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Grimes CA, Bolton KA, Trieu K, Reimers J, Armstrong S, Bolam B, Beckford K, Santos JA, Rosewarne E, Dunford EK, Jan S, Webster J, Neal B, Nowson C, Woodward M. Evaluation of a state-wide intervention on salt intake in primary schoolchildren living in Victoria, Australia. Public Health Nutr 2023; 26:1456-1467. [PMID: 36785876 PMCID: PMC10346046 DOI: 10.1017/s1368980023000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/11/2023] [Accepted: 01/30/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE In 2015, the Victorian Salt Reduction Partnership launched a 4-year multifaceted salt reduction intervention designed to reduce salt intake by 1 g/d in children and adults living in Victoria, Australia. Child-relevant intervention strategies included a consumer awareness campaign targeting parents and food industry engagement seeking to reduce salt levels in processed foods. This study aimed to assess trends in salt intake, dietary sources of salt and discretionary salt use in primary schoolchildren pre- and post-delivery of the intervention. DESIGN Repeated cross-sectional surveys were completed at baseline (2010-2013) and follow-up (2018-2019). Salt intake was measured via 24-h urinary Na excretion, discretionary salt use behaviours by self-report and sources of salt by 24-h dietary recall. Data were analysed with multivariable-adjusted regression models. SETTING Victoria, Australia. PARTICIPANTS Children aged 4-12 years. RESULTS Complete 24-h urine samples were collected from 666 children at baseline and 161 at follow-up. Mean salt intake remained unchanged from baseline (6·0; se 0·1 g/d) to follow-up (6·1; 0·4 g/d) (P = 0·36), and there were no clear differences in the food sources of salt and at both time points approximately 70 % of children exceeded Na intake recommendations. At follow-up, 14 % more parents (P = 0·001) reported adding salt during cooking, but child use of table salt and inclusion of a saltshaker on the table remained unchanged. CONCLUSION These findings show no beneficial effect of the Victorian Salt Reduction Partnership intervention on children's salt intake. More intensive, sustained and coordinated efforts between state and federal stakeholders are required.
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Affiliation(s)
- Carley A Grimes
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC3216, Australia
| | - Kristy A Bolton
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC3216, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Reimers
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC, Australia
| | | | - Bruce Bolam
- Department of Health and Human Services, Melbourne, VIC, Australia
| | - Kelsey Beckford
- Deakin University, School of Exercise and Nutrition Sciences, Geelong, VIC, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth K Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Caryl Nowson
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC3216, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
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Abstract
AIM To compare the cost and nutritional profiles of toddler-specific foods and milks to 'regular' foods and milks. METHODS Cross-sectional audit of non-toddler specific ('regular') foods and milks and secondary analysis of existing audit data of toddler specific (12-36 months) foods and milks in Australia. MAIN FINDINGS The cost of all toddler-specific foods and milks was higher than the regular non-toddler foods. Foods varied in nutritional content, but toddler foods were mostly of poorer nutritional profile than regular foods. Fresh milk cost, on average, $0.22 less per 100 mL than toddler milk. Toddler milks had higher mean sugar and carbohydrate levels and lower mean protein, fat, saturated fat, sodium and calcium levels per 100 mL, when compared to fresh full fat cow's milk. CONCLUSIONS Toddler specific foods and milks cost more and do not represent value for money or good nutrition for young children.
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Affiliation(s)
- Jennifer McCann
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | | | | | | | - Julie Woods
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
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Beckford K, Grimes CA, Margerison C, Riddell LJ, Skeaff SA, West ML, Nowson CA. Reply to: A systematic review and meta-analysis of 24-h urinary output of children and adolescents: impact on the assessment of iodine status using urinary biomarkers-don't forget creatinine. Eur J Nutr 2021; 60:1165-1166. [PMID: 33438059 DOI: 10.1007/s00394-020-02468-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Kelsey Beckford
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000 Waurn Ponds, Geelong, VIC, 3220, Australia.
