rural population. N Assess the nutritional status of children (0–5 years) in the study area. Systematic sampling procedure with a random starting was employed to select the sampled households from the list of participant households. 1991).107. The Nigerian demographic and health survey (FOS.5 328 sufficient nutrition to lead full and active lives (FGN/UNICEF. livestock production. Notable among them is UNICEF/FGN intervention programme on household food security and nutrition. These are Ibadan/Ibarapa. Abidoye and Ihebuzor.

Anthropometric measurements were taken for all the children.000 annually. release 6. weight for height and weight for age.4 per cent) and 52. The belongingness of most participants to social organizations may have positive impact on their willingness to accept change as a result of group influence.1 per cent of the non-participants were members of the religious and women groups respectively.selected household was a mother having at least one child below the age of six.8 per cent of participants and 54. 2000) that rural women are actively involved in farming activities. On the other hand.5 per cent) of participants and 47 per cent of non-participants were between the age category of 30 and 39.7 per cent of non-participants cultivated between 1 and 1. The data collected were analysed using Epi info (CDC.000. 1995.001 and N40. Frequencies. The three indices of nutritional status used for the analysis were height for age. The relatively poor financial status of most women farmers may however discourage the use of innovations especially those.0 and Z-score was calculated and compared with WHO/ NCHS reference data. Food security and nutrition programme 329 . This shows a higher level of education among participants as compared with non-participants. 52.99 hectares of land (Table I). More than half (53. Results and discussion Personal and socio-economic characteristics of women farmers The data in Table I reveal that more than half (51. More than half of the participants (59 per cent) and non-participants (53 per cent) had between five and eight children. household related characteristics and utilization of improved recommendations introduced through the programme. which are expensive to adopt. while 36. Pre-tested structured interview schedule was used to collect information from women farmers on the personal. The sample size of 201 participants and 201 non-participants were selected for the study. socio-economic.4 per cent) of the participants and 48. Height and weight of children of the respondents were measured using standard anthropometric techniques as described by WHO (1983). Education must therefore have given the participants a higher propensity to participate in the programme directed towards improving the nutrition and health status of their children as well as agricultural development within the households. All the women farmers interviewed were married and the vast majority of them were currently living with their husbands.2 per cent of the non-participants had income of between N20. Atlanta). Farming was the major occupation of 43 per cent of participants and 60.0 per cent of participants and non-participants respectively had no formal education. The mean age of women participants was 35. This is an indication that farmers in the study area had relatively large number of children with whom they would readily augment their farm labour (Table I). Forty-five per cent of the participants spent between 1 and 6 years in school while 42.7 per cent and 8.0 cent) of the participants were members of the religious societies and women groups respectively.7 per cent and 76. percentages and means were used to quantify the data generated while analysis of variance (anova) was used to determine the significant difference between the nutritional status of children in the two groups selected for the study. The finding corroborates other findings (Siyanbola.3 per cent and 20 per cent of participants and non-participants respectively earned more than N40.3 per cent of non-participants spent same number of years in school. Majority (82. More than onequarter (29.79 while that of non-participants was 35. The data on farm size show that 46.8 per cent of non-participants (Table I). Odebode and Akinbile.08.

8 13.4 1. The majority of the participants (68.0 40.6 6.08 71.000 60.6 per cent of the non-participants were household heads.1 34.1 per cent) and 54.000 Mean Participant (n 5 210) 16.4 24.7 37.8 35. Majority 330 Personal/socio-economic characteristics Age (years) 20–29 30–39 40–49 Mean Marital status Married and living with husband Widowed Separated Divorced Religion Christianity Islam Traditional Total number of children 1–4 5–8 .2 16.8 13.5 46.000 40.4 40.850.7 35.32 34. Percentage distribution of respondents by personal and socio-economic characteristics .1 1–1.5 31.919.9 5.1 22.0 1.4 6.7 7 52.4 – 30.7 16.3 53.7 2.000 .1 43.5 Household characteristics of women farmers The data on Table II show the household related characteristics of women.0 42.0 5.3 15.0 32.5 1.4 20.0 4.3 5. 15.4 45.1 46.6 0.99 2–2.NFS 36.3 47.000 20.001–80.99 >3 Mean Annual income (in naira) 0–20.79 87.4 59.2 54.3 5. 80.9 per cent of the non-participants were first and only wife of the household head.7 51.75 Non-participants (n 5 210) 20.4 3.8 2.5 1.7 20.2 5.8 60.2 55.1 0.001–60.86 10.40 (continued) Table I.0 42.6 4.6 2.001–40.8 Mean Years of schooling None 1–6 7–12 . 12 Mean Major occupation Farming Trading Agro-processing Artisan Civil servant Size of farm land cultivated (hectare) .9 53.5 59.5 6 29.8 48.1 percent of the participants and 24.9 6.2 10.7 – 3.9 2. However.2 42.2 9.2 11.

8 per cent and 16.5 46.99 2–2. Also. 9.9 per cent of participants and 56. majority of the participants (60.1 4.4 per cent of non-participants were food insecure.5 8.2 per cent of the participants and the non-participants were food secure. do boil their water before drinking. .4 1. of the participants (71. while a lesser percentage (56. Fasorannti. Household food security status of the respondents revealed that while 12. This has implications for child and family health.86 82. Seventy-two per cent of participants’ household heads were literates and had attained primary. 1995.5 per cent) and 22 per cent of the non-participants utilized health services on a regular basis.0 28.1 1–1.5 1.9 per cent) had between seven and 12 household members.31 and 8.58 respectively.2 per cent) while less than half (33. 1999). secondary or tertiary education. 77.2 10.7 20. However.3 per cent) of participants resorted to the bush.9 6.3 per cent of the participants and nonparticipants respectively. 8. majority of participants (57 per cent) and non-participants (79.21 for participants’ and non-participants’ household head. The mean household size for the participants and non-participants was 8.0 per cent and 31.9 per cent) failed to treat their water before drinking. (2004) also revealed similar unhygienic conditions at the household level which are pre-conditions for diarrhoea diseases in young children. It is worth noting that none of the two groups had access to public tap. A very small proportion of the households used the most sanitary means of human waste disposal.2 per cent of the participants and less than one-third (27.1 76.7 72.6 per cent) and non-participants (72. as access to clean safe water may not be met.Personal/socio-economic characteristics Size of farm land cultivated (hectare) .8 13.09 and 4.32 52. The mean years of schooling were 7.2 54.9 15. Data in Table II further show that 33.7 46.0 per cent of participants and non-participants sourced drinking water from dug wells. There was a slight difference in the years of schooling spent by household head between the two groups.1 per cent) of the non-participants household heads were represented in the same category (Table II).1 Food security and nutrition programme 331 Table I. 2001 Participant (n 5 210) 34.7 per cent and 2. Siyanbola. 1995.1 18. However.2 11.99 >3 Mean Social organizations Religious organization Cooperative organisations Women groups Community development associations Political organisations Village council Source: Field survey. Also. This is in support of other findings indicating large household size of rural households (Ojolo. The bush was therefore the most commonly used means among the non-participants (66.3 per cent) of the non-participants were moderately food secure. FG/ UNICEF (1994) and Maxiya-Dixon et al.7 8.7 Non-participants (n 5 210) 22. Improved level of education within a household is advantageous for encouraging people to bring about change.

majority (77.1 0.1 68.09 63.6 8.6 7.1 per cent).2 72.2 8.0 per cent of the women farmers indicated their present usage of fertilizer.31 28.58 43.3 16.5 39.1 79.2 17.7 2.0 31.4 0.5 3.6 8.7 31. melon sheller and maize hand sheller were well utilized by more than half of the .9 32.NFS 36.3 17.3 30.6 8. cassava cuttings and maize seeds were the major ones presently being utilized by majority of the participants (Table III).9 12.5 Household related characteristics Women status Household head 1st/only wife 2nd wife 3rd wife Household size 1–6 7–12 > 13 Mean Years of schooling of household head 0 1–6 7–12 13–18 Mean Sources of drinking water Well Stream Borehole Water treatment No treatment Addition of Alum Filteration Boiling Waste disposal Bush Ordinary pit latrine VIP Water closet Use of health services Regularly Occasionally Not at all Household food security status Food insecure Moderate Food secure/adequate Source: Field survey.2 69.1 5. Only 1.9 77.5 per cent) and feeding of livestock with crop residue (34.3 16.4 4.4 9.1 16.9 18. Out of all the processing equipment.7 33.2 71.21 51. There was a poor utilization of fertilizer by women for most of their crop production.2 56.5 33.1 60.1 – 22. cassava processing machine.7 2.0 14.2 12.5 per cent) of the women indicated they have utilized them before.3 54.9 10.3 66.4 4.4 6.0 57.9 8.7 19.4 27. However.2 332 Table II. Percentage distribution of respondents by household characteristics Utilization of HFSN recommendations by women farmers Among the improved seeds/seedlings introduced.1 10.2 8. There was also poor utilization of improved livestock breeds (5.2 31. The percentage for the two crops was 72 per cent. 2001 Participant 15.6 54.4 20.8 Non-participant 24.2 2.

4) 17(8. Majority (86.5) 23(11.5) 1(0.8) 5(2.0) 11(5.5) 23(11.0) 110(54.7) 24(11.7 per cent respectively.5) 75(37.6 per cent.7) 67(33.7) 112(55.8 per cent).7) 148(73.2) 17(8.5 per cent).4) 173(86. The frequencies and percentages of respondents who had used each recommended practice before but discontinued are shown in Table III.1 per cent) of the women still practice continued breastfeeding while less than half (45.1) 47(23.5) 85(42.5) Food security and nutrition programme 333 Table III. Nutritional status of children in study area The height for age (HAZ) index show that 35.9) 2(1.5) 69(34. poor germination of seeds/seedlings (37.3) 112(55.3) 47(23.7) 91(45.2) 164(81. 73.1 per cent) and lack of access to enough information (27.4) 85(42.3) 43(21.6) 108(53.0) 6(3.9) n 5 201 Have used before 48(24.7 per cent of the women were currently utilizing growth-monitoring technique and iodized salt.4) 43(21.9 per cent respectively.1) 83(41.4) 45(22. Distribution of participants by utilization of various introduced recommendations women in the state.4) 19(9.7 per cent) of the women presently utilize gardening for nutrition due to availability of space in their background to practice it.3) 134(66.1) 156(77.4) 17(8.4) 115(57.1) 124(61.7) 147(73.3 per cent and 55.5) 37(18. Majority (61.3) 14(7. This implies that about three in every ten children were stunted .3) 22(11.9 per cent and 90. The percentage of women who indicated their present usage is 79.3) 36(17. 57.8 per cent).8) 17(8.7) 110(54.6) 13(6.0) 62(30.5) 38(18.1) 1(0.4) 75(37. The most currently utilized of all soybean products are soymilk and soy-ogi with the percentage of 73.3 per cent of the participants’ children and 58.3) 48(23. late arrival of inputs (37.6) 182(90.9) 160(80.1) 69(34.5) 58(28.Recommendations Maize Cassava Oil palm Citrus Mango Soybeans Fertilizer Improved livestock breeds Crop residue Cassava processing Palm oil processing Melon hand sheller Maize sheller Exclusive breastfeeding Continued breastfeeding Gardening Soymilk Soyflour Soy-ogi Growth monitoring Iodized salt Vitamin A Iron Note: Percentages in parentheses Source: Field survey.4) 177(88.0) 9(4. The reasons adduced for discontinuance of the various recommendations by women farmers include non-availability of input/recommendations (77 per cent).5) 17(8.3) 82(40. lack of time for preparation (36.8) 96(48.8) 23(11.1) 160(79.7) 74(36.4 per cent) of the women currently breastfeed their children exclusively.0) 2(1.5) 115(57.7 per cent of non-participants’ children fell below minus two standard deviations (22SD) from the median of the reference population for the height for age index (Table IV).0) 7(3.6) Never used 8(4.1 per cent and 66.6) 18(9. 2001 Presently using 145(72) 145(72) 8(4.

5 per cent of the participants’ children and 7.011* Table V.002* 0.8 Variable WHZ Group Participants Non-participants Participants Non-participants Participants Non-participants Number of case 201 201 201 201 201 201 Mean score 0.52 p value 0.01 9. Prevalence of malnutrition in children (0–5 years) of participants and nonparticipants Type of malnutrition Stunting (HAZ) Wasting (WHZ) Underweight (WAZ) Source: Field survey.186 9. The majority of participants and non-participants were between the age Table IV.96 1.7 7. 0. 5. A similar pattern as reported for height for age and weight for height is observed in weight for age.56 3.667 0.9 per cent of the participants’ children were underweight and fell in the medium prevalence reference value. In relation to weight for height (WAZ) index. Women farmers who had formal education were more among the participants than the nonparticipants.5 334 in the study population for the participants’ communities while six in every ten children were stunted in the non-participants’ communities.5 per cent of the non-participants’ children suffer from wasting.29 and 6.5 33.9 Non-participant Frequency Percentage 118 15 68 58.2 3. only 14. Test of difference between nutritional status of children in two groups WAZ HAZ Note: *Significant at p .29 6. However.07 22. which had resulted into better nutrition. The table shows that there was a significant difference in the weight for age and height for age indices of the children of participants and non-participants (F 5 9. Relationship between the nutritional status of the participants and the non-participants The result of the analysis of variance (ANOVA) is presented in Table V.5 14.8 per cent) and therefore fell in the very high prevalence reference value. This implies that a small percentage of the children from both participants and non-participants’ suffered recent undernutrition. The difference could be entrenched in the effect of the programme. Participants were exposed to the programme and utilized the various recommendations over the years. Children below two standard deviation (22SD) from the mean of the reference population are classified as being underweight. Children of nonparticipants were more underweight (33.NFS 36.3 5. 2001 Participant Frequency Percentage 71 11 30 35. The result indicates that participants’ children were nutritionally better in terms of prevalence of undernutrition and stunting. which influenced the nutritional status of the children.05 .52 respectively).41 F value 0. Conclusions and recommendations It is evident from the findings of this study that women farmer participants possessed some characteristics.

A. J. 15.. FGN/UNICEF. Columbia. USA. Ile-Ife. M. UNICEF..B. N. Federal Office of Statistics (FOS. Akinyele. Jinadu.. pp. (1993). Master Plan of Operation for the 1991–95 Programme of Cooperation. and Ojofeitimi.A. (1997). pp. 4–16. Nigeria’’. Lagos. This will go a long way in reducing the incidence of water borne diseases and improve the nutritional status of the people. O. D.O. and were members of more social organizations than non-participants. Vol. Ibadan. the nutritional status of participants’ children were better than that of non-participants’ in terms of height for age.O. ‘‘Prevalence of malnutrition and vitamin A deficiency in Nigerian preschool children subsisting on high intakes of carotenes’’.. pp.. extension and educational departments to work together in providing women farmers with education and training to support their roles in household food security and nutrition management and be encouraged to utilize such recommendations.K. Vol. The study therefore recommended that incidence of malnutrition could be reduced through constant surveillance from the agricultural and health workers. University of Ibadan.category of 30 and 39 and were living with their spouses. weight for height and weight for age indices.. References Abidoye. This will go a long way in identifying early and correcting malnutrition. majority of non-participants and lesser percentage of the participants made use of the bush for human waste disposal. E. Also. Olotu C. 1–25. secondary or tertiary education while lesser percentages of nonparticipant household heads were represented in the same category. A substantial percentage of participants utilized improved cassava cuttings and improved maize varieties while improved livestock were poorly utilized. Federal Office of Statistics and Macro International Inc. pp. ‘‘Nigeria demographic and health survey 1990’’. there is need for health. Adelekan. Government must ensure that there is adequate provision of potable water and sanitary means of human waste disposal in rural areas. 17–24. 2. Journal of Nutrition and Health. pp.O. Agricultural workers attached to rural areas should be equipped with simple anthropometric tools to assess the children under the age of five.A.T. R. (1999). Also. Participants earned higher incomes. protein energy malnutrition is still a major problem of public health importance in the study area. (1991). ‘‘Impact of agricultural development programme on rural communities in Ondo state’’. and Ihebuzor. Maryland. The average number of children was six for participants and seven for non-participants. Participants utilized health services on a more regular basis than non-participants and most of the participants were more food secured than the non-participants. Women farmer participants however had higher years of formal schooling than the non-participants. Nigeria. (2001). ‘‘Give us this day our daily bread: an inaugural lecture from the faculty of basic medical sciences’’. Majority of participant household heads were literate and had attained primary.O. Nigeria) (1992). Olukoga. 29–39. Food security and nutrition programme 335 .N. Journal of Nutrition and Health. Majority of the participants sourced water from wells while majority of non-participants failed to treat their water before drinking. I. 107–112. unpublished PhD thesis. I. ‘‘Assessment of nutritional status using anthropometric methods on 1–4 year old children in an urban Ghetto in Lagos. Although. Nigeria. Fasorannti. Fakunle. There is need for women farmers to be educated on socio-economic and household characteristics which are likely to affect the nutritional status of children and other household members in general. Nigeria. Fatusi. Obafemi Awolowo University.

