AbstractObjectiveCurrent indices of diet quality generally include intakes of specific foods or nutrients. We sought to develop an index that discriminates healthy and unhealthy eating choices for use in large surveys as a short questionnaire and as a measure in existing studies with adequate dietary data.DesignThe Eating Choices Index (ECI) score included four components: (i) consumption of breakfast, (ii) consumption of two portions of fruit per day, (iii) type of milk consumed and (iv) type of bread consumed, each providing a score from 1 to 5. In analysis of 5 d food records, the ECI score was examined in relation to macronutrients, fibre, vitamin C, Fe, Ca and folate using Pearson correlations. Variation with sex, BMI, socio-economic status, marital status, smoking status and physical activity were also investigated.SettingMedical Research Council National Survey of Health and Development.SubjectsIndividuals (n2256) aged 43 years.ResultsThe ECI score (mean 12·3 (sd3·5)) was significantly positively associated with protein, carbohydrate, fibre, vitamin C, Fe, Ca and folate (r= 0·2–0·5;P< 0·001) and significantly negatively associated with fat intake (r= –0·2;P< 0·001); ECI scores were not correlated with total energy intake. Individuals with a lower ECI score were more likely to be men (P< 0·001), overweight or obese (P< 0·001), have lower socio-economic status (P< 0·001), smoke more (P< 0·001) and be less physically active (P< 0·001).ConclusionsECI scores correlated with nutrient profiles consistent with a healthy diet. It provides a simple method to rank diet healthiness in large observational studies.

As populations are ageing, more emphasis is placed on healthy ageing. Over the past decades, food consumption patterns and food availability have also changed drastically, and therefore this study aimed to describe these changes in an ageing population. Food consumption of participants from the Medical Research Council National Survey on Health and Development, a British birth cohort study, was assessed using a 5-day estimated food records at 60–64 years (2006–11), 53 years (1999), 43 years (1989) and 36 years (1982). Only those who recorded ⩾3 days at all four time points were included in the analyses, n=989 (n=438 men and n=551 women); trends were tested using the Friedman test. Consumption of white bread, whole milk, fats and oils, meat and meat products, alcoholic drinks, coffee, sugar, preserves and confectionery decreased (P<0.001), whereas consumption of wholemeal and granary bread, semi-skimmed milk, fish and fruit and vegetables increased (P<0.001) over time. These observed changes in food consumption reflect a healthier diet, for example, replacement of white bread by granary and wholemeal bread, lower consumption of red and processed meats, somewhat higher consumption of fish, higher consumption of vegetables and lower consumption of coffee. This could partly be because of ageing of the cohort or compliance with dietary recommendations, facilitated by greater availability of healthier foods, such as semi-skimmed milk and wholegrain bread, in the UK. The changes in food consumption in this British birth cohort over the past three decades are encouraging and reflect a healthier diet in the later years.

OBJECTIVE:Few studies have considered the combined effects of home-related determinants on children’s diet. The present study investigated independent associations between sociodemographic and food practice (SFP) characteristics and fruit and vegetable consumption in U.K. children and the combined effects of SFP on consumption using pattern analysis. DESIGN:Diet was assessed using 4 d food diaries, SFP were collected using computer-assisted personal interview. Linear regressions were used to test associations; principal component analysis was used to identify patterns of SFP characteristics. Regression of fruit (g/d) and vegetables (g/d) v. component scores of each pattern were performed. SETTING:U.K. National Diet and Nutrition Survey Rolling Programme (2008–2010). SUBJECTS:Children aged 1.5–10 years (n 642). RESULTS:Significant associations were found between fruit and vegetable consumption and household socio-economic status. Pattern 1, which was positively correlated with household structure characteristics, was associated with increased fruit consumption (P < 0.001). Pattern 2, characterised by positive correlations for socio-economic status, fruit availability and organic food purchase, and negatively correlated with household size and the number of children per household, was associated with higher fruit and vegetable consumption (both P < 0.001). Pattern 3, characterised by high frequency of eating out and eating takeaway, was associated with a lower consumption of both fruit (P < 0.012) and vegetables (P < 0.023). CONCLUSIONS:Patterns of SFP determinants may be more informative than individual characteristics in relation to dietary outcomes. Results have public health implications on the healthfulness of meals eaten out of home and in takeaways, as well as the need to reduce diet inequality in larger households with lower socio-economic status.