| | - Carley A Grimes
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000 Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Claire Margerison
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000 Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Lynn J Riddell
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000 Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Sheila A Skeaff
- Department of Human Nutrition, University of Otago, 362 Leith St, North Dunedin, Dunedin, 9016, New Zealand
| | - Madeline L West
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000 Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000 Waurn Ponds, Geelong, VIC, 3220, Australia
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Beckford K, Grimes CA, Margerison C, Riddell LJ, Skeaff SA, West ML, Nowson CA. A systematic review and meta-analysis of 24-h urinary output of children and adolescents: impact on the assessment of iodine status using urinary biomarkers. Eur J Nutr 2020; 59:3113-3131. [PMID: 31784814 PMCID: PMC7501103 DOI: 10.1007/s00394-019-02151-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE Urinary iodine concentration (UIC (μg/ml) from spot urine samples collected from school-aged children is used to determine the iodine status of populations. Some studies further extrapolate UIC to represent daily iodine intake, based on the assumption that children pass approximately 1 L urine over 24-h, but this has never been assessed in population studies. Therefore, the present review aimed to collate and produce an estimate of the average 24-h urine volume of children and adolescents (> 1 year and < 19 years) from published studies. METHODS EBSCOHOST and EMBASE databases were searched to identify studies which reported the mean 24-h urinary volume of healthy children (> 1 year and < 19 years). The overall mean (95% CI) estimate of 24-h urine volume was determined using a random effects model, broken down by age group. RESULTS Of the 44 studies identified, a meta-analysis of 27 studies, with at least one criterion for assessing the completeness of urine collections, indicated that the mean urine volume of 2-19 year olds was 773 (654, 893) (95% CI) mL/24-h. When broken down by age group, mean (95% CI) 24-h urine volume was 531 mL/day (454, 607) for 2-5 year olds, 771 mL/day (734, 808) for 6-12 year olds, and 1067 mL/day (855, 1279) for 13-19 year olds. CONCLUSIONS These results demonstrate that the average urine volume of children aged 2-12 years is less than 1 L, therefore, misclassification of iodine intakes may occur when urine volumes fall below or above 1 L. Future studies utilizing spot urine samples to assess iodine status should consider this when extrapolating UIC to represent iodine intakes of a population.
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Affiliation(s)
- Kelsey Beckford
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia.
| | - Carley A Grimes
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Claire Margerison
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Lynn J Riddell
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Sheila A Skeaff
- Department of Human Nutrition, University of Otago, 362 Leith St, North Dunedin, Dunedin, 9016, New Zealand
| | - Madeline L West
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC, 3220, Australia
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Grimes CA, Riddell LJ, Campbell KJ, Beckford K, Baxter JR, He FJ, Nowson CA. Dietary intake and sources of sodium and potassium among Australian schoolchildren: results from the cross-sectional Salt and Other Nutrients in Children (SONIC) study. BMJ Open 2017; 7:e016639. [PMID: 29084791 PMCID: PMC5665305 DOI: 10.1136/bmjopen-2017-016639] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To examine sodium and potassium urinary excretion by socioeconomic status (SES), discretionary salt use habits and dietary sources of sodium and potassium in a sample of Australian schoolchildren. DESIGN Cross-sectional study. SETTING Primary schools located in Victoria, Australia. PARTICIPANTS 666 of 780 children aged 4-12 years who participated in the Salt and Other Nutrients in Children study returned a complete 24-hour urine collection. PRIMARY AND SECONDARY OUTCOME MEASURES 24-hour urine collection for the measurement of sodium and potassium excretion and 24-hour dietary recall for the assessment of food sources. Parent and child reported use of discretionary salt. SES defined by parental highest level of education. RESULTS Participants were 9.3 years (95% CI 9.0 to 9.6) of age and 55% were boys. Mean urinary sodium and potassium excretion was 103 (95% CI 99 to 108) mmol/day (salt equivalent 6.1 g/day) and 47 (95% CI 45 to 49) mmol/day, respectively. Mean molar Na:K ratio was 2.4 (95% CI 2.3 to 2.5). 72% of children exceeded the age-specific upper level for sodium intake. After adjustment for age, sex and day of urine collection, children from a low socioeconomic background excreted 10.0 (95% CI 17.8 to 2.1) mmol/day more sodium than those of high socioeconomic background (p=0.04). The major sources of sodium were bread (14.8%), mixed cereal-based dishes (9.9%) and processed meat (8.5%). The major sources of potassium were dairy milk (11.5%), potatoes (7.1%) and fruit/vegetable juice (5.4%). Core foods provided 55.3% of dietary sodium and 75.5% of potassium while discretionary foods provided 44.7% and 24.5%, respectively. CONCLUSIONS For most children, sodium intake exceeds dietary recommendations and there is some indication that children of lower socioeconomic background have the highest intakes. Children are consuming about two times more sodium than potassium. To improve sodium and potassium intakes in schoolchildren, product reformulation of lower salt core foods combined with strategies that seek to reduce the consumption of discretionary foods are required.
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Affiliation(s)
- Carley A Grimes
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Lynn J Riddell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Kelsey Beckford
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Janet R Baxter
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Feng J He
- Wolfson Institute of Preventative Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Beckford K, Grimes CA, Margerison C, Riddell LJ, Skeaff SA, Nowson CA. Iodine Intakes of Victorian Schoolchildren Measured Using 24-h Urinary Iodine Excretion. Nutrients 2017; 9:nu9090961. [PMID: 28867787 PMCID: PMC5622721 DOI: 10.3390/nu9090961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022] Open
Abstract
Mandatory fortification of bread with iodized salt was introduced in Australia in 2009, and studies using spot urine collections conducted post fortification indicate that Australian schoolchildren are now replete. However an accurate estimate of daily iodine intake utilizing 24-h urinary iodine excretion (UIE μg/day) has not been reported and compared to the estimated average requirement (EAR). This study aimed to assess daily total iodine intake and status of a sample of primary schoolchildren using 24-h urine samples. Victorian primary school children provided 24-h urine samples between 2011 and 2013, from which urinary iodine concentration (UIC, μg/L) and total iodine excretion (UIE, μg/day) as an estimate of intake was determined. Valid 24-h urine samples were provided by 650 children, mean (SD) age 9.3 (1.8) years (n = 359 boys). The mean UIE of 4–8 and 9–13 year olds was 94 (48) and 111 (57) μg/24-h, respectively, with 29% and 26% having a UIE below the age-specific EAR. The median (IQR) UIC was 124 (83,172) μg/L, with 36% of participants having a UIC < 100 μg/L. This convenience sample of Victorian schoolchildren were found to be iodine replete, based on UIC and estimated iodine intakes derived from 24-h urine collections, confirming the findings of the Australian Health Survey.
