Diet of Finnish children in relation to the family's socio-economic status

Maternal feeding practices and toddlers' fruit and vegetable consumption: results from the DIT-Coombe Hospital birth cohort in Ireland

Background

Health benefits of fruit and vegetable have been well recognized. However, insufficient consumption of fruit and vegetable is prevalent among toddlers, and has become a global public health issue. Maternal feeding practices are potential factors influencing toddlers’ dietary intake, including fruit and vegetable intake. This study was conducted to explore the influence of maternal feeding practices on toddlers’ fruit and vegetable consumption in Ireland.

Methods

A follow-up to the DIT-Coombe Hospital birth cohort was conducted. Mothers in the original cohort were invited to participate in the present follow-up study by phone. A questionnaire assessing maternal feeding behavior and the child’s 3-day food diary was sent to mothers who agreed to take part in the present study by post, together with a self-addressed stamped envelope.

Results

There were 193 mother-children pairs included in the analysis, and the mean age of children was 2.4 (SD 0.7) years old. Toddlers’ mean daily intakes of vegetable and fruit were 67.57 (SD 45.95) g and 213.35 (SD 170.78) g, respectively. Logistic regression analyses showed that maternal practice of breastfeeding for more than 4 weeks was positively associated with fruit (OR = 2.93, 95% CI: 1.29–6.64) and vegetable (OR = 1.95, 95% CI: 1.00–3.81) intake or the contribution of fruit (OR = 2.62, 95% CI: 1.19–5.80) and vegetable (OR = 2.02, 95% CI: 1.02–3.99) to the total diet. Letting the child eat with other family members was associated with high vegetable intake (OR = 5.45, 95%CI: 1.69–17.61) and high contribution of vegetable to total diet (OR = 3.78, 95% CI: 1.04–13.82). Not being too worried about the child’s refusal to eat was positively associated with toddlers’ vegetable intake (OR = 2.10, 95%CI: 1.09–4.05).

Conclusions

To increase children’s fruit and vegetable intake, and develop good eating habits, parents should eat with their toddlers, be patient and not put much pressure on their children in the context of meal feeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00743-z.

Analysis of Fruit and Vegetable Consumption by Children in School Canteens Depending on Selected Sociodemographic Factors

Background and Objectives: Eating habits acquired or changed during childhood are likely to track into adulthood. Due to the fact that nutritional behaviours are not so strongly formed among children, it is easier to change and develop them in children than in adults. The aim of this study was to assess the impact of selected sociodemographic factors affecting fruit and vegetable consumption (i.e., age, parents' body mass index, parents' level education, duration of breastfeeding, child's time spent in front of computer/television) among children in school canteens. Materials and Methods: The sample consisted of 106 participants (52 girls, 54 boys) aged 6-12. The frequency of consuming fruits and vegetables at a school canteen was assessed using bar code cards for two weeks. Body composition estimates were obtained using a foot-to-foot bioelectrical impedance analysis, body height was measured using a stadiometer Seca 213. The questionnaire contained questions about selected factors which can have an influence on fruit and vegetable consumption. In the study group, 13.2% of participants were overweight and 17.9% were obese. Results: Our results showed a statistically significant relationship between age and fruit and vegetable consumption, and it increased with age in both sexes. Conclusions: Bearing in mind the various conditions discussed when shaping the eating habits of pre-school- and early-school-aged children, the importance of proper nutritional education should be stressed both among children and parents.

Adolescents from low-income families in Hong Kong and unhealthy eating behaviours: Implications for health and social care practitioners

The development of dietary preferences of adolescents involves a complex interplay of individual behaviours and environmental factors. Interpersonal factors-such as peer influences and unpleasant school experiences-and institutional factors-such as school rules and policies-are closely associated with unhealthy eating of adolescents. Family support and guidance are also crucial in influencing adolescents' eating habits. However, the low social status, low educational levels, and low household incomes of disadvantaged parents can markedly prevent their children from establishing healthy eating habits. Therefore, adolescents from low-income families are more likely to engage in unhealthy dietary behaviours and hence to be more susceptible to diet-related health problems. However, few studies have addressed the difficulties associated with inculcating healthy eating habits among adolescents from low-income families. Therefore, to investigate the barriers to adopting healthy eating habits, this study adopted a qualitative research approach and conducted five focus-group semistructured interviews with 30 junior- and senior-form students of a secondary school in Hong Kong, all of whom were from low-income families. The results revealed skipping meals because of poverty, following irregular meal patterns on school holidays, receiving poor guidance from family and peers, perceiving healthy eating as expensive and unappealing, and geographical inaccessibility to healthy food all prevented these students from healthy eating. These mutually reinforcing factors were interlocking with the economic strain that was experienced by the participants and their families. In particular, the stereotype of "healthful food is expensive" was strong. Therefore, we suggest students from low-income families should be enabled to understand that healthy eating is not necessarily expensive. The participants' stereotypes about healthy food was handed down by their parents. Such stereotypes, together with the low health literacy, influence the food preparation habits of the parents. Therefore, parents should be made to aware that healthful food can also be affordable.

Smaller long bone cross-sectional size in people who died of tuberculosis: Insights on frailty factors from a 19th and early 20th century Finnish population

There is little research on how individuals suffering from tuberculosis may differ from those not infected in terms of overall skeletal morphology. Tuberculosis was endemic in 19th and early 20th century Finland making documented skeletal collections of Finns ideal to study effects of the disease on bone. The present study compares long bone cross-sectional total area between individuals who died of tuberculosis and those with another recorded cause of death in a Finnish sample. Adult male individuals (N = 105) were selected for analysis. Complete humeri (N = 56), femora (N = 66) and tibiae (N = 64) were 3D scanned using a laser scanner and total cross-sectional areas calculated with AsciiSection software. Individuals who died of tuberculosis (N = 24, 15 humeri, 14 femora, 13 tibiae) had, when standardized for body size, significantly smaller total cross-sectional femoral and humeral, but not tibial, areas. The mechanisms behind the observed relationship may reflect a combination of biological 'frailty' in terms of susceptibility to infection, reduced childhood activity and/or vitamin D deficiency, which possibly influenced both subperiosteal development during adolescence and, later, susceptibility to contracting and dying of TB. Due to the relatively small sample future studies are needed to further investigate the relationship between TB and bone cross-sectional size.

Sociodemographic, lifestyle and behavioural factors associated with consumption of sweetened beverages among adults in Cambridgeshire, UK: the Fenland Study

OBJECTIVE

We aimed to identify sociodemographic, lifestyle and behavioural determinants of consumption of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) among adults in Cambridgeshire, UK.

DESIGN

Cross-sectional data were obtained from a cohort of 9991 adults born between 1950 and 1975. An FFQ was used to assess consumption of beverages and other dietary factors. Multivariable logistic regression was used to examine potential determinants of consuming SSB and ASB (≥1 serving/d).

SETTING

Recruitment from general practice surgeries to participate in the ongoing population-based Fenland Study.

