Charlotte Musgrove

Nutrition Scientist, Education Team, British Nutrition Foundation, London, UK. E-mail c.musgrove@nutrition.org.uk

The most recent data on the dietary patterns, nutritional intakes and status, and physical activity levels of British children is provided by the Government’s National Diet and Nutrition Survey: Young People Aged 4-18 years, published in 2000.  Findings from the survey in 2000 showed that over recent years there had been a reduction in children’s energy intake and the percentage of energy derived from fat. 

The Committee on Medical Aspects of Food and Nutrition Policy (COMA) recommends that a maximum of 35% of our energy should come from fat. Intakes estimated by the NDNS in 2000 showed that boys derived 35% of food energy from fat and girls 36%. Encouragingly this is close to the COMA recommendation. However, the concern arises over the type of fat young people are consuming as the average proportion of energy derived from saturated fat is above the COMA recommendation of 11%, with boys deriving 14.2% of food energy from saturated fat and girls 14.3% (Gregory et al. 2000). 

Children also tend to be eating too much salt and sugar.  Again, data from the 2000 NDNS found that non milk extrinsic sugars (NMES; added sugars) on average provided 16.7% of food energy for boys and 16.4% for girls.  Both of these figures are above the COMA recommendation of 11%.  The main source of NMES in the diet was from carbonated soft drinks, followed by chocolate and confectionery.  Mean average intakes of sodium, in both boys and girls, were also above the recommended level.  On average, boys were consuming over twice the amount of sodium recommended each day (Gregory et al. 2000).  Nearly 40% of sodium intake came from cereals and cereal products, with white bread providing 15% of the average daily intake and breakfast cereals providing on average 8%.  Around 5% was contributed by cakes, buns and pastries, and a further 4% by pizza.  The next main contributor to sodium intake came from meat and meat products, which on average contributed 24% (Gregory et al. 2000).

Fortunately, the message to be eat at least five portions of fruit and vegetables a day appears to be getting across. Although many children are still not consuming the recommended amount of fruit and vegetables intakes have increased over recent years. In 2000, children were on average eating only 2 portions of fruit and vegetables a day. One in five children did not report eating any fruit, and three in five children did not report eating any green leafy vegetables over an average week (Gregory et al. 2000).  Between 2001 and 2004, average intakes of fruit and vegetable portions per day increased slightly, with boys consuming 2.5 portions per day, and girls consuming 2.6 (Sproston and Primatesta 2003).  Data from 2005 shows the average number of daily portions of fruit and vegetables eaten was 3.1 (for both boys and girls) and there was an increase in the proportion of children eating five or more portions per day (Health Survey for England 2005).

Generally, children’s intakes of vitamins meet the recommendations set, with the exception of vitamin A (Gregory et al. 2000).  For younger children (4-10 years), average intakes of vitamin A were at an acceptable level, but intakes in older children (11-18 years) were of concern.  Nearly 20% of older girls and 12% of older boys had vitamin A intakes below the lower recommended nutrient intake (LRNI).  At this level of intake, the vast majority of the population will not be getting sufficient amounts of a vitamin or mineral to reach their needs.

Mineral intakes in younger children are generally at an acceptable level and meet current recommended intakes.  However, in older children intakes of a number of minerals (zinc, potassium, magnesium, calcium and iron) are significantly below the LRNI (see Figure 1; Gregory et al. 2000).  Most shocking is that up to 50% of older girls have iron intakes below the LRNI.  This may be because rich sources of iron, such as red meat, are not eaten and also because iron requirements increase in this age group due to losses during menstruation.  Iron is most readily absorbed from animal sources, such as red meat.  However, iron is also present in some plant foods, such as cereals, bread, and green leafy vegetables, but this form of iron, known as non haem iron, is harder for our bodies to absorb.  One way to maximize absorption of non haem iron is to eat foods containing ascorbic acid, such as a glass of orange juice, at the same meal.  Food and drinks that contain tannins and polyphenols, such as tea, should be avoided as these can bind to non haem iron making it difficult for our body to absorb it. 

Although diet plays an important role in the health and nutritional status of today’s children, it is only part of the equation.  Energy balance is a key message that needs to be conveyed and encouraged, and to achieve this, physical activity should be incorporated into children’s daily routines.  Physical activity helps to maintain a healthy weight, prevent diseases in later life, improve psychological health and overall fitness levels.  It has been shown to help protect against cardiovascular disease, obesity, diabetes, high blood pressure and osteoporosis in later life.  Currently, children aged 5-18 should undertake a minimum of an hour of moderate intensity physical activity every day (Department of Health 2005).  Recent data shows that, in England, 70% of boys and 61% of girls are reaching this recommendation.  However, for girls, the proportion partaking in the recommended level of physical activity declines with age, and by the age of 15 only 50% of girls are achieving the recommended level for physical activity (Sproston and Primatesta 2003; Gregory et al. 2000).