L. The Nutritional Status of Women and Children in Nigeria. International Institute of Tropical Agriculture. 1–15. ‘‘The organization and management of rural women cooperative in Osun state’’. (Ed. B. Proceedings of the Sixth Annual National Conference of the Agricultural Extension Society of Nigeria.. Nigeria. Ile-Ife. (2000). Sanusi. T. S. WHO. 111. E. Lawal can be contacted at: bolaw2001@yahoo. p.O.A. Geneva. 46.O. Odebode. Nokoe. Nigeria. UNICEF. in Olowu. p. Siyanbola. Guidelines for Assessing the Nutritional Impact of Supplementary Feeding Programmes for Vulnerable Groups. Agricultural Extension and Poverty Alleviation in Nigeria. Obafemi Awolowo University. (1995). Nigeria. pp. p. ‘‘Nigeria food consumption and nutrition survey 2001–2003’’. A. Unpublished MSc thesis. Nigeria. Oguntona. Akinyele.A. Ojolo.emeraldinsight. Oyo Sstate Agricultural Development Programme. unpublished PhD thesis.NFS 36. (2004)..B.. and Harris. ‘‘Measuring change in nutritional status’’. ‘‘Improved agricultural technology for poverty alleviation among rural women in Oyo state’’. Lagos. I. p.T. Ile-Ife.O. Planning. Monitoring.5 336 FGN/UNICEF. (1994). ‘‘A report of village listing survey in Oyo state’’. and Evaluation Department. S. Nigeria. pp. Ibadan. Corresponding author B. OYSADEP (2001). 65–73.com/reprints .com To purchase reprints of this article please e-mail: reprints@emeraldinsight. 75. 46.. and Akinbile. Maxiya-Dixon. World Health Organization (1983). ‘‘Participation of women in agricultural and rural development projects in Osun state of Nigeria’’. E.). Obafemi Awolowo University. pp. (1995). 1–18.O. R.com Or visit our web site for further details: www. B.

2003) and several observational studies have detected inverse associations between dietary calcium intake and body weight (Davies et al. Dietary intake was measured using the 7-day weighed inventory method. reduce lipolysis and reduce thermogenesis. Physical Activity and Wellbeing. Davies Academy of Sport. Ultimately energy imbalance is the reason for excessive weight gain. there were no significant correlations between body weight or body mass index (BMI) and habitual intake of dietary calcium in this age group. 5. Children (age groups). 2000).9) were recruited from 12 primary schools in the London area. 2004). suggested that children who avoid milk. Hull. However. London. which is in contrast with the results of similar studies conducted in adults. however. 36 No. it was recently demonstrated that longitudinal calcium intake is negatively associated with children’s body fat levels. Skinner et al.The current issue and full text archive of this journal is available at www. have recently demonstrated that longitudinal calcium intake is negatively associated with children’s body fat levels (Skinner et al. The authors thank all of the children and their guardians for generously volunteering to participate in the study and the schools for their contribution. London South Bank University. Also Reckitt Benckiser Healthcare E for their financial assistance. It was demonstrated that low calcium diets lead to an increase in intracellular calcium concentrations. Most of these studies have been conducted with adults.. however. Another recent study which was set out to investigate risk of prepubertal bone fractures and milk intake. 21 boys and 64 girls (mean age: 9. 2004).emeraldinsight. Body weight and height measurements were also recorded. UK Calcium and body weight in children 337 P. It is important for future studies to measure levels of body fat in children together with body weight in conjunction with calcium intake in order to elucidate the original hypothesis.. Findings – Data suggested that girls have significantly lower intakes of calcium than boys and that 48 per cent of boys and 38 per cent of girls were overweight (above the 91st centile). are more likely to be of heavier weight than children who do not avoid milk (Goulding et al. Nutrition & Food Science Vol. 2006 pp.. Dettmar Reckitt Benckiser Healthcare Ltd.2¡0. which in turn act to promote body fat deposition. Most of the studies have been conducted on adults.htm Habitual dietary calcium intake and body weight in 7–10 year old children Amy Jennings. Design/methodology/approach – Eighty-five children. 337-342 Emerald Group Publishing Limited 0034-6659 DOI 10. Costarelli and G. UK Abstract Purpose – Several recent observational studies detected inverse associations between dietary calcium intake and body weight. Dietary calcium has been shown to play a pivotal role in the regulation of energy metabolism (Teegarden. whether the main cause is consumption of a high-energy diet. V. Keywords Diet.com/0034-6659. The purpose of the current study is to investigate possible associations between habitual calcium intake and body weight in a group of 7–10 years old children. United Kingdom Paper type Research paper Introduction Obesity in children has reached epidemic proportions (Matayka.J.W. Originality/value – One explanation could be that the possible effect of calcium on adiposity and body weight is more pronounced in adulthood than in childhood.1108/00346650610703180 . 2003). lack of physical activity or genetics.

The above review has also shown that studies relating nutrient intake to body composition. (2003) conducted a study that investigated which aspect of energy balance was responsible for the decrease in body fat content of rats fed a highcalcium and high-dairy protein diet. They concluded that a high-calcium diet decreases body weight and fat content due to a lower digestible energy intake caused by increased fecal lipid and a non-significant reduction in gross energy intake.. Melanson et al. 2001). It was also shown that increasing 1. 2003). suppresses lipolysis and increases lipid accumulation.0 kg lower body weight in adults. and reduced weight gain at midlife.25dihydroxy vitamin D are significantly lower in obese individuals compared to non-obese individuals (Parikh et al. 2003). It has been demonstrated that agouti protein stimulates calcium influx in human adiposities promoting the process of fat formation and lipogenesis and inhibiting fat breakdown.. such as the angiotensin converting enzyme inhibitor found in milk. Data from six observational studies and three controlled trials in which calcium intake was the independent variable have been reanalyzed by Heaney et al. report negative associations between calcium intake and body weight at midlife and between calcium and body fat accumulation during childhood (Heaney et al. which is found in human adiposities. It was found that subjects with high intakes of dietary calcium had higher rates of fat oxidation (Melanson et al. expressed as lower body fat and/or body weight. Notably. 2002). 2002).. whereas increasing dietary calcium inhibits these effects and markedly accelerates fat loss in mice subjected to caloric restriction (Zemel. A consistent effect of higher calcium intakes. 2002. dairy sources of calcium exert a significantly greater anti-obesity effect than supplemental sources in each of these studies. The purpose of the current study was to investigate possible associations between habitual calcium intake and body weight in a group of 7–10 years old children.. to evaluate the effect of calcium intake on body weight and body fat. (2003) carried out a trial investigating a relationship between calcium and fat oxidation in 35 obese individuals who were moderately active. The idea of dietary calcium having an anti obesity effect was derived from studies investigating the mechanism of agouti. Habitual calcium intake was self-reported and each subject completed a 24 hour stay in a whole room calorimeter. the first obesity gene to be cloned.NFS 36. It was also reported that parathyroid hormone positively correlates with body mass index (BMI) and levels of 1. 2004). Increasing evidence suggests that calcium from dairy sources has a greater antiobesity effect than tablet supplementation and calcium enriched foods (Zemel. and they proceeded to state that increasing calcium intake by the equivalent of two dairy servings per day could reduce the risk of overweight by as much as 70 per cent (Heaney et al.. Papakonstantinou et al. possibly due to the effects of other bioactive compounds on adipocyte metabolism.5 338 It has been reported that increasing dietary calcium significantly augments weight and fat loss in the absence of caloric restriction in obese adults with dairy products exerting a substantially greater effect (Zemel et al.5–3. There is sufficient data from controlled animal studies to demonstrate a beneficial role for dietary calcium in regulating weight during energy restriction (Shi et al.. 2004). stimulates lipogenesis. was found.25-dihydroxy vitamin D in response to lowcalcium diets stimulates adipocyte Ca2+ influx and as a consequence. indicating an important role for dairy products in the control of obesity.. . The same group has also optimistically concluded that a 300 mg increment in regular calcium intake per day is associated with approximately 1 kg lower body fat in children and 2. 2003).

If a subject had school meals. and a laminated instruction sheet outlining the cumulative weighing method. gender. BMI values were then converted into percentiles using BMI charts. a BMI was calculated for each subject using the equation kg/m2. Dietplan 5 has also identified the major source of calcium in each child’s diet. had lived in the United Kingdom for at least 5 years and were able to give written. Daily nutrient and calcium intakes were estimated for each subject using the nutritional software programme Dietplan 5 (Forestfield Software Ltd). materials and methods Subjects Eighty-five healthy pre-adolescent children aged 7–10 years were recruited from primary schools in the London area. they were recorded by the investigator. Body weight measurements were taken using electronic digital weighing scales (Salter electronic scales. Statistical analysis One-way analysis of variance (ANOVA) and Pearson correlations were conducted using SPSS/PC version 10. calibrated to 1 g. calibrated to 500 g). Anthropometric measurements Height and weight measurements were taken for all subjects on the day prior to data collection.0. Results There were no significant correlations between body weight or BMI and habitual intake of dietary calcium in this age group. Height measurements were taken using the Leicester height measure (Child Growth Foundation). socioeconomic group and ethnicity was obtained from a guardian.Subjects. Subjects were only accepted for entry into the study if they were attending school in the London area. Ethical approval was also obtained from London South Bank University ethic’s committee. The investigator visited subjects on the day prior to data collection to provide verbal instructions on how to complete the diaries.2 years (SD: 0. Each subject was presented with a diary. It was noted that in six children. It may be of some importance that children with dietary calcium mainly derived from dairy Calcium and body weight in children 339 . Demographic information on subjects’ age. The measurements were taken without shoes or heavy outdoor clothing. Girls were also more likely to consume less dairy products than boys. which is 550 mg/d. with assistance from their guardians at home and from the investigator during school time. a set of Soehnle electronic weighing scales. voluntary informed consent from a guardian. Daily contact was made to ensure that the diaries were completed accurately and to help maintain the subjects’ motivation.9). Forty eight per cent of boys and 38 per cent of girls were overweight (above the 91st centile). Data also suggest that girls have significantly lower intakes of calcium than boys (Table I) with the average intakes of girls failing to meet the reference nutrient intake for calcium. the main source of dietary calcium was white bread whereas the main source of calcium for three other children was pizza. which is very worrying given the fact that the average age of the group was 9. Packed lunches were weighed by the children or guardians at home and leftovers were recorded by the investigator. Using the height and weight measurements. Calcium intake Subjects were required to complete a 7-day weighed inventory of all food and drink consumed.

13 585.0.and post-menopausal women (Parikh and Yanovski. Of the 85 children.95 1558..05 (one-way ANOVA) Figure 1. The earlier study by Carruth and Skinner has suggested a possible role of dietary calcium in moderating body fat levels in children (Carruth and Skinner.4 19. Studies conducted in children are limited.63 263. 2004). This relationship has been demonstrated in both black and white cohorts and in pre.96 1508.79 1.10 3.93 0.4 251.76 526.5 0. The strength of the relationship between dairy and calcium intake and body fat and body weight mainly derives from studies conducted in adults (Shapses et al. Another recent study which was set out to investigate risk of prepubertal bone fractures and milk intake.41 0.26 1.61 Boys (n521).09 3.16 530. 2004).7 266.. mean¡SD Age (year) Weight (kg) Height (m) BMI Calcium intake/d (mg) Energy intake/d (kcals) 9. 14 derived their calcium mainly from dairy sources and 71 from non-dairy sources (Figure 1).5 sources tended to be of smaller body weight than children with calcium derived mainly from non-dairy sources.00 11.19 559. suggested that children who avoid milk are more likely to be of heavier weight than children who do not avoid milk (Goulding et al.31 1.1 648.10 3.4 19.8 0.23 38. Body weight and source of dietary calcium in children .86 604.09 36 1. mean¡SD 9. mean¡SD 9.6 1.2 38. after adjusting for age and energy intake. Discussion This study set out to investigate a possible relationship between habitual dietary calcium intake and body weight in a group of 7–10 years old London children. 2003).91 Girls (n564). which however was not statistically significant.87 Table I. 2003).88 11.37 19. 340 All subjects (n585).32* 1708.NFS 36.04 9. Body weight and BMI in relation to habitual calcium intake in children Note: *Significantly different compared to the calcium intake of girls: p.

J. Recker. Obes. I. The different rates of growth and development in boys and girls. J. It is important for future studies to measure levels of body fat in children together with body weight in conjunction with calcium intake in order to elucidate the original hypothesis. Coll.B. pp... Grunwald. E. R. Clin. S. J. Calcium and body weight in children 341 .J. It is important to note. J. Children. Melanson.M. 2. Vol. digestibility of fat. References Carruth. Davies.K. National Diet and Nutrition Survey.. Flatt. 4635–8. Goulding. Huth. In another study by Phillips et al. Assoc. pp.J.. and Yanovski. ‘‘Calcium intake and adiposity’’. S. Am. Vol. 2003).. Rockell. Nutr. Vol. Int.M. we found no significant correlations between body weight or BMI and habitual intake of dietary calcium in this age group in both boys and girls. Am. Jones.. 196–203.P. Am. ‘‘Managing obesity in children’’. Metab. Matayka. T. should be strongly encouraged to regularly include calcium-rich foods and beverages in their diets because of the general well documented effects of calcium on bone mass and overall health..P. (2003). that percentage of body fat was not measured in this study. Anthropometric measurements in children of this age must be interpreted with some caution due to the growth and development patterns seen (Gregory and Lowe.In our study. Rafferty. which is in contrast with the results of similar studies conducted in adults.. K. Lappe. ‘‘High dietary calcium reduces body fat content.E. and Harris. dairy food consumption. The finding that children who derived their dietary calcium mainly from dairy sources tended to be of a smaller body weight than children who derived their calcium mainly from non-dairy sources. Heaney. J. J. Davies. 250–3. and serum vitamin D in rats’’. ‘‘Children who avoid drinking cow’s milk are at increased risk for prepubertal bone fractures’’.P... body weight and fatness were investigated in a total of 196 non-obese pre-menarcheal girls aged 8–12 years who were enrolled between 1990 and 1993. 11.. however. (2001). Obes. They found no evidence that dairy food consumption was associated with BMI or per cent body fat during adolescence (Phillips et al. ‘‘Calcium intake and body weight’’. Int. The Stationary Office. J. G. 152S–5S.. 2. Obes. J. Diet. ‘‘Relation between calcium and fat oxidation in adult humans’’. (2002). however. 104 No.R. 281–7.. Vol. ‘‘The role of dietary calcium and other nutrients in moderating body fat in preschool children’’.T. J. S. Prac. pp. Nutr. Heaney. Girls were followed until 4-year postmenarche. Donahoo.R. pp. R. E. Vol. Vol. S. Schneider.E. Parikh. K.. London. 2000).E. Papakonstantinou. and Lowe. and Hinders.. and Barger-Lux. P. and Hill. Sharp... pp. Vol. (2003). Barger-Lux. J. and Williams. B. pp.O. 4. in addition to the gender imbalance in this study (21 boys and 65 girls).L.A. may have had some effect on the results. 387–94.. ‘‘Calcium and weight: clinical studies’’. R.. K. (2003). J. (2004). Vol. K. Obes. (2000). A. Black. was not statistically significant and may be reflective of the low number of subjects.M. A.A. J. and Skinner. Grant. 85. M. (2000)...D. R. R. Res.. 77.M. W.J. 2–6.M. (2003). 27... Gregory. 559–66. pp. J. Clin. One explanation for our findings could be that the possible effect of calcium on adiposity and body weight is more pronounced in adulthood than in childhood. (2002). 25. W. pp. Edocrinol.M.. J.

