Children and Young People

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ISSN 0034-6659
Volume 36 Number 5 2006
Nutrition & Food

Science
Children and young people
www.emeraldinsight.com
ISSN 0034-6659
Nutrition & Food

Science
Volume 36
Number 5
2006
Children and young people

Editor
Dr Mabel Blades
Access this journal online___________________________
283
Editorial board ______________________________________
284
Editorial ____________________________________________
285
Gaps in the awareness of current nutrition issues as

dependent on age
Melanie S. Adams _________________________________________________
286
Prevalence of dieting, overweight, body image

satisfaction and associated psychological problems in
adolescent boys
Abdulbari Bener, Abdulaziz Kamal, Ihab Tewfik and
Osman Sabuncuoglu _______________________________________________
295
Generating effective change in school meals: a

case study
Claire Seaman and Julia Moss ______________________________________
305
Breakfast frequency and fruit and vegetable

consumption in Belgian adolescents:
a cross-sectional study
P. Mullie, P. Clarys, D. De Ridder, P. Deriemaeker, N. Duvigneaud,
M. Hebbelinck, A.R. Grivegnee and P. Autier__________________________
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315
CONTENTS
CONTENTS
continued
Impact of household food security and nutrition

programme on the nutritional status of children in
Oyo state, Nigeria
B.O. Lawal and A.A. Jibowo ________________________________________
327
Habitual dietary calcium intake and body weight in

710 year old children
Amy Jennings, V. Costarelli, G.J. Davies and P.W. Dettmar _____________
337
Nutritional knowledge and dietary intakes of young

professional football players
Sue Murphy and Yvonne Jeanes _____________________________________
343
Probiotic acidophilus milk for infants and children

S. Sarkar and A.K. Misra __________________________________________
349
Cultured milk products for lactose-intolerant

recipients
S. Sarkar _________________________________________________________
357
Food facts___________________________________________
365
Book reviews _______________________________________
381
Conference reports__________________________________
382
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NFS
36,5
EDITORIAL BOARD
John J.B. Anderson, PhD

Professor of Nutrition, University of Carolina School
of Public Health and School of Medicine, USA
284
Nutrition & Food Science

Vol. 36 No. 5, 2006
p. 284
# Emerald Group Publishing Limited
0034-6659
David C. Nieman, DrPH MPH FACSM

Professor, Appalachian State University, USA
Professor Winston Craig

Andrews University, Berrien Springs, MI, USA
Claire Seaman, BSc, MPhil, SRD

Lecturer on Food Studies, Queen Margaret College,
Edinburgh, UK
Christopher Strugnell, BSc, PhD, MIFST
University of Ulster at Jordanstown, Northern
Ireland
Marcel Hebbelinck, PhD

Professor, Laboratory Human Biometry, Vrije
Universiteit Brussels, Belgium
Margaret Thorogood, PhD

Senior Lecturer, London School of Hygiene and
Tropical Medicine, UK
Ann Reed Mangels, PhD RD FADA

Nutrition Advisor, Vegetarian Resource Group,
USA
Dr Wendy Wrieden
Centre for Public Health Nutrition Research,
Ninewells Medical School, Dundee, UK
Dr Margaret Ashwell OBE

Ashwell Associates (Independent Scientific
Co-ordinators & Consultants) Ashwell, UK
Editorial
Editorial
Good nutrition is important at whatever age and in this edition of Nutrition and Food
Science, there is a focus on nutrition particularly of young people.
At this stage, good nutrition has an impact not only on their daily well-being but
also on their growth and future health.
While in developing countries, enabling children to get enough food is the main
problem, here in the Western countries, the whole matter is getting children to eat
good food.
All too often children and young people make less prudent choices with over
consumption of fat and sugar and too little fruit and vegetables.
Recently, I was asked to judge a Food In Schools competition for those attending
secondary schools. The competition was held at the East of England Show in
Peterborough. The schools had been through a number of stages before the final days
competition. The standard was extremely high and it was excellent to see young
people involved in enjoying cooking as well as doing it to such a high standard.
Also I was delighted to be asked to judge a competition called Care Cook of the Year
on behalf of the National Association of Care Caterers. This was open to cooks who
are involved in preparing food for those they care for in residential care homes and
day centres. Most of the entrants to the competition were cooking for elderly. Real
attention to the food and suitability of it for the group catered for had been made.
Again the standard was extremely high.
These competitions and the high standard achieved by the participants show how
one can tempt people of whatever age into enjoying good, nutritious and varied food.
285
Mabel Blades

Vol. 36 No. 5, 2006
p. 285
Emerald Group Publishing Limited
0034-6659
The current issue and full text archive of this journal is available at
NFS
36,5
Gaps in the awareness of current

nutrition issues as dependent
on age
Melanie S. Adams
286
Summit Middle School, Boulder, Colorado, USA

Abstract
Purpose The goal of this study is to identify important current topics in nutrition that may be
poorly understood by the public.
Design/methodology/approach A questionnaire was designed to assess public awareness of a
range of important findings uncovered by recent scientific research on nutrition. Responses were
collected in December 2005 from 171 well-educated male and female respondents ranging from
1870 years of age.
Findings The highly educated group of respondents surveyed with respect to their awareness of
nutrition was well informed on the importance of a balanced diet, the recommendations concerning
saturated fat and olive oil, the calcium content of dairy products, and the effect of diet on diabetes and
cancer. Important gaps in their knowledge included a low level of awareness of the health effects of
canola and corn oil, the high calcium content of several vegetables, the effect of diet on mental
processes and the power of the Mediterranean diet in preventing heart attacks. In several of these
latter cases, it was the group of younger participants who had the lowest level of awareness. Only
about one-third of the 1830 years old participants were well informed about canola/corn oil and the
calcium content of green vegetables, respectively, vs about two-thirds in the 3170 years old age
group. Likewise, the participants of ages 1830 were significantly less well informed about the effect
of diet on cancer, intelligence and disruptive behavior than the older participants. In addition, women
were found to be better informed than men on the issue of vegetables with high calcium content.
Research limitations/implications The number of male respondents was lower than that of
female respondents and this may have limited the identification of additional cases where genderrelated differences in awareness exist.
Originality/value This study provides new information about current, important issues in
nutrition that are poorly understood even by an educated sample audience, particularly by younger
participants. This information should be used as the basis for an education program to improve
public health and that should target younger people.
Keywords Nutrition, Diet, Public health, Health education
Paper type Research paper
Introduction
Over the past few decades, research has made rapid progress in uncovering the
mechanisms of how food affects all aspects of human health. However, access to the
original scientific studies is limited and much of the information of the public is
obtained from the mass media. This study identifies important issues in nutrition that
are well documented in the original scientific literature but poorly recognized by the
public. A questionnaire was designed and responses collected from 171 male and
female participants ranging in age from 1870 years.

Vol. 36 No. 5, 2006
pp. 286-294
0034-6659
DOI 10.1108/00346650610703135
I am grateful to Dr Barbara Demmig-Adams for her guidance during the planning of this study
and writing of the manuscript, to Dr William Adams, Jr, for his advice on survey design and
statistical evaluation, to Dr Volker Ebbert for making the figures and to Dr Kristine Mueh,
Dr James Adams, Dr William Adams III, Ms Haydee Phelps and Mr Peter Teasdale for their
help in administering the surveys.
Several questions were included for which a reasonably good public awareness was
expected, such as the high calcium content of dairy products, the role of diet in
diabetes and the adverse effects of excess saturated fat consumption. In addition,
other issues were included for which public awareness was unknown, such as the high
calcium content of various vegetables, the role of diet in mental disorders and other
conditions, the value of different types of unsaturated fats and the remarkable power
of the Mediterranean diet in preventing heart attacks.
Methodology
A questionnaire was designed to gauge awareness of a range of current issues in
nutrition (see Appendix). The questionnaire included (A) demographic questions, (B)
questions on different groups of dietary fats, (C) questions on overall diet composition,
(D) questions on the effect of diet on a range of diseases and disorders, (E) questions
on the calcium content of different food groups and (F) questions about the benefit
obtained from the Mediterranean diet. The survey questions were designed to
minimize guessing or arbitrary choices on part of the respondents by offering a range
of answers including havent seen any information on this.
The data were collected in December 2005. Respondents included parents of the 7th
and 8th Graders from two schools in the Boulder Valley School District (Summit
Middle School and Centennial Middle School) as well as college students (University of
Colorado and Dalton College, GA). Because 90 per cent of the parents had college
degrees, surveys were collected from college students as a group younger in age
but well matched in education level. Participants included a total of 49 men and 122
women with 67 participants of the ages 1830 and 101 participants of the ages 3170.
Initial analysis of the full age profile with narrower brackets of ages 1825 (38 per cent
of participants), 2635 (8 per cent), 3645 (26 per cent), 4655 (26 per cent), and 56+
(3 per cent) showed insufficient statistical power to allow the detection of significant
differences among these subgroups. Because the age profile showed two natural
peaks, only two groups of ages 1830 and ages 3170 were therefore analyzed for the
final comparison. The answers from the surveys were tabulated and significant
differences in the percentage of female, male, young, old and combined total
participants that gave a particular answer were determined using the formula
S5[(Q6P)/N]1/2, where S is the sampling error at the 95 per cent confidence level, P is
the percent calculated, Q is 100P and N is the total sample size (Babbi, 1991).
Only significantly different results are shown for the two gender and age groups
(Figures 15). Results were graphed as pie diagrams showing the percentage of
participants who gave the different answers, with the best (or correct) answer as
based on current scientific literature emphasized in black.
Results and discussion
Awareness of good and bad fats
The typical American diet is excessively high in saturated fat and corn oil. Vegetable
oils contain two types of polyunsaturated fats, omega-6 and omega-3 fats, which
should be consumed in similar proportions. Canola oil contains these two kinds of fats
in similar proportions (2:1). Corn oil, however, contains them in a ratio 50:1, which can
induce cancer and other chronic diseases (Simopoulos, 2004). A large percentage of the
participants were aware that the level of saturated fats should be reduced in the
typical American diet (Figure 1, top: saturated fat) and be replaced by oils such as
olive oil (Figure 1, top: olive oil). Many participants did not know that canola oil
The awareness
of current
nutrition issues
287
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36,5
288
Figure 1.
Awareness of good and
bad fats
Figure 2.
Awareness of sensible
diet composition
Notes: Percentages for correct answer (in black) and sampling error at 95 per cent
confidence respectively for all participants were: 97.7 per cent, 1.2 (saturated),
85.5 per cent, 1.2 (olive), 58.5 per cent, 2.9 (canola) and 52.0 per cent, 3.8 (corn)
confidence respectively for all participants were: 67.3 per cent, 3.6 (left) and 93.6 per cent,
1.9 (right)
consumption should not be reduced (Figure 1, bottom: canola oil) and that corn oil
consumption should be reduced in the American diet (Figure 1, bottom: corn oil).
However, a significantly higher percentage of older participants were aware of the
correct information for canola and olive oil compared to younger people.
The awareness
of current
nutrition issues
289
confidence respectively for all participants were: 94.7 per cent, 1.7 (yogurt),
90.0 per cent, 2.3 (cottage cheese), 21.0 per cent, 3.1 (beans), 47.0 per cent, 3.8
(broccoli) and 46.8 per cent, 3.8 (kale/collard greens)
Figure 3.
Awareness of foods that
are good calcium
sources
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36,5
290
Figure 4.
Awareness of diet impact
on various conditions
Notes: Percentages for correct answer (in black) and sampling error at 95 per cent confidence respectively for all participants were: 97.0 per cent, 1.3 (diabetes), 77.8 per cent,
3.2 (cancer), 45.0 per cent, 3.8 (intelligence), 74.9 per cent, 3.3 (disruptive behavior)
and 34.3 per cent, 3.6 (mental disorders)
Awareness of sensible diet composition

Well-designed scientific studies with many participants show that diets aimed at weight
loss and weight maintenance that are very low in fat and diets low in carbs (carbohydrates) work only for a small percentage of dieters (Tsai and Wadden, 2005). The
majority of dieters abandon such diets sooner or later, due to their restrictive nature. In
addition, individuals on low fat diets may be deficient in healthful fats and individuals on
low carb diets (such as the Atkins diet that restricts fruits and vegetables) may suffer from
vitamin deficiencies and other problems. The best option for long-term weight maintenance
is to change poor dietary habits and consume a balanced diet with healthful choices.
Furthermore, scientific studies have shown that consuming excessive amounts of most
vitamins is equally undesirable as consuming insufficient quantities (Pryor et al., 2000;
Pham and Plakogiannis, 2005). Some supplements contain excessively high concentrations of vitamins, which have been shown to cause harmful effects. There is evidence that
a truly balanced diet is the best way to provide an optimal vitamin supply. While a truly
balanced diet is the recommended option, it is difficult for individuals with a busy lifestyle
to achieve this and a number of participants commented on that. The answer of taking a
regular multivitamin was therefore counted as a correct answer as well.
Two-thirds of participants knew that the most successful diet for the long-term
maintenance of a healthy weight consists of healthful choices rather than low fat and/
or low carb fad diets (Figure 2, left pie diagram). A majority of the participants was
furthermore aware of the fact that a balanced diet with a resulting balanced vitamin
intake, is the recommended option. Only a very small percentage of the participants
favored the use of high dose megavitamins (Figure 2, right pie diagram).
The awareness
of current
nutrition issues
291
Awareness of foods that are good calcium sources

A very large percentage of participants knew that dairy products (like yogurt and
cottage cheese) are a good source of calcium (Figure 3, top). However, not many
respondents knew that vegetables, such as beans, broccoli and kale/collard greens, are
similarly good sources of calcium as dairy products (Farnham et al., 2000; Mangels,
2003) (Figure 3, bottom). Kale and collard greens actually have more calcium than
milk on an equal volume basis (Mangels, 2003). A significantly higher percentage of
women were aware of the calcium content of all of these vegetables and a significantly
higher percentage of the older respondents were found to have better information in
the case of kale and collard greens than younger participants (Figure 3, bottom).
Awareness of diet impact on various conditions
All five of the conditions included in the questionnaire (cancer, diabetes, intelligence,
disruptive behavior and mental disorders) are affected by dietary factors. While this is
well studied for cancer and diabetes, an increasing number of studies with good
controls also show a strong impact of dietary factors on mood and behavior (Bryan
et al., 2004; Dani et al., 2005). A large percentage of participants were aware of the
Figure 5.
confidence respectively for all participants were 22.2 per cent, 3.2
Awareness of the power

of the Mediterranean
diet in preventing heart
attacks
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36,5
292
effect of diet on diabetes and cancer (Figure 4, top). In the case of cancer, it was again
found that a significantly higher percentage of older participants had better
information than younger respondents. This may not be surprising because older
individuals are likely to worry more about getting cancer.
However, a much lower percentage of participants were aware of the effect of
nutrition on the other three conditions, i.e. intelligence, disruptive behavior and mental
disorders (Figure 4, bottom). Once again, the older participants were better informed
than the younger group in the cases of intelligence and disruptive behavior.
Awareness of the power of the Mediterranean diet in preventing heart attacks
A rigorously designed scientific study testing the effect of the Mediterranean diet (rich in
vegetables, fruit, olive oil, seafood and lean meat) found that this diet prevented 72 per
cent of second heart attacks in a large group of men (de Lorgeril et al., 1999). This
outcome is much better than that of currently prescribed medications. Only a very small
percentage of participants knew about the effectiveness of the Mediterranean diet (22 per
cent), and 78 per cent of the participants either marked the wrong answer (33 per cent) or
marked that they had not heard of this diet (45 per cent) (Figure 5). There were no
significant differences in awareness among groups. In contrast, this diet and its ability to
prevent heart attacks are widely acknowledged among scientists, which is demonstrated
by the fact that the original study by de Lorgeril has been cited 485 times by other
original peer-reviewed studies (as of January 2006) since it was published in 1999.
Discussion
While there is much discussion about appropriate nutrition, the present survey is unique
in that it targets specific current issues that are not widely recognized by the public.
Other published surveys have targeted issues that have been discussed for decades,
such as the concern about excessive salt intake and cholesterol-increasing foods (Girois
et al., 2001). While the highly educated group of individuals targeted in the present
survey was well informed in a number of issues, even this group had important gaps in
their knowledge. In a number of these cases, older participants were better informed
than younger people. In the case of vegetables with high calcium content, women were
better informed than men. A greater nutrition awareness of women has also been noted
in other nutrition surveys (Variyam et al., 1996; Girois et al., 2001). Repetition of the
present survey with a larger number of participants, and particularly a larger male
group, may reveal additional instances of gender-related differences in awareness.
The present results apply only to the highly educated group studied and additional
work with less well educated participants may show even wider gaps of awareness in
these other populations.
Conclusions
The highly educated group of respondents surveyed with respect to their awareness of
nutrition was well informed in many issues, such as the importance of a balanced diet,
the recommendations concerning saturated fat and olive oil, the calcium content of
dairy products and the effect of diet on diabetes and cancer.
However, even this select group showed important gaps in their knowledge, such as
less awareness of the health effects of canola and corn oil, the high calcium content of
several vegetables, the effect of diet on several mental processes and the power of diet
in preventing heart attacks. In a number of these cases, however, women were better
informed than men and older participants were better informed than younger people.
In several of the above cases where there were gaps, one may speculate that this is
related to the fact that common advertisements focus on different and more profitable
treatments.
References
Babbi, E.R. (1991), The Practice of Social Research, 6th ed., Appendix G, Wadsworth, Belmont,
CA. p. A31.
Bryan, J., Osendarp, S., Hughes, D., Calvaresi, E., Baghurst, K. and van Klinken, J.W. (2004),
Nutrients for cognitive development in school-aged children, Nutrition Reviews, Vol. 62,
pp. 295306.
de Lorgeril, M., Salen, P., Martin, J.L., Monjaud, I., Delaye, J. and Mamelle, N. (1999),
Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications
after myocardial infarction Final report of the Lyon Diet Heart Study, Circulation,
Vol. 99, pp. 77985.
Dani, J., Burrill, C. and Demmig-Adams, B. (2005), The remarkable role of nutrition in learning
and behaviour, Nutrition & Food Science, Vol. 35 No. 4, pp. 25863.
Farnham, M.W., Grusak, M.A. and Wang, M. (2000), Calcium and magnesium concentration of
inbred and hybrid broccoli heads, Journal of the American Society for Horticultural
Science, Vol. 125, pp. 34449.
Girois, S.B., Kumanyika, S.K., Morabia, A. and Mauger, E. (2001), A comparison of knowledge
and attitudes about diet and health among 35- to 75-year-old adults in the United States
and Geneva, Switzerland, American Journal of Public Health, Vol. 91 No. 3, pp. 41824.
Mangels, R. (2003), Calcium in the vegan diet, The Vegetarian Resource Group, available at:
www.vrg.org/nutrition/calcium.htm (accessed 12 November 2005).
Pham, D.Q. and Plakogiannis, R. (2005), Vitamin E supplementation in cardiovascular disease
and cancer prevention: Part 1, Annals of Pharmacotherapy, Vol. 39, pp. 18708.
Pryor, W.A., Stahl, W. and Rock, C.L. (2000), Beta carotene: from biochemistry to clinical
trials, Nutrition Reviews, Vol. 58, pp. 3953.
Simopoulos, A.P. (2004), Omega-6/omega-3 essential fatty acid ratio and chronic diseases,
Food Reviews International, Vol. 20, pp. 7790.
Tsai, A.G. and Wadden, T.A. (2005), Systematic review: an evaluation of major commercial
weight loss programs in the United States, Annals of Internal Medicine, Vol. 142,
pp. 5666.
Variyam, J.N., Blaylock, J. and Smallwood, D.M. (1996), Modelling nutrition knowledge,
attitudes, and diet-disease awareness: the case of dietary fibre, Statistics in Medicine,
Vol. 15 No. 1, pp. 2335.
Appendix
A. Demographic questions
(1)
gender;
(2)
age (in years);
(3)
the highest level of education obtained.
B. Questions related to dietary fats (should be reduced/should not be reduced/havent seen any
information on this)
(4)
olive oil;
(5)
animal fats;
The awareness
of current
nutrition issues
293
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36,5
(6)
canola oil;
(7)
corn oil.
C. Questions on diet composition

(8)
Based on what you have heard or read, what do you think is the best way to get your
vitamins and minerals? (It is best to add a regular multi-vitamin/multi-mineral
supplement to ones diet/it is best to add vitamin/mineral supplements to ones diet with
higher amounts than suggested by the current guidelines because these are not high
enough/it is enough to eat a balanced diet; no supplements are needed/none of these
choices reflect my opinion/havent seen any information on this);
(9)
Based on what you have heard or read, which one of the following do you think would
be most likely to help you reach and maintain a healthy weight? [Eat healthy choices/eat
a diet low in fat/eat a diet low in carbs (carbohydrate)/eat a diet low in fat and low in
carbs (carbohydrates)/none of these reflect my opinion/havent seen any information
on this].
294
D. Questions on what food are good calcium sources (good source of calcium/not a good source of
calcium/havent seen any information on this)
(10) yogurt;
(11) beans;
(12) cottage cheese;
(13) collard greens/kale;
(14) broccoli.
E. Questions on which of conditions are affected by eating habits (affected by eating habits/not
affected by eating habits/havent seen any information in this)
(15) cancer;
(16) diabetes;
(17) mental disorders;
(18) intelligence (IQ);
(19) disruptive behavior.
F. Question on Mediterranean diet
(20) In a large experiment, men in their mid-50s who had suffered a heart attack either
continued eating the same diet as before or were put on the Mediterranean diet. Based
on what you might have heard about the effect of diet on heart disease, how many
second heart attacks do you think were prevented by the Mediterranean diet over the
next 5 years? (10%/20%/40%/60%/80%/havent seen any information on this)
Corresponding author
Melanie S. Adams can be contacted at: Barbara.Demmig-Adams@colorado.edu
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Prevalence of dieting,
overweight, body image
satisfaction and associated
psychological problems in
adolescent boys
Dieting,
overweight and
body image
295
Abdulbari Bener
Department of Medical Statistics and Epidemiology, Hamad General Hospital
and Hamad Medical Corporation, Doha, State of Qatar
Abdulaziz Kamal
Department of Psychology, University of Qatar, State of Qatar
Ihab Tewfik
School of Biosciences, University of Westminster, London, UK
Osman Sabuncuoglu
Department of Child and Adolescent Psychiatry, Marmara University, Istanbul,
Turkey
Abstract
Purpose The aim of the present study is to examine the severity of dieting and its association with
obesity, body satisfaction and psychological problems in adolescent boys.
Design/methodology/approach A representative sample of 800 boys in the age group of 1419
in Qatar was approached during the period from October to December, 2004 and 593 boys gave
consent to participate in this study, thus giving a response rate of 74.1 per cent. Self-reports were
obtained from 593 teenage boys using the adolescent dieting scale (ADS), and the self-reporting
questionnaire (SRQ-20) for psychopathology.
Findings Of the studied subjects, 33.1 per cent were overweight, 10.1 per cent were extreme dieters
and 37.4 per cent were intermediate dieters. Among the dieters, 34 per cent were overweight. Dieting
was more likely in subjects who practiced exercise and who were perceived by peers or themselves as
overweight. The extreme dieters experienced more psychological problems than the intermediate
dieters and non-dieters. Extreme dieters reported sleeping problems (58.3 per cent), tired all the time
(53.3 per cent) and felt like crying more than usual (50 per cent). Television was the main source of
information on diet (61.7 per cent).
Originality/value The present study findings provide a strong evidence for the association
between frequent dieting and overweight, body image dissatisfaction and psychological problems.
Keywords Diet, Obesity, Adolescents, Boys, Self-esteem, Qatar
Introduction
Adolescence is a time when social demands influence the individual and when
others perceptions become very significant to the individual adolescent (Hill, 1989).
Capacity and competence in adolescent boys are complex issues, because adolescents
have a tendency to make treatment decisions by themselves (Tan and Fegert, 2004).
Although dieting among boys are less common when compared with girls, some
Vol. 36 No. 5, 2006
studies have shown the prevalence of eating disorders among boys cannot be taken
pp. 295-304
Limited
too lightly (Braun et al., 1999). In complying with the demands of being socially E Emerald Group Publishing0034-6659
DOI 10.1108/00346650610703144
attractive, dieting as a method of weight control has been a common behaviour
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particularly in Western culture and within particular groups such as adolescents