SUBJECTS

Adults (n 9991) aged 30-64 years from three areas of Cambridgeshire, UK.

RESULTS

Prevalence estimates for daily SSB and ASB consumption were 20·4 % (n 2041) and 8·9 % (n 893), respectively. SSB consumption (OR; 95 % CI) was more common in men than women (1·33; CI 1·17, 1·50) and among those reporting lower income (£40 000/year; 1·31; 1·09, 1·58). In contrast, daily ASB consumption was more common among women than men (1·62; 1·34, 1·96), those on weight-loss diets than those who were not (2·58; 2·05, 3·24) and those reporting higher income than lower income (1·53; 1·16, 2·00). Factors associated with higher consumption of each of SSB and ASB included being a younger adult, being overweight/obese, having shorter education, eating meals or snack foods while watching television, and skipping breakfast (P<0·05 each).

CONCLUSIONS

Frequent consumers of SSB and ASB differ by several sociodemographic characteristics. However, increased BMI, younger age and unhealthy eating behaviours are common to both groups.

Can socioeconomic factors explain geographic variation in overweight in Norway?

We explore if the geographic variation in excess body-mass in Norway can be explained by socioeconomic status, as this has consequences for public policy. The analysis was based on individual height and weight for 198,311 Norwegian youth in 2011, 2012 and 2013, stemming from a compulsory screening for military service, which covers the whole population aged seventeen. These data were merged with municipality-level socioeconomic status (SES) variables and we estimated both ecological models and two-level models with a random term at the municipality level. Overweight was negatively associated with income, education and occupation at municipality level. Furthermore, the municipality-level variance in overweight was reduced by 57% in females and 40% in males, when SES factors were taken into account. This suggests that successful interventions aimed at reducing socioeconomic variation in overweight will also contribute to reducing the geographic variation in overweight, especially in females.

Clustering of Risk Behaviors and their Social Determinants among Primary School Learners in Beijing, China: A Cross-sectional Study

Background:

Studies in developed countries reveal that poor lifestyle choices triggering diseases typically cluster among children. However, there is insufficient evidence on the clustering of risk behaviors among children in developing countries. This study aimed to determine the clustering of risk behaviors and their social determinants among 4^th-and 5^th -grade learners in Beijing, China.

Methods:

The sample comprised of 967 learners from six primary schools enrolled migrant and resident learners by two-stage stratified cluster sampling. Prevalence denoted the risk behaviors and their clustering. A log-linear model was used to explore the clustering patterns. Ordinal logistic regression determined the influence of demographic characteristics, school environment, and family context on behavioral clustering.

Results:

The prevalence of none, one, two, and three or more risk factors was 61.2%, 20.0%, 10.8%, and 8.1% for infectious diseases and 46.0%, 30.6%, 15.4%, and 8.0% for chronic diseases, respectively. Some behaviors appeared dependent and were more likely to be observed together. The three most influential factors for infectious diseases were school type (odds ratio [OR] =4.47, 95% confidence interval [CI] 3.00–6.66), school located in an inner suburb (OR = 0.27, 95% CI 0.18–0.38), and gender (OR = 0.56, 95% CI 0.42–0.74). Regarding risk behaviors for chronic diseases, clustering was not associated with household registration status and number of appliances, but was significantly associated with school type (OR = 5.36, 95% CI 3.72–7.73), school located in an inner suburb (OR = 0.59, 95% CI 0.43–0.81), and gender (OR = 0.61, 95% CI 0.47–0.78). School environment variables were the most significant contributor to the number of risk behaviors.

Conclusions:

The characteristics of schools enrolling migrants and residents influenced the number of risk behaviors. Therefore, improved school conditions and integrated behavioral interventions are particularly recommended for health promotion.

Dietary behaviour and parental socioeconomic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS)

Background

The positive association between parental socioeconomic position (PSEP) and health among adolescents may be partly explained by dietary behaviour. We investigated the associations between fruit intake, vegetable intake, energy-dense food intake, the Healthy Nutrition Score for Kids and Youth (HuSKY) and parental education in a nationwide, cluster-randomized sample of adolescents in Germany.

Methods

The German Health Interview and Examination Survey for Children and Adolescents 2003–2006 (KiGGS) included 17,641 individuals aged 0–17 years and their parents. Complete information on relevant variables was available for 6359 individuals in the 11–17 age group. The associations between nutrition indicators and parental education were analysed separately for boys and girls, using multivariate logistic regression analysis. Odds ratios (ORs) adjusted for age, region, income, occupation, physical activity and weight status related variables, were calculated for the associations between parental education and nutrition indicators.

Results

After full adjustment, higher parental education level was associated with lower energy-dense food intake – with an OR of 1.3 (95 % CI 1.0–1.7) for boys with secondary educated parents and 1.8 (1.4–2.3) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.2 (0.9–1.5) and 1.6 (1.2–2.2). Higher parental education was associated with higher fruit intake – with an OR of 1.3 (1.0–1.7) for boys with secondary educated parents and 2.0 (1.5–2.7) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.0 (0.8–1.4) and 1.5 (1.0–2.1). Among boys and girls with tertiary educated parents compared to those with primary educated parents an OR of 1.3 (CI boys: 1.0–1.7, CI girls: 1.0–1.6) was observed for high vegetable intake. Among boys with tertiary educated parents compared to boys with primary educated parents an OR of 1.6 (1.2–2.2) was observed for a high HuSKY; the corresponding OR for girls was 1.5 (1.1–1.9).

Conclusions

A high PSEP is associated with consumption of less energy-dense food, more fruits and vegetables and more favourable overall dietary behaviour. Preferably school-based interventions are needed to promote healthy dietary behaviour among German adolescents and a special effort is needed to reach adolescents from low-PSEP families.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1830-2) contains supplementary material, which is available to authorized users.

Finnish Children Healthy Eating Index (FCHEI) and its associations with family and child characteristics in pre-school children

OBJECTIVE

The objective was to develop a Finnish Children Healthy Eating Index (FCHEI), to determine the relative validity of the index and to examine associations between the index and familial sociodemographic and lifestyle characteristics.

DESIGN

Cross-sectional samples of children participating in a population-based birth cohort study in Finland.

SETTING

Type I Diabetes Prediction and Prevention (DIPP) Study cohort.

SUBJECTS

Three-day food records from 1-year-old (n 455), 3-year-old (n 471) and 6-year-old (n 713) children were completed between 2003 and 2005.

RESULTS

Validity of the FCHEI was assessed by studying the associations between the FCHEI and nutrient intakes of the children. Among all age groups, intakes of SFA and sugars decreased across increasing quartiles of the FCHEI while intakes of PUFA, dietary fibre, vitamin D and vitamin E increased. Among 3- and 6-year-olds, being cared for at home was associated with the lowest FCHEI quartile (diet that deviates most from the recommendations). The lowest FCHEI quartile was also associated with residence in a semi-urban area among the 3-year-olds and low maternal education and smoking during pregnancy among the 6-year-olds.