‘‘Effect of calcium supplementation on weight and fat loss in women’’. J. Dirienzo.A.M. J. Metab. Obes. J. E. D. ‘‘Dairy food consumption and body weight and fatness studied longitudinally over the adolescent period’’. Shi. Obes.G.. ‘‘Mechanism of adiposity and obesity risk by dietary calcium: mechanism and implications’’. and Must. Corresponding author V. and Yanorski. Int.. Bandini. 103. Carruth.5 342 Parikh. Heshka. R.. J. and Zemel. and Heymsfield. Vol. 133.B. B... Uwaito. (2003). J. M. Vol. 249–51..emeraldinsight. Colclough-Douglas. Morris. 89. 1626–31. Am. M... pp. H. Endocrinol. S. Semega-Janneh. ‘‘Effects of dietary calcium on adipocyte lipid metabolism and body weight regulation in energy-restricted aP2-agouti transgenic mice’’.. pp. P. 1196–9. (2004).J.B.. L. Nutr. Vol. Zemel. Teegarden.. Reynolds. A.J.com/reprints . FASEB J.A.. M.B. Endocrinol. (2004).. A. W. Diet. Vol. G. pp. (2003). (2003). pp. D. S. J. 632–7. Phillips.25 dihydroxy vitamin D concentrations in healthy adult’’. Clin.D. 27.com Or visit our web site for further details: www.. 15. pp. 252s–6s. S. pp. K. S. (2004). 12. Freedman. 1106–13. Vol. M. J. Skinner. pp. 89.gr To purchase reprints of this article please e-mail: reprints@emeraldinsight.I. Metab.. pp.. Milstead. ‘‘Calcium intake and reduction in weight or fat mass’’. S... Elderman. Nutr. (2003).. Naumova. Vol. Thompson. Bounds. M. 133. P. Costarelli can be contacted at: costarv@hua.. Vol.B. Vol. Cyr. Res. Clin. ‘‘The relationship between obesity and serum 1. ‘‘Calcium and dairy acceleration of weight and fat loss during energy restriction in obese adults’’. 582–90. Shapses. 291–3. (2001). J.. H. Assoc. Zemel. W. S.R..NFS 36. ‘‘Longitudinal calcium intake is negatively related to children’s body fat indexes’’.. J.. and Campbell. and Ziegler.

They also consumed significantly fewer calories than the controls (10.7 MJ per day).1108/00346650610703199 . 1996). London. Keith and all the footballers that took part E in the study. namely carbohydrate.8 v. protein and fat. Football Paper type Research paper Nutritional knowledge and dietary intakes 343 Introduction Football can be a physiologically demanding game that is characterized by irregular changes of pace and anaerobic efforts superimposed on light to moderate aerobic activity (Reilly and Doran. However. Mr J. Adequate protein intakes are also essential to enhance tissue repair and strength and supply amino acids for oxidation to provide energy during intense prolonged exercise (Lemon. 1994). Keywords Nutrition. which consequently contributes to fatigue and a reduction in performance (Hargreaves. Nutritional knowledge had little impact on dietary intakes. players who resided in the soccer club hostels had significantly greater energy intakes.emeraldinsight. Design/methodology/approach – Seven day dietary records and nutritional knowledge questionnaires were analyzed and anthropometric measurements were taken mid-way through the competitive season. Nutrition & Food Science Vol. fine motor coordination and skill performance (MacLaren. Many youth soccer players are still growing and this puts further stress on their energy and nutrient reserves.05) than players who lived in their parental home. 5. protein. as well as maintain general health. 343-348 Emerald Group Publishing Limited 0034-6659 DOI 10. 2000). and less than the recommended amounts for soccer players. This places a heavy demand on the body’s liver and muscle glycogen stores. Both groups could benefit from increasing their carbohydrate intakes. 1994). reduce fatigue and allow players to train for a longer duration and recover faster between sessions. The nutrients energy.com/0034-6659. Appropriate nutrition can optimize energy stores for competition.6 ¡ 1. UK Abstract Purpose – To determine how nutritional knowledge and residential status influences the diets of a group of young professional football players and compare them to controls of the same age. 13. 36 No. The importance of carbohydrate cannot be over emphasized since carbohydrate depletion causes fatigue which may disrupt concentration. Findings – The football players.htm Nutritional knowledge and dietary intakes of young professional football players Sue Murphy and Yvonne Jeanes Roehampton University. Originality/value – It was identified that youth players require assistance in the implementation of their knowledge of nutrition to their own diets. The physiological demands of growth mean that there are additional nutritional requirements. in order to optimize their playing ability and provide the energy they need for growth. although fat and protein intakes were appropriate. 2006 pp. calcium. Diet. with a mean body mass index of 23. In particular they need to increase their nutritional intakes inline with recommendations. and iron The authors would like to thank Mr R. Reeves. 0. A suitable nutritional intake that contains a variety of nutrients and adequate amounts of energy is essential to supply the required fuel sources.89 + 0. This is particularly true for those who live away from the scrutiny of the football club.2 kg m2 and body fat of 15. consumed more carbohydrate and less fat (p .26 + 1.3 ¡ 3 per cent were significantly lighter than the controls.The current issue and full text archive of this journal is available at www.

05) in the mean scores of the nutrition students and the football players. tailored for football players. The aim of this study was to determine some of the factors including nutritional knowledge and residential status that influence the diets of a group of professional football players from a Premier division and a 1st division football clubs youth squads. hydration and weight control. This method prevented artificially high scores since random responding would tend to sum to zero rather than 50 per cent. For comparative purposes. There was a significant difference (p . The questionnaire was piloted using university students studying nutrition. which tested their knowledge of nutrition. The diaries were then analyzed using Diet 5 (Univation.5 times BMR. These are equations based on individual body weights. . Aberdeen). vitamins and minerals. that the subjects are not recording all foods consumed. including the type and brand. availability. In fact studies on footballers have shown that most (Ingram and Davies. the maximum possible score was therefore 100 per cent. Questions were included from the following categories: energy. supplements. To estimate body fat. Subjects were measured bare footed. Height was measured using a portable stadiometer to the nearest 0. This score was then used in subsequent analyses. how the food was cooked and the amount consumed. 1995). Germany) to the nearest 0. Both sections of the questionnaire were combined and presented as a percentage. For the multiple choice section of the questionnaire correct responses were scored as 1 and incorrect as 0. Body mass was measured with a digital balance (Seca. macronutrients. living situation and were asked to complete a questionnaire. To eliminate the possibility of under-reporting. The participants were provided with verbal and written instructions on how to complete a 7 day food diary. As well as the energy requirements of exercise and growth there are many factors that affect food intake including access.5 344 have been highlighted as being particularly important in supporting growth (National Dairy Council. one club was in the English premier league and the other in the first division. For the true or false section correct answers scored 1 whereas incorrect answers scored 21. the basal metabolic rate (BMR) of all participants was calculated using the FAO/WHO/UNU (1985) equations. The participants were interviewed about their exercise and training schedules. If energy intakes are less than 1. which they were asked to carry with them at all times and record everything they ate and drank. Methodology Thirty five players were recruited mid-season from two professional football clubs. This entailed ten multiple choice questions and ten questions in a true/false format. 1996) do not consume a diet considered compatible with peak physical performance and leave much room for improvement. 0.NFS 36. A full description of the foods consumed was requested. heels together with heads in the Frankfort plane.1 kg. individual circumstances such as living conditions and nutritional knowledge. The balance was calibrated for accuracy with known weights. 20 controls who did not participate regularly in sport were also recruited. Any subjects thought to be underreporting were eliminated from the study. this suggests that unless there is a loss in body weight. Twentytwo players with a median age of 17 years (range 16–19 years) completed the study.5 cm. Whilst many football players are aware of the importance of diet very few actually employ ideal dietary practice.

05) lighter.04 3* 1. This is below the recommendations for football players whereby more than 55 per cent of the diet should be made of carbohydrate rich foods. or 6 g kg21 day21 (Economos et al. T-tests and Pearsons correlations were calculated using SPSS (v 10. There was no significant difference in age between the two groups. had a lower body mass index and less body fat than the controls. sub-scapular and supra-iliac and calculated using the Durnin and Womersley (1974) equations. The energy and macronutrient intakes of youth football players and controls (mean ¡ SD) .05 17 104. Football players 1.1 32 87. although both groups would benefit by increasing their intakes.3 0.6** 11** Table II.05. UK) to the nearest 0. and show that the football players ate significantly (p .1 1.9 ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ 1. The football players consumed 51 per cent of their energy from carbohydrate and an equivalent of 4.1 135 31. 0. **p .54 MJ day21 recommended for adolescents (Department of Health.75 72. 0. Football players 10.9 24.26 51 310. In addition.3 grams per kilogram of body weight per day (g kg21 day21).80 87.9 ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ 0. triceps.8 4* 22 2 16 3 4 1 1 Controls 13.7 117 6.73 31.9 373 15. A significance level of p.05) less than the controls and their intakes were below the 11.05 was adopted. 0. 1998). Results The participants’ anthropometric characteristics are presented in Table I. A difference of 4 per cent Nutritional knowledge and dietary intakes 345 Variable Height (m) Weight (kg) Body Mass Index (kg m22) Body fat (per cent) Note: * p.1) and graphed using Excel (Microsoft Corporations) software. however the football players were significantly (p .7* 5..1 mm.0.6 15.05.07 4.skinfolds were measured using Harpenden calipers (British Indicators.7 0. Total body fat was estimated from the sum of four skinfold values taken at the biceps.3 23. 0.1 26.05) more carbohydrate as a percentage of energy intake than the controls.1 ¡ ¡ ¡ ¡ 0. 1999).0. All data are presented as mean values ¡ standard deviation (SD).01.2 5 Controls 1. Anthropometric characteristics of youth football players and controls (mean ¡ SD) Nutrient Energy (MJ) Carbohydrate (per cent) Carbohydrate (g) Protein (per cent) Protein (g) Fat (per cent) Fat (g) Alcohol (per cent) Alcohol (g) Notes: *p .89 44.3 13 5 2* 0.0 32 2. 0. Results of energy intake and macronutrient consumption are shown in Table II.0 ¡ ¡ ¡ ¡ 0. The football players consumed significantly (p . the macro-nutrients were not consumed in optimal proportions. 1996) as well as the guideline of 14–15 MJ day21 for football players (Shepherd.6* 3* Table I.

1 189 3 Controls 82. Correlation between carbohydrate intake and nutritional knowledge score was determined by carrying out a Pearsons correlation.5 346 between the average amount of carbohydrate consumed and the recommendations may seem minor but for some individuals this deficit was as much as 15 per cent and such an amount is likely to affect performance (Brouns. Although protein was consumed in adequate amounts it was still below the 142 g day21 consumed by elite soccer players reported by Rico-Sanz et al. 0. p . This is probably a sensible decision on behalf of the football players since even small quantities of alcohol can produce a Table III.82 ¡ ¡ ¡ ¡ 6 4. it was revealed that players who resided in the club hostel had significantly greater energy intakes.2. 1998). 2002). you would expect the more a player knew about nutrition the greater they would understand the need for high intakes of carbohydrate.82 665 11. Fat intakes were also appropriate in both groups but for a comparison were less than the 158 g day21 consumed by Greek football players (Hassapidou et al. The controls reported drinking alcohol between two and four times a week. which was below recommendations for both groups (Department of Health.. Similar patterns were seen in the control subjects.3. however the football players rarely drunk.07).14 ¡ ¡ ¡ ¡ 4. When player living situation was investigated.6 3.05) more fat. There was a disparity between nutritional knowledge and the nutritional practices employed by the players. There were no significant differences in the diets consumed by the players from the premier division club and those from the first division club.NFS 36. 1998). From this it was revealed that carbohydrate intake and nutritional knowledge were poorly correlated (R 5 0. The football players could do with increasing their energy intakes inline with recommendations for athletes (Economos et al. 2000). For example.1 4. with the exception of calcium.5 626 17. p . The micronutrient intakes of youth football players and controls (mean ¡ SD) Nutrient Vitamin C (mg) Vitamin E (mg) Calcium (mg) Iron (mg) Football players 90. 0. 0. Discussion Measurements of body composition are necessary in order to assess appropriate nutritional intakes and the fact the football players were lighter and had less body fat may account for and be a result of the differences in energy intakes between the two groups...9 5. 1996). 0. Alcohol was consumed in very small quantities by the football players and significantly (p . 0. however the controls consumed significantly (p . consumed more carbohydrate and less fat (p . It is also recommended that the football players increase their carbohydrate intakes since low carbohydrate intakes are also associated with less distance covered and lower speeds during matches (Rico-Sanz et al.06).01) less than the controls.05) than players who lived in their parental home. This was not the case for the control subjects. Both protein and fat were consumed in appropriate amounts by both groups. Energy intake and nutritional knowledge score were also weakly correlated (R 5 0.5 320 48 . (1998). Adequate intakes of all vitamin and minerals were consumed (Table III).

and Womersley. in reality this rarely occurs. Journal of Sport Science. J. FAO/WHO/UNU (1985). pp.D. (1974). pp. 12 No. 4. 191–4. faster recovery. Many studies have shown even when life and/or livelihood dependant. Vol. J. pp. M. Nutritional knowledge and dietary intakes 347 . Vol.. (2001). 96 No. Vol. Durnin. Nutritional guidance may be particularly beneficial to those who live away from the scrutiny of the football club. John Wiley & Sons. J. and do not relate general nutritional advice to their own lifestyle habits (Fieldhouse. Dietary Reference Values. L.G.V. 30 No. pp.negative effect on aerobic performance. (2002). C. Vol. Nutrition and Food Science. 2002). London.. (2000). 16 No. Yet when given accurate information about their own individual intakes. Yet this is no reflection on their level of education or the dietary information provided. F. Ingram. ‘‘Body fat assessed from total body density and it’s estimation from skinfold thickness: measurements on 481 men and women aged 16–72’’. 2000). 381–94. Essentials of Sports Nutrition. 1. 77–97.N. pp. There is a need to improve understanding of personal dietary intakes in order to improve personal attitudes towards and desire to modify dietary habits. Even in those clubs which do provide a good level of nutritional education perhaps in conjunction with a college based training programme this knowledge does not always manifest itself into a good diet. 12–14. and Davies. 6. pp. subjects are still reluctant to alter their habitual diets (Webb. 1999). Botrz. 1993). Food and Nutrition: Customs and Culture. S. Economos. Fieldhouse. it more likely improvements will be made (Raats et al. (1998). T. P. and Liarigovinos. (1996).. Protein and Energy Requirements. ‘‘Nutritional practices of elite athletes’’. 13–16. who studied female university athletes. In theory nutritional education should have an impact on the adequacy of food choices however. although anaerobic performance may not be affected (O’Brien. ‘‘Nutritional awareness of professional football teams with particular reference to carbohydrate’’. London. Sports Medicine. Hassapidou. 32 No. WHO Press. HMSO. Grammatikopoulou. Hargreaves. Lemon. there was a disparity between nutritional knowledge and the nutritional practices employed by the players. hence generally there is a large disparity between nutritional knowledge and the dietary practices employed (Packman and Kirk. Vol. This discrepancy may be due to the fact that most subjects are over optimistic about their own diets. (1994). These dietary changes can then in turn lead to an improvement in the football players’ physical condition. British Journal of Nutrition. maintain growth and ultimately better performance on the pitch. L. ‘‘Dietary intakes of Greek professional football players’’. 1.S. 1. 1998). P. Chichester. Technical Report Series 724. In accordance with the findings of Rockwell et al. Department of Health (1996). Journal of Sports Science. Routledge. S17–22. ‘‘Protein requirements of soccer’’.E. References Brouns. Vol. (1994). provide better protection against injuries. and Nelson. 12 No. Nutrition and Food Science. M. M. Geneva. ‘‘Carbohydrate and lipid requirements in soccer’’. Conclusions It is apparent that the players need assistance in the implementation of their knowledge of nutrition to their own diets. 3. to increase their nutritional intakes in line with recommendations. (1998).A.