(Swadi et al., 2000). While the definition of dieting includes weight reduction efforts
generally considered to be healthy (e.g. increased fruit and vegetable intake and
decreased fat and sugar intake), many individuals also consider dieting to include
unhealthy weight control behaviours such as fasting, skipping meals and eliminating
food groups (Ackard et al., 2002; Brownell and Rodin, 1994).
While dieting may be viewed as a useful exercise in body weight control, the
occurrence of psychiatric symptoms in association with dieting seems to be an
indication that dieting is not necessarily a healthy method of weight control, at least in
some to support this view as recently highlighted by Patton (Patton et al., 1997) who
found that psychiatric morbidity was clearly associated with extreme dieters reported
high levels of depression and anxiety.
There are issues of concern over the practice of dieting among boys. First, many of
the adolescent boys who dieted are of normal weight for their height, yet they use
unhealthy weight control behaviours such as fasting and use appetite suppressants,
rather than healthier weight loss practices such as reducing intake of fat and sweets
and increasing physical activity (Ackard et al., 2002). Usually, adolescents are using
unhealthy weight control measures (Neumark-Sztainer et al., 1999).
While dieting efforts among average weight or underweight individuals are most
often considered negative, dieting efforts among overweight individuals have been
viewed more positively (Ackard et al., 2002). For example, Wing and Jeffery (1999)
found that among overweight individuals, modest weight reduction (1015 per cent of
individual body weight) achieved by the combination of calorie reduction and exercise
implementation was associated with positive changes in cardiovascular risk factors.
Despite a large body of literature on emotional and behavioural factors associated
with dieting, we are unaware of any studies that have looked at these associations
independent of body mass index (BMI).
Dieting as part of an eating disorder has been well documented and accepted in
Western culture, but it was only recently that eating disorders began to be viewed as
cross-cultural phenomena with reports of clinical eating disorders in the Arab World
(Hill, 1989; Swadi et al., 2000).
To our knowledge, no studies reported the prevalence of obesity or dieting
behaviour among adolescent boys neither in Qatar nor in the region. The aim of the
present study was to examine the severity of dieting and its association with obesity,
body image satisfaction and psychological problems in adolescent boys in the State of
Qatar.
Methods
Qatar is an independent state occupying the Qatar Peninsula, jutting into the Persian
Gulf from the eastern coast of the Arabian Peninsula. On its southern side it is
bordered by Saudi Arabia. Qatar has an area of 11493 km2. The land is stony and
largely barren. An extremely hot, arid climate prevails. Humidity is high during the
summer, but the annual rainfall is scarce. The population of Qatar is 724125 (Annual
Health Report, 2003) and 30 per cent of the total population constitutes Qatari
nationals.
A representative sample of 800 adolescent boys aged 1419 was included in this
study. The study was conducted from October to December 2004. The population
were derived from secondary and high schools in Qatar. A multistage stratified
sampling design was developed. In order to secure a representative sample of the
study population, the sampling plan was stratified with proportional allocation
according to stratum size. The sample size was determined with the a priori
knowledge that the prevalence rate of dieting in the State of Qatar is more or less
similar to UAE and Western countries; or that it may be affected by parity, heredity,
climate and sociodemographic and environmental factors. Allowing an error of 2.5 per
cent and level of significance (Type-1 error) of 1 per cent, it was believed that a sample
size of 800 is adequate to achieve a high degree of precision in estimating the true
prevalence rate of dieting in the general population. Schools were then selected
according to geographical location. Of the schools selected, half of the classes were
chosen (e.g. 5A, 5C, 5E6A, 6C, 6E, etc.). In those classes, half of the students were
chosen on the basis of alternate names according to the class registration list. A total
of 800 boys were approached and 593 expressed their consent to participate in this
study. Two hundred and seven boys were excluded from the study due to incomplete
questionnaire or did not give their consent or did not want to respond to the
questionnaire due to lack of time.
Instruments
Self-reports were obtained by using adolescent dieting scale (ADS) (Patton et al., 1997)
and self-reporting questionnaire (SRQ-20) (El-Rufaie and Absood, 1994) for
psychopathology. Questionnaire including the general demographic variables and
dieting information was filled out by the research assistants. The anthropometrics
measures of adolescent boys were measured and collected by qualified nurses.
The ADS (Patton et al., 1997)
The ADS consists of eight items and for each question; there are four possible answers
seldom or never, sometimes, almost and always. They attracted a score of 0, 1, 2 and
3 respectively. The ADS is based on a refinement of a number of other scales for
measuring dietary restraint. The authors identified behaviours typical of dieting but
did not include the extreme weight control strategies that are characteristics of clinical
eating disorders. They identified nine behaviours, which covered three broad dieting
strategies (calorie counting, reducing food quantity and meal skipping). The
unidimensionality of the ADS was assessed by using a principal component analysis
which showed that, for the nine item scales, there were two main components, one
with an Eigen value of 5.4 and the other with a much smaller Eigen value of 1.2.
However, they found that one of the items skipping breakfast has a low item
correlation and therefore carried out a separate analysis without that item. The alpha
coefficient for the eight items scale was 0.83 and it had two principal components with
an Eigen value of 3.5 and the other component had an Eigen value of 1.0. On that
basis, they considered the eight item ADS a suitable scale for measuring dieting in a
non-clinical population. Three bands of dieting were in a non-clinical population.
Three bands of dieting, minimal (total score 16), intermediate (total score 714) and
extreme (total score more than 15) were identified using data obtained from their
study.
Because of the ease of administration, the feasibility of quantification of dieting and
understand ability and acceptability of this questionnaire, we decided to use it in our
survey. Moreover, it seems to be culture free since it inquires about specific
behaviours rather than concepts, which may be influenced by cultural factors. We
therefore did a translation into Arabic with back translation by a non-clinician who
was fluent in both Arabic and English. We piloted the questionnaire on a small
Dieting,
overweight and
body image
297
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298
number of adolescents who reported that the questionnaire was understandable and
easy to answer. There were minimal changes in the wording following the piloting
process. For the above reasons, we did not feel that a full validation study of the ADS
in this culture was not necessary and was not carried out.
The Arabic version of the SRQ (El-Rufaie and Absood, 1994)
This is a screening instrument for identifying potential psychiatric cases in
community settings and is not designed for diagnostic purposes. The original version
(Harding et al., 1980) consists of 20 items designed to detect non-psychotic symptoms.
Each item would attract a score of 1 for a yes response and 0 for a no response. It
has been found to have a fairly good sensitivity and specificity and has been
successfully used in adolescent populations (Feijo et al., 1997). El-Rufaie and Absood
(1994) validated the SRQ-20 in a primary care sample in the United Arab Emirates and
found it to be a valid instrument for detecting minor psychiatric morbidity.
Body mass index was calculated as the weight in kilograms (1 kg subtracted to
allow for clothing) divided by height squared in meters. Subjects were classified into
three categories: acceptable weight (BMI,25 kg m22), overweight (BMI 2529.9 kg
m22) and obese (BMI 30+ kg m22) (Garner, 1993).
Statistical methods and analysis
The statistical package for social sciences (SPSS) (Norusis, 1998) was used for
statistical analysis. Data were expressed as mean and standard deviation (SD) unless
otherwise stated. Student-t test was used to ascertain the significance of differences
between mean values of two continuous variables. Chi-square analysis was performed
to test for differences in proportions of categorical variables between two or more
groups. In 2 6 2 tables, the fishers exact text (two tailed) replaced the chi-square test
if the assumptions underlying chi-square violated, namely in case of small sample size
and where the expected frequency is less than 5 in any of the cells. One way analysis
of variance (ANOVA) was employed for comparison of several group means and to
determine the presence of significant differences between group means of continuous
variables. The level p,0.05 was considered as the cutoff value for significance.
Results
A total of 593 of 800 enrolled school boys participated in this study, thus giving a
response rate of 74.1 per cent.
Table I shows the sociodemographic characteristics of the studied subjects. The
mean BMI for the studied population was 23.2 (SD 3.9) (with range of 15.634.0). Of
the total respondent population, BMI calculation showed that 196 (33.1 per cent) fell
above the 25 kg m22. But, among the dieters, 34 per cent were overweight.
Table II shows the adolescent dieting score and BMI by age group. Only a small
minority of the adolescent boys were non-dieters (11.8 per cent). Almost 90 per cent
were dieting mostly on a minimal or moderate basis. However, 10.1 per cent were
extreme dieters. The prevalence of dieting did not show great variations in the two
age groups of 1416 and 1719.
Table III shows the comparison of dieting severity by ADS. Among the overweight
boys, 49 per cent were dieters. Extreme dieting was higher among the subjects whose
family members practiced dieting, however no significant difference was found.
Dieting was most likely to be practiced among subjects who had a family history of
arthritis (P50.008) and heart disease (P,0.001). Dieting was clearly associated with
Variables
Age (years)
1416
1719
BMI (kg m22)
#25 Normal
.25 Overweight
Education
Intermediate
Secondary
Living condition
Excellent
Above average
Average
Below average
Poor
No of siblings
#6
.6
Dieters N5282
n(per cent)
Non-dieters N5311
n(per cent)
119(42.2)
163(57.8)
142(45.7)
169(54.3)
NS*
186(66.0)
96(34.0)
211(67.8)
100(32.2)
NS
111(39.4)
171(60.6)
128(41.2)
183(58.8)
NS
63(22.3)
81(28.7)
43(15.2)
39(13.8)
56(19.9)
60(19.3)
82(26.4)
63(20.3)
41(13.2)
65(20.9)
NS
161(57.1)
121(42.9)
180(57.9)
131(42.1)
NS
P value
Note: *NS5Not significant
Age group
1416 N5261
1719 N5332
Non-dieters
ADS50
Minimal
dieters
ADS516
Intermediate
dieters
ADS5714
Extreme
dieters
ADS51524
32(12.3)
38(11.4)
110(42.1)
131(39.5)
98(37.5)
124(37.3)
21(8.0)
39(11.7)
Dieting,
overweight and
body image
299
Table I.
Sociodemographic
characteristics of the
studied subjects by gender
BMI groups (kg m22)

#25
.25
171(65.5)
226(68.1)
90(34.5)
106(31.9)
exercise showing that those who diet more often also practiced exercise regularly
(P50.002). Self-perception and peers perception of body weight also contributed
heavily to the boys ADS score (P,0.001) in both cases.
Table IV shows the association between the dieting behaviour and psychological
factors in studied adolescent boys. Television and magazines were the main sources of
information for the extreme dieters on dieting and have shown a significant
association. About 23.3 per cent of extreme dieters got their information on dieting
from school friends compared with 12.5 per cent of non-dieters and 18.9 per cent of
intermediate dieters (P50.037). Television was the main source of information on diet
for all subjects and again the extreme dieters were more influenced by the information
through television (61.7 per cent). The self-reported questionnaires revealed that poor
appetite (45 per cent) was more common among the extreme dieters. The other
significant psychological problems among the extreme dieters were that sleeping
problems (58.3 per cent) and feeling tired all the time (53.3 per cent), crying more than
usual (50 per cent).
Discussion
The rate of overweight among children continues to increase in every society.
Overweight and distorted body perception can both lead to serious physical and
Table II.
Adolescent dieting score
and BMI by age group
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Variable
22
300
Table III.
Comparison of dieting
severity by ADS
BMI, kg m (MeanSD)
BMI group, kg m22
#25
.25
Dieting in family
Yes
No
Obesity in family
Yes
No
Family history of diabetes
Yes
No
Family history of high blood pressure
Yes
No
Family history of Arthritis
Yes
No
Family history of mental disorders
Yes
No
Family history of heart diseases
Yes
No
Dieting friends
Yes
No
Practice exercise
Yes
No
Satisfied with own body
Yes
No
Peers perception of respondents figure
Overweight
Average
Underweight
Self-perception of figure
Overweight
Average
Underweight
SRQ (MeanSD)
Non-/minimal
dieters
ADS506
Intermediate
dieters
ADS5714
Extreme
dieters
ADS51524
p value
23.14.0
23.43.9
22.63.3
NS
211(53.1)
100(51.0)
140(35.3)
82(41.8)
46(11.6)
14(7.1)
NS
155(49.7)
156(55.5)
118(37.8)
104(37.0)
39(12.5)
21(7.5)
NS
241(52.6)
70(51.9)
165(36.0)
57(42.2)
52(11.4)
8(5.9)
NS
188(51.6)
123(53.7)
137(37.6)
85(37.1)
39(10.7)
21(9.2)
NS
169(53.1)
142(51.6)
117(36.8)
105(38.2)
32(10.1)
28(10.2)
NS
75(51.7)
236(52.7)
46(31.7)
176(39.3)
24(16.6)
36(8.0)
0.008
17(42.5)
294(53.2)
15(37.5)
207(37.4)
8(20.0)
52(9.4)
NS
75(46.3)
236(54.8)
55(34.0)
167(38.7)
32(19.8)
28(6.5)
,0.001
165(51.7)
146(53.3)
121(37.9)
101(36.9)
33(10.3)
27(9.9)
NS
148(46.3)
163(59.7)
131(40.9)
91(33.3)
41(12.8)
19(7.0)
0.002
215(55.6)
96(46.6)
135(34.9)
87(42.2)
37(9.6)
23(11.2)
NS
67(40.4)
139(50.7)
105(68.6)
78(47.0)
111(40.5)
33(21.6)
21(12.7)
24(8.8)
15(9.8)
107(44.4)
123(53.2)
81(66.9)
6.83.8
101(41.9)
87(37.7)
34(28.1)
6.63.7
33(13.7)
21(9.1)
6(5.0)
7.43.9
,0.001
,0.001
NS
psychological problems (Strauss, 1999). Specific risk factors of eating disorders are
body dissatisfaction, low self-esteem, high need for social approval and history of
physical abuse among adolescents (Garner, 1993). It is interesting to point out that
their actions are focused on diet without paying much attention to other aspects of life
style including physical activity and even psychosocial problems.
Variable
Source of information on dieting
School
TV
Magazine
Radio
Often has headache
Has poor appetite
Sleeping badly
Are you easily frightened
Sometimes hand shakes
Feel tensed, nervous or worried
Poor digestion
Having trouble thinking clearly
Feeling unhappy
Crying more than usual
Difficulty in enjoying daily activities
Difficulty in making decisions
Daily work is suffering
Unable to play useful part in life
Lost interest in things
Feeling worthless person
Thought of losing life in mind
Feeling tired all the time
Uncomfortable feeling in stomach
Easily tired
Non-/minimal
dieters
ADS506
(n5311)
Intermediate
dieters
ADS5714
(n5222)
Extreme
dieters
ADS51524
(n560)
p value
39(12.5)
130(41.48)
123(39.5)
31(10.0)
111(35.7)
82(26.4)
146(46.9)
111(35.7)
89(28.6)
183(58.8)
67(21.5)
140(45.0)
101(32.5)
42(7.1)
93(29.9)
120(38.6)
110(35.4)
75(24.1)
106(34.1)
36(11.6)
78(25.1)
156(50.2)
97(31.2)
107(34.4)
42(18.9)
107(48.2)
93(41.9)
28(12.6)
88(39.6)
58(26.1)
84(37.8)
81(36.5)
62(27.9)
116(52.3)
49(22.1)
87(39.2)
91(41.0)
21(9.4)
77(34.7)
90(40.5)
81(36.5)
47(21.2)
77(34.7)
31(14.0)
55(24.8)
92(41.4)
56(25.2)
61(27.5)
14(23.3)
37(61.7)
27(45.0)
10(16.7)
25(41.7)
27(45.0)
35(58.3)
24(40.0)
16(26.7)
31(51.7)
22(36.7)
21(35.0)
18(30.0)
12(20.0)
22(36.7)
22(36.7)
17(28.3)
19(31.7)
15(25.0)
6(10.0)
20(33.3)
32(53.3)
16(26.7)
25(41.7)
0.037
0.014
NS
NS
NS
0.009
0.009
NS
NS
NS
0.035
NS
NS
0.041
NS
NS
NS
NS
Ns
NS
NS
NS
NS
NS
There are very few studies on dieting and eating behaviour conducted in other Arab
countries. Two relevant studies have been recently carried out, but their main focus
was on obesity. Both studies indicated that a significant proportion of males (adults
and adolescents) were overweight. First, Musaiger (Musaiger et al., 2003) found that
17.1 per cent of male students were overweight and 8.4 per cent were grossly obese.
More recently, a cross-sectional study (Bener and Kamal) involving a sample of 8566
secondary and high school students boys aged from 14 to19 found that 11.9 per cent of
boys were at a risk of being overweight. The rate reported in our study was higher
than these studies that 33.1 per cent of the adolescent boys were overweight. But, the
overweight rate of Qatari adolescent boys were very similar to the rate found in a
study of Fonseca (Fonseca et al., 2002) that the proportion of overweight individuals
among boys (BMI greater than 90th percentile of the Brazelian population) was
23.9 per cent.
Of the studied adolescent boys in the current study, 37.4 per cent were intermediate
dieters and 10.1 per cent were extreme dieters which is quite higher than the rate
found in an Australian study (Patton et al., 1997) that 12 per cent of boys and 38
per cent of girls were categorised as intermediate dieters and 1 per cent of boys and
7 per cent of girls were extreme dieters. Despite differences in methodology, several
Western studies indicated that dieting (of varying severity) is a common behaviour
Dieting,
overweight and
body image
301
Table IV.
Association between
dieting severity and
psychological factors
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302
even among young people of normal weight range. Wooley and Wooley (1984)
estimated that 72 per cent of adolescents and young adults were dieting.
A research (Xie et al., 2003) done by the Institute for Health Promotion and Disease
Prevention in California documented that perceived overweight boys and girls were
more likely to experience anxiety and depression than perceived normal and
underweight subjects. In our study, half of the extreme dieters had significant
psychological problems like crying more than usual (50 per cent), sleeping problems
(58.3 per cent) and feeling tired all the time (53.3 per cent).
Environmental influences particularly peer groups perceptions and attitudes, role
models and learned behaviour seem to be influential in this respect. The mass medical
are believed to encourage girls to form unrealistically think body ideals (Field et al.,
1999), but their impact on boys has not been investigated earlier. A study from
Portugal (Fonseca et al., 1998) also reported that among boys the main factors for
dieting were parental supervision and BMI. Also a report from Latin America
(McArthur et al., 2001) found that the adolescents are very interested in learning more
about obesity and weight loss methods.
A study on body weight perception among Bahraini adolescents (Al Sendi et al.,
2004) revealed a significant discrepancy between adolescents perception of body
weight and actual BMI. There was a tendency for teenagers to underestimate their
weight status, which was especially noteworthy among the overweight and obese.
One third of the adolescent boys thought that their parents and their peers
respectively, could consider them to be overweight or obese. Data revealed in our
study that self-perception and peers perception of body weight also contributed
heavily to the boys ADS score (P,0.001) in dieters. But, Steen (Steen et al., 1996)
reported in their study that the obese boys perceived themselves to be less overweight
and happier with their looks than obese girls.
The use of problematic weight loss tactics were significantly higher among
students who are involved in substance misuse reported by several studies (Garry
et al., 2003; Durant et al., 1999). We have not covered these factors in our study. Weight
concern develops among girls in all weight spectrum but among the boys it is strongly
related to BMI (Field et al., 2001). On the contrary, our results showed that there is no
association of dieting with BMI. The only factors which contribute to starting dieting
among Qatari boys are self-perception and peers perception of their own figure.
Conclusion
The present study findings revealed a strong evidence for the association between
frequent dieting and eating disorders, body image dissatisfaction and psychological
problems in adolescent boys in Qatar. Half of the overweight boys were dieters.
Extreme dieters were under stress like they felt like crying more than usual, could not
sleep well and felt tired all the time. Special attention needs to be directed toward
teenagers for educating them about a healthy weight, body image, nutrition and
exercises using culturally appropriate materials.
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Child Psychology and Psychiatry, Vol. 38, pp. 299306.
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Abdulbari Bener can be contacted at: abener@hmc.org.qa