CONCLUSIONS

The FCHEI serves as a valid indicator of the quality of Finnish children's diet. Public health programmes aimed at improving the dietary behaviours of pre-school aged children should aim to improve the quality of food served at home. Families with history of lower parental education, maternal smoking during pregnancy or non-urban place of residence may require special attention.

Associations between socioeconomic, parental and home environment factors and fruit and vegetable consumption of children in grades five and six in British Columbia, Canada

Background

Regular fruit and vegetable (FV) consumption has been associated with reduced chronic disease risk. Evidence from adults shows a social gradient in FV consumption. Evidence from pre-adolescent children varies and there is little Canadian data. This study assessed the FV intake of school children in British Columbia (BC), Canada to determine whether socio-economic status (SES), parental and the home environment factors were related to FV consumption.

Methods

As part of the BC School Fruit and Vegetable Nutrition Program, 773 British Columbia fifth-and sixth-grade school children (Mean age 11.3 years; range 10.3-12.5) and their parents were surveyed to determine FV consumption and overall dietary intake. Students completed a web-based 24-hour dietary food recall, and a student measure of socio-economic status (The Family Affluence Scale). Parents completed a self-administered survey about their education, income, home environment and perceptions of their neighbourhood and children’s eating habits. Correlations and multiple regression analyses were used to examine the association between SES, parental and home environment factors and FV consumption.

Results

Approximately 85.8% of children in this study failed to meet minimum Canadian guidelines for FV intake (6 servings). Parent income and education were not significantly associated with child FV consumption but were associated with each other, child-reported family affluence, neighbourhood environment, access to FV, and eating at the table or in front of the television. Significant positive associations were found between FV consumption and child-reported family affluence, meal-time habits, neighbourhood environment and parent perceptions of the healthiness of their child’s diet; however, these correlations were weak (ranging from .089-.115). Multiple regression analysis showed that only child-reported family affluence significantly predicted FV consumption (std-β = 0.096 95% CI = 0.01 to 0.27).

Conclusions

The majority of children in our study were not meeting guidelines for FV intake irrespective of SES, parent perceptions or home environment, making this a population wide concern. An almost trivial socio-economic gradient was observed for the child-reported SES measure only. These results are consistent with several other studies of children. Longitudinal research is needed to further explore individual and social factors associated with FV consumption in childhood and their development over time.

The influence of early exposure to vitamin D for development of diseases later in life

Background

Vitamin D deficiency is common among otherwise healthy pregnant women and may have consequences for them as well as the early development and long-term health of their children. However, the importance of maternal vitamin D status on offspring health later in life has not been widely studied. The present study includes an in-depth examination of the influence of exposure to vitamin D early in life for development of fractures of the wrist, arm and clavicle; obesity, and type 1 diabetes (T1D) during child- and adulthood.

Methods/design

The study is based on the fact that in 1961 fortifying margarine with vitamin D became mandatory in Denmark and in 1972 low fat milk fortification was allowed. Apart from determining the influences of exposure prior to conception and during prenatal life, we will examine the importance of vitamin D exposure during specific seasons and trimesters, by comparing disease incidence among individuals born before and after fortification. The Danish National databases assure that there are a sufficient number of individuals to verify any vitamin D effects during different gestation phases. Additionally, a validated method will be used to determine neonatal vitamin D status using stored dried blood spots (DBS) from individuals who developed the aforementioned disease entities as adults and their time and gender-matched controls.

Discussion

The results of the study will contribute to our current understanding of the significance of supplementation with vitamin D. More specifically, they will enable new research in related fields, including interventional research designed to assess supplementation needs for different subgroups of pregnant women. Also, other health outcomes can subsequently be studied to generate multiple health research opportunities involving vitamin D. Finally, the results of the study will justify the debate of Danish health authorities whether to resume vitamin D supplementation policies.

Parental education and frequency of food consumption in European children: the IDEFICS study

Objective

To assess the relationship between parental education level and the consumption frequency of obesity-related foods in European children.

Design

The analysis was based on data from the cross-sectional baseline survey of a prospective cohort study. The effects of parental education on food consumption were explored using analysis of covariance and logistic regression.

Setting

Primary schools and pre-schools of selected regions in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain.

Subjects

Participants (n 14 426) of the IDEFICS baseline cohort study aged 2 to 9 years.

Results

Parental education level affected the intake of obesity-related foods in children. Children in the low and medium parental education level groups had lower odds of more frequently eating low-sugar and low-fat foods (vegetables, fruits, pasta/noodles/rice and wholemeal bread) and higher odds of more frequently eating high-sugar and high-fat foods (fried potatoes, fruits with sugar and nuts, snacks/desserts and sugared beverages; P < 0·001). The largest odds ratio differences were found in the low category (reference category: high) for vegetables (OR = 0·56; 95 % CI 0·47, 0·65), fruits (OR = 0·56; 95 % CI 0·48, 0·65), fruits with sugar and nuts (OR = 2·23; 95 % CI 1·92, 2·59) and sugared beverages (OR = 2·01; 95 % CI 1·77, 2·37).

Conclusions

Low parental education level was associated with intakes of sugar-rich and fatty foods among children, while high parental education level was associated with intakes of low-sugar and low-fat foods. These findings should be taken into account in public health interventions, with more targeted policies aiming at an improvement of children's diet.

Associations between characteristics of the home food environment and fruit and vegetable intake in preschool children: a cross-sectional study

Background

Early childhood is critical to the development of lifelong food habits. Given the high proportion of children with inadequate fruit and vegetable consumption, identification of modifiable factors associated with higher consumption may be useful in developing interventions to address this public health issue. This study aimed to identify the characteristics of the home food environment that are associated with higher fruit and vegetable consumption in a sample of Australian preschool children.

Methods

A cross-sectional telephone survey was conducted with 396 parents of 3 to 5 year-old children attending 30 preschools within the Hunter region, New South Wales, Australia. Children's fruit and vegetable consumption was measured using a valid and reliable subscale from the Children's Dietary Questionnaire. Associations were investigated between children's fruit and vegetable intake and characteristics of the home food environment including parental role-modeling, parental providing behaviour, fruit and vegetable availability, fruit and vegetable accessibility, pressure to eat, family eating policies and family mealtime practices. Characteristics of the home food environment that showed evidence of an association with children's fruit and vegetable consumption in simple regression models were entered into a backwards stepwise multiple regression analysis. The multiple regression analysis used generalised linear mixed models, controlled for parental education, household income and child gender, and was adjusted for the correlation between children's fruit and vegetable consumption within a preschool.

Results

The multiple regression analysis found positive associations between children's fruit and vegetable consumption and parental fruit and vegetable intake (p = 0.005), fruit and vegetable availability (p = 0.006) and accessibility (p = 0.012), the number of occasions each day that parents provided their child with fruit and vegetables (p < 0.001), and allowing children to eat only at set meal times all or most of the time (p = 0.006). Combined, these characteristics of the home food environment accounted for 48% of the variation in the child's fruit and vegetable score.