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MacLaren, D. (1996), ‘‘Nutrition’’, in Reilly, T. (Ed.), Science and Soccer, E & FN Spon, London. The National Dairy Council (1995), Nutrition and Teenagers, Fact File Number 5, London. O’Brien, C.P. (1993), ‘‘Alcohol and sport; the impact of social drinking on recreational and competitive sports competition’’, Sports Medicine, Vol. 15 No. 2, pp. 71–7. Packman, J. and Kirk, S. (2000), ‘‘The relationship between nutritional knowledge, attitudes and dietary fat consumption in male students’’, Journal of Human Nutrition and Dietetics, Vol. 13 No. 6, pp. 389–95. Raats, M.M., Sparks, P., Geekie, M.A. and Shepherd, R. (1999), ‘‘The effects of providing personalized dietary feedback’’, Patient Education Counsel, Vol. 37 No. 2, pp. 177–89. Reilly, T. and Doran, D. (2000), ‘‘Science and Football: A review’’, Journal of Sports Science, Vol. 19 No. 3, pp. 181–93. Rico-Sanz, J., Frontera, W., Mole, P., Rivera, M., Rivera-Brown, A. and Meredith, C. (1998), ‘‘Dietary and performance assessment of elite soccer players during a period of intense training’’, International Journal of Sports Nutrition, Vol. 8 No. 8, pp. 230–41. Rockwell, M.S., Nickols, S.M. and Thye, F.W. (2001), ‘‘Nutritional knowledge and practices of coaches at University’’, International Journal of Sport Nutrition and Metabolism, Vol. 11 No. 3, pp. 174–85. Shepherd, R. (1999), ‘‘Biology of medicine and soccer’’, Journal of Sport Sciences, Vol. 17 No. 10, pp. 757–86. Webb, G. (2002), Nutrition a Health Promotion Approach, Arnold, London. Corresponding author Yvonne Jeanes can be contacted at: y.jeanes@roehampton.ac.uk

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Probiotic acidophilus milk for infants and children
S. Sarkar
Department of Quality Assurance at Metro Dairy Limited, Kolkata, West Bengal, India

Probiotic acidophilus milk

349

A.K. Misra
Department of Dairy Bacteriology, Faculty of Dairy Technology, West Bengal University of Animal and Fishery Sciences, West Bengal, India
Abstract
Purpose – The objective of the present investigation is to evaluate the effect of incorporation of Bifidobacterium bifidum NDRI and Propionibacterium freudenreichii subsp. shermanii MTCC 1371 along with Leuconostoc acidophilus R on the technological and dietetic behaviour of starter cultures and to assess their suitability for the manufacture of probiotic acidophilus milk for infant feeding. Design/methodology/approach – The paper assesses the effect of incorporation of Propionibacterium freudenreichii subsp. shermanii MTCC 1371 and Bifidobacterium bifidum NDRI with Lactobacillus acidophilus R on the technological and dietetic characteristics and their suitability for the manufacture of probiotic acidophilus milk. Findings – Based upon the results of technological and dietetic characteristics of starter cultures, conjugated use of Propionibacterium freudenreichii subsp. shermanii MTCC 1371 and Bifidobacterium bifidum NDRI with Lactobacillus acidophilus R, inoculated at 1 per cent level individually and incubated at 37¡1 ˚C for 12 h, is recommended for the manufacture of probiotic acidophilus milk with better nutritional and therapeutic properties. Probiotic acidophilus milk may be recommended for feeding normal as well as lactose-intolerant infants. Originality/value – The paper offers an assessment of the suitability of probiotic acidophilus milk for infant feeding. Keywords Milk, Diet, Nutrition, Infants Paper type Research paper

Introduction Breast milk is considered superior over any other modified infant formula due to its inherent properties and advantages. In the absence or with insufficient production of breast milk, various modified milk formulae developed may be nutritionally adequate but could not confer any protection to the infants. Technological innovations made in the commercial infant milk powder have not been able to meet the critical nutritional and physiological needs of infants (Thompkinson and Mathur, 1995). Under this circumstance, various cultured milk products developed for infants and children can be a practical and suitable substitute (Sarkar, 2003). Lactobacilli is the normal resident of gastro-intestinal tract (Mitsuoka, 1992) and capable of restoring the normal microbial balance in the intestine (Garvie et al., 1984), whose application during the manufacture of cultured milk products are proposed to exert ‘‘probiotic’’ effects in humans (Gilliland, 1989). Bifidobacteria based cultured milk products may be beneficial as a probiotic for improving the intestinal flora and for maintaining the healthy intestinal conditions of infants during and after weaning Nutrition & Food Science (Fukushima et al., 1997; Fukushima and Yamano, 2003). Vol. 36 No. 5, 2006 Propionibacterium spp. is reported to synthesise vitamins (Skupin et al., 1974), pp. 349-356 Limited exhibit antagonism (Al-Zoreky et al., 1993) and possess b-D-galactosidase activity E Emerald Group Publishing 0034-6659 DOI 10.1108/00346650610703207 (Kujawski et al., 1990). Inclusion of Propionibacterium freudenreichii subsp. shermanii

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with Lactobacillus acidophilus resulted in a product, which was more efficacious than acidophilus milk in preventing the gastro-intestinal disease in infants (Nabukhotnyi et al., 1983). Reddy (1989) suggested associative application of propionic acid bacteria with Lactobacillus acidophilus, Bifidobacterium bifidum and Leuconostoc citrovorum during the preparation of dietary supplements for enhanced viability of these organisms in the human intestinal tract. The objective of the present investigation was to evaluate the effect of incorporation of B. bifidum NDRI and P. freudenreichii subsp. shermanii MTCC 1371 along with L. acidophilus R on the technological and dietetic behaviour of starter cultures and to assess their suitability for the manufacture of probiotic acidophilus milk for infant feeding. Materials and methods Type of milk Reconstituted skim milk (SM) [0.5 per cent fat and 7.64 per cent solid non-fat (SNF)] was used for evaluating rate of acid production by starter cultures. Formulated milk (FM) was obtained on fortification of standardised cow milk (2.5 per cent fat and 10.46 per cent SNF) with vitamins A, D and E (Roche Chemicals, Bombay, India) at the levels of 500 IU, 80 IU and 750 mg respectively and addition of 12 per cent sucrose (Misra and Kuila, 1992). Different technological and dietetic attributes of starter cultures were evaluated in both SM and FM. Starter cultures Freeze dried cultures of Bifidobacterium bifidum NDRI (National Collection of Dairy Cultures, National Dairy Research Institute, Karnal, India) and Propionibacterium freudenreichii subsp. shermanii MTCC 1371 (Institute of Microbial Technology, Chandigarh, India) were maintained in sterile SM containing 1 per cent dextrose and 0.1 per cent yeast extract as suggested by Misra and Kuila (1991). Lactobacillus acidophilus R (National Collection of Dairy Cultures, National Dairy Research Institute, Karnal, India) was maintained in plain sterile SM. Pathogenic cultures Virulent pathogenic strains of Bacillus cereus, Shigella dysenteriae (National Collection of Dairy Cultures, National Dairy Research Institute, Karnal, India), Escherichia coli 03, 018, 078 and Salmonella typhimurium P3 (Department of Veterinary Microbiology, West Bengal University of Animal and Fishery Sciences, Nadia, India) were maintained on nutrient agar slants (Hi-Media, Bombay, India) by weekly propagations and were activated by three successive transfers at 24 h intervals in nutrient broth (Hi-Media, Bombay, India). Analytical techniques Technological characteristics Technological attributes of starter cultures were evaluated on the basis of titratable acidity (BIS, 1960), diacetyl and acetoin production (King, 1948), volatile acidity (Hempenien and Liska, 1968) and extent of proteolysis (Hull, 1947). Dietetic characteristics Dietetic attributes of starter cultures were evaluated on the basis of lactic acid content (Barker and Summerson, 1941), lactose hydrolysing activity (Citti et al., 1965), antibacterial activity (BSI, 1968) and bile salt tolerance using Man Rogosa Sharpe (MRS) broth (Hoier, 1992).

acidophilus R may be suggested for the manufacture of probiotic acidophilus milk for infant feeding. Effect of incorporation of P. Conjugated use of P.206 12 FM 1.360 0. B: rate of acid production by Lactobacillus acidophilus Bifidobacterium bifidum . improvement could be observed after 8 h of incubation in SM (1. FM: formulated propionibacterium on the milk.116 0. acidophilus R in association with B. acidophilus R also induced an improvement in the rate of acid production in FM (0. Because the starter cultures attained the desired level of acidity of 0.1 N NaOH/50 g curd) even after introduction of B. Parker and Moon (1982) reported a beneficial synergistic effect on volatile acid production between L. Volatile acidity.5 ml 0. acidophilus has been reported (Anand et al.378 0.865 1.260 1.567 0.333 Acid production (per cent lactic acid) Duration of incubation at 37¡1 ˚C (h) 8 FM SM FM SM 0.783 0. LA: Lactobacillus acidophilus.368 1. Prasad and Gandhi. acidophilus and P. bifidum and L.368 per cent lactic acid) throughout the incubation.0. Incorporation of P.315 0.378–1.990 1. freudenreichii subsp. freudenreichii subsp. was investigated. Extent of volatile acid production by L. freudenreichii subsp. shermanii MTCC 1371. bifidum NDRI along with L. shermanii MTCC 1371 and B.261 0. shermanii MTCC 1371 with L.864 0. The volatile acidity expressed in terms of ml 0.468 0.783 0..405 0.116 per cent lactic acid). however.6–0. shermanii. Probiotic acidophilus milk 351 4 Starter culturesa LA LA+P LA+B LA+P+B SM 0. acidophilus R and its association with P. expressed in terms of lactic acid in autoclaved SM and FM.7 per cent as suggested by Foster et al. bifidum NDRI showed no improvement in volatile acid production in either of the milks. freudenreichii subsp. freudenreichii subsp.052 1. A minimum incubation period of 12 h for optimum antibacterial activity of B.585 0. significant improvement (p.495 0. bifidum NDRI. however. L. bifidum NDRI with L. shermanii MTCC 1371 in SM remained unaltered (2. Effect of incorporation of bifidobacterium and Notes: aAll cultures were inoculated at 1 per cent level individually. acidophilus R in association with P.1 N NaOH/50 g curd is depicted in Table II. Incorporation of B.05) could be registered in SM due to its association with P.Statistical analysis Results obtained in the present investigation were analysed statistically by the method of Snedecor and Cochran (1967). an incubation period of 12 h was recommended. Incorporation of B. freudenreichii subsp. keeping in consideration the dietetic characteristics. Results and discussion Technological characteristics Titratable acidity. SM: skim milk. bifidum NDRI and P. bifidum NDRI were higher in FM than in SM (Table I). 1984. shermanii MTCC 1371 with L. 1987). incubated at 37¡1 ˚C. freudenreichii subsp. shermanii MTCC 1371 and/or B. acidophilus R in FM induced an improvement in acid production throughout the incubation.622 0. Rate of acid production by L. acidophilus R on the rate of acid production. (1958). freudenreichii subsp. acidophilus R induced a higher rate of acid production after 4 and 12 h of incubation in SM and throughout the incubation in FM. shermanii MTCC 1371 and B. shermanii. P: Propionibacterium freudenreichii subsp. bifidum NDRI with L.332 Table I.126 1.513 0.

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Brown and Townsley (1970) reported Bifidobacterium cultures to produce less than 0.05% volatile acidity. Diacetyl and acetoin content. The diacetyl and acetoin contents along with volatile acids contribute to the characteristic aroma and flavour of the product. Incorporation of P. freudenreichii subsp. shermanii MTCC 1371 with L. acidophilus R induced a significant (p,0.05) improvement in diacetyl and acetoin production, irrespective of the type of milk. However, introduction of B. bifidum NDRI with L. acidophilus R induced an improvement in diacetyl and acetoin production only when cultured in SM (Table II). B. bifidum cultures are reported to produce mainly acetoin while diacetyl is present only in traces (Dolezalek and Plockova, 1981). Conjugated use of P. freudenreichii subsp. shermanii MTCC 1371 and B. bifidum NDRI with L. acidophilus R resulted in a significant (p,0.05) improvement in diacetyl and acetoin production, irrespective of type of milk used. Conjugated use of all these three cultures in the manufacture of probiotic acidophilus milk is recommended. Proteolytic activity. It is difficult to set certain parameters of selection because proteolysis exerts opposite effects, such as an increase in the digestibility (dietetic characteristic) and a decrease in the consistency or flavour of culture (technological characteristic). The results pertaining to the proteolytic activity of starter cultures, expressed in terms of mg tyrosine/ml are given in Table II. L. acidophilus R alone or in association with P freudenreichii subsp. shermanii MTCC 1371 and/or B. bifidum NDRI had significantly (p,0.05) higher proteolytic activity in SM than in FM. L. acidophilus R in association with B. bifidum NDRI and/or P. freudenreichii subsp. shermanii MTCC 1371 showed no improvement in proteolytic activity in SM, however, a significant (p,0.05) improvement was registered when cultured in FM. Extent of proteolysis by L. acidophilus R in FM was higher when used in association with P. freudenreichii subsp. shermanii MTCC (240 mg tyrosine/ml) than with B. bifidum NDRI (200 mg tyrosine/ml). Results indicate P. freudenreichii subsp. shermanii MTCC 1371 to be more proteolytic in nature than B. bifidum NDRI. Proteolytic nature of B. bifidum (Misra and Kuila, 1991) and propionic acid bacteria (Brendehaug and Langsrud, 1985) has been reported. Conjugated use of P. freudenreichii subsp. shermanii MTCC 1371 and B. bifidum NDRI with L. acidophilus R may be suggested to have a moderate proteolytic activity and to satisfy both technological and dietetic criteria of probiotic acidophilus milk.

Starter culturesa

b-D-gal Volatile Proteolytic actosidase activity Lactic acidity (ml 0.1 Diacetyl Titratable acid activity acidity (per cent N NaOH/ and acetoin (mg tyrosine/ ml) (mg/ml) (mg ONP/ml) lactic acid) 50 g curd) (ppm) SM FM SM FM SM FM SM FM SM FM SM FM 1.052 1.116 0.855 1.206 1.126 1.368 1.260 1.332 1.5 2.5 1.2 2.5 1.8 0.8 0.5 1.5 5.0 9.0 7.0 10.0 5.0 7.0 4.6 11.0 440 310 215 240 170 240 200 187 330 320 330 330 220 220 220 220 108 95 85 86 38 33 31 44

Table II.
Effect of incorporation of bifidobacterium and propionibacterium on the technological and dietetic characteristics of Lactobacillus acidophilus

LA LA+P LA+B LA+P+B

Notes: aInoculated at 1 per cent level individually and incubated at 37¡1 ˚C for 12 h. SM: skim milk; FM: formulated milk; LA: Lactobacillus acidophilus; P: Propionibacterium freudenreichii subsp. shermanii; B: Bifidobacterium bifidum

Dietetic attributes Lactic acid. Lactic acid production was observed to be significantly (p,0.05) higher in SM (330 mg/ml) than in FM (220 mg/ml) by all starter combinations except for mixed cultures of L. acidophilus R and P. freudenreichii subsp. shermanii MTCC 1371, which produced the same degree of lactic acid (220 mg/ml) in both type of milk (Table II). Lactic acid production by L. acidophilus R in FM remained unaltered either due to incorporation of P. freudenreichii subsp. shermanii MTCC 1371 and/or B. bifidum NDRI. Results indicate disparity in the behaviour of P. freudenreichii subsp. shermanii MTCC 1371 in SM and FM. Lowering of lactic acid content may be due to its utilisation by P. freudenreichii subsp. shermanii MTCC 1371 as reported by Parker and Moon (1982). Incorporation of B. bifidum NDRI and P. freudenreichii subsp. shermanii MTCC 1371 with L. acidophilus R may be recommended for the manufacture of probiotic acidophilus milk for infant feeding without the risk of high acid load. Probiotic acidophilus milk with B. bifidum NDRI may be assumed to have L(+) lactic acid as a major form of lactic acid because in bifidobacteria based fermented milk, dominance of the desired L(+) lactic acid to a level of 90 per cent is reported (Klupsch, 1983). b-D-galactosidase activity. b-galactosidase (b-gal) activity of L. acidophilus R in association with P. freudenreichii subsp. shermanii MTCC 1371 and/or B. bifidum NDRI was observed to be significantly (p,0.05) higher in SM (85–108 mg ONP/ml) than in FM (31–44 mg ONP/ml). Introduction of P. freudenreichii subsp. shermanii MTCC 1371 or B. bifidum NDRI to L. acidophilus R showed lower b-gal activity with respect to control, irrespective of the type of milk (Table II). Conjugated use of L. acidophilus R, B. bifidum NDRI and P. freudenreichii subsp. shermanii MTCC 1371 in FM induced an improvement in b-gal activity. Presence of b–gal enzyme in L. acidophilus (Fisher et al., 1985), B. bifidum (Premi et al., 1972) and P. freudenreichii subsp. shermanii (Kujawski et al., 1990) has been reported. Conjugate application of all these three cultures is suggested to obtain probiotic acidophilus milk, which would be highly suitable for lactose-intolerant infants. Antibacterial activity. All starter combinations exhibited variable inhibitory activity against the pathogenic test organisms (Table III). Incorporation of P. freudenreichii subsp. shermanii MTCC 1371 with L. acidophilus R in SM induced an improvement in the antagonism against all the test organisms except for E. coli 078. However, when cultured in FM, an improvement in antagonism against S. typhimurium P3 could only be observed. Incorporation of B. bifidum NDRI also induced an improvement in antagonism against all test organisms in both SM and