Objectives: The role of circadian rhythm of energy and macronutrient intake in influencing cardiometabolic risk factors is increasingly recognized. However, little is known of the association between time of energy intake and blood pressure. We examined the association between time-of-day of energy intake and subsequent hypertension and change in blood pressure. Methods: The analysis included 517 men and 635 women from the 1946 British birth cohort. Diet was assessed using 5-day estimated diaries. Diaries were divided into seven meal slots: breakfast, mid-morning, lunch, mid-afternoon, dinner, late evening and extras. Time-of-day of energy intake at age 43 years was related to hypertension prevalence at 43 years and incidence at age 53 years and 10-year changes in SBP and DBP using logistic regression and censored regression controlling for medication use. Results: Cohort members in the highest quintile of energy intake at breakfast at age 43 years had 30% lower odds of hypertension prevalence compared with those in the lowest. Cohort members in the highest quintile of energy intake at late evening had higher odds of incident hypertension at age 53 years [odds ratio = 1.55; 95% confidence interval (CI) 0.93–2.61; P for linear trend = 0.052]. Compared to the lowest quintile, the highest quintile of energy intake late in the evening was related to a greater rise in SBP (&bgr; = 5.09; 95% CI 1.25–8.93) and DBP (43–53 years) (&bgr; = 2.08; 95%CI 0.27–5.32). Conclusion: Higher energy intake at breakfast is associated with lower hypertension prevalence. Greater energy intake late in the evening is associated with higher hypertension prevalence, incidence and greater increases in blood pressure.

AbstractObjectiveTo compare food and nutrient intakes from midday meals provided by schools with those from packed lunches and to estimate the contribution from food eaten at midday to the total daily energy and nutrient intakes of teenagers.DesignDietary data were recorded in 4 d estimated diaries of which 2 d were school days. The school day data were analysed for total and midday energy and nutrient intakes. The latter were compared with the recommendations of the Caroline Walker Trust (CWT).SettingCambridgeshire, UK, 2006.SubjectsTeenagers (n 757) aged 14–15 years, from eighteen secondary schools, who reported food eaten at school.ResultsThe contribution to total daily energy intake from all lunches eaten at school was 29 % (boys) and 28 % (girls). School meals provided greater quantities of protein, starch, carotene and folate but also more saturated fats and Na than packed lunches. Intakes of energy and several nutrients fell below the CWT recommendations for both types of lunch. School meals and packed lunches provided different types of foods; greater quantities of rice, pasta and vegetables in school meals; more yoghurt, cheese, fruit and juices but also more confectionery and soft drinks in packed lunches.ConclusionsThere has been concern that schoolchildren who are not opting for lunch provided by schools are compromising the overall quality of their diet, but the present study showed small differences in nutrient content between packed and school lunches. These data were collected in 2005–2007 before the government programme of improvements reached secondary schools.

Background and aims: Few studies have described the association between time-of-day of macronutrient intake and diabetes. This study examined the prospective association between time-of-day and nutrient composition of eating occasions in relation to diabetes incidence in the 1946 British birth cohort.Methods and results: The study included 1618 survey members who completed dietary assessment at age 43 (1989) and for whom data on glycosylated haemoglobin at age 53 years (1999) were available. Diet was assessed using 5d estimated diaries, divided into seven meal slots: breakfast, mid-morning, lunch, mid-afternoon, dinner, late evening and extras. Diabetes was defined by glycosylated haemoglobin (Hb(A1c)) >= 6.5% or diabetes medication use. The association between time-of-day of macronutrient intake at age 43 years and diabetes at age 53 years was assessed using logistic multivariate nutrient density models after adjustment for potential confounders. There were 66 cases of diabetes at age 53 years. Survey members with diabetes obtained 50.4% of their energy from carbohydrate at breakfast compared to 55.9% in survey members without diabetes (P = 0.001). Increasing carbohydrate intake at breakfast at the expense of fat was related to lower odds ratio (OR) of diabetes (OR = 0.86; 95% CI = 0.79-0.93; P < 0.001). This relationship was attenuated after adjustment for body mass index and waist circumference.Conclusion: Increasing energy intake from carbohydrate at the expense of fat at breakfast is inversely associated with 10-year diabetes incidence. However, further studies are required to elucidate whether the type or source of carbohydrates or fat influences the above association. (C) 2013 Elsevier B.V. All rights reserved.