Conclusions

This study identified a range of modifiable characteristics within the home food environment that are associated with fruit and vegetable consumption among preschool children. Such characteristics could be considered potential targets for interventions to promote intake among children of this age.

Dietary factors and their associations with socioeconomic background in Finnish girls and boys 6-8 years of age: the PANIC Study

BACKGROUND/OBJECTIVES

To study nutrient intake, food consumption and meal pattern, and their associations with socioeconomic background in Finnish children.

SUBJECTS/METHODS

The subjects were a population sample of 424 children (211 girls, 213 boys) 6-8 years of age. Nutrient intake and meal pattern were measured by food records, and food intake and socioeconomic characteristics were assessed by questionnaires.

RESULTS

Intakes of saturated fat, sucrose and salt were higher, and intakes of vitamin D, iron and fibre and unsaturated-to-saturated fat ratio lower than recommended. Less than 5% of children consumed vegetables, fruit and berries as recommended. Children with highest parental education more likely ate fish (odds ratio (OR) 2.20, 95% confidence interval (CI) 1.06-4.54), fibre-rich bread (OR 5.06, 95% CI 1.80-14.29) and main meals (OR 2.54, 95% CI 1.34-4.83), but less likely used soft margarine (OR 0.43, 95% CI 0.20-0.94) as recommended than children with lowest parental education. Children with highest household income more likely consumed skimmed milk (OR 2.43, 95% CI 1.21-4.88) and fish (OR 2.21, 95% CI 1.12-4.36) as recommended than children with lowest household income. Only 34% of girls and 45% of boys ate all main meals daily. Snacks provided as much as 42% of total energy intake.

CONCLUSIONS

Children do not meet recommendations in all important nutrients. Children from lowest socioeconomic position least likely consumed fish, skimmed milk and fibre-rich bread and ate main meals, but most likely used soft margarine as recommended. Less than half of children ate all main meals daily.

Characteristics of family mealtimes affecting children's vegetable consumption and liking

Research has documented an association between family mealtimes and higher dietary quality in school-aged children and adolescents. However, there is little understanding of the specific characteristics of mealtimes that are beneficial and a lack of research with preschool-aged children. This cross-sectional study conducted in the United Kingdom in 2008 examined associations between mealtime characteristics and preschoolers' vegetable consumption and liking. Four hundred and thirty-four primary caregivers of children aged 2 to 5 years reported on children's vegetable intake and liking and completed a questionnaire on frequency of family meals, food preparation, and the social and environmental context of family mealtimes. Univariate and multiple linear regression analyses assessed mealtime variables and children's vegetable intake and liking. Multiple regression analysis revealed children's vegetable consumption was predicted by eating approximately the same food as their parents (β=.14; P ≤ 0.01), using ready-made sauces (β=-.12; P ≤ 0.05), and cooking from scratch (β=.11; P ≤ 0.05), accounting for 21% of the variance (with covariates). Children's liking for vegetables was predicted by eating approximately the same food as their parents (β=.15; P ≤ 0.01) and use of preprepared dishes (β=-.15; P ≤ 0.01), accounting for 8% of the variance (with covariates). Frequency of family mealtimes was unrelated to children's vegetable consumption or liking in this sample. This contrasts with findings in older children and adolescents, where frequency of family mealtimes is related to dietary quality and intake. In preschool-aged children, it seems emphasis should be placed on encouraging parents to provide home-cooked meals that mirror those eaten by the adults in the family to improve vegetable intake.

Regional and socio-economic differences in food, nutrient and supplement intake in school-age children in Germany: results from the GINIplus and the LISAplus studies

OBJECTIVE

To describe regional differences between eastern and western Germany with regard to food, nutrient and supplement intake in 9-12-year-old children, and analyse its association with parental education and equivalent income.

DESIGN

Data were obtained from the 10-year follow-up of the two prospective birth cohort studies - GINIplus and LISAplus. Data on food consumption and supplement intake were collected using an FFQ, which had been designed for the specific study population. Information on parental educational level and equivalent income was derived from questionnaires. Logistic regression modelling was used to analyse the effect of parental education, equivalent income and region on food intake, after adjusting for potential confounders.

SETTING

Germany.

SUBJECTS

A total of 3435 children aged 9-12 years.

RESULTS

Substantial regional differences in food intake were observed between eastern and western Germany. Intakes of bread, butter, eggs, pasta, vegetables/salad and fruit showed a significant direct relationship with the level of parental education after adjusting for potential confounders, whereas intakes of margarine, meat products, pizza, desserts and soft drinks were inversely associated with parental education. Equivalent income had a weaker influence on the child's food intake.

CONCLUSIONS

Nutritional education programmes for school-age children should therefore account for regional differences and parental education.

Influences on child fruit and vegetable intake: sociodemographic, parental and child factors in a longitudinal cohort study

OBJECTIVE

To examine the sociodemographic, parental and child factors that predict fruit and vegetable consumption in 7-year-old children.

DESIGN

Diet was assessed using three 1d unweighed food diaries. The child's daily fruit and vegetable consumption was calculated by summing the weight of each type of fruit, fruit juice and vegetable consumed. The various others factors measured were assessed by a questionnaire at different time points.

SETTING

The Avon Longitudinal Study of Parents and Children (ALSPAC).

SUBJECTS

A total of 7285 children aged 7 years residing in the south-west of England during 1999-2000.

RESULTS

Median daily fruit and vegetable consumption (201 g) was below the recommendations for this age group (320 g). Girls ate more fruit and vegetables per unit energy (30.3 g/MJ) than boys (26.7 g/MJ; P =< 0.001). The predictors of fruit and vegetable consumption were mostly similar. Fruit and vegetable consumption was associated with maternal consumption, maternal education status and parental rules about serving fruit/vegetables every day, food expenditure per person and whether the child was choosy about food. Vegetable consumption was also associated with the other characteristics of the child, such as whether the child enjoyed food and whether the child tried a variety of foods.

CONCLUSIONS

Children are not eating recommended amounts of fruit and vegetables, particularly boys. Consumption of fruit and vegetables appears to be influenced by parental rules about daily consumption and parental consumption and by the child's choosiness. Parent's actions could influence this. These findings may prove useful for those planning healthy eating campaigns for children.

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

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

Does social class predict diet quality?

A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.

Socioeconomic status and health behaviors in adolescence: a review of the literature

OBJECTIVE

The goal of this review was to determine the direction of associations between SES and health behaviors during the period of adolescence.

METHOD

We searched the PsychInfo and Pubmed databases for studies that measured the association between SES and cigarette smoking, alcohol consumption, marijuana use, diet, and physical activity in adolescents between 10- and 21-years old.

RESULTS

Associations between SES and health behaviors conformed to two patterns. First, low SES was associated with poorer diets, less physical activity, and greater cigarette smoking. Second, there was no clear pattern of associations between SES and alcohol consumption or marijuana use.