Probiotic acidophilus milk

353

Starter culturesa LA LA+P LA+B LA+P+B

Diameter of zone of inhibitionb (mm) E.coli 03 E. coli 018 B. cereus S. dysenteriae S. typhimurium P3 E. coli 078 SM FM SM FM SM FM SM FM SM FM SM FM 6.5 7.0 7.0 7.5 7.0 7.5 7.5 8.0 6.5 6.5 7.0 7.0 7.0 6.5 7.5 7.5 5.5 6.0 7.0 7.0 6.5 6.5 7.5 8.0 5.5 6.0 6.5 6.5 6.0 6.0 7.0 7.0 5.5 6.0 6.0 7.0 6.0 6.0 6.5 7.0 6.5 7.0 7.0 7.0 7.0 7.0 7.0 8.0

Table III. Effect of incorporation of bifidobacterium and Notes: aInoculated at 1 per cent level individually and incubated at 37¡1 ˚C for 12 h. Including the propionibacterium on the diameter of the well (5 mm). SM: skim milk; FM: formulated milk; LA: Lactobacillus acidophilus, antibacterial properties of Lactobacillus acidophilus P: Propionibacterium freudenreichii subsp. shermanii; B: Bifidobacterium bifidum

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FM, however, no difference in antagonism against S. dysenteriae in FM could be observed. Acidophilus milk exhibited antimicrobial activity against 92 per cent Salmonella, 76 per cent Shigella and 67 per cent E. coli (Anon, 1999). Results indicate better antagonism of pathogens by L. acidophilus R when used in association with B. bifidum NDRI than with P. freudenreichii subsp. shermanii MTCC 1371. Amelioration in the antibacterial activity may be attributed to the production of a higher amount of antimicrobial compounds by increased B.bifidum NDRI population in mixed culture with L. acidophilus. R. Khedkar et al. (1994) registered viable cell counts of Bifidobacteria and L. acidophilus to be much higher in mixed culture. Conjugated use of B. bifidum NDRI and P. freudenreichii subsp. shermanii MTCC 1371 with L.acidophilus R exhibited improved degree of antagonism against all test organisms with respect to antagonism registered due to L. acidophilus R alone. Production of bacteriocin-like compounds, designated as MicrogardTM (Al-Zoreky et al., 1993), acidophilin (Shahani et al., 1977) and bifidin (Anand et al., 1984) by P. freudenreichii subsp. shermanii, L. acidophilus and B. bifidum respectively, has been reported. Banina et al. (1998) reported that antagonism of L. acidophilus may be due to lactic acid production rather than hydrogen peroxide or bacteriocin. Exhibition of maximum antagonism against all test organisms suggested conjugated use of P. freudenreichii subsp. shermanii MTCC 1371, B. bifidum NDRI with L. acidophilus R for the manufacture of probiotic acidophilus milk, which would compete with undesirable flora and maintain the normal gut flora of infants. Bile salt tolerance. The most important criteria for selection of a starter culture for the manufacture of a therapeutic product for infants are its ability to withstand and grow under the conditions prevailing in the intestine. Bile salt tolerance of starter cultures was determined by their capability to grow in the presence of 0.5, 1.0 and 2.0 per cent bile salt within 2 h of incubation at 37¡1 ˚C in MRS broth. Results showed that P. freudenreichii subsp. shermanii MTCC 1371 failed to grow in the presence of 0.5–2.0 per cent bile salt and hence were not bile salt tolerant. However, B. bifidum NDRI and L. acidophilus R had appreciable growth in the presence of 0.5 per cent bile salt. Survival of B. bifidum in the presence of 0.2 per cent sodium tauroglycocholate (Misra, 1988) and L. acidophilus in the presence of 0.15% oxgall (Brennan et al., 1986) has been reported. Shah and Jelen (Misra, 1992) have reported a higher bile salt tolerance of L. acidophilus and B. subsp. than in yoghurt cultures. Survival of L. acidophilus R and B. bifidum NDRI in the presence of bile salt suggested their use in the manufacture of probiotic acidophilus milk for infants with better prophylactic properties. Conclusion Based upon technological and dietetic characteristics, incorporation of B. bifidum NDRI and P. freudenreichii subsp. shermanii MTCC 1371 along with L. acidophilus R is recommended for the manufacture of probiotic acidophilus milk with enhanced dietetic properties. An inoculation rate of 1 per cent each culture and an incubation temperature of 37¡1 ˚C for 12 h are recommended for the manufacture of probiotic acidophilus milk. Probiotic acidophilus milk may be suitable for normal as well as lactose-intolerant infants and children and possess the capability to maintain the normal gut flora.
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Findings – Starter cultures possess the enzyme b-galactosidase. Nutrition & Food Science Significance of lactase enzyme Vol. commonly known as lactase is capable of hydrolyzing b-D-galactoside bond between D-galactose and glucose. increase in microbial lactase enzyme. 36 No. a membrane bound enzyme present in the brush border of the small DOI 10.htm Cultured milk products for lactose-intolerant recipients S. 2006 Lactose. This is followed by a discussion of lactase activities in starter cultures and cultured milk products for lactose-intolerant participants. a disaccharide composed of glucose and galactose. which render it suitable for lactose-intolerant subjects.com/0034-6659. b-galactosidase.emeraldinsight. Shahani and Chandan (1979) pointed out that cultured milk products may provide supplementary quantities of lactase and other constituent enzymes. Originality/value – Consumption of cultured milk products by lactose-intolerant recipients is suggested. 5.. India Abstract Purpose – The purpose of this paper is to enlighten the prophylactic aspect of cultured milk products. Reasons attributable for better digestion of cultured milk products than milk are reduction in lactose content. which render them more suitable for ingestion by lactose-intolerant recipients.1108/00346650610703216 . which include improvement of lactose digestion (Gilliland. required for lactose hydrolysis and their application led to the development of a number of cultured milk products. 1989). Kolkata. utilization of lactobacilli during the manufacture of cultured milk products are proposed to exhibit ‘‘health-promoting’’ or ‘‘probiotic’’ effect in humans.The current issue and full text archive of this journal is available at www. Design/methodology/approach – The paper outlines the significance of lactase enzyme and the mechanism of lactase digestion. 1965. animals and microorganisms. an endeavor has been made to enlighten the prophylactic aspect of cultured milk products. elaborated by cultures during fermentation. contributing towards the assimilation of lactose by lactose-intolerant individuals. In the present article. Metro Dairy Ltd. stimulation of host’s mucosal lactase activity and slower transit of cultured milk products as compared to milk. Bayless and Rosenweig. West Bengal. 1992) and capable of restoring the normal microbial balance in the intestine (Garvie et al. is the major solid pp. The enzyme is widely distributed in nature and has been isolated from plants. Digestive sysytem Paper type Research paper Cultured milk products for lactose 357 Introduction Inability of human beings to digest lactose is often referred to as ‘‘Lactose-intolerance’’ and has been attributed to insufficient amounts of lactase in the small intestine to hydrolyze lactose consumed in the diet (Littman and Hammond. Factors affecting lactase activity are described. 1966). which are more easily digestible than milk by lactose-intolerant individuals. Lactobacilli is the normal resident of gastro-intestinal tract (Mitsuoka. 357-364 Emerald Group Publishing Limited component of milk and must be hydrolyzed into its components under the influence of E 0034-6659 enzyme lactase. Keywords Milk. 1984). Sarkar Department of Quality Assurance.

Semenza and Auricchio (1995) registered reduction in lactase activity due to digestion of lactase–phlonizin hydrolase molecule by pancreatic proteases at the brush border membrane. acidophilus which remained above the recommended level of 106 cfu/mL. In case the quantum of lactose ingested exceeds the hydrolytic capacity of the available intestinal lactase. Lactose maldigestion occurs due to either gastro-intestinal disease or physiological decline in the intestinal lactase activity and may lead to clinical symptoms of lactose-intolerance. Congenital lactase deficiency Persons cannot tolerate lactose due to absence of lactase enzyme in the intestine. Mechanism of lactose digestion Lactic acid bacteria must survive the gastro-intestinal tract to provide the beneficial effect.. Lactase deficiency in premature infants This condition occurs in premature infants due to decrease lactase enzyme activity in the intestinal mucosa. Shah and Lankaputhra (1997) noted that rupturing of bacterial cells of yoghurt cultures reduced viable counts but the released intracellular b-galactosidase improved the viability of probiotic bacteria such as Bifidobacterium spp. 1998). Undigested lactose undergoes bacterial fermentation in the colon. stimulation of host’s mucosal lactase activity or slower intestinal transit of cultured milk product compared to milk (Kolars et al. 1980. 1984). abdominal cramps. 1996) Efficient utilization of lactose from cultured milk products than in milk may be attributed to improved digestion of lactose resulting from lactase activity of bacteria. Hofi. while still inside the bacterial cells. Microorganisms residing in the large intestine made themselves tolerant to lactose through modifications of their metabolic activity (Hertzler and Savaiano. 1984. Permeability of yoghurt cultures is altered. 1998). The sensitivity of yoghurt cultures to bile has been proposed as an advantage for lactose digestion.NFS 36. 1984). the undigested portion of lactose is transported to the large intestine. Hourigan. Initially. Gibson and Fuller. and L. are primarily responsible for various symptoms such as bloating. resulting in accumulation of lactose in the intestine causing abdominal pain and loose motion. infants cannot utilize lactose efficiently. carbondioxide and hydrogen. where it increases the osmolarity of the intestinal fluids. generating organic acids. flatulence. because it increases the permeability of the bacterial cell (McDonough et al. diarrhoea and loss of appetite (Hourigan. . Acquired lactase deficiency Adults and older children cannot tolerate large amounts of milk due to their nonhabitual consumption of milk resulting in low lactase in the intestinal mucosa. however they are able to tolerate and digest milk after one month due to increase in lactase activity. Deficiency of enzyme lactase may be of three types (Swaminathan.5 358 intestinal epithelial cell prior to its absorption by humans (Miller and Brand. Cells of yoghurt cultures contain b-galactosidase as an intracellular enzyme. 1984. when it comes in contact with bile so that lactose can enter and get hydrolyzed (Gilliland and Kim. which along with the large amount of water is drawn into the intestine.. 1990). 1987). therefore it is protected during passage through the harsh environment of stomach and is able to reach the small intestine.

1989) indicated that presence of lactase enzyme and viable flora are necessary for the beneficial effects. acidophilus or B.90 per cent lactose in small intestine of lactase-deficient subjects due to lactase activity of yoghurt cultures were noted (Streiff et al. 1988). bulgaricus. bifidum and propionibacterium freudenreichii subsp. lactis. 1998.. Cultured milk products containing Cultured milk products for lactose 359 . thermoplilus. 1989)...26 to 3. Gnomik – 2 (based on bifidobacterium). Leuconostor citrovorum. B. shermanii) were recommended for lactose – intolerant infants and children (Schacht and Syrazyski.5 to 9. which may be related to hydrolysis of lactose by L. acidophilus strains was reported to vary within a range of 0. 1976) and a decline in faecal lactase activity in lactase non-persistent human subjects consuming nonpasteurized yoghurt (Pochart et al. acidophilus. 1972. Zdorove – 2 (based on L. Sarkar and Misra. L.. bifidum). L. Effect of feeding cultured milk products on breath hydrogen test in humans is shown in Table I. Probiotic cultures such as lactobacillus acidophilus and bifidobacterium. Lactase activity of L. Lipatov et al. 2001) and Propiono-Acido-Bifido (PAB) milk (Sarkar and Misra. Sieber. Cultured milk products for lactose-intolerant recipients Better tolerance of yoghurt and acidophilus milk in comparison to milk by lactase non-persistent subjects has been reported (Alm. 1983).5 6 106 to 2. Short-term ingestion of acidophilus milk proved to be not better than milk (Newcomer et al.. 2000). S. 1984) and the later organism possess higher b-galactosidase activity than the former (Lee.. 1992). 1992.05 to 2. 1982. Efficacy of fermented and non-fermented acidophilus milk or bifidus milk is under debate for their benefits for lactose-intolerant subjects. L. 1998a.... acidophilus (2. 1992). bifidobacterium). butter milk or yoghurt-like product (based on S. 1975. A decline in lactose content from 5. 1990).19 per cent and an increase in glucose and galactose from 0. Progurt (based on streptococcus diacetylactis or S. 1992) and digestion of . 1974) and differs greatly in their lactase activity (Premi et al. namely Antoshka-L (based on bifidobacterium). cremoris. Roberts.. acidophilus or by lactase in gastro-intestinal tract or reduction in hydrogen producing bacteria (Fernandes and Shahani. possess lower levels of lactase and being more resistant to bile than yoghurt cultures are less efficacious in helping lactose digestion (Shah and Jelen. acidophilus. 1985) and this disparity may be due to micro-heterogeneity in the amino acid composition of lactose (Styrer. Kim and Gilliland (1983) reported that addition of a large number of L. lactic streptococci. Vesa et al. Efficient absorption of lactose by rats from yoghurt containing viable flora (Goodenough and Kleyn. bifidum) and PAB milk (based on L. 1998b).11 per cent in yoghurt (Abd-Rabo et al. 1996). 1990) suggested their conjugated use during the manufacture of cultured milk products such as dietetic yoghurt (Sarkar and Misra.5 units (Fisher et al.. 1985). Higher lactase activity of propionic acid bacteria than lactic acid bacteria (Kujawski et al. acidophilus and/or B... Variation in lactase activity of different strains of lactobacillus delbrueckii subsp bulgaricus and streptococcus thermophilus were noted (Gilliand and Kim.Lactase activity in starter cultures Galactose activity has been demonstrated in many lactobacilli (Mittal et al. A number of cultured milk products. and less than yoghurt (Shah et al. 1977. Fisher et al. however sonication of bacterial cells induced better tolerance by lactase non-persistent subjects and may be ascribed to elevation of lactase activity due to lysis of bacterial cells (McDonough et al. 1987).5 6 108 cfu/mL) to milk prior to ingestion improved lactose digestion and noted a reduction in breath hydrogen due to prolonged consumption of sweet acidophilus milk for 6 days. 1998b).