Background: Eating context is the immediate environment of each eating occasion (EO). There is limited knowledge on the effects of the eating context on food consumption in children, due to the difficulty in measuring the multiple eating contexts children experience throughout the day. This study applied ecological momentary assessment using food diaries to explore the relationships between eating context and fruit and vegetable consumption in UK children.Methods: Using 4 d unweighed food diaries, data were collected for 642 children aged 1.5-10y in two years of the UK National Diet and Nutrition Survey (2008-2010). Participants recorded all foods and drinks consumed at each EO, where and with whom the food was consumed, whether the TV was on and if eaten at a table. Mixed logistic regression and mixed multinomial logistic regression were used to calculate associations between eating contexts and fruit and vegetables (FV) consumed by quartiles.Results: Of 16,840 EOs, 73% took place at home and 31% with parents only. Frequency of eating alone and with friends increased with age. Compared to eating at home, children aged 1.5-3y were more likely to consume fruit at care outside home (>10-50g OR: 2.39; >50-100g OR: 2.12); children aged 4-6y were more likely to consume fruit (>50-100g OR: 3.53; >100g OR: 1.88) and vegetables at school (>30-60g OR: 3.56). Compared to eating with parents only, children aged 1.5-3y were more likely to consume fruit with friends (>10-50g OR: 2.69; >50-100g OR: 3.49), and with carer and other children/others (>10-50g OR: 2.25); children aged 4-6y were more likely to consume fruit (>50-100g OR: 1.96) and vegetables with friends (>30-60g OR: 3.56). Children of all ages were more likely to eat vegetables when the TV was off than on and at a table than not at table.Conclusions: The use of food diaries to capture multiple eating contexts and detailed fruit and vegetable consumption data was demonstrated at a population level. Higher odds of FV consumption were seen from structured settings such as school and care outside home than at home, as well as when eating at a table and the TV off. This study highlights eating contexts where provision of fruit and vegetables could be improved, especially at home. Future research should take eating context into consideration when planning interventions to target children's food consumption and eating behaviour.

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We aimed to examine the association between intake of different subgroups of dairy products and blood pressure and incident hypertension 10 years later, adjusting for confounding factors.

Background: Diet is a key modifiable factor in the prevention and treatment of the metabolic syndrome. However, few studies have examined the prospective association between time-of-day of nutrient intake and the metabolic syndrome. Objective: To examine the association between time-of-day and nutrient composition of eating occasions and the long-term development of metabolic syndrome in the Medical Research Council (MRC) National Survey of Health and Development (NSHD; 1946 British birth cohort). Methods: The analysis comprised 1488 survey members who completed at least 3 days of estimated diet records at age 43 years (1989) and for whom data on metabolic syndrome at age 53 years (1999) were available. Dietary records were divided into seven meal slots: breakfast, mid-morning, lunch, mid-afternoon, dinner, late evening and extras. Metabolic syndrome was defined by the criteria of the adult treatment panel (ATPIII8), and was modified to include glycosylated haemoglobin instead of fasting glucose. Associations between time-of-day of nutrient intake at age 43 years and prevalence of metabolic syndrome at age 53 years were assessed using multivariate nutrient density logistic models after adjustment for sex, social class, smoking status, region, alcohol intake and recreational physical activity. Results: There were 390 cases of metabolic syndrome at age 53 years. Substituting 5% of energy from carbohydrate for a similar amount of energy from fat at breakfast (odds ratio=0.93; 95% confidence interval=0.89–0.98; P =0.002) and mid-morning at age 43 years (odds ratio=0.96; 95% confidence interval=0.93–0.99; P =0.011) was associated with lower odds of the metabolic syndrome at age 53 years. Carbohydrate intake at breakfast or mid-morning was particularly protective against abdominal obesity ( P ⩽0.001). Increasing carbohydrate intake at breakfast while simultaneously decreasing fat intake was also negatively related to triacylglycerols ( P ⩽0.001). Conclusions: Increasing carbohydrate intake in the morning while simultaneously reducing fat intake could be protective against long-term development of the metabolic syndrome and its components.