CONCLUSION

Results from this review indicate that, although some associations between SES and health behaviors exist during adolescence, the associations are not as robust as those in adulthood. Efforts to curb poor diet, inactivity, and smoking behaviors should target low SES adolescents, whereas efforts to curb teen drinking and marijuana use may be useful across the SES spectrum.

Impact of parental education and income inequality on children's food intake

Objective

To analyse the association between socio-economic indicators and diet among 2-year-old children, by assessing the independent contribution of parental education and equivalent income to food intake.

Design

The analysis was based on data from a prospective birth cohort study. Information on diet was obtained using a semi-quantitative food-frequency questionnaire. Low and high intake of food was defined according to the lowest and the highest quintile of food consumption frequency, respectively.

Setting

Four German cities (Munich, Leipzig, Wesel, Bad Honnef), 1999–2001.

Subjects

Subjects were 2637 children at the age of 2 years, whose parents completed questionnaires gathering information on lifestyle factors, including parental socio-economic status, household consumption frequencies and children's diet.

Results

Both low parental education and low equivalent income were associated with a low intake of fresh fruit, cooked vegetables and olive oil, and a high intake of canned vegetables or fruit, margarine, mayonnaise and processed salad dressing in children. Children with a low intake of milk and cream, and a high intake of hardened vegetable fat, more likely had parents with lower education. Low butter intake was associated with low equivalent income only.

Conclusions

These findings may be helpful for future intervention programmes with more targeted policies aiming at an improvement of children's diets.

School region socio-economic status and geographic locale is associated with food behaviour of Ontario and Alberta adolescents

BACKGROUND

In an attempt to elucidate broader determinants of adolescent dietary intake and habits, food intakes and selected food behaviours of grades 9 and 10 students from Ontario and Alberta were examined according to school region socio-economic status and urban/rural locale.

METHODS

Using a stratified random sample framework, 53 high schools from 28 school boards were recruited (45 public and 8 private; 33 urban and 20 rural). Median family income for Canada Post's forward sortation area of the school was used to define school region SES. Public and private schools were compared as a proxy measure of SES. A web-based survey of food intake and behaviours, including a 24-hour diet recall and food frequency questionnaire, was completed by 2,621 students in grades 9 and 10. Comparison of intakes and behaviours by school designation as urban/rural, public/private or regional SES (generalized linear model procedure) controlled for student gender and grade distribution and number of participants within schools.

RESULTS

School region SES ranged from dollars 40,959 to dollars 85,922/year. Vegetable and fruit consumption (p < 0.001), fibre intake (p < 0.001) and frequency of breakfast consumption (p < 0.01) increased with increasing income, while added sugar intake decreased (p < 0.01). Private versus public school students had lower intakes of sweetened drinks (p < 0.01) and higher intakes of fibre (p=0.02). Rural students reported higher mean intakes of calcium (1106 vs. 995 mg/day, respectively, p = 0.03) and milk products (2.7 vs. 2.3 servings/day, p < 0.01) than urban students.

CONCLUSION

Selected food behaviours of youth from Ontario and Alberta improve with increasing school SES and vary with rural/urban school locale. Identifying regional demographics may be useful in tailoring healthy eating programs to the specific school.

Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: Quantitative studies

BACKGROUND

In order to more effectively promote fruit and vegetable intake among children and adolescents, insight into determinants of intake is necessary. We conducted a review of the literature for potential determinants of fruit and vegetable intake in children and adolescents.

METHODS

Papers were identified from Medline and PsycINFO by using all combinations of the search terms: "fruit(s) or vegetable(s)" and "children or adolescents". Quantitative research examining determinants of fruit and/or vegetable intake among children and adolescents aged 6-18 years were included. The selection and review process was conducted according to a four-step protocol resulting in information on country, population, design, methodology, theoretical basis, instrument used for measuring intake, statistical analysis, included independent variables, and effect sizes.

RESULTS

Ninety-eight papers were included. A large number of potential determinants have been studied among children and adolescents. However, for many presumed determinants convincing evidence is lacking, mostly because of paucity of studies. The determinants best supported by evidence are: age, gender, socio-economic position, preferences, parental intake, and home availability/accessibility. Girls and younger children tend to have a higher or more frequent intake than boys and older children. Socio-economic position, preferences, parental intake, and home availability/accessibility are all consistently positively associated with intake.

CONCLUSION

The determinants most consistently supported by evidence are gender, age, socio-economic position, preferences, parental intake and home availability/accessibility. There is a need for internationally comparative, longitudinal, theory-based and multi-level studies taking both personal and environmental factors into account. This paper is published as part of the special Pro Children series in the International Journal of Behavioral Nutrition and Physical Activity. Please see [http://www.ijbnpa.org/content/3/1/26] for the relevant editorial.

Intake of vitamin D by Finnish children aged 3 months to 3 years in relation to sociodemographic factors

OBJECTIVE

To study the total daily intake of vitamin D from food and supplements among Finnish children aged 3 months to 3 years, the dietary sources of vitamin D and the association between vitamin D intake and sociodemographic factors.

SUBJECTS AND METHODS

The subjects are participants in the Finnish Type I Diabetes Prediction and Prevention Nutrition Study born between October 1997 and October 1998. At the age of 3 and 6 months, 1, 2 and 3 years, 342 (72% of the invited families), 298 (63%), 267 (56%), 233 (49%) and 209 (44%) families, respectively, participated in the present study. Food consumption was assessed by a 3-day food record. A structured questionnaire was used to record the parents' socioeconomic status.

RESULTS

The mean dietary vitamin D intake exceeded the recommendation (10 microg/day) at the age of 3 (11.0 microg) and 6 months (12.0 microg), but decreased thereafter being 9.8, 5.0 and 4.1 microg at 1, 2 and 3 years of age, respectively. Among the children 91, 91, 81, 42 and 26% used vitamin D supplements at the age of 3 and 6 months, and 1, 2 and 3 years, respectively. In children not using vitamin D supplements, vitamin D intake was less than 10 microg/day at all ages. Vitamin D intake from food did not differ in children who used and did not use vitamin D supplements. Vitamin D supplements were the main source of vitamin D intake in all age groups studied, followed by vitamin D-fortified infant formula in 3-month-olds and infant formula and baby foods in 6-month-olds. After the age of 1 year, the most important food sources of vitamin D were margarine, fish, baby foods, low-fat milk and eggs. Sociodemographic factors, especially the number of children in the family and maternal age, were associated with the total vitamin D intake and vitamin D supplement use.

CONCLUSION

Vitamin D supplements are not used according to the dietary recommendations in a substantial proportion of Finnish children.