Generating effective change in

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

Queen Margaret University College, Edinburgh, UK
Abstract
305
Purpose Obesity among primary school children is an area of current concern throughout the UK,
alongside much discussion surrounding the opportunities and challenges of effecting change. School
meals may contribute to obesity, tending to be high in fat and sugar and lacking in essential
nutrients. The primary purpose of this study is to investigate the success of a healthy eating
programme and to examine the work that had been done to identify areas where further work was
required, where lessons might be learned for future campaigns and areas where further research
would be useful.
Design/methodology/approach The current study uses a case study approach to examine food
provision and education within a primary school in Edinburgh, which adopts a healthy eating
programme based on the guidelines of Hungry for Success. Within the case study, both quantitative
and qualitative methods were used, including semistructured interviews, recipe analysis and
observational research.
Findings Results indicate some considerable success has been achieved and more ways in which
healthy eating can be promoted within the school have been identified. The manner in which change
can most effectively be implemented is explored and some indicators for future work highlighted. In
addition, results indicate that slow subtle change will be more effective than well intentioned attempts
to achieve the ideal in a peremptory manor and that persistence is likely to play a key role.
Research limitations/implications The study was carried out in one school where the school
meals were prepared on an in-house basis. Nonetheless, looking at ways in which effective change in
childrens eating habits and food choices can be achieved on a small scale provides some useful
pointers for future research with schools where meals are prepared by contract caterers.
Originality/value The paper focuses on a healthy eating programme.
Keywords Nutrition, Children (age groups), Primary schools, Health education, United Kingdom
Paper type Case Study
Introduction
In Britain, one in five children is currently estimated to be overweight and 2.5 per cent
are classed as obese. Obesity among children is reported as having risen continuously
for around two decades (Reilly, 2002) and currently a third of twelve year olds in
Scotland are classed as overweight. In addition, recent studies of children aged
between 11 and 12, established that there was confusion over what constitutes healthy
eating (Health Pro, 2004). At a time when the country has never had more nutritional
information, children in Britain are more likely to be overweight and to suffer the
associated health and social problems. On average, children are reaching their teens a
stone heavier than previous generations (Yapp, 2003).
Among other factors, it has been suggested by many authors that unhealthy school
meals are contributing to the problem. Menus in school canteens have been reported to
regularly feature high fat, and sugary meal options (Department of Education and
Skills, 2004). In Britain approximately four million school meals are prepared daily
providing for 45 per cent of school children (Eves et al., 1997; current dietary advice in
Scotland).
Vol. 36 No. 5, 2006
The irony is that school meals were introduced in 1900 due to the anxiety over the
pp. 305-314
Limited
health of children, particularly those in poorer areas where the children were shorter E Emerald Group Publishing0034-6659
DOI 10.1108/00346650610703153
and thinner than those in more privileged areas (Alexander et al., 2001). During the
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Boer war it was brought to the attention of the government, that the young men being
recruited were, small, undernourished and unwell. There was also an absence of
nutritional information. In an attempt to combat the problem, the London School
Board offered cheap or free school dinners. The rational behind the idea was also that
if the children were hungry it would affect their studies (Learning Curve, 2003).
Nutrient standards for school meals were established by the government during the
Second World War, but lapsed over time. In 1980 with the revision of the Education
Act they were withdrawn formally, allowing a great change in school meal provision.
There was no specific costing of meals and no statutory requirement to meet
nutritional guidelines. This provided the opportunity for choice but not necessarily for
the good (Adams et al., 1997; Church, 1997; Blades, 2001). The standards for school
meals became very relaxed and the Local Education Authorities (LEAs) were only
obliged to provide school meals to those children entitled (Church, 1997).
Recent concern has been mounting over the nutritional content of school meals,
focussing primarily on studies that indicate that current school meals lack nutritional
balance and contain excess fat, sugar and salt (Bunker and Burgess, 2002; DoH 1989;
MAFF, 1996; Noble and Kipps, 1994; Eves et al., 1997). Attempts have been made to
reintroduce national guidelines for schools, none of which have been adopted formally.
In April 2001 minimal nutritional standards, using dietary reference values, based on
government advice on healthy eating were introduced by the Caroline Walker Trust
(Harvey, 2001). Caterers are now provided with a guide with which they can compare
the nutritional content of the school meals they produce (Bunker and Burgess, 2002).
In 2002 a report, Hungry for Success A Whole School Approach to School Meals
was published, providing recommendations for radical improvements in the school
meals service (BNF, 2004).
In addition to the problems associated with being overweight during childhood itself,
school is an influential time for children in relation to moulding their dietary
preferences. Healthy eating habits established in childhood are likely to influence food
consumption over the lifespan and form a key part of strategies to tackle obesity in the
UK. For many children the school meal is their main or in some cases, only meal of the
day. A survey by the DHSS, The Diets of British School-Children revealed that around
30 per cent of a childs energy intake is derived from school meals (Health Pro, 2004).
Various bodies have become involved with schools throughout the UK in a bid to
improve school meals:
N The Food Standards Agency (FSA).
N The School Nutrition Action Group (SNAG).
N The European Network of Health Promoting Schools (ENHPS).
These groups regularly carry out surveys, reports and studies into school meals in an
attempt to solve current problems.
Price and budget in relation to school meals are also an issue. The budget delegated
to a school, can limit the food that is served (FSA, 2004). Free meals are provided for
eligible pupils whose families receive certain benefits (SPEC, 2004). This development
aimed to provide a meal during the day to children from less privileged backgrounds.
However, the meals that are provided are not required to meet a nutritional standard.
Many cafeterias are Free Choice and need to generate business. Therefore, popular
options such as burgers and chips feature prominently (Health Pro, 2004; Caraher et al.,
2004).
Methodology
The primary methodology for this study involves a case study carried out within a
primary school. Within this case study, however, the methodology that was developed
in three parts to cover the span of data that it was perceived would offer a useful
perspective both on the participants understanding of the school meals project and on
the actual changes identified. The three categories in which data were collected were
an nutritional analysis of the meals served, interviews with staff associated with food
provision and a small observational study of the food choices that individuals pupils
made.
To explore the wide range of issues, both quantitative and qualitative methods were
used, including an analysis of the nutritional content of the school meal served,
providing a comparison with the guidelines published by the Caroline Walker Trust,
which was carried out using Comp-Eat Software and three observational studies
carried out during the serving period for lunch. In addition, semistructured depth
interviews were carried out with the head of the kitchen staff, the head teacher, the
member of staff who had organised the healthy eating project and a PE teacher who
was also a parent of children within the school. While the choice of those individuals
who were to take part in the interviews was naturally affected by the availability and
willingness of the participants, it is important to note that all those interviewed had
had direct contact with the project. The results obtained should therefore be viewed as
the views of those staff involved in the project; the opinions of those schoolchildren
who regularly ate the meals and of their parents would form a fascinating piece of
supplementary research. The questions asked within the interviews varied slightly
according to the focus, involvement and experience of each staff member and are
listed in Table I.
Three mealtimes were observed and anonymous records of the actual food choices
made by children were kept to facilitate practical suggestions for future development
work. Two types of observational techniques; participant and non-participant
observation are in current general use (Sarantakos, 1998). During participant
observations, natural science processes are studied as they happen. Researchers
observe the activities and interact with the subjects (Schutt, 1999). Non-participant
observations require the researcher to play a passive role in avoiding the direct
influencing of events (Grix, 2001). Non-participant observations were used for this
study, both for ethical reasons and to avoid distracting or influencing the children. A
major concern was that if the children had known that they were being analysed, their
food choices might have been affected.
Three observational studies of the food choices of 180 children took place over a
period of three weeks. The observations were applied to sittings of 120 primary three
and four children aged between seven and nine. Each alternate childs meal [in
queuing order] was noted for analysis. A different day of each week was selected to
ensure menu variety. With this type of observational study White (2002) states that it
is important to blend into the background and not cause an obstruction. Therefore the
observer stood to the side of the cash desk, at the best vantage point without being
obtrusive. The study was repeated three times to get as much information as possible
and to improve the reliability of the results.
A nutritional analysis of four popular meal choices was made to allow comparisons
with the Caroline Walker Trust guidelines. The foods available within the meal and
the quantities provided were noted and the nutritional analysis was carried out using
Comp-Eat.
Generating
effective change
in school meals
307
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36,5
Head of Canteen
The importance of integrating a healthy eating programme.

The main aims.
What changes were made.
Surveillance of the childrens eating habits.
Guidelines.
How easy it is to follow the advice provided.
How lunch is organised.
Waste.
Should the children be educated on healthy eating earlier on in the curriculum.
Head Master
Changes in the food served over the years.

Increase in obesity.
Why the programme for healthy eating was introduced.
Budget.
The success of the project.
Other reasons for healthy eating.
Project Leader
The importance of integrating a healthy eating programme.

What changes have been made.
Changes in the food served over the years.
Nutritional background.
Availability of advice.
Use of support groups.
Levels of physical education.
Monitoring choice.
Traffic light system.
Budget.
Childrens reactions to the programme.
PE teacher and Parent
How the programme has affected the children.

Advice given by a parent.
If children at p3 and p4 level are too young to make food choices.
Satisfaction with the schools efforts.
Availability of confectionary.
308
Table I.

The healthy eating programme
As part of the programme the school:
N Integrated healthier meals into the mainstream food service.
N Reduced the amount of fast food served.
N Encouraged the children to drink water throughout the day in order to aid their
ability to study and to control their appetite.
There have been various changes within the canteen over the last fifteen years.
Initially set meals were served but due to the amount of waste, the school brought in
outside caterers, providing the children with a wide choice. This was also recognised
as a problem in schools by Coles and Turner (1993). However, the caterers were selling
a lot of fast food products which were not of an acceptable quality supporting the
research of Ruxton et al. (1993). Three years ago the school employed an individual
with experience on healthy eating and running a school canteen, to establish a basis
for the provision of healthier food. A number of substantive changes have occurred,
including the introduction of healthier recipes, salad bowls and fresh and dried fruit as
an alternative to confectionary. Sugar free flavoured waters and fruit juices were
introduced as an alternative to the more sugary beverages available previously.
Within the school, it is perceived that while the kitchen is running at a minor
budgetary deficit the quality of the food has greatly improved.
Over the years the ambience of the canteen has also changed. Initially, due to an
unfriendly atmosphere the children were being deterred from eating there. However, a
change in staff and attitude has altered this ensuring that it is an inviting and friendly
place to be. This has been a positive move, corresponding closely with recommendations within Hungry for Success (2002), which state that a good atmosphere in the
canteen is essential.
Although none of the staff actually have a background in nutrition, they have been
able to follow the guidelines from Hungry for Success fairly easily. The school also
used information from the Health Education Board of Scotlands programme called,
Healthy for Life which they found very useful. The project leader was also involved
with the Health Promoting Schools programme.
Although food such as pizza, which sounds like an unhealthy option is still served
in the canteen, it was ascertained that the pizzas are made in on site. Therefore the
bases are baked and not fried and can also be made with wholemeal flour providing a
healthier fast food option. Chips are only served once a week, in line with current
dietary advice in Scotland.
The staff have devised other ways to cook potatoes which seem fairly popular, such
as slicing them and cooking them with stock.
Children are not allowed to use the confectionary machines provided for the senior
school which is based on the same sight. This was a move to reduce the amount of
crisps and sweets that they were eating previously. The school have done this by
locking the machines during their play time and lunch time. However, there has been
no move up to now to monitor the snacks that children bring in at break time. This is
perceived as being the parents decision and confirms the importance of parental
education. Many vending machines are now being removed from schools by the Food
and Drink Federation (FDF) when requested by the school or the LEA due to dietary
reasons (FDF, 2005). Another recent change with regard to confectionary within the
school, was that the teachers were stopped from giving sweets as rewards at primary
level.
At lunch time children are not allowed to purchase any confectionary from the
counters except fudge bars. They are however, able to choose a cake such as a
doughnut as desert. It could be argued that a chocolate bar may be less harmful to a
child nutritionally than a doughnut, although the differences are likely to be very
small.
Healthy eating education
With regards to education on healthy eating, the children are taught all the way
through the school but in more depth within primary six and seven. In primary one
the children spend a lesson making up a lunch box and deciding what healthy
foodstuffs it should contain. This has been successful to a point as the children have
Generating
effective change
in school meals
309
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been found to discuss and in some cases even advise their parents as to what they
should have in their lunchboxes. This supports the view of Bowker et al. (1998) who
have focused on the importance of nutritional education and its advantages. It would
beneficial to go into more depth at this point in order to make the children more aware
of the food choices they are making.
The school recognises the importance of parental input and is aware that there is
more that could be done to encourage parents to become involved. For example, the
school could advise the parents on giving the children healthy snacks for break time.
Findings and discussion from the interviews
The initial observation made during the headmaster, the head of the catering staff and
the project leader, was very content and positive about the programme. These
participants were more directly involved with the introduction of the programme
which may have introduced bias but which may also have provided a useful
perspective about the amount of change which had actually been achieved. The
person that questioned the effectiveness of the programme was actually the physical
education teacher, who is also a parent, and provides an interesting insight. Though
he did not state doubts as to the effectiveness of the food improvements, he did not
allow his own children to eat within the school refectory. This may suggest that he
doubts the success of the healthy eating programme and is an area where future
research might focus. While the numbers of people interviewed are too small to draw
any firm conclusions, the importance of liaison with parents is highlighted.
Findings and discussion from the observational study
In general, the results from the observational study indicate that the unhealthier
options on the menu or those options that appeared to be unhealthy were the most
popular, notably the pizza and the hot dogs (Table II). There was a day within the
three monitored when the majority of the children selected the healthier choice
sausage casserole. This revealed a pattern whereby sausages were revealed as
the main choice throughout the study whether they occurred in a healthy or
unhealthy option. This information could be built on and the sausage selections
could be made healthier, perhaps by using leaner sausages.
Each day, out of the healthy options, the pasta seemed to be the most popular dish.
By developing on this information, the kitchen staff could begin to infiltrate more
healthy ingredients into the sauces such as more vegetables or more lean meat which
would benefit the children nutritionally. A key area for future work will be the
development of more and even more popular recipes that also happen to be healthy.
Results indicated overwhelmingly that the salad boxes were unpopular. The school
had previously considered installing a salad bar, but decided that there would be too
much waste. Given the lack of enthusiasm for the salad boxes, this appears to have
been a sensible decision; more work to increase the popularity of this group of foods
would be required before this became a sensible option. Adding to the current salad
box to make it more popular might provide a reasonable way forward, perhaps by
adding cheese or pasta, as pasta in particular is such a popular option. The best
alternative, however, would be to serve a small portion of salad with more of the main
meals for example the burgers. The portion of salad could be slowly increased as the
children became acclimatised to it.
Almost all of the children accompanied their meal with a cake. The healthier
options were not selected. Throughout the study only four fruit box selections were
Healthy option
Day 1
Fish cakes
Pasta and tomato sauce
Baked potato
Sandwich
Salad
Total
Per cent
Day 2
Roast beef, yorkshire pudding and stovies
Sausage casserole
Baked potato
Sandwich
Salad
Green split pea soup
Total
Per cent
Day 3
Turkey and stuffing
Baked potato
Sandwich
Salad
Mushroom soup
Total
Per cent
Unhealthy option
3
7
7
3
0
Pastry
Pizza
Sausage roll
Burger
Waffles
Sausage sandwich
1
4
7
10
10
8
40
66.6
2
16
17
2
3
0
0
40
66.6
Burger
Pizza
Sausage roll
Pie
Sausage sandwich
1
7
5
3
7
4
6
0
1
21
35
Hot dog
Pizza
Sausage roll
Pie
20
33.3
Generating
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311
7
20
33.3
29
2
6
2
39
65
made. In relation to the children choosing cakes as desert options the view of the
school is that they are happy for the children to reward themselves with something
sweet after their meal. This suggests that the school do not take into consideration the
fact that there are two snack breaks per day and most of the children will have sweets
or crisps provided by the parents for both breaks, thus undermining calculations on
sugar and fat consumption. A way to combat this unhealthy routine could be to
restrict the cakes to once or twice a week. This will also encourage the children to
select the healthier options.
The menu varied more for the healthier options but the unhealthy options generally
stayed constant. The healthier options seemed to be based on more traditional meal
choices such as casseroles. The observational study showed that what the children
chose varied with the menu. Kitchen staff at the school may find it useful to
investigate which are the more popular healthy options and build on this information.
The unhealthier options could then be reduced gradually. This would move the
healthy eating programme onto another level. As the unhealthy options tend to be
very similar each day this task would be simple and effective.
Findings and discussion from the Comp-Eat analysis
The nutritional analysis work carried out to estimate the nutritional content of the
dishes routinely provided as part of the school lunch is summarised in Table III. The
results indicate that the main meals were reasonably healthy and fell more or less into
Table II.
Interview schedules
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the Caroline Walker Trust guidelines. However, the sausage casserole was found to
have a high fat content. The pizza which could be perceived as an unhealthy meal
actually had a lower fat content than the sausage casserole. This illustrates the
contribution that can be made by nutritional analysis software to the identification of
food choices that fall within the golden ideal of a healthy and popular dish!
The sodium content for each savoury dish exceeded the recommended daily amount
(RDA) of 5 g (CASH, 2004) and is a cause for concern. In addition, almost all of the
children accompanied their meal with a cake. As doughnuts were the most popular
choice, the average nutritional content of chocolate iced doughnuts were analysed
against the Caroline Walker Trust guidelines in order to see what contribution they
make to the average school meal. A doughnut contributes half of the recommended
energy intake and almost all of the recommended fat content that a midday meal
should have for a child. If a doughnut is selected as a desert this will cause all menu
combinations to exceed the recommendations for fat. If the meals were combined with
yoghurt or with fruit for desert they would fit in with the guidelines. Most children
chose a doughnut or something similar thus exceeding the guidelines with regard to
fat and protein.
Booth et al. (1990) suggested that too much variety may have a negative effect on
childrens food choice. Research in other countries has indicated that limiting food
choice has improved dietary habits of children (current dietary advice in Scotland). In
a canteen run establishment there is often a wide choice for children. An effective
move for the school involved with the study may be to reduce the unhealthier options
further in favour of the healthier options. It was noted that there was a great variety of
choice for the children which was possibly daunting for them.
From the popularity of some of the healthy dishes served at the school,
improvements could be made by simply reducing the more unhealthy meals and
developing the more popular healthy dishes. It has been recognised that salad boxes
have not been popular. Instead of the school just reducing the amount that they
produce, they should try to find new ways of introducing salad. More recipes could be
developed such in a similar way suggested for the pizza in order to make them more
nutritious. Pureeing more vegetables into dishes such as the pasta sauces where they
will be concealed may be effective as children may not be aware that they are eating
them.
Conclusions and recommendations for further research
Throughout this study the commitment and enthusiasm of staff within the individual
school has been apparent and is likely to have been the key factor for success in this
project. Staff enthusiasm, alongside parental involvement and the involvement of the
Table III.
Comp-Eat
nutritional analysis
Energy (Kcal)
(KJ)
Carbohydrate (g)
Protein (g)
Fat (g)
Sodium (mg)
Pizza
Chicken
casserole
Sausage
casserole
Chocolate iced
doughnut
404
1700
54.07
17.25
14.71
664
226
1115
11.38
29
12
1233
230
960
11.15
10.76
16.45
1085
250
1047
33
3
12
100
children themselves, is likely to be a key to the success of future projects and

generating this atmosphere remains a key goal and a vital area for future research.
Throughout the interviews it was clear that the school has found it very difficult to
measure what difference the healthy eating regime is making to the diets of the school
children, but there is little doubt that the changes made are positive and are likely to
make a long term contribution to health and wellbeing. The enthusiasm of the
children was also notable and, in itself, a very positive factor.
Further research would be required to investigate the long term impact of
decreasing food choices in a school canteen situation, but this is an area that would
merit further research, alongside recipe modification work to establish versions of
current dishes that are healthier but retain their popularity.
The school in which this study was carried out has a number of advantages in
terms of making change happen; it has in-house catering, facilitating trying out
simple, small changes relatively quickly and funding is perhaps easier than in some
areas of the UK. Nonetheless, the benefits of change and the ways in which it can most
effectively be achieved are substantial and would merit further investigation.
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Claire Seaman can be contacted at: CSeaman@qmuc.ac.uk

Breakfast frequency and fruit

and vegetable consumption in
Belgian adolescents
A cross-sectional study
Fruit and
vegetable
consumption
315
P. Mullie, P. Clarys, D. De Ridder, P. Deriemaeker, N. Duvigneaud

and M. Hebbelinck
Faculty of Physical Education and Physiotherapy, Department of Human
Biometry and Biomechanics, Vrije Universiteit Brussel, Belgium
A.R. Grivegnee and P. Autier

Unit of Epidemiology and Prevention, Jules Bordet Institute, Brussels, Belgium
Abstract
Purpose Several cross-sectional studies reported that breakfast skipping and a poor consumption
of fruits and vegetables are associated with overweight and obesity-related morbidities. In this
respect healthy eating habits such as regular breakfast and a sufficient intake of fruit and
vegetables are two important items to prevent childhood and adolescent obesity. The purpose of this
study is to determine the breakfast frequency and the fruit and vegetable consumption in Belgian
adolescents.
Design/methodology/approach A cross-sectional study using pupils contacted by nurses in
schools during an information session about female hygiene. On that occasion all pupils (boys and
girls) completed a questionnaire concerning their eating habits. Subjects were boys (n51390) and
girls (n53610) between 12 and 15 years of age from the main three educational programmes (general,
technical and occupational programme).
Findings Socio-economic status significantly influenced breakfast frequency with differences
between the highest educational programme (general) and the lower technical- and occupational
programmes. The use of daily breakfast was respectively 67 versus 49 and 48 per cent for the boys
and 60 versus 42 and 39 per cent for the girls). For both sexes breakfast frequency decreased when
comparing age groups from 12 with 15 years of age respectively from 67 to 55 per cent for the boys
and from 61 to 47 per cent for the girls. Half of the subjects who declared to have overweight (selfimage) did not take breakfast at a regular base. Twenty six per cent of the boys of the French
speaking part and 19 per cent of the boys of the Flemish speaking part of Belgium declared to take
only one or less than one portion of fruit and/or vegetables a day. For the girls the reported intake of
one or less than one portion of fruit and/or vegetables was respectively 20 and 16 per cent. Only
13 per cent of the French speaking boys and 10 per cent of the Flemish speaking boys reported an
intake of four or more fruits and/or vegetables a day. The percentage of girls reaching an intake of
four or more a day was 15 per cent for the two language regions. Fruit and/or vegetable intake was
influenced significantly by the educational programme and by the educational level of the mother. In
conclusion, healthy eating habits among girls and boys in Belgium (as estimated by breakfast
frequency and fruit and/or vegetable intake) are rather poor. These habits are influenced by age,
educational programme, self-image and educational level of the mother.
Originality/value In the light of these findings action should be taken to improve the eating
habits among Belgian children to prevent childhood obesity.
Keywords Diet, Nutrition, Adolescents, Fruits, Vegetables, Belgium
The authors would like to thank the nurses for their participation. They would also like to thank
Martine Mullie-Devos who coded and entered the records in the database. This research was E
made possible due to the unconditional financial support of Proctor and Gamble, Belgium.