BACKGROUND/OBJECTIVES:Associations between timing of eating occasions and their nutrient composition and health have been described in interventional and cross-sectional studies. However, data from longitudinal data are limited. This study examined 17-year changes in energy and macronutrient intake across eating occasions in the 1946 British birth cohort. SUBJECTS/METHODS:Data were obtained from the 1946 British birth cohort. Cohort members completed 5d-estimated diaries at ages 36 (1982), 43 (1989) and 53 years (1999). Data from subjects who provided dietary data at all three time points were analysed (n = 1253). Repeated-measures analysis of variance with post hoc Bonferroni's adjustment was used to examine changes in energy and macronutrient at breakfast, mid-morning, lunch, mid-afternoon, evening and extra meal slots between 1982 and 1999. Analyses were stratified by sex and social class. RESULTS:The proportion of energy and macronutrients consumed at lunch declined between 1982 and 1999, which was compensated by a greater intake in the mid-afternoon and evening. This trend was seen across sex and social class, although women and adults with a non-manual occupation reported greater energy, carbohydrate and non-starch polysaccharide intake at breakfast in 1982 and had a higher protein intake in the evening compared with men and adults with a manual occupation. CONCLUSIONS:The timing of energy and nutrient intake has shifted slightly over time, with a greater proportion of intake later in the day. The association between the observed sex and occupational social class differences in eating profiles and chronic disease warrants investigation.

Socio-demographic determinants of fruit and vegetable consumption in children aged 1.5 to 10 years: results from the National Diet and Nutrition Survey rolling programme (2008–9) - Volume 70 Issue OCE1

Supplement of bamboo extract lowers serum monocyte chemoattractant

High saturated fat intake is an established risk factor for several chronic diseases. The objective of the present study is to report dietary intakes and main food sources of fat and fatty acids (FA) from the first year of the National Diet and Nutrition Survey (NDNS) rolling programme in the UK. Dietary data were collected using 4 d estimated food diaries ( n 896) and compared with dietary reference values (DRV) and previous NDNS results. Total fat provided 34–36 % food energy (FE) across all age groups, which was similar to previous surveys for adults. Men (19–64 years) and older girls (11–18 years) had mean intakes just above the DRV, while all other groups had mean total fat intakes of < 35 % FE. SFA intakes were lower compared with previous surveys, ranging from 13 to 15 % FE, but still above the DRV. Mean MUFA intakes were 12·5 % FE for adults and children aged 4–18 years and all were below the DRV. Mean n -3 PUFA intake represented 0·7–1·1 % FE. Compared with previous survey data, the direction of change for n -3 PUFA was upwards for all age groups, although the differences in absolute terms were very small. Trans -FA intakes were lower than in previous NDNS and were less than 2 g/d for all age groups, representing 0·8 % FE and lower than the DRV in all age groups. In conclusion, dietary intake of fat and FA is moving towards recommended levels for the UK population. However, there remains room for considerable further improvement.