Clearly, the issues highlighted so far are of prime importance.  Poor dietary and physical activity habits in childhood are both factors, to varying degrees, for the development of a number of diseases such as obesity, iron deficiency anaemia, dental caries, diabetes, coronary heart disease, hypertension, osteoporosis and cancer, either in childhood itself or in later life.  There is some evidence to suggest that health traits present in childhood tend to continue into adult life, including body weight, blood cholesterol levels, other blood lipids and blood pressure.  However, adopting sensible eating habits and an active lifestyle in early childhood will help to maximise positive health outcomes, both throughout childhood years and in adult life.

Currently, the diet and health of the nation’s children is receiving much attention. The food industry is being encouraged to look at the nutritional composition of their products in order to make changes, where possible, to provide healthier products.  Some members of the food industry have decreased the amount and type of fat their products contain, as well as the quantity of sugar and salt.  This is one approach that will help to reduce the amount of saturated fat, sugar and salt that children consume.  However, the use of nutrition education to inform children about healthier dietary habits and choices is also much needed. 

Recent curriculum reviews in England and Wales propose to strengthen food, nutrition and healthy eating in school, with practical cookery becoming compulsory at Key Stage 2 and 3 in Wales. Northern Ireland has also pledged to make teaching food and nutrition compulsory, with the changes implemented from September 2007.  Scotland sees the integration of a curriculum of excellence where the teaching of food will be strengthened through two themes, Health and Wellbeing, which will incorporate Home Economics and Technologies, which will encourage more creative work related experiences through food.

Improving the health and nutrition of children should remain a priority for the Government, health professionals, the food industry and teachers alike. The Healthy Schools Programme, the introduction of food based and nutrient based standards for school lunches and food served in school other than lunch, compulsory teaching of food and nutrition in Science, Design and Technology, and Personal, Social and Health Education programmes of study, together with other Government initiatives such as the School Fruit and Vegetable Scheme, will help to contribute towards empowering children with the knowledge and opportunities to make informed choices for their future health.

The Foundation’s Education website, Food - a fact of life (www.foodafactoflife.org.uk) provides a wealth of information and resources for teachers and pupils on ‘Healthy eating’, ‘Cooking and food skills’ and ‘Food and farming’.  The Foundation has also been involved in setting up the Food Partnership programme with the Design and Technology Association, the Department for Education and Skills, and the Department of Health.  The Food Partnership is part of the national Food in Schools programme, and allows primary school teachers to take part in free training to help enhance and develop food education in primary schools.  Training is provided by a local, secondary food specialist teacher to help primary school teachers to become more confident and competent in teaching practical food skills in their own primary school (see www.foodinschools.org for more information).  In addition, the Foundation is also involved with the ‘Active Kids Get Cooking’ scheme, which is run in partnership with Sainsbury’s and the Design and Technology Association.  This scheme encourages children aged 5-18 years to plan, prepare and cook fun and innovative dishes whilst learning about healthy eating (see www.activekidsgetcooking.org.uk).  The scheme also has an annual challenge, where children from primary and secondary schools in England, Wales, Scotland and Northern Ireland plan, prepare and make a healthy recipe.  These recipes are entered into the competition and the regional winners are invited to a prize giving ceremony to collect a certificate and cash prize.  This year Jamie Oliver presented the prizes to the regional and national primary and secondary school winners.  For more information on the work of the Foundation, or to find out more about food, nutrition and healthy eating, visit the British Nutrition Foundation website www.nutrition.org.uk.

References

Department for Food and Rural Affairs. 2007. Family food – Report on the Family Food and Expenditure Survey 2007. Available at: http://statistics.defra.gov.uk/esg/publications/efs/default.asp.

Department of Health. 1994.  Nutritional aspects of cardiovascular disease.  Report of the Cardiovascular Review Group of the Committee on Medical Aspects of Food Policy. HMSO, London, UK.

Department of Health. 2005. Choosing activity: a physical activity action plan.  Department of Health, London, UK.

Gregory, J., Lowe, S., Bates C. et al. 2000.  National diet and nutrition survey: young people aged 4 to 18 years. Volume 1: Report of the diet and nutrition survey.  The Stationery Office: London.

Health Survey for England - updating of trend tables to include 2005 data. Available at: http://www.ic.nhs.uk/pubs/hseupdate05.

Sproston, K. and Primatesta, P., editors. 2003. Health Survey for England 2002. Volume 1: the health of children and young people. The Stationery Office, London, UK.


About the author

Charlotte Musgrove is a Nutrition Scientist on the Education Team at the British Nutrition Foundation.  Charlotte has a degree in Biology from the University of East Anglia, Norwich after which she went on to study an MSc in Public Health Nutrition at the University of Southampton.  Since completing her studies she has worked at the British Nutrition Foundation, initially as a research assistant on the Science Team and more recently as a Nutrition Scientist on the Education Team.

The British Nutrition Foundation is a scientific and educational charity which promotes the wellbeing of society through the impartial interpretation and effective dissemination of evidence-based nutritional knowledge and advice on the relationship between diet, physical activity and health. The Education Team at the Foundation is dedicated to producing resources and information to help educate children, young people and the general public about food, nutrition and healthy eating.  Charlotte’s role at the Foundation is to ensure the nutrition content of these educational resources and information is accurate and evidence based.