Vol. 36 No. 5, 2006
pp. 315-326
0034-6659
DOI 10.1108/00346650610703162
NFS
36,5
316
Background
As several other behaviours, healthy eating habits at younger age may be an
important factor for healthy eating habits in later live. Regular breakfast and a
sufficient intake of fruit and vegetables are two important items of a healthy eating
pattern to prevent childhood obesity. The regular intake of breakfast increases the
possibility of a balanced diet improving the overall nutritional status and the nutrient
density, especially during growth stages (Nicklas et al., 2004). Lack of regular
breakfast influences cognition and learning in a negative way (Pollitt and Mathews,
1998). Skipping breakfast has also been associated with poor eating habits and
multiple snacking during the reminder of the day. Skipping breakfast increased the
risk for overweight in adolescents (Berkey et al., 2003; Keski-Rahkonen et al., 2003).
Reported reasons for poor breakfast habits are stress, lack of time, lack of parental
control (outdoor working or divorced parents), or it may be a part of the
individualisation process (Nicklas et al., 2004; Pollitt and Mathews,1998; Berkey
et al., 2003; Keski-Rahkonen et al., 2003). Moreover, breakfast skipping in adolescents
has been associated with several health compromising behaviours and unhealthy
lifestyles (Keski-Rahkonen et al., 2003).
The health aspects of daily fruit and vegetable intake are sustained by several
epidemiological studies. Fruit and vegetables may protect against excessive weight
gain because of their low energy density, high fiber content and low glycemic index.
In addition, poor consumption of fruit and vegetable has been associated with obesityrelated morbidities (Bowman et al., 2004). According to the study of Epstein et al.
(2001) increasing fruit and vegetable intake should help to decrease the consumption
of high-fat and high-sugar foods among obese parents and their children. By
consequence, increasing the consumption of fruit and vegetable may be a useful
approach for nutritional change in obese individuals. It was estimated that a daily
intake of more than 400 g of fruit and vegetables may decrease cancer incidence by
20 per cent (World Cancer Research Fund, 1997). There is also epidemiological
evidence that sufficient intake of fruit and vegetables protects against cardiovascular
and other prosperity diseases (World Cancer Research Fund, 1997). Again, an intake
of over 400 g a day decreases the risk for cardiovascular diseases between 20 and
40 per cent. In a recent study of Tylavsky et al. (2004), three or more servings of fruit
and vegetables a day resulted in a better bone mineral density and a lower urinary
calcium output in early pubertal girls compared with girls with a low fruit and
vegetables consumption.
However, these well documented positive health outcomes of regular fruit and
vegetable consumption do not lead to a sufficient intake in the major part of the
population. Different studies showed that the consumption of fruit and vegetables is
low among adolescents. In the Unites States less than 20 per cent of the children
between 2 and 18 years eat the recommended 5 portions of fruit and vegetables a day
(Krebs-Smith et al., 1996). The consumption of fruit and vegetables is influenced by
several social and environmental factors. The study of Boynton-Jarett et al. (2003) for
example suggests that television viewing may contribute to a decline in fruit and
vegetable consumption among adolescents.
Consumption of fruit and vegetables was more likely as the education level of the
responsible adult increased (Lowry et al., 1996). Especially maternal education is
considered as an important determinant of dietary intake (North and Emmett, 2000).
The aim of this study was to evaluate the breakfast frequency and the fruit and
vegetable intake in adolescents between 12 and 15 years. It was equally the aim to
evaluate these two aspects of healthy eating habits in function of age, gender,
educational programme, education of the mother and self image of the adolescent.
The results of this study may help to give direction to health education projects for
adolescents.
Fruit and
vegetable
consumption
Methods
Subjects/setting
Subjects were girls (n53,610) and boys (n51,390) of different educational
programmes (general, technical, and occupational level) aged between 12 and 15
years. Between September 1999 and May 2000, pupils were contacted in the school
setting during an information session about female hygiene. School directions over the
country (the French and Flemish region) could invite a team of nurses to give these
information sessions for female adolescents between 12 and 15 years. During this
1 hour session the girls completed a short questionnaire concerning their eating
habits, living environment and their self image with regard to their body weight.
During the same hour, boys completed the same questionnaire in a separate classroom
under supervision of a teacher. Since not all schools/teachers agreed to participate in
this procedure the group of questioned boys was smaller compared with the group of
the girls.
317
Measures
A closed questionnaire was developed to assess breakfast frequency, fruit and
vegetable consumption, self-image in relation to body weight, educational programme
of the respondent and educational level of the mother.
Subjects could report breakfast frequency during a 1 week period ranging from
never over once a week (1) to all days of the week (7). No distinction was made
between week and weekend days. Breakfast was defined as all food used between 5
and 10 am (without inclusion of drinks) (Siega-Riz et al., 1998).
Daily fruit and vegetable intake was assessed by the use of portions a day. One
portion of fruit was defined as a medium sized apple while a portion of vegetables was
defined as a quarter of a plate. Possibilities for daily fruit portions ranged from none
with half of a portion interval to 4 portions. For vegetable intake answer possibilities
ranged from none to ,1, 1, 1.5, 2 or more than 2 portions. Intake of fruit juice, potatoes
and potatoes derived products (French fries, chips) was not considered as fruit or
vegetables (Cullen et al., 2000).
Self-image concerning body weight was reported using the following classification:
too thin, thin, satisfied, thick, too thick.
Answering possibilities for educational programme were from high to low level:
general, technical or occupational programme. The following levels were possible for
the educational level of the mother: lower grade (up to 12 years), higher grade (up to
18 years), non university higher education, university degree.
The subjects indicated their living environment (town versus rural), time to reach the
school (in 10 minute intervals) and mode of transportation (bus, train, car, bike, foot).
For all questions the option I do not know was a possible answer.
The questionnaire was designed in two languages (French and Dutch). After a
validation try-out on 200 pupils, corrections were made to improve the comprehensibility. The questionnaire was not validated against other research methods.
NFS
36,5
318
Statistics
The fruit and vegetable consumption and breakfast frequency were analysed using
the MantaelHaenstzel x2 for trends. Influence of independent variables was assessed
using multilinear regression. The level of significance was set at 0.05.
Results
Table I gives an overview of the subjects and the different groups (sex, age, region
and education programme) used for the analysis. The data collection procedure (on
invitation with the target age for the information session at the onset of girls puberty)
provoked an uneven distribution between girls and boys and between the different
age groups. More girls (n53,610) than boys (n51,390) completed the questionnaire.
For both sexes an overrepresentation was noticed for the age group of 13 years:
57.3 per cent for the girls (n52,069) and 56.1 per cent (n5780) for the boys. More
subjects from the French speaking region (62 per cent) completed the questionnaire
compared with the Flemish speaking region (38 per cent). There was an
overrepresentation of pupils from the general programme: three out of four
respondents, and this for both sexes, followed general education. The representation
of the girls was comparable for technical (12.7 per cent) and occupational programme
(11.4 per cent) while there was an under representation for the boys from the
occupational programme (5.0 per cent) compared with the technical programme
(15 per cent).
Breakfast frequency was divided into four categories: never, one to four times a
week, five to six times a week and every day.
Fruit and vegetable portions were summed and subjects were divided in three
categories: 0 to 1 portion a day; 1.5 tot 3.5 portions a day and more than 4 portions a
day.
Data concerning breakfast frequency are represented in Tables II and III.
Significantly (p , 0.05) less girls consumed breakfast compared with the boys. The
latter was independent of the language region.
Breakfast frequency for both sexes differed when comparing the two language
regions. Significantly (p , 0.05) more girls and boys from the Flemish speaking region
(respectively 59.9 and 71.8 per cent) consumed breakfast compared with their
counterparts in the French speaking region (respectively 52.6 and 58.9 per cent).
Male adolescents
n
Per cent
Table I.
Distribution of the 5000
male and female
adolescents
Total group
Regions
Flemish speaking
French speaking
Age
12 years
13 years
14 years
15 years
School programme
General
Technical
Occupational
Female adolescents
n
Per cent
1,390
100.0
3,610
100.0
528
862
38.0
62.0
1,353
2,257
37.5
62.5
157
780
319
134
11.3
56.1
22.9
9.6
326
2,069
721
494
9.0
57.3
20.0
13.7
1.108
213
69
79.7
15.3
5.0
2,742
457
411
76.0
12.7
11.4
One to four Five to six

Never
breakfast(s)
breakfasts
Every day
Do not
a week
a breakfast
know
breakfast
a week
n per cent n per cent n per cent n per cent n per cent
Region male
Flemish speaking
French speaking
Region female
Flemish speaking
French speaking
Age male
12 years
13 years
14 years
15 years
Age female
12 years
13 years
14 years
15 years
Self-image male
To thin + thin
Good
Overweight + obesity
Self-image female
To thin + thin
Good
Overweight + obesity
School programme male
General
Technical
Occupational
School programme female
General
Technical
Occupational
Travel time to school
10 to 20 min
30 to 40 min
50 and more min
Education mother
Lesser than six years
Six years
Twelve years
Higher non-university
University
Unknown
16
55
3.0
6.4
59
154
11.2
17.9
65
105
12.3 379
12.2 508
71.8
58.9
9
40
1.7
4.6
57
179
4.2
7.9
261
521
19.3
23.1
170
257
12.6 811
11.4 1187
59.9
52.6
54
113
4.0
5.0
6
29
26
10
3.8
3.7
8.2
7.5
10
107
72
24
6.4
13.7
22.6
17.9
18
96
41
15
11.5 111
12.3 519
12.9 174
11.2 83
70.7
66.5
54.5
61.9
12
29
6
2
7.6
3.7
1.9
1.5
6
107
50
73
1.8
5.2
6.9
14.8
52
362
211
157
16.0
17.5
29.3
31.8
43
246
82
56
13.2 213
11.9
1.262
11.4 340
11.3 183
65.3
61.0
47.2
37.0
12
92
38
25
3.7
4.4
5.3
5.1
4
40
27
2.5
4.2
10.1
17
143
53
10.5
14.9
19.9
16
107
47
9.9 122
11.1 635
17.6 130
75.3
66.1
48.7
3
36
10
1.9
3.7
3.7
21
80
135
6.5
4.4
9.3
48
325
409
15.0
17.7
28.1
35
216
176
10.9 201
62.6
11.8
1.138 62.1
12.1 659
45.2
16
73
78
5.0
4.0
5.4
45
18
8
4.1
8.5
11.6
152
41
20
13.7
19.2
29.0
129
35
6
11.6 749
16.4 105
8.7 33
67.6
49.3
47.8
33
14
2
3.0
6.6
2.9
137
48
51
5.0
10.5
12.4
508
140
134
18.5
30.6
32.6
337
55
35
12.3
1.644 60.0
12.0 193
42.2
8.5 161
39.2
116
21
30
4.2
4.6
7.3
204
73
30
5.5
7.8
9.4
726
202
67
19.4
21.5
20.9
456
113
28
12.2
2.202 58.9
12.0 504
53.6
8.8 179
55.9
151
49
16
4.0
5.2
5.0
13
19
81
23
36
135
24.5
8.9
6.8
4.5
4.8
5.9
14
54
272
77
131
447
26.4
25.4
22.9
15.2
17.4
19.6
6
28
151
62
87
263
11.3
13.1
12.7
12.3
11.5
11.5
5
4
42
19
26
120
9.4
1.9
3.5
3.8
3.4
5.2
15
108
642
325
474
1.321
28.3
50.7
54.0
64.2
62.9
57.8
The use of a daily breakfast decreased as a function of age and this for both sexes.
When comparing age 13 with age 14 percentages decreased from 61.0 to 47.2 per cent
for the girls and from 66.5 to 54.5 per cent for the boys. Over 45 per cent of the female
adolescents of 15 years of age had a breakfast frequency of four times or less a week.
Fruit and
vegetable
consumption
319
Table II.
Breakfast frequency in
function of gender, region,
age and self-image of
5,000 male and female
adolescents
NFS
36,5
320
Table III.
Multilinear regression
analysis of the
independent variables
gender, age, region,
school programme,
self-image and
education of the mother
and the dependant
variable breakfast
frequency
Variable
Sex
Male
Female
Age
12 years
13 years
14 years
15 years
Region
Flemish speaking
French speaking
School programme
General
Technical
Occupational
Self-image
To thin
Thin
Good
Overweight
Obesity
Education mother
Lesser than six years
Six years
Twelve years
Higher non-university
University
Coefficient
SE
p value
95% Confidence interval
Ref.
20.186
0.072
0.01
20.330 to 20.042
Ref.
20.103
20.634
20.788
0.113
0.127
0.146
0.36
, 0.0001
, 0.0001
20.329 to 0.123
20.888 to 20.380
21.080 to 20.496
Ref.
20.649
0.069
, 0.0001
20.787 to 20.511
Ref.
20.759
20.989
0.102
0.121
, 0.0001
, 0.0001
20.963 to 20.555
21.231 to 20.747
Ref.
0.380
0.168
20.408
21.038
0.238
0.212
0.217
0.231
0.11
0.43
0.06
, 0.0001
20.096
20.256
20.842
21.500
to
to
to
to
Ref.
0.924
1.125
1.380
1.331
0.352
0.325
0.335
0.330
0.008
0.0005
, 0.0001
, 0.0001
0.220
0.475
0.710
0.671
1.628
1.775
2.050
1.991
to
to
to
to
0.856
0.592
0.026
20.576
For girls and boys, breakfast frequency was influenced by the self-image of the
respondents. Lower breakfast frequencies were noticed for adolescents reporting thick
or too thick for their self-image compared with those reporting to be satisfied of their
self-image and those reporting to be thin or too thin. For the adolescents from the
categories thick or too thick less than 50 per cent consumed daily breakfast.
The educational programme had a significant impact on the breakfast frequency.
The pupils from the general education programme consumed more regularly
breakfast compared with pupils from the technical and occupational programme:
60.0 per cent of the girls and 67.6 per cent of the boys from the general education level
consume breakfast every day compared with respectively 47.8 and 49.3 per cent for
the technical programme and 39.2 and 42.5 per cent for the occupational programme.
Time to reach the school in the morning did not influence the breakfast frequency.
Educational level of the mother significantly (p , 0.05) influenced the breakfast
frequency with breakfast frequency increasing as a function of the educational level of
the mother. Only 28.3 of the pupils reporting their mother to have the lowest
educational level consumed breakfast every day compared with 62.9 per cent of the
pupils of which their mother obtained a university degree.
Results for fruit and vegetable consumption are represented in Table IV. Only a
very low percentage of girls and boys reached the recommended intake of fruit and
vegetables. More girls than boys reached the recommended intake: for the girls
respectively 15 per cent from the Flemish speaking region and 14.6 per cent from the
0 to 1 portion
a day
n
per cent
Region male
Flanders
101
19.1
Wallonia
227
26.3
Region female
Flanders
216
16.0
Wallonia
439
19.5
Age male
12 years
38
24.2
13 years
158
20.3
14 years
94
29.5
15 years
38
28.4
Age female
12 years
55
16.9
13 years
315
15.2
14 years
142
19.7
15 years
143
28.9
Education male Flemish speaking
General Education School
72
17.3
Technical Education School
23
27.7
Professional Education School
6
21.4
Education male French speaking
150
21.7
46
42.6
31
49.2
Education female Flemish speaking
93
11.6
47
17.5
76
26.8
Education female French speaking
338
17.4
47
31.1
54
32.7
Education mother male Flemish speaking
Unknown
56
22.7
Six years or lesser
6
22.2
12 years
23
19.5
More than 12 years
16
11.8
Education mother male French speaking
Unknown
123
32.5
Six years or lesser
13
25.5
Twelve years
41
21.5
More than 12 years
50
20.7
Education mother female Flemish speaking
Unknown
129
19.1
Six years or lesser
11
17.2
12 years
46
13.9
More than 12 years
30
10.7
Education mother female French speaking
Unknown
220
22.4
Six years or lesser
25
20.2
12 years
108
19.7
More than 12 years
86
14.3
1.5 to 3.5
4 and more
portions a day
portions a day x2 for trend
n
per cent
n
per cent p value
374
521
70.8
60.4
53
114
10.0
13.2
0.21
934
1.489
69.0
66.0
203
329
15.0
14.6
0.0468
106
523
183
83
67.5
67.1
57.4
61.9
13
99
42
13
8.2
12.7
13.2
9.7
Ref.
0.092
0.95
0.68
216
1.450
466
291
66.3
70.1
64.6
58.9
55
304
113
60
16.8
14.6
15.7
12.2
Ref.
0.872
0.307
0.0001
307
48
19
73.6
57.8
67.9
38
12
3
9.1
14.5
10.7
Ref.
0.42
0.797
444
56
21
64.3
51.9
33.3
97
6
11
14.0
5.6
17.5
Ref.
0.001
0.0028
577
182
175
72.0
67.9
61.6
131
39
33
16.4
14.6
11.6
Ref.
0.042
0.0001
67.5
54.3
58.8
293
22
14
15.1
14.6
10.5
Ref.
0.0035
0.0001
174
14
86
100
70.4
51.9
72.9
73.5
17
7
9
20
6.9
25.9
7.6
14.7
Ref.
0.077
0.50
0.00086
211
33
126
151
55.7
64.7
66.0
62.7
45
5
24
40
11.9
9.8
12.6
16.6
Ref.
0.60
0.033
0.0015
462
44
233
195
68.2
68.8
70.4
69.4
86
9
52
56
12.7
14.1
15.7
19.9
Ref.
0.66
0.029
0.00019
635
87
351
416
64.6
70.2
64.1
69.1
128
12
89
100
13.0
9.7
16.2
16.6
Ref.
0.84
0.062
0.0001
1.310
82
97
Fruit and
vegetable
consumption
321
Table IV.
Fruit and vegetable
consumption in function
of gender, region, age and
school programme of
5,000 male and female
adolescents
NFS
36,5
322
French speaking region versus 10.0 per cent for the Flemish speaking region and 13.2
per cent for the French speaking region for the boys. Discrepancies between the
language regions were less pronounced compared with the results of the breakfast
frequency.
Fruit and vegetable consumption decreased as a function of age. This trend was
significant (p , 0.05) for the girls but not for the boys. The girls reaching the
recommended intake decreased from 16.8 per cent at the age of 12 years to 12.2 per cent
at the age of 15 years while the number of girls reporting an intake between 0 and 1
portion a day increased from 16.9 to 28.9 per cent over that age period. At the age of
15 years, 28.4 per cent of the boys reported an intake between 0 and 1 portion of fruit
and vegetables a day while only 9.7 per cent of the boys reached the recommended
intake at that age.
The educational programme of the respondents influenced the fruit and vegetable
consumption with lowest intakes for the lowest educational programme. The latter
was significant (p , 0.05) for the girls and the boys in the French speaking region and
for the girls in the Flemish speaking region.
Educational level of the mother influenced the fruit and vegetable intake. The
number of pupils reporting an intake from 0 to 1 portion a day decreased with
increasing educational level of the mother, while an intake of 4 and more portions a
day increased with increasing educational level of the mother. These trends were
significant (p , 0.05) for the girls and boys of the Flemish speaking region and for the
boys of the French speaking region.
Discussion
The method used for data collection (collection during information sessions about
female hygiene) provoked an uneven distribution between girls and boys, with more
girls than boys in the analysis. Due to the uneven distribution of participants and
because of the distribution in several categories (age, language region, education
programme, educational level of the mother, time used for travelling to school), some
categories are underrepresented.
However, our results on breakfast frequency and fruit and vegetable intake
corroborate the findings of several other studies carried out on adolescents in affluent
countries (Keski-Rahkonen et al., 2003; Frost-Anderson et al., 1997; Gleason, 1995;
Hoglund et al., 1998; Skinner et al., 1985; Krebs-Smith and Kantor, 2001). They equally
shed some light on the particular situation in Belgium as several inequalities between
the two main language regions were detected. National statistics point to a weaker
health and socio-economic status in the French compared with the Flemish speaking
region of Belgium (Center for Operational Research in Public Health, 1997a). Our
study indicates that these differences in health and socio-economic status result
already at young age in poorer nutritional habits for the adolescents from the French
speaking region.
A study carried out among 7600 Swedish youngsters of 15 years of age revealed
that 27 per cent of the girls and 17 per cent of the boys never consumed breakfast
(Skinner et al., 1985). Prevalence of no breakfast at all for the group of 15 years of age
was lower in our study with a prevalence of 14.8 per cent for the girls and 7.5 per cent
for the boys. Considering all age groups we found that 4.2 per cent of the girls of the
Flemish speaking region never took breakfast versus 7.9 per cent of the French
speaking region. Percentages for boys were respectively 3 per cent for the Flemish
region and 6.4 per cent for the French region.
The results obtained by De Henauw et al. (1997) on Flemish primary school children
are in good agreement with our study. Data on breakfast frequency were obtained
with the 24 h food recall method on 1.321 Flemish children between 6 and 12 years old.
They observed that 4.4 per cent of the children did not take breakfast or less than
420 kJ during breakfast. In our study the prevalence of children taking no breakfast at
all at 12 years of age was 1.8 per cent for the girls and 3.8 per cent for the boys. Our
study extends the data obtained by De Henauw et al. (1997) towards older adolescents.
The data indicate a further increase of the breakfast skippers up to 15 years
(respectively 14.8 per cent for the girls and 7.5 per cent for the boys). The increasing
trend of skipping breakfast in function of age was equally reported by Frost-Anderson
et al. (1997). In their study 9 per cent of the girls and 5 per cent of the boys did take
less than two times breakfast a week. These percentages increased to respectively
12 and 15 per cent at the age of 18. In our study the critical age for a significant
decrease in breakfast frequency was between 13 and 14 years of age. According to
Morgan et al. (1986) breakfast frequency decreases significantly during puberty. The
latter was noticed especially for girls fearing an increase in body mass. According to
Keski-Rahkonen et al. (2003) dieting and body shape ideals are the strongest
determinants for the eating pattern amongst teenage girls. Our results indicate
indeed a decreased breakfast frequency at that age, but also as a function of the selfimage of their body: subjects with a self-image related with overweight skipped
breakfast more frequently compared with subjects classifying their self-image
concerning body weight as normal or as thin and too thin. Moreover, several crosssectional studies have consistently reported that skipping breakfast tended to increase
snacking and the risk of overweight among children and adolescents. In contrast, the
longitudinal study of Berkey et al. (2003) suggested that overweight children
who never ate breakfast had lower daily energy intakes and may lose body fat. On the
other hand, normal weighted children who never ate breakfast tended to gain weight.
In any case, skipping breakfast is not an adequate method to reduce energy intake
given its adverse effects on academic performance (Wyon et al., 1997) and general
health.
Ortega et al. (1998) demonstrated that breakfast frequency among children
increased during holidays compared with school days, pointing to the possible
influence of stress and lack of time as possible reasons for skipping breakfast. The
finding in our study that time to school does not influence the breakfast frequency is
in contradiction with the stress hypothesis as postulated by Ortega et al. (1998).
Fruit and vegetable consumption was evaluated in the study of Paulus et al. (2001).
They studied eating habits in 1,526 adolescents between 12 and 17 years of age living
in the province of Luxemburg, a part of the French speaking region of Belgium. Using
semi-quantitative food frequency questionnaires they revealed that 59 per cent of the
respondents did not consume vegetables on daily basis while 17 per cent of them
reported to eat only one serving of vegetables a week. Similar findings were reported
for fruit intake: 54 per cent reported an intake of one portion of fruit per day while
10 per cent of the respondents consumed only 1 portion of fruit per week. In their
study differences in fruit and vegetable intake were more pronounced when
comparing girls and boys. Sixty one per cent of the girls reported a daily intake of
at least 1 portion of fruit whilst 46 per cent of the girls reported an intake of minimum
1 portion of vegetables a day, this was respectively 47 and 35 per cent for the boys.
However, when considering the recommended intake we also found a better profile for
the girls compared with the boys. Of the girls 15 per cent from the Flemish speaking
Fruit and
vegetable
consumption
323
NFS
36,5
324
region and 14.6 per cent of the French speaking region reached the recommended
intake compared with respectively 10 and 13.2 per cent of the boys.
Other similarities between the study of Paulus et al. (2001) and ours were the
decreasing trend of the daily intake of fruit and vegetables in function of age as well
as the influence of the educational programme of the respondents. The study of Lien
et al. (2001), carried out on 885 Nordic subjects between 15 and 21 years also indicated
a decrease of fruit and vegetable consumption as a function of age. Their sample is
indeed somewhat older compared with ours, but their results are alarming since they
indicate a continuous decrease also after the age of 15. Indeed, they reported a
decrease in the consumption of 1 portion of fruit from 59 per cent at 14 years of age to
29 per cent at 21 years of age for the girls and a decrease from 53 to 20 per cent for the
boys. In our study, at the age of 15, one out of three female and male adolescents
(respectively 28.9 and 28.4 per cent) declared to eat 1 or less than 1 portion of fruit and
vegetables a day. The fruit and vegetable consumption among most Belgian
adolescents is insufficient and should be encouraged to protect against weight gain
and obesity-related morbidities such as cardiovascular disease and diabetes.
Conclusions
Our results indicate alarming trends for unhealthy eating habits such as skipping
daily breakfast and insufficient intake of fruit and vegetables. These unhealthy eating
habits increase the risk of overweight and obesity among adolescents. Breakfast
intake has been identified as an important factor in nutritional well-being, especially
during growth (Berkey et al., 2003).The downward trend in these eating habits as a
function of age should receive uttermost attention. In the light of these findings action
should be taken to improve the eating habits among Belgian children to prevent
childhood obesity.
From a public health perspective, improved understanding of the determinants of
adolescents dietary behaviors is critical for the promotion of healthy dietary habits.
In our study fruit and vegetable consumption was not different when comparing
girls and boys while breakfast frequency was significantly higher for the boys
compared with the girls. The latter finding may be an indication that healthy
nutritional habits are not always interrelated. Again, this should be taken into account
when designing health promotion campaigns.
The type of educational programme followed by the adolescent and the educational
level of the mother were found to be strong determinants for healthy eating habits.
Our study indicated also different healthy eating patterns as a function of the
language region (the French versus the Flemish speaking region).
As mentioned by Keski-Rahkonen et al. (2003), breakfast skippers tend to have
more health compromising behaviors and unhealthy lifestyles compared with the
regular breakfast eaters. Their family study indicates equally that parental breakfast
eating was the most significant factor associated with adolescent breakfast eating.
Hence they advice to address breakfast endorsing progammes to the entire family
with sufficient attention for the influence of peers and other health behaviours related
with regular breakfast eating.
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understanding the complexities, J. Nutr., Vol. 131, pp. 487S501S.
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sugary foods in a cohort from age 14 to age 21, Prev. Med., Vol. 33, pp. 21726.
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of the Belgian Adolux Study, Eur. J. Clin. Nutr., Vol. 55, pp. 1306.
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P. Mullie can be contacted at: patrick.mullie@skynet.be