The National Diet and Nutrition Survey (NDNS) is a cross-sectional survey designed to gather data representative of the UK population on food consumption, nutrient intakes and nutritional status. The objectives of the present paper were to identify and describe food consumption and nutrient intakes in the UK from the first year of the NDNS rolling programme (2008–09) and compare these with the 2000–01 NDNS of adults aged 19–64 years and the 1997 NDNS of young people aged 4–18 years. Differences in median daily food consumption and nutrient intakes between the surveys were compared by sex and age group (4–10 years, 11–18 years and 19–64 years). There were no changes in energy, total fat or carbohydrate intakes between the surveys. Children aged 4–10 years had significantly lower consumption of soft drinks (not low calorie), crisps and savoury snacks and chocolate confectionery in 2008–09 than in 1997 (all P < 0·0001). The percentage contribution of non-milk extrinsic sugars to food energy was also significantly lower than in 1997 in children aged 4–10 years (P < 0·0001), contributing 13·7–14·6 % in 2008–09 compared with 16·8 % in 1997. These changes were not as marked in older children and there were no changes in these foods and nutrients in adults. There was still a substantial proportion (46 %) of girls aged 11–18 years and women aged 19–64 years (21 %) with mean daily Fe intakes below the lower reference nutrient intake. Since previous surveys there have been some positive changes in intakes especially in younger children. However, further attention is required in other groups, in particular adolescent girls.

Studies show an inverse relationship between breakfast frequency and weight gain. This may reflect poor eating habits generally and associated low physical activity (PA) or direct impacts of breakfast on mechanisms leading to lethargy and reduced PA. The relationship between breakfast frequency and PA is inconclusive. We aimed to determine whether breakfast frequency is associated with PA levels in British adolescents independent of body composition and socio-economic status (SES). Habitual breakfast frequency (self-report questionnaire) was assessed in 877 adolescents (43 % male, age 14·5 (sd 0·5) years old). PA was measured over 5 d (accelerometry, average counts/min; cpm). Associations between daily PA and breakfast frequency were assessed using linear regression adjusted for body fat percentage and SES. Effect modification by sex and associations with PA during the morning (06.00–12.00 hours) were explored. For boys, there were no significant associations between breakfast frequency and PA. For girls, less frequent breakfast consumption was significantly associated with lower PA (cpm) during the morning (occasional v. frequent β − 6·1 (95 % CI − 11·1, − 1·1), P = 0·017) when adjusted for body fat percentage and SES. There were no associations between PA and breakfast consumption over the whole day; however, for girls, less frequent breakfast consumption may be associated with lower PA levels during the morning, suggesting that breakfast consumption should perhaps be taken into consideration when aiming to promote PA in adolescent girls.

BACKGROUND Ischemic heart disease (IHD) rates are lower in UK black Africans and black Caribbeans and higher in South Asians when compared with white Europeans. Ethnic differences in lipid concentrations may play a part in these differences. OBJECTIVE The objective was to investigate blood lipid and dietary patterns in UK children from different ethnic groups. DESIGN This was a cross-sectional study in 2026 UK children (including 285 black Africans, 188 black Caribbeans, 534 South Asians, and 512 white Europeans) attending primary schools in London, Birmingham, and Leicester. We measured fasting blood lipid concentrations and collected 24-h dietary recalls. RESULTS In comparison with white Europeans, black African children had lower total cholesterol (-0.14 mmol/L; 95% CI: -0.25, -0.04 mmol/L), LDL-cholesterol (-0.10 mmol/L; 95% CI: -0.20, -0.01 mmol/L), and triglyceride concentrations (proportional difference: -0.11 mmol/L; 95% CI: -0.16, -0.06 mmol/L); HDL-cholesterol concentrations were similar. Lower saturated fat intakes (-1.4%; 95% CI: -1.9%, -0.9%) explained the differences between total and LDL cholesterol. Black Caribbean children had total, LDL-cholesterol, HDL-cholesterol, and triglyceride concentrations similar to those for white Europeans, with slightly lower saturated fat intakes. South Asian children had total and LDL-cholesterol concentrations similar to those for white Europeans, lower HDL-cholesterol concentrations (-0.7 mmol/L; 95% CI: -0.11, -0.03 mmol/L), and elevated triglyceride concentrations (proportional difference: 0.14 mmol/L; 95% CI: 0.09, 0.20 mmol/L); higher polyunsaturated and monounsaturated fat intakes did not explain these lipid differences. CONCLUSIONS Only black African children had a blood lipid profile and associated dietary pattern likely to protect against future IHD. The loss of historically lower LDL-cholesterol concentrations among UK black Caribbeans and South Asians may have important adverse consequences for future IHD risk in these groups.