Common sources and estimated intake of plant sterols in the Spanish diet

Plant sterols (PS) are minor lipid components of plants, which may have potential health benefits, mainly based in their cholesterol-lowering effect. The aim of this study was to determine the composition and content of PS in plant-based foods commonly consumed in Spain and to estimate the PS intake in the Spanish diet. For this purpose, the determination of PS content, using a modern methodology to measure free, esterified, and glycosidic sterol forms, was done. Second, an estimation of the intake of PS, using the Spanish National Food Consumption data, was made. The daily intake per person of PS--campesterol, beta-sitosterol, stigmasterol, and stigmastanol--in the Spanish diet was estimated at 276 mg, the largest component being beta-sitosterol (79.7%). Other unknown compounds, tentatively identified as PS, may constitute a considerable potential intake (99 mg). When the daily PS intake among European diets was compared in terms of campesterol, beta-sitosterol, stigmasterol, and stigmastanol, the PS intake in the Spanish diet was in the same range of other countries such as Finland (15.7% higher) or The Netherlands (equal). However, some qualitative differences in the PS sources were detected, that is, the predominant brown bread and vegetable fat consumption in the northern diets versus the white bread and vegetable oil consumption in the Spanish diet. These differences may help to provide a link between the consumption of PS and healthy effects of the diet.

Associations between sociodemographic and lifestyle factors and dietary quality among adolescents in Palma de Mallorca

OBJECTIVE

We assessed associations between sociodemographic and lifestyle factors and dietary quality among adolescents.

METHODS

Subjects were 445 adolescents (171 boys, 274 girls; 14 to 18 y old) selected from the Palma de Mallorca (Balearic Islands, Spain) school census (96% participation) using two-stage probability sampling. The study protocol included dietary intake by means of a validated semiquantitative food-frequency questionnaire; sociodemographic factors of sex, maternal level of education, parental occupational status, and maternal region of origin; physical activity; and body weight and height measurements. Body mass index was calculated and energy intake expressed as multiples of basal metabolic rate.

RESULTS

Mean daily energy intakes were 12.9 MJ for boys and 12.0 MJ for girls. Boys showed a higher percentage of energy from carbohydrates but a lower percentage from proteins and fat than did girls (44.9 versus 41.6, 18.8 versus 19.8, and 36.3 versus 38.5, respectively). Dietary fiber intake was within the recommended levels. Mineral and vitamin intakes generally met their estimated needs, except for vitamins A and D, which covered less than two-thirds of the recommended intake. Maternal educational level was positively correlated with dietary mineral and vitamin intakes. A positive relation between physical activity and dietary intakes of carbohydrate and of mineral and vitamin was found.

CONCLUSIONS

Maternal level of education and physical activity are associated to the quality of diet among adolescents in Palma de Mallorca.

Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children

OBJECTIVE

To examine the contribution to fruit and vegetable eating in children of potential predictive variables within the domains of demographics, parental feeding practices and personality traits.

DESIGN

Cross-sectional survey.

SETTING

Questionnaires were distributed to parents through 22 London nursery schools.

SUBJECTS

Questionnaires were completed and returned by 564 parents or principal caregivers of 2-6-year-old children.

RESULTS

Significant predictors of children's fruit and vegetable intake emerged from all three domains examined. Demographic variables associated with child's vegetable consumption were mother's education and child's age and gender. Only ethnicity was significantly associated with fruit consumption. Parental consumption, breast-feeding and early introduction to fruit and vegetables were related to intake of both. Family meal times were associated with higher intake of vegetables, but not of fruit. Two characteristics of children themselves (food neophobia and enjoyment of food) were strongly related to the consumption of fruit and vegetables. Subsequent multivariate analyses revealed that parental intake and child food neophobia independently predicted intake of both foods. In the presence of these, fruit consumption was affected by breast-feeding and early introduction to fruit, whereas vegetable consumption was related only to child's gender and enjoyment of food.

CONCLUSIONS

These findings may be used to inform future interventions aimed at increasing children's consumption of fruit and vegetables. Parents should be made aware of the possible impact of their own behaviour on the eating habits of their children.

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

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

Applying theory of planned behavior to fruit and vegetable consumption of young adolescents

PURPOSE

The purpose of this research was to investigate how well Theory of Planned Behavior (TPB) predicted frequency of consumption of fruits and vegetables among seventh graders and to investigate whether gender or socioeconomic status (SES) had moderating effects on the relationships between the constructs in the model.

DESIGN

Two identical self-administered paper and pencil surveys were distributed 6 months apart. Path analyses of the TPB models by gender and SES were performed with AMOS software.

SETTING

The study occurred in eight middle schools from school districts in the Minneapolis--St. Paul metropolitan area, where a minimum of 20% of the students qualified for free or reduced-price meals.

SUBJECTS

Of the invited seventh graders, 1406 (74%) completed data for the model constructs at baseline and for behavior at interim data collection.

MEASURES

We assessed frequency of consumption of fruits and vegetables and attitudes, subjective norms, barriers, and intentions related to this behavior. Three levels of SES were created based on questions about free lunch, parents' education, and work.

RESULTS

No significant direct effects of attitudes and subjective norms on behavior were found, but for barriers, both indirect effects through intentions and direct effects on behavior were significant. Seven percent of the variation in the frequency of fruit and vegetable consumption and 31% of the variation in intention to eat more fruits and vegetables were explained by the model. Gender appeared to have moderating effects on the relationships between attitudes and intention and between intentions and behavior in the model. There were no moderator effects of SES, but the larger dropout rates from the low-SES group could have caused the groups to become more homogeneous.

CONCLUSION

The data fit the model well; still, large proportions of the variance in the frequency of consumption of fruits and vegetables were unexplained. This may be related to the operationalization of the model constructs or to missing important factors in the model. Furthermore, there appeared to be strong relationships between subjective norms or barriers and intentions as well as gender differences in the strengths of the relationships in the model that may have implications for intervention methods or messages.

Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study

BACKGROUND

Dietary vitamin D supplementation is associated with reduced risk of type 1 diabetes in animals. Our aim was to ascertain whether or not vitamin D supplementation or deficiency in infancy could affect development of type 1 diabetes.

METHODS

A birth-cohort study was done, in which all pregnant women (n=12055) in Oulu and Lapland, northern Finland, who were due to give birth in 1966 were enrolled. Data was collected in the first year of life about frequency and dose of vitamin D supplementation and presence of suspected rickets. Our primary outcome measure was diagnosis of type 1 diabetes by end of December, 1997.

FINDINGS

12058 of 12231 represented live births, and 10821 (91% of those alive) children were followed-up at age 1 year. Of the 10366 children included in analyses, 81 were diagnosed with diabetes during the study. Vitamin D supplementation was associated with a decreased frequency of type 1 diabetes when adjusted for neonatal, anthropometric, and social characteristics (rate ratio [RR] for regular vs no supplementation 0.12, 95% CI 0.03-0.51, and irregular vs no supplementation 0.16, 0.04-0.74. Children who regularly took the recommended dose of vitamin D (2000 IU daily) had a RR of 0.22 (0.05-0.89) compared with those who regularly received less than the recommended amount. Children suspected of having rickets during the first year of life had a RR of 3.0 (1.0-9.0) compared with those without such a suspicion.

INTERPRETATION

Dietary vitamin D supplementation is associated with reduced risk of type 1 diabetes. Ensuring adequate vitamin D supplementation for infants could help to reverse the increasing trend in the incidence of type 1 diabetes.