Impact of household food security

and nutrition programme on the
nutritional status of children in
Oyo state, Nigeria
Food security
and nutrition
programme
327
B.O. Lawal
Farming Systems Research and Extension Programme, Institute of
Agricultural Research and Training, Obafemi Awolowo University, Ibadan,
Nigeria
A.A. Jibowo
Department of Agricultural Extension and Rural Sociology, Obafemi Awolowo
University, Ile-Ife, Nigeria
Abstract
Purpose The purpose of this paper is to assess the impact of household food security and nutrition
programme (HFSN) on the nutritional status of children (05 years) in Oyo state, Nigeria.
Design/methodology/approach Pre-tested structured and unstructured questionnaires were
used to elicit information from 201 programme and 201 non-programme women participants. The
participants who are farmers were selected using systematic random sampling technique from each
of the six local government areas covered by the programme, while non-participants were selected
using simple random sampling technique. Also, anthropometry technique was used to assess the
nutritional status of the children of both groups. Descriptive statistics such as frequency counts,
percentages and means were used to describe the findings while analysis of variance (ANOVA) was
used to determine the significant difference in the nutritional status of the children of the two groups.
Findings The results show that the women farmers who participated in programme activities
possessed some personal and household characteristics which influenced the nutritional status of the
children. The participants utilized most of the prograrmme recommendations and significant
differences existed in the weight for age and height for age indices of their children.
Originality/value The results indicate the need for constant surveillance and collaborative effort
of the health, agricultural extension and education departments in providing women farmers with the
education and training needed to reduce the incidence of malnutrition and food insecurity.
Keywords Nutrition, Diet, Children (age groups), Health education, Nigeria
Introduction
Nigeria is still faced with the problem of equating the supply of food with the everincreasing demand for it four decades after attaining her independence. Increasing
malnutrition and household food insecurity are related human welfare problems
heightened in the last few decades by economic recession (Akinyele, 1993). This led to
poverty, which became real in many households with effects on women and children.
These effects are visible in the living conditions of the people especially those residing
in rural and peri-urban areas. Such conditions cause high levels of mortality and
morbidity and spread of ill health and malnutrition.
Malnutrition is a serious problem, causing morbidity and mortality among young
children and women of childbearing age. It has also been recognized that malnutrition
Vol. 36 No. 5, 2006
is a consequence of poverty and low food production, and it is also increasingly clear
pp. 327-336
Limited
that poverty is one of the causes of malnutrition. About 200 million children under the E Emerald Group Publishing0034-6659
DOI 10.1108/00346650610703171
age of five, that is about 40 per cent of all children in the developing world, lack
NFS
36,5
328
sufficient nutrition to lead full and active lives (FGN/UNICEF, 1991). The Nigerian
demographic and health survey (FOS, 1992) showed that in 1990, 43 per cent of
Nigerian children under the age of five years were stunted, an indication of the
prevalence of malnutrition and chronic household food security; while 36 per cent
were underweight and 9 per cent wasted. Also, nutritional surveys conducted in
Nigeria (Adelekan et al., 1997; Abidoye and Ihebuzor, 2001) reveal high prevalence of
malnutrition among the same group of children in Nigeria.
This problem of malnutrition had led to embarking on strategies of direct
intervention in form of agricultural and rural development programmes to alleviate
the problem. Notable among them is UNICEF/FGN intervention programme on
household food security and nutrition. The aim of the programme is to increase the
availability of staple foods throughout the year and also to promote the nutritional
well-being of household members especially women and children. UNICEF recognized
the fact that women are the driving force in achieving project effectiveness and
reducing poverty and also the key to addressing the household food security and
nutrition goals. The need to enhance food security and nutrition at the household level
has led to the development of improved technologies in the area of farming, livestock
production, time and labour saving devices, improved feeding practices and child care
which are being promoted among households in Nigeria especially through nutritional
education. To understand the present situation therefore, this study embarked on the
assessment of the impact of the household food security and nutrition programme on
the nutritional status of children in the target area.
Objectives of the paper
The general objective of the paper is to assess the effect of household food security
and nutrition programme on the nutritional status of the children in the study area.
The specific objectives are to:
N Identify the personal and household characteristics of women in the study area;
N Determine the utilization of the various household food security and nutrition
Programme recommendations by the women;
N Assess the nutritional status of children (05 years) in the study area;
N Assess the impact of the programme on the nutritional status of children.
Methodology
The study was carried out in Oyo state, which is one of the states in the South
Western Nigeria. The state is predominantly agrarian with about 70 per cent rural
population. The land area covers a vast landmass of 32,249.1 square kilometers out of
which 27,107.93 km2 is cultivable (OYSADEP, 2001).
The programme of intervention covered the four agricultural zones to which the
state was divided. These are Ibadan/Ibarapa, Oyo, Ogbomoso and Saki. The
programme however covered six local government areas (LGAs) in all the four zones.
These LGAs were purposively selected for the study. Systematic sampling procedure
with a random starting was employed to select the sampled households from the list
of participant households. For non-programme communities non-participants were
selected through random sampling technique from communities similar to the
programme areas in ecology and socio-economic background. The main target in each
selected household was a mother having at least one child below the age of six.
The sample size of 201 participants and 201 non-participants were selected for the
study.
Pre-tested structured interview schedule was used to collect information from
women farmers on the personal, socio-economic, household related characteristics and
utilization of improved recommendations introduced through the programme.
Anthropometric measurements were taken for all the children. Height and weight
of children of the respondents were measured using standard anthropometric
techniques as described by WHO (1983). The data collected were analysed using Epi
info (CDC, Atlanta), release 6.0 and Z-score was calculated and compared with WHO/
NCHS reference data. The three indices of nutritional status used for the analysis were
height for age, weight for height and weight for age. Frequencies, percentages and
means were used to quantify the data generated while analysis of variance (anova)
was used to determine the significant difference between the nutritional status of
children in the two groups selected for the study.
Personal and socio-economic characteristics of women farmers
The data in Table I reveal that more than half (51.5 per cent) of participants and 47
per cent of non-participants were between the age category of 30 and 39. The mean
age of women participants was 35.79 while that of non-participants was 35.08. All the
women farmers interviewed were married and the vast majority of them were
currently living with their husbands. More than half of the participants (59 per cent)
and non-participants (53 per cent) had between five and eight children. This is an
indication that farmers in the study area had relatively large number of children with
whom they would readily augment their farm labour (Table I).
Forty-five per cent of the participants spent between 1 and 6 years in school while
42.3 per cent of non-participants spent same number of years in school. More than onequarter (29.4 per cent) and 52.0 per cent of participants and non-participants
respectively had no formal education. This shows a higher level of education among
participants as compared with non-participants. Education must therefore have given
the participants a higher propensity to participate in the programme directed towards
improving the nutrition and health status of their children as well as agricultural
development within the households. Farming was the major occupation of 43 per cent
of participants and 60.8 per cent of non-participants (Table I). The finding
corroborates other findings (Siyanbola, 1995; Odebode and Akinbile, 2000) that rural
women are actively involved in farming activities. The data on farm size show that
46.8 per cent of participants and 54.7 per cent of non-participants cultivated between 1
and 1.99 hectares of land (Table I). More than half (53.4 per cent) of the participants
and 48.2 per cent of the non-participants had income of between N20,001 and N40,000;
while 36.3 per cent and 20 per cent of participants and non-participants respectively
earned more than N40,000 annually. The relatively poor financial status of most
women farmers may however discourage the use of innovations especially those,
which are expensive to adopt. Majority (82.7 per cent and 76.0 cent) of the participants
were members of the religious societies and women groups respectively. On the other
hand, 52.7 per cent and 8.1 per cent of the non-participants were members of the
religious and women groups respectively. The belongingness of most participants to
social organizations may have positive impact on their willingness to accept change as
a result of group influence.
Food security
and nutrition
programme
329
NFS
36,5
Household characteristics of women farmers

The data on Table II show the household related characteristics of women. The
majority of the participants (68.1 per cent) and 54.9 per cent of the non-participants
were first and only wife of the household head. However, 15.1 percent of the
participants and 24.6 per cent of the non-participants were household heads. Majority
330
Personal/socio-economic characteristics
Table I.
Percentage distribution
of respondents by
personal and
socio-economic
characteristics
Age (years)
2029
3039
4049
Mean
Marital status
Married and living with husband
Widowed
Separated
Divorced
Religion
Christianity
Islam
Traditional
Total number of children
14
58
.8
Mean
Years of schooling
None
16
712
. 12
Mean
Major occupation
Farming
Trading
Agro-processing
Artisan
Civil servant
Size of farm land cultivated (hectare)
,1
11.99
22.99
>3
Mean
Annual income (in naira)
020,000
20,00140,000
40,00160,000
60,00180,000
. 80,000
Mean
Participant (n 5 210)
Non-participants (n 5 210)
16.7
51.5
31.8
35.79
20.3
47.0
32.7
35.08
87.9
5.0
4.9
2.2
71.3
15.6
2.7
2.5
55.1
43.5
1.4
59.0
40.0
1.0
40.4
59.1
0.5
6
42.9
53.4
3.7
7
29.4
45.4
20.0
5.2
5.2
52.0
42.3
5.7
3.8
42.7
37.2
9.6
4.4
6.1
60.8
13.7
16.6
6.8
2.1
34.5
46.8
13.2
11.5
1.86
22.2
54.7
20.2
10.4
1.32
10.3
53.4
24.9
6.3
5.1
46,850.75
34.8
48.2
16.6
0.4
30,919.40
(continued)
Personal/socio-economic characteristics
Size of farm land cultivated (hectare)
,1
11.99
22.99
>3
Mean
Social organizations
Religious organization
Cooperative organisations
Women groups
Community development associations
Political organisations
Village council
Participant (n 5 210)
Non-participants (n 5 210)
34.5
46.8
13.2
11.5
1.86
22.2
54.7
20.2
10.4
1.32
82.7
72.1
76.0
28.9
15.9
6.7
52.7
46.5
8.1
18.1
4.7
8.1
Source: Field survey, 2001
of the participants (71.6 per cent) and non-participants (72.9 per cent) had between
seven and 12 household members. The mean household size for the participants and
non-participants was 8.31 and 8.58 respectively. This is in support of other findings
indicating large household size of rural households (Ojolo, 1995; Siyanbola, 1995;
Fasorannti, 1999). There was a slight difference in the years of schooling spent by
household head between the two groups. Seventy-two per cent of participants
household heads were literates and had attained primary, secondary or tertiary
education, while a lesser percentage (56.1 per cent) of the non-participants household
heads were represented in the same category (Table II). The mean years of schooling
were 7.09 and 4.21 for participants and non-participants household head. Improved
level of education within a household is advantageous for encouraging people to bring
about change.
Data in Table II further show that 33.0 per cent and 31.0 per cent of participants
and non-participants sourced drinking water from dug wells. It is worth noting that
none of the two groups had access to public tap. This has implications for child and
family health, as access to clean safe water may not be met. Also, majority of
participants (57 per cent) and non-participants (79.9 per cent) failed to treat their water
before drinking. However, 8.7 per cent and 2.3 per cent of the participants and nonparticipants respectively, do boil their water before drinking. A very small proportion
of the households used the most sanitary means of human waste disposal. The bush
was therefore the most commonly used means among the non-participants (66.2 per
cent) while less than half (33.3 per cent) of participants resorted to the bush. FG/
UNICEF (1994) and Maxiya-Dixon et al. (2004) also revealed similar unhygienic
conditions at the household level which are pre-conditions for diarrhoea diseases in
young children. Also, majority of the participants (60.5 per cent) and 22 per cent of the
non-participants utilized health services on a regular basis. Household food security
status of the respondents revealed that while 12.8 per cent and 16.2 per cent of the
participants and the non-participants were food secure, 9.9 per cent of participants and
56.4 per cent of non-participants were food insecure. However, 77.2 per cent of the
participants and less than one-third (27.3 per cent) of the non-participants were
moderately food secure.
Food security
and nutrition
programme
331
Table I.
NFS
36,5
332
Table II.
Percentage distribution
of respondents by
household
characteristics
Household related characteristics

Women status
Household head
1st/only wife
2nd wife
3rd wife
Household size
16
712
> 13
Mean
Years of schooling of household head
0
16
712
1318
Mean
Sources of drinking water
Well
Stream
Borehole
Water treatment
No treatment
Addition of Alum
Filteration
Boiling
Waste disposal
Bush
Ordinary pit latrine
VIP
Water closet
Use of health services
Regularly
Occasionally
Not at all
Household food security status
Food insecure
Moderate
Food secure/adequate
Participant
Non-participant
15.1
68.1
16.4
0.4
24.6
54.9
18.2
2.3
20.2
71.6
8.2
8.31
16.2
72.9
10.9
8.58
28.0
31.3
30.1
10.6
7.09
43.9
32.3
17.4
6.4
4.21
63.5
3.5
33.0
51.2
17.7
31.1
57.0
14.7
19.6
8.7
79.9
12.1
5.7
2.3
33.3
54.2
8.4
4.1
66.2
31.7
2.1
60.5
39.1
0.4
22.2
69.6
8.2
9.9
77.2
12.8
56.4
27.3
16.2
Utilization of HFSN recommendations by women farmers

Among the improved seeds/seedlings introduced, cassava cuttings and maize seeds
were the major ones presently being utilized by majority of the participants (Table III).
The percentage for the two crops was 72 per cent. There was a poor utilization of
fertilizer by women for most of their crop production. However, majority (77.5 per cent)
of the women indicated they have utilized them before. Only 1.0 per cent of the women
farmers indicated their present usage of fertilizer. There was also poor utilization of
improved livestock breeds (5.5 per cent) and feeding of livestock with crop residue
(34.1 per cent). Out of all the processing equipment, cassava processing machine,
melon sheller and maize hand sheller were well utilized by more than half of the
Recommendations
Maize
Cassava
Oil palm
Citrus
Mango
Soybeans
Fertilizer
Improved livestock breeds
Crop residue
Cassava processing
Palm oil processing
Melon hand sheller
Maize sheller
Exclusive breastfeeding
Continued breastfeeding
Gardening
Soymilk
Soyflour
Soy-ogi
Growth monitoring
Iodized salt
Vitamin A
Iron
Presently using
n 5 201
Have used before
Never used
145(72)
145(72)
8(4.0)
7(3.5)
17(8.5)
38(18.9)
2(1.0)
11(5.5)
69(34.1)
160(79.6)
18(9.5)
115(57.3)
112(55.7)
91(45.4)
173(86.1)
124(61.7)
147(73.1)
83(41.3)
134(66.7)
148(73.6)
182(90.5)
85(42.3)
36(17.9)
48(24.1)
47(23.4)
85(42.3)
82(40.7)
74(36.8)
96(48.1)
156(77.6)
13(6.5)
23(11.2)
17(8.5)
23(11.4)
17(8.3)
14(7.0)
62(30.8)
23(11.4)
19(9.5)
37(18.4)
43(21.4)
45(22.3)
47(23.4)
17(8.4)
115(57.2)
164(81.6)
8(4.0)
9(4.6)
108(53.7)
112(55.7)
110(54.7)
67(33.3)
43(21.4)
177(88.0)
110(54.7)
24(11.9)
160(80.1)
69(34.4)
75(37.3)
48(23.8)
5(2.5)
58(28.8)
17(8.5)
75(37.3)
22(11.0)
6(3.0)
2(1.1)
1(0.5)
1(0.5)
Note: Percentages in parentheses

women in the state. The percentage of women who indicated their present usage is
79.6 per cent, 57.3 per cent and 55.7 per cent respectively. Majority (86.1 per cent) of
the women still practice continued breastfeeding while less than half (45.4 per cent)
of the women currently breastfeed their children exclusively. Majority (61.7 per cent)
of the women presently utilize gardening for nutrition due to availability of space in
their background to practice it. The most currently utilized of all soybean products are
soymilk and soy-ogi with the percentage of 73.1 per cent and 66.9 per cent
respectively; 73.9 per cent and 90.7 per cent of the women were currently utilizing
growth-monitoring technique and iodized salt. The frequencies and percentages of
respondents who had used each recommended practice before but discontinued are
shown in Table III. The reasons adduced for discontinuance of the various
recommendations by women farmers include non-availability of input/recommendations (77 per cent), poor germination of seeds/seedlings (37.8 per cent), late arrival of
inputs (37.8 per cent), lack of time for preparation (36.1 per cent) and lack of access to
enough information (27.5 per cent).
Nutritional status of children in study area
The height for age (HAZ) index show that 35.3 per cent of the participants children
and 58.7 per cent of non-participants children fell below minus two standard
deviations (22SD) from the median of the reference population for the height for
age index (Table IV). This implies that about three in every ten children were stunted
Food security
and nutrition
programme
333
Table III.
Distribution of
participants by utilization
of various introduced
recommendations
NFS
36,5
334
in the study population for the participants communities while six in every ten
children were stunted in the non-participants communities. In relation to weight for
height (WAZ) index, 5.5 per cent of the participants children and 7.5 per cent of the
non-participants children suffer from wasting. This implies that a small percentage of
the children from both participants and non-participants suffered recent undernutrition.
Children below two standard deviation (22SD) from the mean of the reference
population are classified as being underweight. A similar pattern as reported for
height for age and weight for height is observed in weight for age. Children of nonparticipants were more underweight (33.8 per cent) and therefore fell in the very high
prevalence reference value. However, only 14.9 per cent of the participants children
were underweight and fell in the medium prevalence reference value.
Relationship between the nutritional status of the participants and the non-participants
The result of the analysis of variance (ANOVA) is presented in Table V. The table
shows that there was a significant difference in the weight for age and height for age
indices of the children of participants and non-participants (F 5 9.29 and 6.52
respectively). The result indicates that participants children were nutritionally better
in terms of prevalence of undernutrition and stunting. The difference could be
entrenched in the effect of the programme. Participants were exposed to the
programme and utilized the various recommendations over the years, which had
resulted into better nutrition.
Conclusions and recommendations
It is evident from the findings of this study that women farmer participants possessed
some characteristics, which influenced the nutritional status of the children. Women
farmers who had formal education were more among the participants than the nonparticipants. The majority of participants and non-participants were between the age
Table IV.
Type of malnutrition
Prevalence of
malnutrition in children
(05 years) of
participants and nonparticipants
Stunting (HAZ)
Wasting (WHZ)
Underweight (WAZ)
WHZ
Test of difference
between nutritional
status of children in
two groups
71
11
30
Non-participant
Frequency
Percentage
35.3
5.5
14.9
118
15
68
58.7
7.5
33.8
Variable
Table V.
Participant
Frequency
Percentage
WAZ
HAZ
Group
Participants
Non-participants
Participants
Non-participants
Participants
Non-participants
Note: *Significant at p , 0.05
Number of case
Mean score
F value
p value
201
201
201
201
201
201
0.56
3.01
9.96
1.07
22.2
3.41
0.186
0.667
9.29
0.002*
6.52
0.011*
category of 30 and 39 and were living with their spouses. The average number of
children was six for participants and seven for non-participants. Women farmer
participants however had higher years of formal schooling than the non-participants.
Participants earned higher incomes, and were members of more social organizations
than non-participants. Majority of participant household heads were literate and had
attained primary, secondary or tertiary education while lesser percentages of nonparticipant household heads were represented in the same category. Majority of the
participants sourced water from wells while majority of non-participants failed to
treat their water before drinking. Also, majority of non-participants and lesser
percentage of the participants made use of the bush for human waste disposal.
Participants utilized health services on a more regular basis than non-participants and
most of the participants were more food secured than the non-participants.
A substantial percentage of participants utilized improved cassava cuttings and
improved maize varieties while improved livestock were poorly utilized. Although, the
nutritional status of participants children were better than that of non-participants in
terms of height for age, weight for height and weight for age indices, protein energy
malnutrition is still a major problem of public health importance in the study area.
The study therefore recommended that incidence of malnutrition could be reduced
through constant surveillance from the agricultural and health workers. Agricultural
workers attached to rural areas should be equipped with simple anthropometric tools
to assess the children under the age of five. This will go a long way in identifying
early and correcting malnutrition. Also, there is need for health, extension and
educational departments to work together in providing women farmers with education
and training to support their roles in household food security and nutrition
management and be encouraged to utilize such recommendations. Government must
ensure that there is adequate provision of potable water and sanitary means of human
waste disposal in rural areas. This will go a long way in reducing the incidence of
water borne diseases and improve the nutritional status of the people. There is need
for women farmers to be educated on socio-economic and household characteristics
which are likely to affect the nutritional status of children and other household
members in general.
References
Abidoye, R.O. and Ihebuzor, N.N. (2001), Assessment of nutritional status using anthropometric methods on 14 year old children in an urban Ghetto in Lagos, Nigeria, Journal of
Nutrition and Health, Vol. 15, pp. 2939.
Adelekan, D.A., Fatusi, A.O., Fakunle, J.B., Olotu C.T., Olukoga, I.A., Jinadu, M.K. and
Ojofeitimi, E.O. (1997), Prevalence of malnutrition and vitamin A deficiency in Nigerian
preschool children subsisting on high intakes of carotenes, Journal of Nutrition and
Health, Vol. 2, pp. 1724.
Akinyele, I.O. (1993), Give us this day our daily bread: an inaugural lecture from the faculty of
basic medical sciences, University of Ibadan, Ibadan, Nigeria, pp. 416.
Fasorannti, O. (1999), Impact of agricultural development programme on rural communities in
Ondo state, unpublished PhD thesis, Obafemi Awolowo University, Ile-Ife, Nigeria.
Federal Office of Statistics (FOS, Nigeria) (1992), Nigeria demographic and health survey
1990, Columbia, Maryland, Federal Office of Statistics and Macro International Inc.,
USA, pp. 107112.
FGN/UNICEF, (1991), Master Plan of Operation for the 199195 Programme of Cooperation,
UNICEF, Lagos, Nigeria, pp. 125.
Food security
and nutrition
programme
335
NFS
36,5
336
FGN/UNICEF, (1994), The Nutritional Status of Women and Children in Nigeria, UNICEF,
Lagos, Nigeria, p. 111.
Maxiya-Dixon, B., Akinyele, I.O., Oguntona, E.B., Nokoe, S., Sanusi, R.A. and Harris, E. (2004),
Nigeria food consumption and nutrition survey 20012003, International Institute of
Tropical Agriculture, Ibadan, Nigeria, p. 75.
Odebode, S.O. and Akinbile, L.A. (2000), Improved agricultural technology for poverty
alleviation among rural women in Oyo state, in Olowu, T. (Ed.), Agricultural Extension
and Poverty Alleviation in Nigeria, Proceedings of the Sixth Annual National Conference
of the Agricultural Extension Society of Nigeria, pp. 6573.
Ojolo, B.O. (1995), The organization and management of rural women cooperative in Osun
state, Unpublished MSc thesis, Obafemi Awolowo University, Ile-Ife, Nigeria, p. 46.
OYSADEP (2001), A report of village listing survey in Oyo state, Planning, Monitoring, and
Evaluation Department, Oyo Sstate Agricultural Development Programme, Nigeria,
pp. 115.
Siyanbola, A.T. (1995), Participation of women in agricultural and rural development projects
in Osun state of Nigeria, unpublished PhD thesis, Obafemi Awolowo University, Ile-Ife,
Nigeria, p. 46.
World Health Organization (1983), Measuring change in nutritional status, Guidelines for
Assessing the Nutritional Impact of Supplementary Feeding Programmes for Vulnerable
Groups, WHO, Geneva, pp. 118.
B.O. Lawal can be contacted at: bolaw2001@yahoo.com