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Affiliation(s)
- Kelsey Beckford
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC 3220, Australia.
| | - Carley A Grimes
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC 3220, Australia.
| | - Claire Margerison
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC 3220, Australia.
| | - Lynn J Riddell
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC 3220, Australia.
| | - Sheila A Skeaff
- Department of Human Nutrition, University of Otago, 362 Leith St, North Dunedin, Dunedin 9016, New Zealand.
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20000, Waurn Ponds, Geelong, VIC 3220, Australia.
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Beckford K, Grimes C, Margerison C, Riddell L, Skeaff S, Nowson C. Relationship between urinary iodine excretion, milk and bread intake in a sample of Victorian schoolchildren. Journal of Nutrition & Intermediary Metabolism 2017. [DOI: 10.1016/j.jnim.2017.04.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Beckford K, Grimes CA, Riddell LJ. Australian children's consumption of caffeinated, formulated beverages: a cross-sectional analysis. BMC Public Health 2015; 15:70. [PMID: 25636490 PMCID: PMC4314765 DOI: 10.1186/s12889-015-1443-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 01/19/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Caffeine is a common additive in formulated beverages, including sugar-sweetened beverages. Currently there are no data on the consumption of caffeinated formulated beverages in Australian children and adolescents. This study aimed to determine total intake and consumption patterns of CFBs in a nationally representative sample of Australian children aged 2-16 years and to determine contribution of CFBs to total caffeine intake. Consumption by day type, mealtime and location was also examined. METHODS Dietary data from one 24-hour recall collected in the 2007 Australian National Children's Nutrition and Physical Activity Survey were analysed. CFBs were defined as beverages to which caffeine has been added as an additive, including cola-type beverages and energy drinks. Socioeconomic status was based on the highest level of education attained by the participant's primary caregiver. Time of day of consumption was classified based on traditional mealtimes and type of day of consumption as either a school or non-school day. Location of consumption was defined by the participant during the survey. RESULTS On the day of the survey 15% (n = 642) of participants consumed CFBs. Older children and those of low socioeconomic background were more likely to consume CFBs (both P < 0.001). Amongst the 642 consumers mean (95% CI) intakes were 151 (115-187)g/day, 287 (252-321)g/day, 442 (400-484)g/day, and 555 (507-602)g/day for 2-3, 4-8, 9-13 and 14-16 year olds respectively. Consumers of CFBs had higher intakes of caffeine (mean (95% CI) 61 (55-67)mg vs. 11 (10-12)mg) and energy (mean (95% CI) 9,612 (9,247-9978)kJ vs. 8,186 (8,040-8,335)kJ) than non-consumers (both P < 0.001). CFBs contributed 69% of total daily caffeine intake. CFB intake was higher on non-school days compared with school days (P < 0.005) and consumption occurred predominantly at the place of residence (56%), within the "dinner" time bracket (17:00-20:30, 44%). CONCLUSIONS The consumption of CFBs by all age groups within Australian children is of concern. Modifications to the permissibility of caffeine as a food additive may be an appropriate strategy to reduce the intake of caffeine in this age group. Additional areas for intervention include targeting parental influences over mealtime beverage choices.
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Affiliation(s)
- Kelsey Beckford
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Victoria, 3125, Australia.
| | - Carley A Grimes
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Victoria, 3125, Australia.
| | - Lynn J Riddell
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Victoria, 3125, Australia.
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Hansen J, Sato M, Ruedy R, Lacis A, Asamoah K, Beckford K, Borenstein S, Brown E, Cairns B, Carlson B, Curran B, de Castro S, Druyan L, Etwarrow P, Ferede T, Fox M, Gaffen D, Glascoe J, Gordon H, Hollandsworth S, Jiang X, Johnson C, Lawrence N, Lean J, Lerner J, Lo K, Logan J, Luckett A, McCormick MP, McPeters R, Miller R, Minnis P, Ramberran I, Russell G, Russell P, Stone P, Tegen I, Thomas S, Thomason L, Thompson A, Wilder J, Willson R, Zawodny J. Forcings and chaos in interannual to decadal climate change. ACTA ACUST UNITED AC 1997. [DOI: 10.1029/97jd01495] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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