Galvao et al. 1984). 1998).. (1988) Gilliland and Kim (1984) Mc Donough et al. 1987).80 4. Dave et al.NFS 36..00 < 200. 1994). acidophilus depends on the growth temperature and pH of medium (Seema et al. (1987) Savaiano et al.90 5. (1993) registered higher b-galactosidase activity in dahi made from milk with higher total solids. which declined throughout the storage. which is dependent on buffering capacity of the medium (Conway et al. (1995) noted b-galactosidase activity of 0. 1998a). Effect of ingesting cultured milk products on breath hydrogen test in humans 4.0). 2001)... 106 cfu/mL is known to exhibit a positive prophylactic effect (Mijacevic et al. Microbial viability Strains of starter cultures must survive the gastro-intestinal tract.0610 8 Table I. Higher activity was also noted in formulated milk than in skim milk due to higher total solid content in the former milk (Sarkar and Misra.64 (mg/h g) 16108 – 1.30 33.8 (ONPG units) 3724 (mg glucose/dL) 0.06108 3. 1998) and survivality of greater number of bile – resistant lactobacilli strains in gastrointestinal tract have been reported (Gilliland et al. Factors affecting lactase activity Microbial growth conditions b-galactosidase activity of L. (1987) Onwulata et al.06108 – 2.3 units in yoghurt.. A decrease in enzyme activity between 4–6 h of incubation is due to an increase in titratable acidity (Kilara and Shahani. Acid tolerant strains have an advantage in surviving the low pH conditions in the stomach (pH 2. .40 < 50..1610 7 Breath hydrogen (ppm) Reference 28.20 6. (1989) Savaiano et al. thermophilus were tolerated well by infants and the higher level of hydrogen exhaled indicated an earlier bacterial colonization in the digestive tract.00 1593 9. (1984) Dewit et al. A viable population of .30 4.20 (ONPG units) 6.90 3. 1976.0 McDonough et al.. 1998b) decreased during refrigerated storage with increasing periods of storage due to shift in pH (Dave et al..58 to 3. bgalactosidase activity reached a maximum value (8 units/g). followed by lowering to a level of 3 units/g. before leveling off. Bile-salt tolerance is important for strains to grow and survive in upper small intestine (Toit et al. 1993).09 (units/g) 0 (mg/h g) 2.5 Cultured milk product Sweet acidophilus milk Lactose content (%) 6. Product processing and storage conditions Dave et al.80 Lactase Cell count activity (cfu/g) (cfu/g) 1427 (mg glucose/dL) 0. b-galactosidase activity in dahi (Dave et al.60 4. (Leke et al. 1993) and PAB milk (Sarkar and Misra..00 bifidobacterium and S. where hydrochloric and gastric acids are secreted (Toit et al. 1993). (1984) 360 Yoghurt 4.. 1999). During incubation of yoghurt cultures up to 4 h.

increase in microbial lactase.. T.. cheeses and cultured milk products in Brazil’’. O... Ahmed. ‘‘Breath hydrogen concentration and plasma glucose. ‘‘Lactose content and b-galactosidase activity in yoghurts.F.I. Better tolerance of cultured milk products than milk by lactose-intolerant subjects may be attributed to reduction in lactose content. F. (1995).S. F. 1–5. Nutrition. 70.. Egypt.68 per cent and differed with the strains of cultures adopted for dahi manufacture (Sarkar et al. pp. 4.C. and Rosenweig. 544–6. ‘‘Lactose intolerance and its modulation with lactobacilli and other microbial supplements’’. Vol. fresh and heated yoghurt ingestion by healthy young adults with or without lactose malabsorption’’. stimulation of host’s mucosal lactase activity and slower transit of cultured milk products in comparison to milk. M. Cole.. 1984).F. Conclusion Possession of b-galactosidase enzyme required for lactose hydrolysis by starter cultures led to their utilization for the manufacture of cultured milk products.M. Galvao. and Hewitt. Fernandes. ‘‘Survival of lactic acid bacteria in the human stomach and adhesion to intestinal cells’’.L. insulin and free fatty acid levels after lactose. pp. 32. 1989). suitable for lactose-intolerant individuals. pp. and Ray. 42. Dairy Sci. Pasteurization of yoghurt reduced viable counts from 3 6 108/g to 3. L. pp.M. J. pp. 56. and Sannabhadti. pp. E.07 units/g (Savaiano et al. Gorbach. A. Nutr. Microbiol.E.64 to 0. K. 1988. N.Post-processing treatments Untreated yoghurt containing live and active flora is tolerated better by lactase nonpersistent individuals than pasteurized yoghurt (McDonough et al. P. (1982). surviability of starter cultures.B. and Desjeux. Bacteriol... R.. Fd. ‘‘The effect of yoghurt on some components of the gut microflora and on the metabolism of lactose in the rats’’. 8–14. Fernandes.. Alm. 1–12. K.L. Thermization of dahi reduced the lactase activity by 50 to 73. Johnson. L.R. C. Appl. Conway. 20. milk. Dave.. Vol. R. pp. Dewit. Vol.C. J.M. Vol.. 237–45. J. ‘‘Changes in milk constituents during the manufacture of goat’s milk yoghurt’’. 968. Vol. and Shahani.. (1989). J. Pochart. J. ‘‘Effect of fermentation of lactose. (1987). p. pp. 317–28. D.S. 50–64. Vol. Vol. (1985).. Vol.. Fisher. 1992).I. Appl. N. 1987. (1992). J.A. Dairy Sci. Dairy Sci. and Hassan. ‘‘A radical difference in incidence of lactase deficiency: a survey of milk intolerance and lactase deficiency in healthy adult males’’. S.H. S. (1984). Bayless. (1993). Assoc.. Dairy Sci. Factors affecting the lactase activity are growth condition survivability of starter cultures. Arquivos de Gastroenterologia. Indian J. Dewit et al. M. Vol. B. C. 23–9. 2. Dave. (1966). 346–52. glucose and galactose content in milk and suitability of fermented milk products for lactose intolerant indiniduals’’. J.M. and Goldin. 65.. J. 197. B. Vol. 46. Pochart et al. P. Med. Cultured milk products for lactose 361 . Fuller. Abou-Dawood. product manufacturing and storage conditions and post-processing treatments. Am.4 6 106/g and lactase activity from 0.M. ‘‘Lactose hydrolyzing enzymes in Lactobacillus acidophilus strains’’. pp.. Garvie. (1988).. ‘‘Effect of starter culture and total solids on b-D-galactosidase activity during manufacture and storage of dahi’’. and Sawamura. R.. References Abd-Rabo.S..I.

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(1996). and Rambaud.net. Nutr. Zidi..C. ‘‘Digestion and toleance of lactose from yoghurt and different semi-solid fermented dairy products containing Lactobacillus acidophilus and bifidobacteria in lactose maldigesters – Is bacterial lactase so important ?’’. J.. Clin.emeraldinsight. pp..vsnl. P. Eur. Marteau. J.com/reprints .NFS 36. Sarkar can be contacted at: metrocal@cal3. Vol. 50. 364 Corresponding author S. S..5 Vesa. P. T. 730–3.in To purchase reprints of this article please e-mail: reprints@emeraldinsight. Pochart.com Or visit our web site for further details: www.

school meals have fallen from favour. the safe preparation and cooking of foodstuffs. such as nuts. aims to reduce the risks faced by the UK’s 1. fish and shellfish.5 per cent drop in the consumption of dinners since Oliver’s show first aired. so that they have knowledge of ingredients in products they sell. Hazel Green. Acknowledging this trend the Chartered Institute of Environmental Health (CIEH) has launched a new DVD to raise awareness of food allergens. and their potential to harm allergy sufferers. 36 No. LACA. Since the show was launched. Addressing legal requirements to keep customers safe and to help avoid expensive liability claims for businesses. soya wheat and sesame. amtproductions. egg. Vol. at: dvd@amtproductions. such as unintentional cross contamination. threatening to put some caterers out of business. makers of Action for Anaphylaxis.co. proper cleaning. Jamie’s School Dinners was seen as the driving force behind the government’s decision to introduce tough new nutritional standards in the autumn. A spokeswoman for the Local Authority Caterers Association (LACA). milk. are explained. to comply with new legislation. Training of staff. said the TV chef was to blame for the slump in demand for school meals. the DVD provides clear guidance for food businesses on how to manage allergens in food production and the knowledge required by staff to answer customer enquiries competently. The Caterers Guide to Food Allergy DVD.uk For further information and to view a clip of the film please visit: www. 2006 pp.co. in March last year.Food facts Chartered Institute of Environmental Health (CIEH) Food businesses have a duty of care to their customers in an environment where more people than ever before are eating out and food allergies are on the rise. sponsored by the CIEH. Better Business campaign.’’ ‘‘While businesses are currently reviewing their food safety management procedures. Ms Green said caterers would use the adverts to prove to parents that their school meals were equally as healthy as Oliver’s creations. The DVD provides guidance on the common types of food allergens. it is an ideal time to ensure that those procedures address the serious risk allergens can pose.uk Food facts 365 LACA School caterers plan to use a national television campaign to convince parents that Jamie Oliver is not the only cook capable of serving up healthy school meals. policy officer Jenny Morris said: ‘‘Peanut allergy. is also an essential ingredient of the DVD. says there has Nutrition & Food Science been a 12. 5. Speaking on behalf of the CIEH. To obtain a copy please email AMT productions. 365-380 She said Oliver may have correctly identified ‘‘a few bad school meals" but most Emerald Group Publishing Limited E caterers only used ‘‘fresh raw ingredients’’. which represents the suppliers of 85 per cent of school meals. 0034-6659 . for example. has risen dramatically in recent years and only small amounts of the nut can cause fatal or near fatal reactions.5 million food allergy sufferers – an element of the Food Standards Agency’s Safer Food. Common causes of concern.

Protein Health Communications.chestnutchina. low fat and no cholesterol.NFS 36.net or wxdrobert@gmail. http://www. gluten free. China. The Westminster Diet and Health Forum (WDHF) seminar papers contain the text of all speeches made. moderate carbohydrate (mostly starch. Ms Green said: ‘‘What we want to do is make parents aware of these standards and the importance of school meals in providing quality nutritional food.com Mountglory Food Corporation.tetrapakrecycling. 366 .5 The adverts. Real choice New companies have registered with the Health Education Trust’s Real Choice healthy vending scheme: see www. and is very fine powder (about 70 per cent pass 200 mesh) – plus very useful fibre. Web: www.uk/07. high sugar content (natural sugar of 25 ˚ Brix). moderate energy). minerals and vitamins – all of which enhance health in general.htm Danone Institute The Danone Institute have produced information on ‘‘Novel concepts in the developmental origins of adult health and diseases’’ which is available on their website. I understand that Lady Waldegrave will attempt to attend at least some of our Conference. President HCA Lady Caroline Waldegrave has agreed to become the President of the Hospital Caterers Association. Av Louise 287. protein. Food in hospitals The above seminar papers have just been published.’’ Recycling milk cartons Tetrapak provide 200 million school milk cartons each year and work with the Milk Development Council. She is a published author and was a Founder President and Managing Director of Leith’s School of Food and Wine who appreciates and understands the issues surrounding hospital catering and the challenges of hospital caterers. Along with other dairy industry partners.com/pages/realchoice for further details. Box 5.co. You can contact us by email: xd-robert@263.healthedtrust. 1050 Brussels Belgium. Shijiazhuang. It is 100 per cent natural. Chestnut flour Chestnut flour is an ideal substitute for wheat flour. together with transcripts of the Q&A sessions. and are available to order now. we help fund the School Milk Project under which a team of facilitators visit schools to promote the uptake of school milk. Hebei. More information can be obtained from Barbara Vanheule. Lady Waldegrave is a fellow caterer who was previously involved at Guy’s Hospital.com. which include limiting chips to twice a week and serving at least two portions of fresh fruit and vegetables a day. prior commitments allowing. will focus on the new standards school caterers will be following. and additional articles from interested parties.

coupled with the detailed trainers’ manual. with a focus on practical solutions including the introduction of snacks. upgrading food for visitors and staff. At the end of May. please contact us again via beth. Where Choosing Health money has been retracted or reduced and a full obesity team cannot be put in place for some time MEND allows PCTs to begin to make immediate progress towards their PSA targets. If you would like to order copies of the briefing papers. further reducing the costs. The detailed training and manual also allow non-specialists to become trainers. with additional children’s data being added to the sample. One of the major benefits of the MEND programme is that it is a relatively straightforward way to implement a multidisciplinary/agency intervention cost-effectively. University College London.Food in Hospitals discusses progress in hospital food service since the implementation of the ‘‘Better Hospital Food’’ programme.allen@westminsterforumprojects. London E1 6BD. one hour per week. United Kingdom. and aims to share best practice and move forward thinking on improving patients’ experience. progress in hospital nutrition and the future of hospital food.mendprogramme. and improvement of menus and supply chains.e. The RCT will continue to run after May. www. 3rd Floor Norvin House. I have Food facts 367 . or possibly because. While we are not permitted to release any comparative data between control and intervention groups from the RCT prior to completion (i. This is despite. as a multi-year multi-site implementation for hundreds of families (in fact we are starting one such project in May). fitness levels and health – for life. The randomised control trial is currently averaging an attendance rate of 92 per cent across five sites – largely due to its relevance to the everyday lives of participants. we will have 6-month data on 92 families and will begin the analysis and write-up of the RCT results. MEND The MEND programme is a family-based prevention and treatment programme for obesity. allows a number of people to devote a small portion of their time. to the project thus minimising impact on people’s stretched time and finances.uk. A high level of interest in implementing the MEND programme is from PCTs.org Randomized control trial (RCT) The multi-site RCT being conducted into the efficacy of the MEND programme as an obesity treatment programme for children is continuing at the Institute of Child Health. of the current tightening of budgets in the NHS. Issues discussed include the role of food in treatment and recovery. the research-based design of the 18 6 2 hour sessions and the fact that it is fun. It does not need a large team or even full-time attention from one person. Local Authorities and other local or national bodies – either as a pilot or. e. in some cases.g. not before June/July). MEND programme. expressly designed to deliver sustained improvements in families’ diets. and with additional follow-up assessments being conducted on all the children at 6 and 12 months. 45–55 Commercial Street. MEND emphasises practical. aimed at children aged 7–12 and their parents/carers. hands-on learning about healthy living and exercise.co. We believe that this RCT will constitute one of the largest sets of data on a community child obesity intervention in the UK. Our ‘‘train the trainer’’ approach. In addition MEND can be deployed as both a treatment and a prevention.

with new programmes anticipated to start Essex. (often due to budgetary constraints) are initially implementing MEND on a pilot basis (12–15 families) as a starting point to develop an evidence base. MEND is currently running at two sites in Lewisham (London) and in Southwark (London) and Waveney (Suffolk). N Recruitment of children and families has been relatively straightforward. This. contain plenaries and are accompanied by multiple handouts to reinforce key messages. we were pleased to see that these preliminary results show very similar health improvements to the successful results achieved on MEND’s initial research pilot. Others. Indeed. the MEND programme is also suitable for use as a prevention programme. N Quality-assurance and standardisation: The MEND teaching manual consists of almost 300 pages. (See ‘‘Private sector sponsorship’’ below for details of more programmes running and starting in May. MEND trainers are also required to go through four . A notable point to mention is that across all five sites participating in the RCT. Furthermore.NFS 36. Waist circumference and cardiovascular fitness. as it is expressly NOT a diet but rather a healthy lifestyle programme teaching children and parents about sustained behavioural change. twice weekly for two hours). including BMI reduction and waist circumference reduction (see attached). Some are engaging in quite extensive multi-year programmes involving multiple sites and total numbers of families covered in the 60–300 range. MEND rolls out across PCTs in London. Essex and Northamptonshire We continue to receive a significant amount of interest in the MEND programme from PCTs. Local Authorities and other local partners looking to implement obesity treatment (or prevention) programmes. programmes are often over-subscribed. only 3 of the 92 children recruited dropped out. Suffolk. healthy eating and the benefits of exercise). London and Northamptonshire in May. Statistically significant results were achieved in most of the key outcome measures. it is becoming increasingly evident that that the key differentiating attributes of the MEND programme as an obesity solution (as compared to other locally-administered obesity programmes) are: N Statistically significant results achieved in key outcome measures such as BMI. Based on feedback we have been getting from PCTs running the MEND programme. N Very high retention and attendance rates: Average attendance and retention achieved on MEND programmes completed to date is 92 per cent with only three drop-outs. (It is important to note that while the RCT is focusing on treatment of obesity. over a period of a year.5 368 attached a slide containing some preliminary results from 41 children who have completed the MEND programme intervention. with the idea to then use this evidence base to substantiate funding for a more comprehensive roll-out thereafter. Many other PCTs are in active discussions with us about implementing MEND in their local areas. all of which are lessonplanned. comprising 18 structured sessions.) PCTs and LA’s are pursuing varying strategies in relation to rolling out MEND at the moment. combined with an overall mean attendance rate of 92 per cent is both impressive and unusual in such a long programme (ten weeks. conducted in 2002–2003.