Habitual dietary calcium intake

and body weight in 710 year
old children
Amy Jennings, V. Costarelli and G.J. Davies
Calcium and
body weight in
children
337
Academy of Sport, Physical Activity and Wellbeing, London South Bank

University, London, UK
P.W. Dettmar
Reckitt Benckiser Healthcare Ltd, Hull, UK
Abstract
Purpose Several recent observational studies detected inverse associations between dietary
calcium intake and body weight. It was demonstrated that low calcium diets lead to an increase in
intracellular calcium concentrations, which in turn act to promote body fat deposition, reduce
lipolysis and reduce thermogenesis. Most of the studies have been conducted on adults, however, it
was recently demonstrated that longitudinal calcium intake is negatively associated with childrens
body fat levels. The purpose of the current study is to investigate possible associations between
habitual calcium intake and body weight in a group of 710 years old children.
Design/methodology/approach Eighty-five children, 21 boys and 64 girls (mean age: 9.20.9)
were recruited from 12 primary schools in the London area. Dietary intake was measured using the
7-day weighed inventory method. Body weight and height measurements were also recorded.
Findings Data suggested that girls have significantly lower intakes of calcium than boys and that
48 per cent of boys and 38 per cent of girls were overweight (above the 91st centile). However, there
were no significant correlations between body weight or body mass index (BMI) and habitual intake
of dietary calcium in this age group, which is in contrast with the results of similar studies conducted
in adults.
Originality/value One explanation could be that the possible effect of calcium on adiposity and
body weight is more pronounced in adulthood than in childhood. It is important for future studies to
measure levels of body fat in children together with body weight in conjunction with calcium intake
in order to elucidate the original hypothesis.
Keywords Diet, Children (age groups), United Kingdom
Introduction
Obesity in children has reached epidemic proportions (Matayka, 2004). Ultimately
energy imbalance is the reason for excessive weight gain, whether the main cause is
consumption of a high-energy diet, lack of physical activity or genetics. Dietary
calcium has been shown to play a pivotal role in the regulation of energy metabolism
(Teegarden, 2003) and several observational studies have detected inverse associations between dietary calcium intake and body weight (Davies et al., 2000). Most of
these studies have been conducted with adults; however, Skinner et al. have recently
demonstrated that longitudinal calcium intake is negatively associated with childrens
body fat levels (Skinner et al., 2003). Another recent study which was set out to
investigate risk of prepubertal bone fractures and milk intake, suggested that children
who avoid milk, are more likely to be of heavier weight than children who do not
avoid milk (Goulding et al., 2004).
The authors thank all of the children and their guardians for generously volunteering to
participate in the study and the schools for their contribution. Also Reckitt Benckiser Healthcare E
for their financial assistance.

Vol. 36 No. 5, 2006
pp. 337-342
0034-6659
DOI 10.1108/00346650610703180
NFS
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338
It has been reported that increasing dietary calcium significantly augments weight
and fat loss in the absence of caloric restriction in obese adults with dairy products
exerting a substantially greater effect (Zemel et al., 2004). The idea of dietary calcium
having an anti obesity effect was derived from studies investigating the mechanism of
agouti, the first obesity gene to be cloned, which is found in human adiposities. It has
been demonstrated that agouti protein stimulates calcium influx in human adiposities
promoting the process of fat formation and lipogenesis and inhibiting fat breakdown.
It was also shown that increasing 1,25-dihydroxy vitamin D in response to lowcalcium diets stimulates adipocyte Ca2+ influx and as a consequence, stimulates
lipogenesis, suppresses lipolysis and increases lipid accumulation, whereas increasing
dietary calcium inhibits these effects and markedly accelerates fat loss in mice
subjected to caloric restriction (Zemel, 2003). It was also reported that parathyroid
hormone positively correlates with body mass index (BMI) and levels of 1,25dihydroxy vitamin D are significantly lower in obese individuals compared to
non-obese individuals (Parikh et al., 2004).
Papakonstantinou et al. (2003) conducted a study that investigated which aspect of
energy balance was responsible for the decrease in body fat content of rats fed a highcalcium and high-dairy protein diet. They concluded that a high-calcium diet
decreases body weight and fat content due to a lower digestible energy intake caused
by increased fecal lipid and a non-significant reduction in gross energy intake. There
is sufficient data from controlled animal studies to demonstrate a beneficial role for
dietary calcium in regulating weight during energy restriction (Shi et al., 2001).
Increasing evidence suggests that calcium from dairy sources has a greater antiobesity effect than tablet supplementation and calcium enriched foods (Zemel, 2003).
Notably, dairy sources of calcium exert a significantly greater anti-obesity effect than
supplemental sources in each of these studies, possibly due to the effects of other
bioactive compounds on adipocyte metabolism, such as the angiotensin converting
enzyme inhibitor found in milk, indicating an important role for dairy products in the
control of obesity.
Melanson et al. (2003) carried out a trial investigating a relationship between
calcium and fat oxidation in 35 obese individuals who were moderately active.
Habitual calcium intake was self-reported and each subject completed a 24 hour stay
in a whole room calorimeter. It was found that subjects with high intakes of dietary
calcium had higher rates of fat oxidation (Melanson et al., 2003).
Data from six observational studies and three controlled trials in which calcium
intake was the independent variable have been reanalyzed by Heaney et al., 2002, to
evaluate the effect of calcium intake on body weight and body fat. A consistent effect
of higher calcium intakes, expressed as lower body fat and/or body weight, and
reduced weight gain at midlife, was found. The above review has also shown that
studies relating nutrient intake to body composition, report negative associations
between calcium intake and body weight at midlife and between calcium and body fat
accumulation during childhood (Heaney et al., 2002). The same group has also
optimistically concluded that a 300 mg increment in regular calcium intake per day is
associated with approximately 1 kg lower body fat in children and 2.53.0 kg lower
body weight in adults, and they proceeded to state that increasing calcium intake by
the equivalent of two dairy servings per day could reduce the risk of overweight by as
much as 70 per cent (Heaney et al., 2002).
The purpose of the current study was to investigate possible associations between
habitual calcium intake and body weight in a group of 710 years old children.
Subjects, materials and methods

Subjects
Eighty-five healthy pre-adolescent children aged 710 years were recruited from
primary schools in the London area. Subjects were only accepted for entry into the
study if they were attending school in the London area, had lived in the United
Kingdom for at least 5 years and were able to give written, voluntary informed
consent from a guardian. Demographic information on subjects age, gender,
socioeconomic group and ethnicity was obtained from a guardian. Ethical approval
was also obtained from London South Bank University ethics committee.
Anthropometric measurements
Height and weight measurements were taken for all subjects on the day prior to data
collection. The measurements were taken without shoes or heavy outdoor clothing.
Height measurements were taken using the Leicester height measure (Child Growth
Foundation). Body weight measurements were taken using electronic digital weighing
scales (Salter electronic scales, calibrated to 500 g). Using the height and weight
measurements, a BMI was calculated for each subject using the equation kg/m2. BMI
values were then converted into percentiles using BMI charts.
Calcium intake
Subjects were required to complete a 7-day weighed inventory of all food and drink
consumed, with assistance from their guardians at home and from the investigator
during school time. Each subject was presented with a diary, a set of Soehnle
electronic weighing scales, calibrated to 1 g, and a laminated instruction sheet
outlining the cumulative weighing method. The investigator visited subjects on the
day prior to data collection to provide verbal instructions on how to complete the
diaries. Daily contact was made to ensure that the diaries were completed accurately
and to help maintain the subjects motivation. If a subject had school meals, they were
recorded by the investigator. Packed lunches were weighed by the children or
guardians at home and leftovers were recorded by the investigator.
Daily nutrient and calcium intakes were estimated for each subject using the
nutritional software programme Dietplan 5 (Forestfield Software Ltd). Dietplan 5 has
also identified the major source of calcium in each childs diet.
Statistical analysis
One-way analysis of variance (ANOVA) and Pearson correlations were conducted
using SPSS/PC version 10.0.
Results
There were no significant correlations between body weight or BMI and habitual
intake of dietary calcium in this age group. Data also suggest that girls have
significantly lower intakes of calcium than boys (Table I) with the average intakes of
girls failing to meet the reference nutrient intake for calcium, which is 550 mg/d. Girls
were also more likely to consume less dairy products than boys. It was noted that in
six children, the main source of dietary calcium was white bread whereas the main
source of calcium for three other children was pizza. Forty eight per cent of boys and
38 per cent of girls were overweight (above the 91st centile), which is very worrying
given the fact that the average age of the group was 9.2 years (SD: 0.9). It may be of
some importance that children with dietary calcium mainly derived from dairy
Calcium and
body weight in
children
339
NFS
36,5
340
sources tended to be of smaller body weight than children with calcium derived
mainly from non-dairy sources, which however was not statistically significant, after
adjusting for age and energy intake. Of the 85 children, 14 derived their calcium
mainly from dairy sources and 71 from non-dairy sources (Figure 1).
Discussion
This study set out to investigate a possible relationship between habitual dietary
calcium intake and body weight in a group of 710 years old London children. The
strength of the relationship between dairy and calcium intake and body fat and body
weight mainly derives from studies conducted in adults (Shapses et al., 2004). This
relationship has been demonstrated in both black and white cohorts and in pre- and
post-menopausal women (Parikh and Yanovski, 2003). Studies conducted in children
are limited. The earlier study by Carruth and Skinner has suggested a possible role of
dietary calcium in moderating body fat levels in children (Carruth and Skinner, 2003).
Another recent study which was set out to investigate risk of prepubertal bone
fractures and milk intake, suggested that children who avoid milk are more likely to
be of heavier weight than children who do not avoid milk (Goulding et al., 2004).
All subjects (n585),

meanSD
Table I.
Body weight and BMI
in relation to habitual
calcium intake
in children
Figure 1.
Body weight and source
of dietary calcium in
children
Age (year)
Weight (kg)
Height (m)
BMI
Calcium intake/d (mg)
Energy intake/d (kcals)
9.2
38.26
1.4
19.19
559.95
1558.31
1.00
11.41
0.10
3.63
263.13
585.61
Boys (n521),
meanSD
9.09
36
1.37
19.1
648.32*
1708.79
1.04
9.5
0.09
3.4
251.76
526.91
Girls (n564),
meanSD
9.23
38.6
1.4
19.16
530.96
1508.93
0.88
11.8
0.10
3.7
266.86
604.87
Note: *Significantly different compared to the calcium intake of girls: p,0.05 (one-way ANOVA)
In our study, we found no significant correlations between body weight or BMI and
habitual intake of dietary calcium in this age group in both boys and girls, which is in
contrast with the results of similar studies conducted in adults. It is important to note,
however, that percentage of body fat was not measured in this study. The finding that
children who derived their dietary calcium mainly from dairy sources tended to be of a
smaller body weight than children who derived their calcium mainly from non-dairy
sources, was not statistically significant and may be reflective of the low number of
subjects.
Anthropometric measurements in children of this age must be interpreted with
some caution due to the growth and development patterns seen (Gregory and Lowe,
2000). The different rates of growth and development in boys and girls, in addition to
the gender imbalance in this study (21 boys and 65 girls), may have had some effect
on the results.
In another study by Phillips et al. (2003), dairy food consumption, body weight and
fatness were investigated in a total of 196 non-obese pre-menarcheal girls aged 812
years who were enrolled between 1990 and 1993. Girls were followed until 4-year postmenarche. They found no evidence that dairy food consumption was associated with
BMI or per cent body fat during adolescence (Phillips et al., 2003).
One explanation for our findings could be that the possible effect of calcium on
adiposity and body weight is more pronounced in adulthood than in childhood. It is
important for future studies to measure levels of body fat in children together with
body weight in conjunction with calcium intake in order to elucidate the original
hypothesis. Children, however, should be strongly encouraged to regularly include
calcium-rich foods and beverages in their diets because of the general well
documented effects of calcium on bone mass and overall health.
References
Carruth, B.R. and Skinner, J.D. (2001), The role of dietary calcium and other nutrients in
moderating body fat in preschool children, Int. J. Obes., Vol. 25, pp. 55966.
Davies, K.M., Heaney, R.P., Recker, R.R., Lappe, J.M., Barger-Lux, J.M., Rafferty, K. and Hinders,
S. (2000), Calcium intake and body weight, J. Clin. Edocrinol. Metab., Vol. 85, pp. 46358.
Goulding, A., Rockell, J.E., Black, R.E., Grant, A.M., Jones, I.E. and Williams, S.M. (2004),
Children who avoid drinking cows milk are at increased risk for prepubertal bone
fractures, J. Am. Diet. Assoc., Vol. 104 No. 2, pp. 2503.
Gregory, J. and Lowe, S. (2000), National Diet and Nutrition Survey, The Stationary Office,
London.
Heaney, R.P., Davies, K.M. and Barger-Lux, M.J. (2002), Calcium and weight: clinical studies,
J. Am. Coll. Nutr., Vol. 2, pp. 152S5S.
Matayka, K. (2002), Managing obesity in children, Obes. Prac., Vol. 4, pp. 26.
Melanson, E.L., Sharp, T.A., Schneider, J., Donahoo, W.T., Grunwald, G.K. and Hill, J.O. (2003),
Relation between calcium and fat oxidation in adult humans, Int. J. Obes., Vol. 27,
pp. 196203.
Papakonstantinou, E., Flatt, W.P., Huth, P.J. and Harris, R.B. (2003), High dietary calcium
reduces body fat content, digestibility of fat, and serum vitamin D in rats, Obes. Res.,
Vol. 11, pp. 38794.
Parikh, S.J. and Yanovski, J.A. (2003), Calcium intake and adiposity, Am. J. Clin. Nutr., Vol. 77,
pp. 2817.
Calcium and
body weight in
children
341
NFS
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Parikh, S.J., Elderman, M., Uwaito, G.I., Freedman, R.J., Semega-Janneh, M., Reynolds, J. and
Yanorski, J.A. (2004), The relationship between obesity and serum 1,25 dihydroxy
vitamin D concentrations in healthy adult, J. Clin. Endocrinol. Metab., Vol. 89, pp. 11969.
Phillips, S.M., Bandini, L.G., Cyr, H., Colclough-Douglas, S., Naumova, E. and Must, A. (2003),
Dairy food consumption and body weight and fatness studied longitudinally over the
adolescent period, Int. J. Obes., Vol. 27, pp. 110613.
Shapses, S.A., Heshka, S. and Heymsfield, S.B. (2004), Effect of calcium supplementation on
weight and fat loss in women, J. Clin. Endocrinol. Metab., Vol. 89, pp. 6327.
Shi, H., Dirienzo, D. and Zemel, M.B. (2001), Effects of dietary calcium on adipocyte lipid
metabolism and body weight regulation in energy-restricted aP2-agouti transgenic mice,
FASEB J., Vol. 15, pp. 2913.
Skinner, J.D., Bounds, W., Carruth, B.R. and Ziegler, P. (2003), Longitudinal calcium intake is
negatively related to childrens body fat indexes, J. Am. Diet. Assoc., Vol. 103,
pp. 162631.
Teegarden, D. (2003), Calcium intake and reduction in weight or fat mass, J. Nutr., Vol. 133,
pp. 24951.
Zemel, M.B. (2003), Mechanism of adiposity and obesity risk by dietary calcium: mechanism
and implications, J. Nutr., Vol. 133, pp. 252s6s.
Zemel, M.B., Thompson, W., Milstead, A., Morris, K. and Campbell, P. (2004), Calcium and
dairy acceleration of weight and fat loss during energy restriction in obese adults, Obes.
Res., Vol. 12, pp. 58290.
V. Costarelli can be contacted at: costarv@hua.gr

Nutritional knowledge and

dietary intakes of young
professional football players
Sue Murphy and Yvonne Jeanes
Nutritional
knowledge and
dietary intakes
343
Roehampton University, London, UK

Abstract
Purpose To determine how nutritional knowledge and residential status influences the diets of a
group of young professional football players and compare them to controls of the same age.
Design/methodology/approach Seven day dietary records and nutritional knowledge
questionnaires were analyzed and anthropometric measurements were taken mid-way through the
competitive season.
Findings The football players, with a mean body mass index of 23.6 1.2 kg m2 and body fat of
15.3 3 per cent were significantly lighter than the controls. They also consumed significantly fewer
calories than the controls (10.26 + 1.8 v. 13.89 + 0.7 MJ per day), and less than the recommended
amounts for soccer players. Both groups could benefit from increasing their carbohydrate intakes,
although fat and protein intakes were appropriate. Nutritional knowledge had little impact on dietary
intakes. However, players who resided in the soccer club hostels had significantly greater energy
intakes, consumed more carbohydrate and less fat (p , 0.05) than players who lived in their parental
home.
Originality/value It was identified that youth players require assistance in the implementation of
their knowledge of nutrition to their own diets. In particular they need to increase their nutritional
intakes inline with recommendations, in order to optimize their playing ability and provide the energy
they need for growth. This is particularly true for those who live away from the scrutiny of the
football club.
Keywords Nutrition, Diet, Football
Introduction
Football can be a physiologically demanding game that is characterized by irregular
changes of pace and anaerobic efforts superimposed on light to moderate aerobic
activity (Reilly and Doran, 2000). This places a heavy demand on the bodys liver and
muscle glycogen stores, which consequently contributes to fatigue and a reduction in
performance (Hargreaves, 1994). A suitable nutritional intake that contains a variety
of nutrients and adequate amounts of energy is essential to supply the required fuel
sources; namely carbohydrate, protein and fat. Appropriate nutrition can optimize
energy stores for competition, reduce fatigue and allow players to train for a longer
duration and recover faster between sessions, as well as maintain general health. The
importance of carbohydrate cannot be over emphasized since carbohydrate depletion
causes fatigue which may disrupt concentration, fine motor coordination and skill
performance (MacLaren, 1996). Adequate protein intakes are also essential to enhance
tissue repair and strength and supply amino acids for oxidation to provide energy
during intense prolonged exercise (Lemon, 1994).
The physiological demands of growth mean that there are additional nutritional
requirements. Many youth soccer players are still growing and this puts further stress
on their energy and nutrient reserves. The nutrients energy, protein, calcium, and iron
The authors would like to thank Mr R. Reeves, Mr J. Keith and all the footballers that took part E
in the study.