Household educational level as a determinant of consumption of raw vegetables among male and female adolescents

BACKGROUND

This study aimed to examine the association between household educational level and consumption of raw vegetables among adolescents and to assess the influence of other determinants on the association, such as family factors, school achievement, health behavior, meal pattern, and weight-related factors. A further aim was to investigate whether the associations were the same for male and female adolescents.

METHODS

The study is based on data from the School Health Promotion Survey 1997-1998. Data were collected by a classroom-administered questionnaire, which was completed by 76,201 secondary school pupils. The study recorded the consumption of raw vegetables, but not the consumption of cooked vegetables. Multivariate logistic regressions were used in the analyses.

RESULTS

A clear positive association between educational level of the household and daily consumption of raw vegetables was found among adolescents. The adolescent's own school achievement explained part of the association between household educational level and consumption of raw vegetables. Other factors explained the association to a small degree, with meal pattern and weight factors having no effect. The associations were similar for both genders.

CONCLUSIONS

Educational level in the household is an important determinant of consumption of raw vegetables. A household with a high educational level will also presumably contain adolescents who have good school achievement, another strong predictor of frequent consumption of raw vegetables.

Motives underlying food choice: dentists, porters and dietary health promotion

OBJECTIVE

Differences in dental decay and disease amongst socioeconomic groups are thought to derive, in part, from variations in dietary practices and differences in education. The aim of this exploratory study was to examine whether differences in motivating factors affecting food choice could be found in a comparison of two groups at very different ends of the social spectrum: dentists and porters/cleaners.

DESIGN

A convenience sample of 100 people (51 porters/cleaners and 49 dentists) working in the dental school at a university in the North West of England were approached to interview face-to-face and complete the Food Choice Questionnaire (FCQ), a previously validated measure designed to assess nine main factors relevant to peoples' food choices. A sample size of 100 was chosen because it was adequate to test validity (using a two-group Chi-square test with a 0.050 two sided significance).

RESULTS

Findings were analysed using independent sample t-test and multiple linear regression. Results indicated significant differences between porters/cleaners and dentists in terms of their motives for food choice on six of the nine FCQ factors. These included convenience (p < 0.001), natural content (p < 0.05), price (p < 0.005), familiarity (p < .0001), mood (p < 0.03) and ethical concern (p < 0.01). Porters/cleaners tended to rate the factors covenience, price, mood and familiarity more highly, whereas dentists did the same for natural content and ethical concern.

CONCLUSIONS

Awareness of the differences in motivational factors affecting food choice between different social groups is important to dental practitioners who are being taught to play an increasing role in health promotion. If dental practitioners are to partake meaningfully in such a role, it is necessary for them to be aware not only of their own motives in food selection, but also of the way in which those motives may differ from those of their clients.

The potential contribution of increased vegetable and fruit consumption to health gain in the European Union

BACKGROUND

The risk of many important diseases can be reduced by consuming a diet rich in vegetables and fruit. For this reason the World Health Organization (WHO) recommends a daily intake of more than 400 g person(-1). The pattern of both the supply and intake of vegetables and fruit and the potential health gain achieved by increasing intake in the European Union (EU) and three accession countries are presented in this paper.

METHODS

Patterns of supply and dietary intake were assessed using (1) FAO food balance sheets, which allow comparison between the levels of supply in countries but do not reflect actual intake; and (2) survey data reflecting dietary intake. Using WHO mortality data for coronary heart and cerebrovascular disease and major cancers up to age 65 years, the number of preventable deaths is estimated, assuming vegetable and fruit consumption were levelled up to that of the highest consuming group, and assuming relative risks of 0.5, 0.7 or 0.9.

RESULTS

Vegetable and fruit consumption varies considerably between EU Member States. The populations of about half (seven) of the EU Member States have a mean daily intake of less than 275 g. Using the best current estimates of relative risk, over 26,000 deaths before the age of 65 years would be prevented annually in the EU if intake was levelled up to the highest consumption levels (and about double this number of deaths before the age of 75 years).

CONCLUSION

Increasing the intake of vegetables and fruit is feasible and could result in considerable improvements in public health within the EU. Priority should be given to developing methods that demonstrate the burden of disease caused by too low intakes of vegetables and fruit. This would enable the appropriate social, cultural and economic policies to be developed within the EU.

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

OBJECTIVES

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

DESIGN

Follow-up study.

SETTING

Two geographically defined areas in eastern and western Finland.

SUBJECTS

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

MAIN OUTCOME MEASURES

Hazard ratios for fatal and non-fatal coronary heart disease

RESULTS

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

CONCLUSIONS

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

Cardiovascular risk factors of young adults in relation to parental socioeconomic status: the Cardiovascular Risk in Young Finns Study

The socioeconomic status (SES) of the family influences the cardiovascular risk status of children and adolescents; however, it is not as well known whether parental SES has any effect on the risk factor profile of young adults. The aim of the present study was to investigate the relations of different aspects of parental SES, namely occupation, education, income and living area, to the common cardiovascular risk factors of their offspring (n = 919) aged 18, 21 and 24 years as a part of the Cardiovascular Risk in Young Finns Study in 1986. Subjects from farming families and rural areas had the highest serum total and low-density lipoprotein cholesterol values, and the lowest diastolic blood pressure compared with subjects from other occupational groups and subjects from urban regions. The diet of young adults from farming families and from rural areas contained more saturated fatty acids and less monounsaturated and polyunsaturated fatty acids. In addition, the body mass index was lower in subjects from urban regions compared with rural regions, and physical inactivity was less common in the urban group. Subjects with the highest parental occupational status smoked less compared with those with the lowest status. Parental education related inversely to physical inactivity and directly to dietary polyunsaturated fatty acids. The income level of the family associated positively with frequent inebriation by alcoholic beverages and inversely with the percentage of dietary energy from fat. In conclusion, there were modest inverse associations between different indicators of the SES of parents and some of the traditional risk factors of their offspring in young adulthood, which may contribute to the future risk of cardiovascular diseases.

Cardiovascular Risk in Young Finns Study: general outline and recent developments

The Cardiovascular Risk in Young Finns Study is a collaborative effort of all university departments of paediatrics and several other institutions in Finland to study the risk factors of coronary heart disease (CHD) and their determinants in children and adolescents in different parts of the country. The main cross-sectional study carried out in 1980 included 3596 3-18-year-old subjects. Follow-up studies have been performed in 1983, 1986, 1989 and 1992; in the last of these studies the subjects were 15-30 years old. The findings in anthropometry, obesity and blood pressure have been rather similar to reports from other countries in Europe. However, serum cholesterol and low-density lipoprotein cholesterol concentrations were higher than in other countries, 4.83 mmol/L and 3.09 mmol/L, respectively in 1980. By 1992 a decrease of 8% took place, probably as a result of dietary changes. Apolipoprotein phenotypes E4E4 or E4E3 were relatively frequent (34%) in the sample. Tracking and clustering have also been studied. Serum insulin levels predicted the clustering of the typical risk factor profile associated with insulin resistance syndrome. The dietary polyunsaturated to saturated fat (P/S) ratio increased from 0.26 in 1980 to 0.39 in 1992, with no significant changes in the total energy derived from fat. 'Hard-driving' was found to be the psychological risk factor most consistently related to the CHD risk factor level.