we would be pleased to facilitate a brainstorm on this issue and provide you with examples of innovative practice. They often engage in multi-agency collaboration with Local Authorities. It is this investment and its multi-disciplinary nature that allow rapid implementation. Department for Education and Skills and the Department for Culture. and tap into a combination of different funding sources. agencies and the charitable sector In recent months. fitness and health. MEND allows you to bypass this due to the clarity of its training materials. statistical reports. the Public Health Clinician said. one Counsellor from Social Services and a Nutritionist and a Dietitian from the PCT. we will continue to work to secure private sector sponsorship for MEND. ‘‘Everyone gave a little bit to deliver the whole Programme. providing the requisite monitoring and evaluation required to justify (further) results-based funding. for example – pump prime funding through LPSA/LAA stretch targets for obesity. etc. MEND as a practical and cost-effective means to achieve the government’s PSA target ‘‘Tackling child obesity – first steps’. In this respect. MEND receives positive feedback from government departments. including a 300 page manual with 100 handouts per participant. The 2 6 2 hours per week Programme was delivered by two PE teachers from Education. MEND believes strongly that the private sector bears the same responsibility as the public sector in being part of the ‘‘solution’’ to the obesity crisis and to financially supporting community-based programmes like MEND that will allow as many families as possible nationwide to benefit from learning about how to bring about long-term improvements in their nutrition. including. local leisure centres and schools. In Waveney. the Audit Commission and the Healthcare Commission warns that there is a risk that the Government’s target to halt the rise in obesity in under-11s will not be met. Media and Food facts 369 . tapping into NRF and NDC funding in areas of social deprivation. yet it met everybody’s individual targets’’. using obesity training money to pay for the training element of the MEND costs. the joint report by the National Audit Office. If you are interested in running a MEND programme in your area. Multi-agency working can be fraught with difficulty and frustration. combining Choosing Health money and Health Inequalities money to fund MEND (since the incidence of obesity has been shown to be higher in areas of greater social deprivation). Suffolk. N External monitoring and evaluation: MEND analyses the measurement data collected on the programme and reports the data back in concise. each contributing about an hour per week – a case-study of multi-agency good practice. especially if the solution has to be invented by the team before it can be delivered.days of MEND training and satisfy a test of knowledge before being approved to run the programme. The research-based MEND programme has been specifically developed to ensure that it can be rolled out rapidly and cost-effectively in a standardised manner – it is literally a ‘‘solution in a box’’. It is interesting to note that PCTs are being very creative how they go about financing MEND in the current climate of budgetary pressure and uncertainty combined with a lack of ring-fenced obesity funds. However. we have had positive and encouraging cross-departmental policy discussions with senior officers leading on obesity at the Department of Health.

as well as do all the recruiting. thereby negating the need for any internal PCT management time or resources to implement MEND. than anything we could say. assessments (pre and post) the programme and the monitoring and evaluation. to train local staff to run a/ several MEND programme(s). several months after) the MEND programme. and Sport England has indicated a willingness to match-fund an emerging MEND project being planned for East London.weightmanagementguide. The website will provide many extra facilities . Consistently positive feedback received from children and parents who have been on the MEND programme Please take a look at the attached testimonials for examples of the type of representative feedback that both children and parents/carers consistently give us about their experiences both on (and. At the request of several PCTs seeking to invest their obesity training funds in the most meaningful manner. In addition the training provides knowledge and a selection of practical insights learned from the MEND Pilot Study as well as the current MEND RCT. where finances allow.uk IFST The IFST has re-launched its website (www. Weight management The Weight Management Guide has now been finalised and launched at: www. in what ways they feel they have benefited from MEND. We believe strongly that it is much more powerful to hear directly from the beneficiaries themselves.NFS 36. The cost for this is £50 per person for up to 30. We are increasingly being asked by PCTs about the possibility of being able to offer MEND as a managed solution – i. N One-day obesity training for health-care professionals (HCPs). We are able to offer this to those interested although we would strongly advise that this is not generally the best solution – it is preferable. Furthermore. we have created a one-day obesity training session for training front-line staff/HCPs on obesity (see attached outline).co.org).5 370 Sport. New services N Obesity management solution.e. where MEND would employ and provide the staff and run the programme for you. MEND has received endorsement from The Obesity Awareness and Solutions Trust and has had discussions with several charities regarding the possibility of engaging in (further) joint research into obesity and obesity-related illnesses and is also engaging in the current public consultation on NICE Guidelines regarding child obesity. The training incorporates and explains the current guidelines contained in the Department of Health’s Obesity Care Pathway Booklet as well as ‘‘Measuring childhood obesity: guidance to primary care trusts’’. who have expressed great interest in MEND and community-based obesity programmes like MEND.ifst. more importantly. The new-look site has been completely rewritten and rebuilt using a content management system to provide improved functionality and navigation. positive discussions have been held with senior Healthy Schools representatives.

Provision of fresh drinking water is an important part of their approach to good health and nutrition. They advise that ‘‘Helping consumers to recognise the important health benefits of their water supply. sports stars and comedians. They lobby governments and others to develop and implement policy that improves the quality of patient care. reliable supply of water – is absolutely essential for maintaining a healthy lifestyle. CC Water is independent of both the water industry and its regulators. and having water on tap – a safe. to be able to demand the best value from their water suppliers. and they will be active in building and promoting the message of good hydration to patients and to staff. exam techniques. CCWater are very active in ensuring that customers are empowered with the information they need.org. promotes excellence in practice and shapes health policies.’’ www. and builds on the importance of nurses. and promoting the significance of remaining well hydrated throughout the day is central to this work. Food facts 371 Water for health Two new key Alliance members join the work to improve hydration. and its Chair is respected health professional. Sport Relief 2006 has water at its heart. on-line membership application and publication ordering via the online shop. The RCN represents nurses and nursing. bringing with them very welcome direct representation for the many consumers in England and Wales. Royal College of Nursing join Alliance Building on the Water for Health Alliance work to improve hydration in NHS hospitals. supported by many of the UK’s top celebrities.uk Water a key partner of Sport Relief 2006 The 2006 Sainsbury’s Sport Relief Mile is about to be launched by the BBC and Comic Relief. graduate recruitment and revision techniques amongst many others. and RCN believe water can contribute positively to patient recovery. tap water at conferences and bottled water in Governments.such as easy access to information services. we are delighted to advise that the Royal College of Nursing have now joined the group. As . An additional feature is the exclusive Member Only area which will provide many new services including: N downloads including the latest keynote and food science and technology meetings. water as a basic nutrient. N facilities to update your membership details and pay your subscription online. Dame Yve Buckland. secure. www. community initiatives from regional water companies. N a young members’ area which includes information on employability skills. and a wholesome diet’’. health care assistants and nursing students to health outcomes.uk Consumer Council for Water join Alliance The Consumer Council for Water (CCWater) has joined the Water for Health Alliance.org.ccwater. CC Water advise that ‘‘Water is a valuable and precious health resource for society.rcn.

000 people donned a single red sock and took part in the first ever Comic Relief led Sport Relief Mile. you don’t have to train like a professional athlete to achieve a healthier lifestyle. and also the brand new Hydration Best Practice Toolkit for Care Homes to use at their conferences. are continuing to raise the profile of the important links between good hydration and good health through . Your muscles need to be well hydrated at all times to make sure they function properly and when you’re training and sweating you need to make sure that you replace the fluid you’re losing. scottishwater.’’ http://www. meetings etc. Gordon Ramsay.sportrelief. 200. involved 253 celebrities and attracted 8. Water and all the positive health messages of good hydration will be featured prominently in the Promotional material.000 registered participants and UK wide support from personalities.uk/ and conference teams can simply download what they need for delegate packs. Blue Peter and A Question of Sport Relief and the health benefits of drinking water will be endorsed by high profile celebrities who have fully backed the work to improve the nations health.org. 81.5 372 part of the Water for Health work.NFS 36. The people who went the extra mile on the day included Prince William. Water Aid. Chris Moyles. Underlining the importance of drinking enough water. Having investigated the requirements of the Alliance. but as an athlete it’s vital.co.waterforhealth. water companies will provide fresh tap water to each televised flagship event. Past beneficiaries of funds raised by Sport Relief have included Water for Health Alliance members WaterAid and Action on Elder Abuse. But. Sir Steve Redgrave. All documents are now available to download free of charge from the Alliance website www. Prime Minister Tony Blair.2 million viewers to the Sport Relief programme on the BBC. Drinking the right amount of water helps keep you hydrated and keep concentration and energy levels at their peak. the UK’s number one four hundred metre sprinter is backing the Scottish Water ‘‘On Tap’’ campaign for Scots to drink more tap water. This year’s Sainsbury’s Sport Relief Mile will be even bigger. tap water will be provided to the related TV programmes such as Ready Steady Cook.uk ‘‘Wise up on Water’’ medical evidence leaflets now available direct Water for Health Alliance members have been contacting Water UK recently to ask how they can get printed copies of the ‘‘Wise up on Water’’ leaflets. and tap water is now the official drink of this high profile occasion. many more. raised 5 A316 million.com Scottish Water leap the water hurdle Lee McConnell. www. Dame Tanni Grey Thompson. Drinking water is so important to everyone. and Prince Harry. Jonathan Ross. Everyone can help boost their memory and energy levels with the turn of the tap. Water UK has developed two methods of obtaining the literature. the UK water industry has joined together to become a partner to the event. It incorporated 14 national and 125 local events. Frank Bruno. Rachel Stevens. Water Aid ‘‘Drink More Water’’ Campaign Committed Water for Health Alliance supporters. meetings and to support their policy work. she advises ‘‘As I have a degree in Sports Science and Nutritional Management I am very aware of what is and isn’t good for me. with 15 BBC televised events across the UK. Jo Brand and many. In 2004.

gov.org/uk/get NHS Direct hydration advice on line The NHS internet and telephone advice service has increased its advice on the subject of hydration www.wateraid. the Scottish Executive has again increased its focus on healthy fluids and its expectations are that by 2007 NHS and Local Authorities should expand oral health programmes to ensure that ‘‘All schools have supporting healthy eating and drinking (water) policies’’. The excellent initiative is actively encouraging UK companies to promote tap water provision for the health of their employees in the workplace. Further information on the guidance can be seen by ordering ISBN 0-7559-4557-8.their ‘‘Drink More Water’’ campaign. fresh-water drinking facilities’’ The full information is available from the NHS response line 0541 555 455. life-giving and sustaining. yet many of us do not drink enough. clean. that requires the buyer to fill it up from their own tap. and to use that educational platform to raise money for those who have no safe water provision at all. In support of the latest part of this campaign. NHS has issued its latest guidance for best practice in continence care and it reinforces the important role of the ‘‘Availability of accessible. the ODPM/MITIE launched a re-usable bottle scheme for the water provided at official Government meetings. there is a new brand of water in the Netherlands that is rapidly making a name for itself. It flows out of our taps so easily that we rarely give it a second thought. Scotland increase water provision for oral health In its Action Plan for improving oral health and modernising NHS dental services. The Executive have already increased children’s access to fresh drinking water by 600 per cent. ODPM has recently advised their staff that these are not being met because bottles are going missing or are not being returned after use. and have funded improved water facilities through increases in the school meal funding system.nhsdirect.uk Netherlands say ‘‘Neau’’ to expensive bottled water Sold as an empty bottle. Water really does help you at work. rest and play – for our health and beauty what could be simpler than to drink more water?’’ The developing WaterAid work can be seen www. Office of the Deputy Prime Minister swing to tap Just before Christmas. as concentrated and highly acidic urine is expelled automatically by the body.barnes@odpm. Neau is positioning itself explicitly against the bottled mineral water trend by advertising Food facts 373 . incontinence is sometimes the last straw and is often a major reason for the breakdown of the caring relationship which can then lead to admission to residential or nursing home care. General guidance within Government offices is now to move away from bottled water. Details of the scheme can be obtained from Andy Barnes andy. Bodyshop founder Anita Roddick says ‘‘Water is elemental.nhs.uk NHS Good Practice in Continence Services For carers. Often dehydration can play a major part and increase the likelihood of soiling incidents.gsi. although while this particular scheme has both financial and environmental benefits.

In practice many venues are very happy to meet the needs of their clients as long as they fully understand what is required of them.bwhwater. Neau is being sold in the form of a firm.5 374 the fact that Netherlands tap water is of renowned and excellent quality. Fresh water for delegates at Bournemouth Care Conference Following an invitation from Alliance members. the National Association of Care Catering. the Chartered Institute of Environmental Health. of Amsterdam-based advertising bureau Vandejong and Stichting Neau (the Neau Foundation). Angela pursued the point on the grounds of sustainability.’’ he explains. These drinking water projects are being coordinated by wellknown Dutch charity organizations like Unicef Nederland and Plan Nederland. The team encouraged people to adopt water as part of healthy nutrition and offered side servings of freshly prepared strawberry’s. oranges and melon. UKPHA. ‘‘When you drink a bottle of Neau. and other poor parts of the world. over and over.uk Thames Water bring hydration to older people in Nunhead Thames Water have been working in partnership with Age Concern Southwark to promote the Nunhead Healthy Ageing Centre to people living in the local area.’’ Tap water offered at all future conferences? Following a recommendation from the last Water for Health Alliance meeting. Fresh tap water was consumed in large quantities and received excellent feedback on the taste. Campaigner of the month award goes to UKPHA Chief Executive and Water for Health Alliance supporter Angela Mawle for an incredible job in getting tap water supplied across their huge national conference in Telford recently. Vietnam. Where venues do not offer tap water.NFS 36. or have simply felt they do not have the option of tap at large commercial venues. At a . and tastes good. good hydration and the protection of public health – and eventually had the entire event served with iced tap water. ‘‘Neau is being sold in empty bottles that you can fill with drinking water. as the Bournemouth Water Company innovatively served it to delegates directly within the main auditorium.co. says Menno Liauw. And that is exactly the crux of Neau. and its revenues are spent in drinking water projects in underdeveloped countries in Africa. the bottle is empty. a little effort can see this turned round. The Neau brand has a dual effect: It makes people conscious of the worldwide water problem. as often as you like. However. a message in a bottle that explains Neau’s position. Peru. In the face of many dubious objections by the venue owners. with whom Neau cooperates. Water UK and an active Primary Care Trust are now working together to develop guidance for conference organisers to have fresh. and the implications of not simply providing pre packaged water. www. or advise that they can not. iced tap water served at conferences.’’ he continues. Many organisers have either been pressured in to buying large volumes of bottled water. Water UK spoke on the importance of hydration at the Care Home Conference and local water supplier Bournemouth and West Hampshire Water provided a tap water tasting for all the delegates. Instead of water it contains a rolled-up Neau flyer. pineapple. Liauw explains. clear blue plastic bottle at the price of regular mineral water. Angela has inspired us all to build ‘‘iced tap water’’ into our conference contracts from the start and insist on it at the point before we place the order. ‘‘You indirectly provide a refugee camp in Sudan with seventeen litres of clean drinking water.

Water was made available throughout the day and local residents were given encouragement to take on board the health benefits of drinking more fluid. The main aim of the open day was to encourage people to make greater use of the valuable services provided by Age Concern. with more when it is hot or when we are exercising. in particular the benefits of drinking water for good hydration. Thames hosted an open day.. We are also working on replacing bottled water with tap water at council meetings – which should save even more money. gives you energy. leader of Gloucestershire County Council. In its pages it advises that water is an essential part of the diet. and we have done so for years. assists in weight control. water controls body temperature. Nutrition for Life says ‘‘Get in to the habit of drinking water’’ ‘‘Nutrition for Life’’. Water is an important part of good nutrition.’’ Director of customer relations at the water provider Jonathan Bailey said using tap Food facts 375 .. and to help overcome their beliefs that they will be frowned upon if they choose not to order bottled water. www. absorptive. a sing along with the Pearly King and a ‘‘talk and walk’’ presentation by the Southwark Primary Health Care Trust aimed at promoting the benefits of walking for exercise. said the drop was thanks to several measures introduced by the Tory administration. inviting local residents aged 55 and over to attend activities including exercise classes..thameswater.uk Top Chef says ‘‘water is an important part of nutrition’’ Top chef and restaurateur Anthony Worrall Thompson has agreed to support the objectives of the Water for Health Alliance. Councillor Barry Dare. and drinking enough each day is an essential ingredient for a healthy life’’. and to raise awareness of the importance of healthy ageing. He advises that ‘‘The way we give our customer’s an enjoyable dining experience is to give them what they want – we wouldn’t have any problem in serving fresh tap water in our restaurant. the best drink to quench thirst and that we all need to drink six to eight glasses of water each day. Northern Ireland MP ‘‘flabbergasted’’ over bottled water bill The Northern Ireland Office has landed itself in hot water after admitting spending a significant on bottled water in the last year. More supporting statements will follow as UK chefs endorse the health drive. circulatory and excretory functions’’. ‘‘Since the Conservatives took control we have banned free lunches for councillors and are looking to change council rules to prevent councillors claiming expenses for lunches. and has kindly given the work a supporting statement to help encourage people to ask for tap water when the eat in restaurants and cafes.and is needed for all digestive. Severn Trent aid bottle water purge at Council Thanks to the Alliance members for the BBC report (20 February 2006) that a purge on lunch time perks at Gloucestershire County Council has so far seen the taxpayers’ bill for county councillors’ lunches’ fall by two-thirds. Alliance members are working hard to give the public the knowledge and confidence they will need to simply ask for tap water with their meals. ISBN 1-4053-03069520. ‘‘Involved in every function of the body.co.recent launch event. The diet manual advises on the high quality of UK tap water and ensures that readers understand the importnace of water to the body.