Vol. 36 No. 5, 2006
pp. 343-348
0034-6659
DOI 10.1108/00346650610703199
NFS
36,5
344
have been highlighted as being particularly important in supporting growth (National

Dairy Council, 1995).
As well as the energy requirements of exercise and growth there are many factors
that affect food intake including access, availability, individual circumstances such as
living conditions and nutritional knowledge. Whilst many football players are aware
of the importance of diet very few actually employ ideal dietary practice. In fact
studies on footballers have shown that most (Ingram and Davies, 1996) do not
consume a diet considered compatible with peak physical performance and leave
much room for improvement.
The aim of this study was to determine some of the factors including nutritional
knowledge and residential status that influence the diets of a group of professional
football players from a Premier division and a 1st division football clubs youth
squads.
Methodology
Thirty five players were recruited mid-season from two professional football clubs;
one club was in the English premier league and the other in the first division. Twentytwo players with a median age of 17 years (range 1619 years) completed the study.
For comparative purposes, 20 controls who did not participate regularly in sport were
also recruited. The participants were provided with verbal and written instructions on
how to complete a 7 day food diary, which they were asked to carry with them at all
times and record everything they ate and drank. A full description of the foods
consumed was requested, including the type and brand, how the food was cooked and
the amount consumed. The diaries were then analyzed using Diet 5 (Univation,
Aberdeen). To eliminate the possibility of under-reporting, the basal metabolic rate
(BMR) of all participants was calculated using the FAO/WHO/UNU (1985) equations.
These are equations based on individual body weights. If energy intakes are less than
1.5 times BMR, this suggests that unless there is a loss in body weight, that the
subjects are not recording all foods consumed. Any subjects thought to be underreporting were eliminated from the study.
The participants were interviewed about their exercise and training schedules,
living situation and were asked to complete a questionnaire, tailored for football
players, which tested their knowledge of nutrition. This entailed ten multiple choice
questions and ten questions in a true/false format. Questions were included from the
following categories: energy, macronutrients, vitamins and minerals, supplements,
hydration and weight control. For the multiple choice section of the questionnaire
correct responses were scored as 1 and incorrect as 0. For the true or false section
correct answers scored 1 whereas incorrect answers scored 21. This method
prevented artificially high scores since random responding would tend to sum to zero
rather than 50 per cent. Both sections of the questionnaire were combined and
presented as a percentage; the maximum possible score was therefore 100 per cent.
This score was then used in subsequent analyses. The questionnaire was piloted
using university students studying nutrition. There was a significant difference
(p , 0.05) in the mean scores of the nutrition students and the football players.
Body mass was measured with a digital balance (Seca, Germany) to the nearest
0.1 kg. The balance was calibrated for accuracy with known weights. Height was
measured using a portable stadiometer to the nearest 0.5 cm. Subjects were measured
bare footed, heels together with heads in the Frankfort plane. To estimate body fat,
skinfolds were measured using Harpenden calipers (British Indicators, UK) to the
nearest 0.1 mm. Total body fat was estimated from the sum of four skinfold values
taken at the biceps, triceps, sub-scapular and supra-iliac and calculated using the
Durnin and Womersley (1974) equations.
All data are presented as mean values standard deviation (SD). T-tests and
Pearsons correlations were calculated using SPSS (v 10.1) and graphed using Excel
(Microsoft Corporations) software. A significance level of p,0.05 was adopted.
Nutritional
knowledge and
dietary intakes
345
Results
The participants anthropometric characteristics are presented in Table I. There was
no significant difference in age between the two groups, however the football players
were significantly (p , 0.05) lighter, had a lower body mass index and less body fat
than the controls.
Results of energy intake and macronutrient consumption are shown in Table II, and
show that the football players ate significantly (p , 0.05) less than the controls and
their intakes were below the 11.54 MJ day21 recommended for adolescents
(Department of Health, 1996) as well as the guideline of 1415 MJ day21 for football
players (Shepherd, 1999). In addition, the macro-nutrients were not consumed in
optimal proportions. The football players consumed significantly (p , 0.05) more
carbohydrate as a percentage of energy intake than the controls, although both groups
would benefit by increasing their intakes. The football players consumed 51 per cent
of their energy from carbohydrate and an equivalent of 4.3 grams per kilogram of
body weight per day (g kg21 day21). This is below the recommendations for football
players whereby more than 55 per cent of the diet should be made of carbohydrate
rich foods, or 6 g kg21 day21 (Economos et al., 1998). A difference of 4 per cent
Variable
Height (m)
Weight (kg)
Body Mass Index (kg m22)
Body fat (per cent)
Football players
1.75
72.3
23.6
15.0
0.07
4.1
1.2
5
Controls
1.80
87.1
26.9
24.1
0.04
3*
1.6*
3*
Note: * p,0.05.
Nutrient
Energy (MJ)
Carbohydrate (per cent)
Carbohydrate (g)
Protein (per cent)
Protein (g)
Fat (per cent)
Fat (g)
Alcohol (per cent)
Alcohol (g)
Notes: *p , 0.05.
**p , 0.01.
Football players
10.26
51
310.05
17
104.1
32
87.7
0.3
0.9
1.8
4*
22
2
16
3
4
1
1
Table I.
Anthropometric
characteristics of youth
football players and
controls (mean SD)
Controls
13.89
44.9
373
15.1
135
31.7
117
6.73
31.9
0.7*
5.0
32
2.3
13
5
2*
0.6**
11**
Table II.
The energy and
macronutrient intakes of
youth football players
and controls (mean SD)
NFS
36,5
346
between the average amount of carbohydrate consumed and the recommendations

may seem minor but for some individuals this deficit was as much as 15 per cent and
such an amount is likely to affect performance (Brouns, 2002).
Both protein and fat were consumed in appropriate amounts by both groups,
however the controls consumed significantly (p , 0.05) more fat. Alcohol was
consumed in very small quantities by the football players and significantly (p , 0.01)
less than the controls.
Adequate intakes of all vitamin and minerals were consumed (Table III), with the
exception of calcium, which was below recommendations for both groups (Department
of Health, 1996).
There was a disparity between nutritional knowledge and the nutritional practices
employed by the players. For example, you would expect the more a player knew
about nutrition the greater they would understand the need for high intakes of
carbohydrate. Correlation between carbohydrate intake and nutritional knowledge
score was determined by carrying out a Pearsons correlation. From this it was
revealed that carbohydrate intake and nutritional knowledge were poorly correlated
(R 5 0.2, p , 0.07). Energy intake and nutritional knowledge score were also weakly
correlated (R 5 0.3, p , 0.06). Similar patterns were seen in the control subjects.
When player living situation was investigated, it was revealed that players who
resided in the club hostel had significantly greater energy intakes, consumed more
carbohydrate and less fat (p , 0.05) than players who lived in their parental home.
This was not the case for the control subjects. There were no significant differences in
the diets consumed by the players from the premier division club and those from the
first division club.
Discussion
Measurements of body composition are necessary in order to assess appropriate
nutritional intakes and the fact the football players were lighter and had less body fat
may account for and be a result of the differences in energy intakes between the two
groups. The football players could do with increasing their energy intakes inline with
recommendations for athletes (Economos et al., 1998). It is also recommended that the
football players increase their carbohydrate intakes since low carbohydrate intakes
are also associated with less distance covered and lower speeds during matches
(Rico-Sanz et al., 1998). Although protein was consumed in adequate amounts it was
still below the 142 g day21 consumed by elite soccer players reported by Rico-Sanz
et al. (1998). Fat intakes were also appropriate in both groups but for a comparison
were less than the 158 g day21 consumed by Greek football players (Hassapidou et al.,
2000). The controls reported drinking alcohol between two and four times a week,
however the football players rarely drunk. This is probably a sensible decision on
behalf of the football players since even small quantities of alcohol can produce a
Table III.
The micronutrient
intakes of youth
football players and
controls (mean SD)
Nutrient
Vitamin C (mg)
Vitamin E (mg)
Calcium (mg)
Iron (mg)
Football players
90.1
4.82
665
11.14
4.6
3.1
189
3
Controls
82.9
5.5
626
17.82
6
4.5
320
48
negative effect on aerobic performance, although anaerobic performance may not be

affected (OBrien, 1993).
In accordance with the findings of Rockwell et al. (2001), who studied female
university athletes, there was a disparity between nutritional knowledge and the
nutritional practices employed by the players. Even in those clubs which do provide a
good level of nutritional education perhaps in conjunction with a college based
training programme this knowledge does not always manifest itself into a good diet.
In theory nutritional education should have an impact on the adequacy of food choices
however, in reality this rarely occurs. Many studies have shown even when life and/or
livelihood dependant, subjects are still reluctant to alter their habitual diets (Webb,
2002). Yet this is no reflection on their level of education or the dietary information
provided, hence generally there is a large disparity between nutritional knowledge
and the dietary practices employed (Packman and Kirk, 2000). This discrepancy may
be due to the fact that most subjects are over optimistic about their own diets, and do
not relate general nutritional advice to their own lifestyle habits (Fieldhouse, 1998).
Yet when given accurate information about their own individual intakes, it more likely
improvements will be made (Raats et al., 1999). There is a need to improve
understanding of personal dietary intakes in order to improve personal attitudes
towards and desire to modify dietary habits. These dietary changes can then in turn
lead to an improvement in the football players physical condition, provide better
protection against injuries, faster recovery, maintain growth and ultimately better
performance on the pitch.
Conclusions
It is apparent that the players need assistance in the implementation of their
knowledge of nutrition to their own diets, to increase their nutritional intakes in line
with recommendations. Nutritional guidance may be particularly beneficial to those
who live away from the scrutiny of the football club.
References
Brouns, F. (2002), Essentials of Sports Nutrition, John Wiley & Sons, Chichester.
Department of Health (1996), Dietary Reference Values, HMSO, London.
Durnin, J.V.G.A. and Womersley, J. (1974), Body fat assessed from total body density and its
estimation from skinfold thickness: measurements on 481 men and women aged 1672,
British Journal of Nutrition, Vol. 32 No. 1, pp. 7797.
Economos, C.D., Botrz, S.S. and Nelson, M.E. (1998), Nutritional practices of elite athletes,
Sports Medicine, Vol. 16 No. 6, pp. 38194.
FAO/WHO/UNU (1985), Protein and Energy Requirements, Technical Report Series 724, WHO
Press, Geneva.
Fieldhouse, P. (1998), Food and Nutrition: Customs and Culture, Routledge, London.
Hargreaves, M. (1994), Carbohydrate and lipid requirements in soccer, Journal of Sport
Science, Vol. 12 No. 1, pp. 1316.
Hassapidou, M.N., Grammatikopoulou, L. and Liarigovinos, T. (2000), Dietary intakes of Greek
professional football players, Nutrition and Food Science, Vol. 30 No. 4, pp. 1914.
Ingram, L. and Davies, J. (1996), Nutritional awareness of professional football teams with
particular reference to carbohydrate, Nutrition and Food Science, Vol. 96 No. 3, pp. 1214.
Lemon, P. (1994), Protein requirements of soccer, Journal of Sports Science, Vol. 12 No. 1,
pp. S1722.
Nutritional
knowledge and
dietary intakes
347
NFS
36,5
348
MacLaren, D. (1996), Nutrition, in Reilly, T. (Ed.), Science and Soccer, E & FN Spon, London.
The National Dairy Council (1995), Nutrition and Teenagers, Fact File Number 5, London.
OBrien, C.P. (1993), Alcohol and sport; the impact of social drinking on recreational and
competitive sports competition, Sports Medicine, Vol. 15 No. 2, pp. 717.
Packman, J. and Kirk, S. (2000), The relationship between nutritional knowledge, attitudes and
dietary fat consumption in male students, Journal of Human Nutrition and Dietetics,
Vol. 13 No. 6, pp. 38995.
Raats, M.M., Sparks, P., Geekie, M.A. and Shepherd, R. (1999), The effects of providing
personalized dietary feedback, Patient Education Counsel, Vol. 37 No. 2, pp. 17789.
Reilly, T. and Doran, D. (2000), Science and Football: A review, Journal of Sports Science,
Vol. 19 No. 3, pp. 18193.
Rico-Sanz, J., Frontera, W., Mole, P., Rivera, M., Rivera-Brown, A. and Meredith, C. (1998),
Dietary and performance assessment of elite soccer players during a period of intense
training, International Journal of Sports Nutrition, Vol. 8 No. 8, pp. 23041.
Rockwell, M.S., Nickols, S.M. and Thye, F.W. (2001), Nutritional knowledge and practices of
coaches at University, International Journal of Sport Nutrition and Metabolism, Vol. 11
No. 3, pp. 17485.
Shepherd, R. (1999), Biology of medicine and soccer, Journal of Sport Sciences, Vol. 17 No. 10,
pp. 75786.
Webb, G. (2002), Nutrition a Health Promotion Approach, Arnold, London.
Yvonne Jeanes can be contacted at: y.jeanes@roehampton.ac.uk

Probiotic acidophilus milk for

infants and children
Probiotic
acidophilus milk
S. Sarkar
Department of Quality Assurance at Metro Dairy Limited, Kolkata,
West Bengal, India
349
A.K. Misra
Department of Dairy Bacteriology, Faculty of Dairy Technology, West Bengal
University of Animal and Fishery Sciences, West Bengal, India
Abstract
Purpose The objective of the present investigation is to evaluate the effect of incorporation of
Bifidobacterium bifidum NDRI and Propionibacterium freudenreichii subsp. shermanii MTCC 1371
along with Leuconostoc acidophilus R on the technological and dietetic behaviour of starter cultures
and to assess their suitability for the manufacture of probiotic acidophilus milk for infant feeding.
Design/methodology/approach The paper assesses the effect of incorporation of
Propionibacterium freudenreichii subsp. shermanii MTCC 1371 and Bifidobacterium bifidum NDRI
with Lactobacillus acidophilus R on the technological and dietetic characteristics and their suitability
for the manufacture of probiotic acidophilus milk.
Findings Based upon the results of technological and dietetic characteristics of starter cultures,
conjugated use of Propionibacterium freudenreichii subsp. shermanii MTCC 1371 and Bifidobacterium
bifidum NDRI with Lactobacillus acidophilus R, inoculated at 1 per cent level individually and
incubated at 371 C for 12 h, is recommended for the manufacture of probiotic acidophilus milk with
better nutritional and therapeutic properties. Probiotic acidophilus milk may be recommended for
feeding normal as well as lactose-intolerant infants.
Originality/value The paper offers an assessment of the suitability of probiotic acidophilus milk
for infant feeding.
Keywords Milk, Diet, Nutrition, Infants
Introduction
Breast milk is considered superior over any other modified infant formula due to its
inherent properties and advantages. In the absence or with insufficient production of
breast milk, various modified milk formulae developed may be nutritionally adequate
but could not confer any protection to the infants. Technological innovations made in
the commercial infant milk powder have not been able to meet the critical nutritional
and physiological needs of infants (Thompkinson and Mathur, 1995). Under this
circumstance, various cultured milk products developed for infants and children can
be a practical and suitable substitute (Sarkar, 2003).
Lactobacilli is the normal resident of gastro-intestinal tract (Mitsuoka, 1992) and
capable of restoring the normal microbial balance in the intestine (Garvie et al., 1984),
whose application during the manufacture of cultured milk products are proposed to
exert probiotic effects in humans (Gilliland, 1989). Bifidobacteria based cultured
milk products may be beneficial as a probiotic for improving the intestinal flora and
for maintaining the healthy intestinal conditions of infants during and after weaning
(Fukushima et al., 1997; Fukushima and Yamano, 2003).
Vol. 36 No. 5, 2006
Propionibacterium spp. is reported to synthesise vitamins (Skupin et al., 1974),
pp. 349-356
Limited
exhibit antagonism (Al-Zoreky et al., 1993) and possess b-D-galactosidase activity E Emerald Group Publishing0034-6659
DOI 10.1108/00346650610703207
(Kujawski et al., 1990). Inclusion of Propionibacterium freudenreichii subsp. shermanii
NFS
36,5
350
with Lactobacillus acidophilus resulted in a product, which was more efficacious than
acidophilus milk in preventing the gastro-intestinal disease in infants (Nabukhotnyi
et al., 1983). Reddy (1989) suggested associative application of propionic acid bacteria
with Lactobacillus acidophilus, Bifidobacterium bifidum and Leuconostoc citrovorum
during the preparation of dietary supplements for enhanced viability of these
organisms in the human intestinal tract. The objective of the present investigation
was to evaluate the effect of incorporation of B. bifidum NDRI and P. freudenreichii
subsp. shermanii MTCC 1371 along with L. acidophilus R on the technological
and dietetic behaviour of starter cultures and to assess their suitability for the
manufacture of probiotic acidophilus milk for infant feeding.
Materials and methods
Type of milk
Reconstituted skim milk (SM) [0.5 per cent fat and 7.64 per cent solid non-fat (SNF)]
was used for evaluating rate of acid production by starter cultures. Formulated milk
(FM) was obtained on fortification of standardised cow milk (2.5 per cent fat and
10.46 per cent SNF) with vitamins A, D and E (Roche Chemicals, Bombay, India) at the
levels of 500 IU, 80 IU and 750 mg respectively and addition of 12 per cent sucrose
(Misra and Kuila, 1992). Different technological and dietetic attributes of starter
cultures were evaluated in both SM and FM.
Starter cultures
Freeze dried cultures of Bifidobacterium bifidum NDRI (National Collection of Dairy
Cultures, National Dairy Research Institute, Karnal, India) and Propionibacterium
freudenreichii subsp. shermanii MTCC 1371 (Institute of Microbial Technology,
Chandigarh, India) were maintained in sterile SM containing 1 per cent dextrose and
0.1 per cent yeast extract as suggested by Misra and Kuila (1991). Lactobacillus
acidophilus R (National Collection of Dairy Cultures, National Dairy Research Institute,
Karnal, India) was maintained in plain sterile SM.
Pathogenic cultures
Virulent pathogenic strains of Bacillus cereus, Shigella dysenteriae (National Collection of
Dairy Cultures, National Dairy Research Institute, Karnal, India), Escherichia coli 03, 018,
078 and Salmonella typhimurium P3 (Department of Veterinary Microbiology, West Bengal
University of Animal and Fishery Sciences, Nadia, India) were maintained on nutrient agar
slants (Hi-Media, Bombay, India) by weekly propagations and were activated by three
successive transfers at 24 h intervals in nutrient broth (Hi-Media, Bombay, India).
Analytical techniques
Technological characteristics
Technological attributes of starter cultures were evaluated on the basis of titratable
acidity (BIS, 1960), diacetyl and acetoin production (King, 1948), volatile acidity
(Hempenien and Liska, 1968) and extent of proteolysis (Hull, 1947).
Dietetic characteristics
Dietetic attributes of starter cultures were evaluated on the basis of lactic acid content
(Barker and Summerson, 1941), lactose hydrolysing activity (Citti et al., 1965),
antibacterial activity (BSI, 1968) and bile salt tolerance using Man Rogosa Sharpe
(MRS) broth (Hoier, 1992).
Statistical analysis
Results obtained in the present investigation were analysed statistically by the
method of Snedecor and Cochran (1967).
Technological characteristics
Titratable acidity. Effect of incorporation of P. freudenreichii subsp. shermanii
MTCC 1371 and B. bifidum NDRI along with L. acidophilus R on the rate of acid
production, expressed in terms of lactic acid in autoclaved SM and FM, incubated at
371 C, was investigated. Rate of acid production by L. acidophilus R and its
association with P. freudenreichii subsp. shermanii MTCC 1371 and/or B. bifidum
NDRI were higher in FM than in SM (Table I). Incorporation of B. bifidum NDRI with
L. acidophilus R in FM induced an improvement in acid production throughout
the incubation. Incorporation of P. freudenreichii subsp. shermanii MTCC 1371 with
L. acidophilus R also induced an improvement in the rate of acid production in FM
(0.3781.368 per cent lactic acid) throughout the incubation, however, improvement
could be observed after 8 h of incubation in SM (1.116 per cent lactic acid). Conjugated
use of P. freudenreichii subsp. shermanii MTCC 1371 and B. bifidum NDRI with
L. acidophilus R induced a higher rate of acid production after 4 and 12 h of incubation
in SM and throughout the incubation in FM. Because the starter cultures attained the
desired level of acidity of 0.60.7 per cent as suggested by Foster et al. (1958), an
incubation period of 12 h was recommended, keeping in consideration the dietetic
characteristics. A minimum incubation period of 12 h for optimum antibacterial
activity of B. bifidum and L. acidophilus has been reported (Anand et al., 1984; Prasad
and Gandhi, 1987). Incorporation of B. bifidum NDRI and P. freudenreichii subsp.
shermanii MTCC 1371 with L. acidophilus R may be suggested for the manufacture of
probiotic acidophilus milk for infant feeding.
Volatile acidity. The volatile acidity expressed in terms of ml 0.1 N NaOH/50 g
curd is depicted in Table II. L. acidophilus R in association with B. bifidum NDRI
showed no improvement in volatile acid production in either of the milks, however,
significant improvement (p,0.05) could be registered in SM due to its association with
P. freudenreichii subsp. shermanii MTCC 1371. Parker and Moon (1982) reported a
beneficial synergistic effect on volatile acid production between L. acidophilus and
P. freudenreichii subsp. shermanii. Extent of volatile acid production by L. acidophilus
R in association with P. freudenreichii subsp. shermanii MTCC 1371 in SM remained
unaltered (2.5 ml 0.1 N NaOH/50 g curd) even after introduction of B. bifidum NDRI.
4
Starter culturesa
LA
LA+P
LA+B
LA+P+B
SM
0.315
0.261
0.405
0.333
Acid production (per cent lactic acid)