Class differences in the food rules mothers impose on their children: a cross-national study

Many studies indicate that children in middle-class families have healthier eating habits than children in lower class families. Class differences in food rules, which parents and especially mothers impose on their children, may underlie these social inequalities in food consumption. The present study uses education as a classifying variable and analyses whether mothers with higher education prescribe more "healthy" foodstuffs for their children and whether they restrict more "unhealthy" food items than less educated mothers. Moreover, the study examines whether higher class mothers consider health aspects more often and the preferences of their family members less often in their choice of food, and whether class differences in these considerations explain class differences in food rules. To answer these questions, questionnaires on the food practices of 849 women living in middle-class or lower class districts in Maastricht (the Netherlands), Liège (Belgium) and Aachen (Germany) were collected and analysed. The majority of mothers in each city prescribed primarily foods that were served at dinner like meat and vegetables, and most mothers limited their children's consumption of sweet foods, soft drinks and snacks. Higher class mothers restricted more foods, but prescribed as many food items as their lower class counterparts. Class differences in the number of restricted foods were partly, but not completely, explained by class differences in health and taste considerations. Despite national variations in dietary habits and possibly in the education of children, class differences in food rules and the explanatory power of health and taste considerations were comparable in the three cities.

Fruit and vegetable consumption, nutritional knowledge and beliefs in mothers and children

Increasing fruit and vegetable consumption is an important health behaviour. Parental and other psychosocial influences on children's fruit and vegetable consumption are poorly understood. The contribution of a variety of psychosocial and environmental factors to consumption of fruit and vegetables by children aged 9-11 years was explored. Ninety-two mothers and children (48 girls and 44 boys) were recruited via urban primary health-care practices. Socio-economic and educational level, nutritional knowledge and health- and diet-related beliefs and attitudes were assessed in mothers and children by questionnaires and semistructured interviews. Mothers>> diets were measured by a food frequency questionnaire, while children's diets were assessed by 3-day diaries (N=80). The pattern of influence of the various measures on fruit and vegetable consumption was compared with that on children's confectionery intake. The children's intakes of macronutrients were typical for the U.K. (37% fat, 50% carbohydrate and 13% protein by energy; 12 g/day fibre), while median fruit, fruit juice and vegetable intake amounted to about 2.5 servings/day. Univariate correlations and subsequent multiple regression analyses revealed quite different influences on the three food types. Independent predictors of children's fruit intake included mothers>> nutritional knowledge (beta=0.37), mothers>> frequency of fruit consumption (beta=0.30) and mothers>> attitudinal conviction that increasing fruit and vegetable consumption by their children could reduce their risk of developing cancer (beta=0.27; multiple r2=0.37,p<0.0001). Children's vegetable consumption was independently explained by the child's liking for commonly eaten vegetables (beta=0.36) and the mother's belief in the importance of disease prevention when choosing her child's food (beta=-0.27 r2=0.20,p<0.001). Children's confectionery consumption was predicted by the mother's liking for confectionery (beta=0.32) and the children's concern for health in choosing what to eat (beta=-0.26 r2=0.16, p<0.005). Children's consumption of fruit and vegetables are related to different psychosocial and environmental factors. Promotion of this behaviour may require attention to nutritional education and child feeding strategies of parents.

Gastric cancer, gastritis and plasma vitamin C: results from an international correlation and cross-sectional study. The Eurogast Study Group

Low intake of foods rich in vitamin C is associated with an increased risk of gastric cancer, and geographic variation in average vitamin C intake, therefore, could explain some of the wide international variation in gastric cancer rates. This multicentre study investigated the relationships between plasma levels of vitamin C, as an indicator of vitamin C intake, and gastric cancer rates, markers of gastritis and other socio-demographic variables. Fasting plasma samples from about 1,400 individuals from 9 centres in 7 countries worldwide were assayed for total vitamin C using a fluorometric assay. There was no association between average plasma vitamin C levels and either gastric cancer mortality or incidence rates in the populations studied. Therefore, variation in fasting plasma vitamin C levels, as an indicator of consumption of vitamin C, does not appear to explain any of the wide geographic variation in gastric cancer rates. Furthermore, there was no association between plasma vitamin C levels and Helicobacter pylori infection, low serum levels of pepsinogen A (as a marker of severe chronic atrophic gastritis) or the presence of DNA adducts in blood leukocyte DNA. Multivariate models showed that fasting plasma vitamin C levels were associated positively with female sex, higher levels of education, never having smoked and increasing height and negatively with number of cigarettes smoked per day and increasing weight. This suggests not only that gender and tobacco smoking, in particular, are important predictors of plasma vitamin C levels but also that their effects are consistent throughout the developed world.

Relation between dietary fat and energy and micronutrient intakes

Concern has been raised about the energy and nutrient adequacy of low fat diets for children that aim to prevent cardiovascular disease in Western populations. The diets of 174 randomly chosen schoolchildren aged 8-12 years from middle and high socioeconomic groups were analysed to determine their nutrient composition in relation to fat intake. The mean percentages of energy intake from fat and saturated fat were 31 and 13%, respectively, and 44% of all children reported consuming < 30% of their energy from fat. The energy intake did not change across the spectrum of fat intake. A decreased fat intake was associated with an increased sugar intake, but also with increased nutrient densities of thiamin, niacin, folate, vitamin C, magnesium, and iron, reflecting an increased intake of fruit, vegetables, and grains. Parental educational level was the most important determinant of fat intake (inverse relation). It is concluded that a self selected low fat intake among children from average to high socioeconomic backgrounds does not compromise their intake of major nutrients or energy.

Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse

Attempts to explain socioeconomic inequalities in health have often made reference to the observation that poor health behaviours and psychosocial characteristics cluster in low socioeconomic status (SES) groups. Causal interpretation of the association between SES, health behaviour, psychosocial orientations, and health inequalities has been hampered because these factors and SES have usually been measured at the same point in time. Data from the Kuopio Ischaemic Heart Disease Risk Factor Study were used to examine the associations between measures of SES reflecting different stages of the lifecourse, health behaviours, and psychosocial characteristics in adulthood in a population-based study of 2674 middle-aged Finnish men. Results show that many adult behaviours and psychosocial dispositions detrimental to health are consistently related to poor childhood conditions, low levels of education, and blue-collar employment. Poor adult health behaviours and psychosocial characteristics were more prevalent among men whose parents were poor. Increases in income inequality which place children into low SES conditions may well produce a negative behavioural and psychosocial health dividend to be reaped in the future. Understanding that adult health behaviour and psychosocial orientations are associated with socioeconomic conditions throughout the lifecourse implies that efforts to reduce socioeconomic inequalities in health must recognize that economic policy is public health policy.