NFS 36. What infuriated me was that you charge for still or carbonated filtered tap water. steady loss of body water is a factor of ageing 376 . Her Majesty’s Inspectors of Schools (HMI). If I went into a restaurant and asked for a jug of tap water I would not pay for it under any circumstances’’.’’ Oh! Sushi An observant Alliance member sent in this web consumer feedback contribution criticising the well known Sushi Company for its bottled water charges in restaurants. fresh water should be provided. The report also fails to link the expectation of the Secretary of State that free.gov. they are now publishing the hydration message for older people. Official Report. It notes the success of introducing drinking water in to the top performing schools.dh. as an internet’s guide to care and the rights of older people. on drinking water. I didn’t see that there was a charge. whether she plans to issue guidance to schools on drinking water provision in relation to the aims of her healthy schools policy.gov. social and health education (PSHE) and from reports on schools visited as part of a survey on learners.wiredforhealth.gov. which supports the National Healthy Schools Standard (www. Additional evidence was gathered from over 50 reports of school inspections that had been conducted under the new framework for inspection. It advises that good quality drinking water should be available to pupils throughout the day and not from taps or drinking fountains located in toilet areas (http://foodinschools. They say that gradual.net Care Directions Care Directions has written to advise the Alliance that. It uses case studies as examples of how schools have improved pupils’ healthier eating and the quality of school meals Primary Schools www.uk/publications Parliamentary Questions on water in the schools Paul Burstow MP has asked the Secretary of State for Education and Skills: pursuant to the answer of 14 December 2005. uk.uk/PolicyAndGuidance/ HealthAnd SocialCareTopics/FoodInSchools).gov. The promotion of good hydration is included within the Government’s Food in Schools programme (www. health and well-being. until I came to pay the bill. accompanied by nutritionists appointed by the Food Standards Agency (FSA).5 water saved the taxpayer thousands. Ofsted on Healthy Eating in Schools As preparation for a major survey of food in schools to be carried out in 2006/07. undertook a small scale survey.uk). The clearly irritated customer advised ‘‘The food was fair value for money.datacenta.ofsted. The report assesses how schools have responded to guidance on school meals and healthier eating.uk/publications Food Technology in Secondary Schools www. from reports on personal. ‘‘It would cost 73p a year for a person to drink eight glasses of Severn Trent water a day. children need access to water at school.074 W.ofsted. column 2. including visits to ten schools from clusters of primary and secondary schools in three local authorities. with the fact that in many schools it is simply not available. but fails to draw the obvious conclusions in its summary. Jacqui Smith responded: In order to keep properly hydrated throughout the day.

When all the responses were received (49 responses from organisations and 17 from individuals) they were analysed and assessed in order to draw out the key themes. www. the effort really must be made. mental confusion.uk/pdf/water_tasting_fresh. As part of the consultation process. Keep your water tasting fresh covers everything from household plumbing to chilling water in the fridge. but wants to ensure that there is a properly co-ordinated approach between NICE and CSCI who are the body responsible for regulating care services. It is worth noting that tea. ECCA said ‘‘ECCA members strive to provide high quality care and nutritious food. you will lose the same volume of water from your body. the HPC also investigated the various approaches taken by other regulators. They advise older people that for every alcoholic drink you consume. and can speed the ageing process generally. Fear of the likelihood of urinary incontinence and the need for visits to the toilet. The toolkit provides fact sheets. Food facts 377 . made worse when diuretic medications (‘‘water tablets’’) have been prescribed.co. Fresh tasting water Three Valleys Water Company has advised us of their guide to ensuring that the public in their region continue to get great tasting tap water. alcohol.and older people do become dehydrated more easily. it is essential that CSCI inspectors have the relevant training and experience to examine malnutrition on a case by case basis rather than a statistical basis which may not allow for differing circumstances’’. as dehydration can result in illness. ECCA advised NICE that the training and education could benefit from the hydration toolkit for care homes produced by the Alliance. The National Institute for Clinical Excellence (NICE) and the National Collaborating Centre for Acute Care have launched a clinical guideline to help the NHS identify patients who are malnourished or at risk of malnutrition.pdf Health Professions Council The Health Professions Council (HPC) consulted on proposals for a new ‘Returners to practice’ process from 1st July 2005 until 9th September 2005. It recommends that all people in care homes should be screened on admission and when there is clinical concern. actually contain dehydrating agents.caredirections. Care Directions recommend that older people should drink at least eight cups of fluids a day. checklists and advice to enable care homes to improve water consumption with older people and care home staff. of course. coffee.3valleys. The English Community Care Association.co.uk Water related malnutrition in care Water for Health Alliance members. It also recommends that all healthcare professionals who are directly involved in patient care should receive education and training on the importance of providing adequate nutrition. will also mean that many older people will be reluctant to drink as much as they should. Malnutrition is a complex issue and although the NICE guideline is welcome. has welcomed the National Institute for Clinical Excellence’s latest guideline on tackling malnutrition in the NHS. Care Directions advise that whatever the reluctance to drink. fizzy drinks or worse. www. This frame of mind is. Water intake is vital. Dehydration can then be a major complicating factor of illness and can have a negative effect upon recovery prospects.

Forbes Medi-Tech Inc.. The inclusion of the phrase ‘‘in standards’’ means that the HPC cannot carry out individual assessments of returners’ requirements. while continuing to enjoy the taste of cheese.com There you will find comparisons and analysis of the nutritional value and ingredients of popular snacks and drinks vended in the UK.org Snacks and drinks www. spreads and yoghurts. HPC introduce CPD The Health Professions Council (HPC) will require all health professionals on the Register to undertake Continuing Professional Development (CPD) from 1st July 2006. Heartfelt+ cheese has been specifically developed to help people who want to lower their cholesterol and maintain a healthy diet. They should complete this period before they apply for ‘‘readmission’’. protein or carbohydrates. The combination of a prudent diet and consumption of products containing the recommended amount of Reducol may help consumers to lower their cholesterol by up to 24 per cent.com) and is supplied to manufacturers as an odourless. The 11 other professions currently on the HPC register. Reducol is a unique ingredient containing plant sterols and stanols. followed by operating department practitioners.NFS 36. Reducol is incorporated into foods such as milk. The standards can make different provision for different classes of returner. the UK’s largest independent dairy company. which was developed by the Canadian company.swipevending.reducol. For further information about the consultations.5 378 Article 19(3) of the Health Professions Order 2001 allows the HPC to. The standards mean that health professionals will have to provide evidence of CPD relating to their previous two years of practice from summer 2008. is launching heartfelt+. to offer cholesterol lowering benefits to consumers who want to continue to enjoy those products.tripp@hpc-uk. a well established and clinically proven ingredient for lowering cholesterol safely and naturally. tasteless powder that contains no fat. N 5 or more years out of practice: 60 days updating. The period required are as follows: N 0–2 years out of practice: no requirements.000 health professionals across the UK. Cholesterol lowering cheese Fayrefield Foods. please contact Rachel Tripp on 020 7840 9760 or email rachel. Heartfelt+ contains ReducolTM. The following decisions have been made with regards to those returning to practise after a period ‘‘out of practice’’: Health professionals who have been out of practice will be required to complete a period of updating before they can come back onto the register. The evidence will . require persons who have not practised for or during a prescribed period to undertake such education or training or to gain such experience as it shall specify in standards. in the UK.. The first audit of these standards will take place in July 2008 with chiropodists and podiatrists being the first profession to be audited. a fully flavoured 12 per cent fat cheese. will be audited during 2009/2010. It is supported by numerous reviewed clinical studies (see www. N 2–5 years out of practice: 30 days updating. This will now be a legal requirement for the future registration of 170.

but CPD will be the responsibility of the individual. This is a robust set of standards which will make an important contribution towards improving our children’s health. including some industry big players.have to show that the CPD an individual has undertaken has contributed to the quality of their practice and demonstrates that it benefited the service user. recognise the importance of CPD. The Chartered Management Institute recently asked over 1. Speaking about the CPD standards.hospitalityleadership. You might like to see agenda papers on eating for health strategy.food. management or education. http://www.gov. Hospitality Leadership Excellence Survey The 2006 Hospitality Leadership Excellence Survey. Nearly 80 per cent felt that a major influence on job satisfaction for managers was to have autonomy. Professor Norma Brook.uk/news/newsarchive/2006/jun/bristol 4th International School Milk Conference The full conference programme is available on internet: http://www. The standards apply not only to those in clinical practice.uk FSA meeting The FSA board meeting was in Bristol on 15th June.schoolmilksa. This involves conducting indepth interviews with up to 25 of the top leaders in the UK hospitality industry to identify how they approach their leadership role and what makes them so successful. ‘‘The HPC offers a clear framework with flexibility at the centre of our decisions. having a poster/display presentation.000 mid-ranking managers what they thought about their work. that we require individual registrants commit themselves to their own professional development and that employers. Food facts 379 . too. all delegates will be encouraged to participate in the conference by: making a country presentation.gov. http://www. You can view them on the DfES website: www. We will therefore be requiring all of our registrants to undertake CPD and be seeking to ensure that the CPD carried out by our professions is robust and effective. See the registration form for details. It was clear from the research that senior managers who give their junior colleagues a free hand are those that are respected. making a presentation on a specific school milk related issue. We believe that it is a vital part of our basic function.teachernet.org.com New standards for school food The new standards for school food were announced on Friday 19 May.’’ The Health Professions Council is an independent. which is to protect the public. The respondents. came from a mix of private and public sector companies and organisations. UK-wide health regulator set up by the Health Professions Order (2001). but also to those working in research. more than 40 per cent of them women. co. President of the Health Professions Council said: ‘‘This is an important event in the development of self-regulation.za/ Time permitting.uk/wholeschool/healthyliving www.schoolfoodtrust.

N Often the improper disposal of unused or expired pharmaceuticals leak out of landfills and infiltrate water supplies. 380 . and rivers in several areas of Europe.NFS 36. N A wide variety of pharmaceutical compounds have been detected at low levels (10–400 mg/L) in aquifers.5 MIP MIP Technologies has just brought out a highly innovative way of detecting the presence of beta-blockers in water using molecularly imprinted polymers separation technology. These compounds can potentially survive sewage treatment systems because of their high stability against biological degradation. a method of detection would be the first step in the investigation toward defining the potential risks. sewage treatment plant effluent. that could pose a threat to living organisms. While the potential effects of these compounds on humans and aquatic organisms are unknown. N Pharmacokinetic studies have shown that more than half of all pharmaceutical compounds consumed are excreted unchanged from the body into wastewater.

E Nutrition & Food Science Vol. 5. 2006 p. guidance is given for helping young people take responsibility and work at helping themselves with various strategies to lose weight. It would be of assistance to those studying in this area or developing products for use in infant feeding. It will be useful for anyone dealing with overweight young people. West Jr Karger-Nestle Nutrition CV 4358 This is a very specialised book consisting of a series of papers on international studies on micronutrients and infants. Nutritional Support For Adults and Children – a Handbook for Hospital Practice Edited by Tim Bowling Radcliffe ISBN 1-85775-831-5 Nutritional support is critical in times of trauma and serious illness. It is an excellent resource for specialists such as dietitians in this area.Book reviews Micronutrient Deficiencies in the First Months of Life Francois M. Delange and Keith P. This is a very specialised book giving very clear guidance on how to feed patients and procedures. Throughout this book. 36 No. help in dealing with it is important. Book reviews 381 Weight Matters for Young Children Rachel Pryke Radcliffe ISBN 1-85775-772-6 Obesity is a major problem for children and young people and with approximately 30 per cent of children being overweight and obese. 381 Emerald Group Publishing Limited 0034-6659 .

Broadcast Committee of Advertising Practice. Media Fellow. 382-383 Emerald Group Publishing Limited 0034-6659 E . 1 June 2006. together with Rosemary Hignett. Director of Policy and Research at the Office of the Children’s Commissioner. The main topic of the symposium was on dysphagia. Institute of Economic Affairs. Director General. Richard D.cieh. Other speakers included: Andrew Brown. For further information.00 pm. please contact www. Consumer Impact Director. Head of Nutrition Division at the Food Standards Agency. Its purpose was to provide an opportunity to share opinions and to help move forward thinking in this area. agreed to take part. Malcolm Earnshaw. together with further articles submitted by interested parties. venue: Westminster. This is a short course culminating with an examination and covers a basic level of nutrition. The association was delighted to host HCI’s 2nd International Symposium which this year focused on nutritional care. Commercial Director. More information is available at: www.NFS 36. 36 No.hospitalcaterers. 5. Cadbury Schweppes. It was distributed to the key figures deciding policy in these areas in Government and Parliament. This year the member organisations of Healthcare Caterers International (HCI) attended the Conference. 382 Nutrition & Food Science Vol. North.org/events or call the events department on 020 7827 5856 Westminster Diet and Health Forum Consultation Seminar: Food Promotion to Children Timing: morning. Incorporated Society of British Advertisers (ISBA). This publication contains transcripts of all the speeches and comments made during the day. Timing of this seminar was arranged with Ofcom to tie in with their consultation. as well as to all delegates. who is leading the consultation for Ofcom. 2006 pp. Claire Phillips.5 Conference reports Hospital Caterers Association National Conference April 2006 The Hospital Caterers Association held its Annual Conference in April 2006 at the Hilton Birmingham Metropole Hotel on the National Exhibition Centre Campus. The discussions were reported in a policy briefing document – an extremely important output from the day. Chairman. and a senior representative from Which?. Ian Blair. Ofcom. Trish Fields. Kate Stross. It is organising various training seminars around the country for trainers who wish to deliver the course as well as providing course books and trainers’ notes and information. SW1 This meeting brought together key stakeholders to discuss Ofcom’s consultation on food advertising to children.30 am to 4. The conference included a large exhibition of more than 60 food and equipment suppliers which was open and free of charge to non-delegates on Thursday 27 April 2006 from 10.org Chartered Institute of Environmental Health (CIEH) The CIEH has produced a new level 2 qualification in Nutrition. gave a keynote address.

functional food and functional drinks industries. Marketing Director. Geneva PALEXPO Vitafoods International was held again in Geneva.dietandhealthforum. media and advertising sectors. officials involved in this area of public policy and representatives of industry. Vitafoods International. which receive prominent coverage in the national and trade media. For more information. invited from the contacts of both the Westminster Diet and Health Forum and the Westminster Media Forum. and media. and have enjoyed considerable support from within Parliament and government. The Forums have no policy agenda of their own. including members of both Houses of Parliament. are impartial and cross-party.Attendees. the food.uk Vitafoods International 9–11 May.co. This exhibition had 50 companies exhibiting the latest products in the dietary supplement. please contact www. For more information. The Westminster Diet and Health Forum. consumer groups and academia. Conference reports 383 . They organise senior level seminars on public policy in nutrition and health. healthcare. interest groups. please contact Charlie Hastings. were a senior and informed group numbering over 100. and its sister forum the Westminster Media Forum. There were also 350 exhibiting companies organised into seven international pavilions which made it a truly global event.