Duration of incubation at 371 C (h)
8
FM
SM
FM
SM
0.360
0.378
0.513
0.495
0.585
0.468
0.783
0.567
0.622
0.783
0.864
0.990
1.052
1.116
0.865
1.206
Probiotic
acidophilus milk
351
12
FM
1.126
1.368
1.260
1.332
Table I.
Effect of incorporation of
bifidobacterium and
Notes: aAll cultures were inoculated at 1 per cent level individually. SM: skim milk; FM: formulated propionibacterium on the
milk; LA: Lactobacillus acidophilus; P: Propionibacterium freudenreichii subsp. shermanii; B: rate of acid production by
Lactobacillus acidophilus
Bifidobacterium bifidum
NFS
36,5
352
Brown and Townsley (1970) reported Bifidobacterium cultures to produce less than
0.05% volatile acidity.
Diacetyl and acetoin content. The diacetyl and acetoin contents along with volatile
acids contribute to the characteristic aroma and flavour of the product. Incorporation
of P. freudenreichii subsp. shermanii MTCC 1371 with L. acidophilus R induced a
significant (p,0.05) improvement in diacetyl and acetoin production, irrespective of
the type of milk. However, introduction of B. bifidum NDRI with L. acidophilus R
induced an improvement in diacetyl and acetoin production only when cultured in SM
(Table II). B. bifidum cultures are reported to produce mainly acetoin while diacetyl is
present only in traces (Dolezalek and Plockova, 1981). Conjugated use of P.
freudenreichii subsp. shermanii MTCC 1371 and B. bifidum NDRI with L. acidophilus
R resulted in a significant (p,0.05) improvement in diacetyl and acetoin production,
irrespective of type of milk used. Conjugated use of all these three cultures in the
manufacture of probiotic acidophilus milk is recommended.
Proteolytic activity. It is difficult to set certain parameters of selection because
proteolysis exerts opposite effects, such as an increase in the digestibility (dietetic
characteristic) and a decrease in the consistency or flavour of culture (technological
characteristic). The results pertaining to the proteolytic activity of starter cultures,
expressed in terms of mg tyrosine/ml are given in Table II. L. acidophilus R alone or in
association with P freudenreichii subsp. shermanii MTCC 1371 and/or B. bifidum
NDRI had significantly (p,0.05) higher proteolytic activity in SM than in FM. L.
acidophilus R in association with B. bifidum NDRI and/or P. freudenreichii subsp.
shermanii MTCC 1371 showed no improvement in proteolytic activity in SM, however,
a significant (p,0.05) improvement was registered when cultured in FM. Extent of
proteolysis by L. acidophilus R in FM was higher when used in association with P.
freudenreichii subsp. shermanii MTCC (240 mg tyrosine/ml) than with B. bifidum
NDRI (200 mg tyrosine/ml). Results indicate P. freudenreichii subsp. shermanii MTCC
1371 to be more proteolytic in nature than B. bifidum NDRI. Proteolytic nature of B.
bifidum (Misra and Kuila, 1991) and propionic acid bacteria (Brendehaug and
Langsrud, 1985) has been reported. Conjugated use of P. freudenreichii subsp.
shermanii MTCC 1371 and B. bifidum NDRI with L. acidophilus R may be suggested to
have a moderate proteolytic activity and to satisfy both technological and dietetic
criteria of probiotic acidophilus milk.
Starter
culturesa
Table II.
Effect of incorporation
of bifidobacterium and
propionibacterium on
the technological and
dietetic characteristics
of Lactobacillus
acidophilus
LA
LA+P
LA+B
LA+P+B
b-D-gal
Volatile
Proteolytic
actosidase
activity
Lactic
acidity (ml 0.1
Diacetyl
Titratable
acid
activity
acidity (per cent N NaOH/
and acetoin (mg tyrosine/
ml)
(mg/ml) (mg ONP/ml)
lactic acid)
50 g curd)
(ppm)
SM
FM
SM
FM SM
FM
SM FM SM FM SM FM
1.052
1.116
0.855
1.206
1.126
1.368
1.260
1.332
1.5
2.5
1.2
2.5
1.8
0.8
0.5
1.5
5.0
9.0
7.0
10.0
5.0
7.0
4.6
11.0
440
310
215
240
170
240
200
187
330
320
330
330
220
220
220
220
108
95
85
86
38
33
31
44
Notes: aInoculated at 1 per cent level individually and incubated at 371 C for 12 h. SM: skim milk;
FM: formulated milk; LA: Lactobacillus acidophilus; P: Propionibacterium freudenreichii subsp.
shermanii; B: Bifidobacterium bifidum
Dietetic attributes
Lactic acid. Lactic acid production was observed to be significantly (p,0.05) higher
in SM (330 mg/ml) than in FM (220 mg/ml) by all starter combinations except for mixed
cultures of L. acidophilus R and P. freudenreichii subsp. shermanii MTCC 1371, which
produced the same degree of lactic acid (220 mg/ml) in both type of milk (Table II).
Lactic acid production by L. acidophilus R in FM remained unaltered either due to
incorporation of P. freudenreichii subsp. shermanii MTCC 1371 and/or B. bifidum
NDRI. Results indicate disparity in the behaviour of P. freudenreichii subsp. shermanii
MTCC 1371 in SM and FM. Lowering of lactic acid content may be due to its
utilisation by P. freudenreichii subsp. shermanii MTCC 1371 as reported by Parker
and Moon (1982). Incorporation of B. bifidum NDRI and P. freudenreichii subsp.
shermanii MTCC 1371 with L. acidophilus R may be recommended for the
manufacture of probiotic acidophilus milk for infant feeding without the risk of high
acid load. Probiotic acidophilus milk with B. bifidum NDRI may be assumed to have
L(+) lactic acid as a major form of lactic acid because in bifidobacteria based
fermented milk, dominance of the desired L(+) lactic acid to a level of 90 per cent is
reported (Klupsch, 1983).
b-D-galactosidase activity. b-galactosidase (b-gal) activity of L. acidophilus R in
association with P. freudenreichii subsp. shermanii MTCC 1371 and/or B. bifidum
NDRI was observed to be significantly (p,0.05) higher in SM (85108 mg ONP/ml)
than in FM (3144 mg ONP/ml). Introduction of P. freudenreichii subsp. shermanii
MTCC 1371 or B. bifidum NDRI to L. acidophilus R showed lower b-gal activity with
respect to control, irrespective of the type of milk (Table II). Conjugated use of L.
acidophilus R, B. bifidum NDRI and P. freudenreichii subsp. shermanii MTCC 1371 in
FM induced an improvement in b-gal activity. Presence of bgal enzyme in L.
acidophilus (Fisher et al., 1985), B. bifidum (Premi et al., 1972) and P. freudenreichii
subsp. shermanii (Kujawski et al., 1990) has been reported. Conjugate application of all
these three cultures is suggested to obtain probiotic acidophilus milk, which would be
highly suitable for lactose-intolerant infants.
Antibacterial activity. All starter combinations exhibited variable inhibitory
activity against the pathogenic test organisms (Table III). Incorporation of P.
freudenreichii subsp. shermanii MTCC 1371 with L. acidophilus R in SM induced an
improvement in the antagonism against all the test organisms except for E. coli 078.
However, when cultured in FM, an improvement in antagonism against S.
typhimurium P3 could only be observed. Incorporation of B. bifidum NDRI also
induced an improvement in antagonism against all test organisms in both SM and
Starter
culturesa
LA
LA+P
LA+B
LA+P+B
Probiotic
acidophilus milk
353
Diameter of zone of inhibitionb (mm)

E.coli 03
E. coli 018
B. cereus S. dysenteriae
S. typhimurium P3 E. coli 078
SM
FM
SM FM SM FM SM FM
SM
FM
SM
FM
6.5
7.0
7.0
7.5
7.0
7.5
7.5
8.0
6.5
6.5
7.0
7.0
7.0
6.5
7.5
7.5
5.5
6.0
7.0
7.0
6.5
6.5
7.5
8.0
5.5
6.0
6.5
6.5
6.0
6.0
7.0
7.0
5.5
6.0
6.0
7.0
6.0
6.0
6.5
7.0
6.5
7.0
7.0
7.0
7.0
7.0
7.0
8.0
Table III.
Effect of incorporation of
bifidobacterium and
Notes: aInoculated at 1 per cent level individually and incubated at 371 C for 12 h. Including the propionibacterium on the
diameter of the well (5 mm). SM: skim milk; FM: formulated milk; LA: Lactobacillus acidophilus, antibacterial properties of
Lactobacillus acidophilus
P: Propionibacterium freudenreichii subsp. shermanii; B: Bifidobacterium bifidum
NFS
36,5
354
FM, however, no difference in antagonism against S. dysenteriae in FM could be

observed. Acidophilus milk exhibited antimicrobial activity against 92 per cent
Salmonella, 76 per cent Shigella and 67 per cent E. coli (Anon, 1999). Results indicate
better antagonism of pathogens by L. acidophilus R when used in association with B.
bifidum NDRI than with P. freudenreichii subsp. shermanii MTCC 1371. Amelioration
in the antibacterial activity may be attributed to the production of a higher amount of
antimicrobial compounds by increased B.bifidum NDRI population in mixed culture
with L. acidophilus. R. Khedkar et al. (1994) registered viable cell counts of
Bifidobacteria and L. acidophilus to be much higher in mixed culture. Conjugated use
of B. bifidum NDRI and P. freudenreichii subsp. shermanii MTCC 1371 with
L.acidophilus R exhibited improved degree of antagonism against all test organisms
with respect to antagonism registered due to L. acidophilus R alone. Production of
bacteriocin-like compounds, designated as MicrogardTM (Al-Zoreky et al., 1993),
acidophilin (Shahani et al., 1977) and bifidin (Anand et al., 1984) by P. freudenreichii
subsp. shermanii, L. acidophilus and B. bifidum respectively, has been reported.
Banina et al. (1998) reported that antagonism of L. acidophilus may be due to lactic
acid production rather than hydrogen peroxide or bacteriocin. Exhibition of maximum
antagonism against all test organisms suggested conjugated use of P. freudenreichii
subsp. shermanii MTCC 1371, B. bifidum NDRI with L. acidophilus R for the
manufacture of probiotic acidophilus milk, which would compete with undesirable
flora and maintain the normal gut flora of infants.
Bile salt tolerance. The most important criteria for selection of a starter culture for
the manufacture of a therapeutic product for infants are its ability to withstand and
grow under the conditions prevailing in the intestine. Bile salt tolerance of starter
cultures was determined by their capability to grow in the presence of 0.5, 1.0 and
2.0 per cent bile salt within 2 h of incubation at 371 C in MRS broth. Results showed
that P. freudenreichii subsp. shermanii MTCC 1371 failed to grow in the presence of
0.52.0 per cent bile salt and hence were not bile salt tolerant. However, B. bifidum NDRI
and L. acidophilus R had appreciable growth in the presence of 0.5 per cent bile salt.
Survival of B. bifidum in the presence of 0.2 per cent sodium tauroglycocholate (Misra,
1988) and L. acidophilus in the presence of 0.15% oxgall (Brennan et al., 1986) has been
reported. Shah and Jelen (Misra, 1992) have reported a higher bile salt tolerance of L.
acidophilus and B. subsp. than in yoghurt cultures. Survival of L. acidophilus R and B.
bifidum NDRI in the presence of bile salt suggested their use in the manufacture of
probiotic acidophilus milk for infants with better prophylactic properties.
Conclusion
Based upon technological and dietetic characteristics, incorporation of B. bifidum NDRI
and P. freudenreichii subsp. shermanii MTCC 1371 along with L. acidophilus R is
recommended for the manufacture of probiotic acidophilus milk with enhanced dietetic
properties. An inoculation rate of 1 per cent each culture and an incubation temperature
of 371 C for 12 h are recommended for the manufacture of probiotic acidophilus milk.
Probiotic acidophilus milk may be suitable for normal as well as lactose-intolerant
infants and children and possess the capability to maintain the normal gut flora.
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S. Sarkar can be contacted at: metrocal@cal3.vsnl.net.in

Cultured milk products for

lactose-intolerant recipients
Cultured milk
products for
lactose
S. Sarkar
Department of Quality Assurance, Metro Dairy Ltd, Kolkata, West Bengal,
India
357
Abstract
Purpose The purpose of this paper is to enlighten the prophylactic aspect of cultured milk
products, which render it suitable for lactose-intolerant subjects.
Design/methodology/approach The paper outlines the significance of lactase enzyme and the
mechanism of lactase digestion. This is followed by a discussion of lactase activities in starter
cultures and cultured milk products for lactose-intolerant participants. Factors affecting lactase
activity are described.
Findings Starter cultures possess the enzyme b-galactosidase, required for lactose hydrolysis and
their application led to the development of a number of cultured milk products, which are more easily
digestible than milk by lactose-intolerant individuals. Reasons attributable for better digestion of
cultured milk products than milk are reduction in lactose content, increase in microbial lactase
enzyme, stimulation of hosts mucosal lactase activity and slower transit of cultured milk products as
compared to milk.
Originality/value Consumption of cultured milk products by lactose-intolerant recipients is
suggested.
Keywords Milk, Digestive sysytem
Introduction
Inability of human beings to digest lactose is often referred to as Lactose-intolerance
and has been attributed to insufficient amounts of lactase in the small intestine to
hydrolyze lactose consumed in the diet (Littman and Hammond, 1965; Bayless and
Rosenweig, 1966). b-galactosidase, commonly known as lactase is capable of
hydrolyzing b-D-galactoside bond between D-galactose and glucose. The enzyme is
widely distributed in nature and has been isolated from plants, animals and
microorganisms.
Lactobacilli is the normal resident of gastro-intestinal tract (Mitsuoka, 1992) and
capable of restoring the normal microbial balance in the intestine (Garvie et al., 1984);
utilization of lactobacilli during the manufacture of cultured milk products are
proposed to exhibit health-promoting or probiotic effect in humans, which include
improvement of lactose digestion (Gilliland, 1989). Shahani and Chandan (1979)
pointed out that cultured milk products may provide supplementary quantities of
lactase and other constituent enzymes, elaborated by cultures during fermentation,
contributing towards the assimilation of lactose by lactose-intolerant individuals.
In the present article, an endeavor has been made to enlighten the prophylactic
aspect of cultured milk products, which render them more suitable for ingestion by
lactose-intolerant recipients.
Significance of lactase enzyme
Vol. 36 No. 5, 2006
Lactose, a disaccharide composed of glucose and galactose, is the major solid
pp. 357-364
Limited
component of milk and must be hydrolyzed into its components under the influence of E Emerald Group Publishing0034-6659
enzyme lactase, a membrane bound enzyme present in the brush border of the small
DOI 10.1108/00346650610703216
NFS
36,5
358
intestinal epithelial cell prior to its absorption by humans (Miller and Brand, 1980;
Hourigan, 1984). In case the quantum of lactose ingested exceeds the hydrolytic
capacity of the available intestinal lactase, the undigested portion of lactose is
transported to the large intestine, where it increases the osmolarity of the intestinal
fluids. Undigested lactose undergoes bacterial fermentation in the colon, generating
organic acids, carbondioxide and hydrogen, which along with the large amount of
water is drawn into the intestine, are primarily responsible for various symptoms such
as bloating, flatulence, abdominal cramps, diarrhoea and loss of appetite (Hourigan,
1984; Hofi, 1990). Lactose maldigestion occurs due to either gastro-intestinal disease or
physiological decline in the intestinal lactase activity and may lead to clinical
symptoms of lactose-intolerance. Semenza and Auricchio (1995) registered reduction
in lactase activity due to digestion of lactasephlonizin hydrolase molecule by
pancreatic proteases at the brush border membrane. Deficiency of enzyme lactase may
be of three types (Swaminathan, 1998).
Congenital lactase deficiency
Persons cannot tolerate lactose due to absence of lactase enzyme in the intestine,
resulting in accumulation of lactose in the intestine causing abdominal pain and loose
motion.
Lactase deficiency in premature infants
This condition occurs in premature infants due to decrease lactase enzyme activity in
the intestinal mucosa. Initially, infants cannot utilize lactose efficiently, however
they are able to tolerate and digest milk after one month due to increase in lactase
activity.
Acquired lactase deficiency
Adults and older children cannot tolerate large amounts of milk due to their nonhabitual consumption of milk resulting in low lactase in the intestinal mucosa.
Mechanism of lactose digestion
Lactic acid bacteria must survive the gastro-intestinal tract to provide the beneficial
effect. Cells of yoghurt cultures contain b-galactosidase as an intracellular enzyme,
therefore it is protected during passage through the harsh environment of stomach
and is able to reach the small intestine, while still inside the bacterial cells.
Permeability of yoghurt cultures is altered, when it comes in contact with bile so that
lactose can enter and get hydrolyzed (Gilliland and Kim, 1984). The sensitivity of
yoghurt cultures to bile has been proposed as an advantage for lactose digestion,
because it increases the permeability of the bacterial cell (McDonough et al., 1987).
Shah and Lankaputhra (1997) noted that rupturing of bacterial cells of yoghurt
cultures reduced viable counts but the released intracellular b-galactosidase improved
the viability of probiotic bacteria such as Bifidobacterium spp. and L. acidophilus
which remained above the recommended level of 106 cfu/mL. Microorganisms residing
in the large intestine made themselves tolerant to lactose through modifications of
their metabolic activity (Hertzler and Savaiano, 1996) Efficient utilization of lactose
from cultured milk products than in milk may be attributed to improved digestion of
lactose resulting from lactase activity of bacteria, stimulation of hosts mucosal lactase
activity or slower intestinal transit of cultured milk product compared to milk (Kolars
et al., 1984; Gibson and Fuller, 1998).
Lactase activity in starter cultures

Galactose activity has been demonstrated in many lactobacilli (Mittal et al., 1974) and
differs greatly in their lactase activity (Premi et al., 1972; Fisher et al., 1985). Variation
in lactase activity of different strains of lactobacillus delbrueckii subsp bulgaricus and
streptococcus thermophilus were noted (Gilliand and Kim, 1984) and the later
organism possess higher b-galactosidase activity than the former (Lee, 1992).
Probiotic cultures such as lactobacillus acidophilus and bifidobacterium, possess
lower levels of lactase and being more resistant to bile than yoghurt cultures are less
efficacious in helping lactose digestion (Shah and Jelen, 1992). Lactase activity of L.
acidophilus strains was reported to vary within a range of 0.5 to 9.5 units (Fisher et al.,
1985) and this disparity may be due to micro-heterogeneity in the amino acid
composition of lactose (Styrer, 1988). Higher lactase activity of propionic acid bacteria
than lactic acid bacteria (Kujawski et al., 1990) suggested their conjugated use during
the manufacture of cultured milk products such as dietetic yoghurt (Sarkar and Misra,
1998a, 2001) and Propiono-Acido-Bifido (PAB) milk (Sarkar and Misra, 1998b).
Cultured milk products for lactose-intolerant recipients
Better tolerance of yoghurt and acidophilus milk in comparison to milk by lactase
non-persistent subjects has been reported (Alm, 1982; Sieber, 2000). A decline in
lactose content from 5.26 to 3.19 per cent and an increase in glucose and galactose
from 0.05 to 2.11 per cent in yoghurt (Abd-Rabo et al., 1992) and digestion of .90 per
cent lactose in small intestine of lactase-deficient subjects due to lactase activity of
yoghurt cultures were noted (Streiff et al., 1990). Efficient absorption of lactose by rats
from yoghurt containing viable flora (Goodenough and Kleyn, 1976) and a decline in
faecal lactase activity in lactase non-persistent human subjects consuming nonpasteurized yoghurt (Pochart et al., 1989) indicated that presence of lactase enzyme
and viable flora are necessary for the beneficial effects.
Efficacy of fermented and non-fermented acidophilus milk or bifidus milk is under
debate for their benefits for lactose-intolerant subjects. Short-term ingestion of
acidophilus milk proved to be not better than milk (Newcomer et al., 1983), and less
than yoghurt (Shah et al., 1992; Vesa et al., 1996), however sonication of bacterial cells
induced better tolerance by lactase non-persistent subjects and may be ascribed to
elevation of lactase activity due to lysis of bacterial cells (McDonough et al., 1987).
Kim and Gilliland (1983) reported that addition of a large number of L. acidophilus
(2.5 6 106 to 2.5 6 108 cfu/mL) to milk prior to ingestion improved lactose digestion
and noted a reduction in breath hydrogen due to prolonged consumption of sweet
acidophilus milk for 6 days, which may be related to hydrolysis of lactose by L.
acidophilus or by lactase in gastro-intestinal tract or reduction in hydrogen producing
bacteria (Fernandes and Shahani, 1989). Effect of feeding cultured milk products on
breath hydrogen test in humans is shown in Table I.
A number of cultured milk products, namely Antoshka-L (based on bifidobacterium), Gnomik 2 (based on bifidobacterium), Zdorove 2 (based on L. acidophilus,
lactic streptococci, bifidobacterium), Progurt (based on streptococcus diacetylactis or
S. cremoris, L. acidophilus and/or B. bifidum), butter milk or yoghurt-like product
(based on S. lactis, Leuconostor citrovorum, L. bulgaricus, S. thermoplilus, L.
acidophilus or B. bifidum) and PAB milk (based on L. acidophilus, B. bifidum and
propionibacterium freudenreichii subsp. shermanii) were recommended for lactose
intolerant infants and children (Schacht and Syrazyski, 1975; Roberts, 1977; Lipatov
et al., 1998; Sarkar and Misra, 1998b). Cultured milk products containing
Cultured milk
products for
lactose
359
NFS
36,5
Cultured milk
product
Sweet
acidophilus milk
360
Yoghurt
Lactose
content (%)
6.30
4.80
1427 (mg
glucose/dL)
0.09 (units/g)
4.90
0 (mg/h g)
3.60
4.20
Table I.
Effect of ingesting
cultured milk products
on breath hydrogen test
in humans
Lactase
Cell count
activity (cfu/g)
(cfu/g)
4.80
4.00
2.20 (ONPG
units)
6.8 (ONPG
units)
3724 (mg
glucose/dL)
0.64 (mg/h g)
Breath
hydrogen (ppm) Reference
16108
28.30
33.00
1.16107
6.0610
< 200.00
1593
9.90
2.06108
5.40
3.06108
< 50.0
McDonough et al.
(1987)
Onwulata et al.
(1989)
Savaiano et al.
(1984)
Dewit et al.
(1988)
Gilliland and
Kim (1984)
Mc Donough et al.
(1987)
Savaiano et al.
(1984)
bifidobacterium and S. thermophilus were tolerated well by infants and the higher
level of hydrogen exhaled indicated an earlier bacterial colonization in the digestive
tract. (Leke et al., 1999).
Factors affecting lactase activity
Microbial growth conditions
b-galactosidase activity of L. acidophilus depends on the growth temperature and pH
of medium (Seema et al., 1994). Acid tolerant strains have an advantage in surviving
the low pH conditions in the stomach (pH 2.0), where hydrochloric and gastric acids
are secreted (Toit et al., 1998). During incubation of yoghurt cultures up to 4 h, bgalactosidase activity reached a maximum value (8 units/g), followed by lowering to a
level of 3 units/g, before leveling off. A decrease in enzyme activity between 46 h of
incubation is due to an increase in titratable acidity (Kilara and Shahani, 1976; Dave
et al., 1993).
Microbial viability
Strains of starter cultures must survive the gastro-intestinal tract, which is dependent
on buffering capacity of the medium (Conway et al., 1987). Bile-salt tolerance is
important for strains to grow and survive in upper small intestine (Toit et al., 1998)
and survivality of greater number of bile resistant lactobacilli strains in gastrointestinal tract have been reported (Gilliland et al., 1984). A viable population of . 106
cfu/mL is known to exhibit a positive prophylactic effect (Mijacevic et al., 2001).
Product processing and storage conditions
Dave et al. (1993) registered higher b-galactosidase activity in dahi made from milk
with higher total solids. Higher activity was also noted in formulated milk than in
skim milk due to higher total solid content in the former milk (Sarkar and Misra,
1998a). b-galactosidase activity in dahi (Dave et al., 1993) and PAB milk (Sarkar and
Misra, 1998b) decreased during refrigerated storage with increasing periods of storage
due to shift in pH (Dave et al., 1993). Galvao et al. (1995) noted b-galactosidase activity
of 0.58 to 3.3 units in yoghurt, which declined throughout the storage.
Post-processing treatments
Untreated yoghurt containing live and active flora is tolerated better by lactase nonpersistent individuals than pasteurized yoghurt (McDonough et al., 1987; Dewit et al.,
1988; Pochart et al., 1989). Pasteurization of yoghurt reduced viable counts from
3 6 108/g to 3.4 6 106/g and lactase activity from 0.64 to 0.07 units/g (Savaiano et al.,
1984). Thermization of dahi reduced the lactase activity by 50 to 73.68 per cent and
differed with the strains of cultures adopted for dahi manufacture (Sarkar et al., 1992).
Conclusion
Possession of b-galactosidase enzyme required for lactose hydrolysis by starter
cultures led to their utilization for the manufacture of cultured milk products, suitable
for lactose-intolerant individuals. Better tolerance of cultured milk products than milk
by lactose-intolerant subjects may be attributed to reduction in lactose content,
increase in microbial lactase, stimulation of hosts mucosal lactase activity and slower
transit of cultured milk products in comparison to milk. Factors affecting the lactase
activity are growth condition survivability of starter cultures, surviability of starter
cultures, product manufacturing and storage conditions and post-processing
treatments.
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S. Sarkar can be contacted at: metrocal@cal3.vsnl.net.in

Food facts
Chartered Institute of Environmental Health (CIEH)
Food businesses have a duty of care to their customers in an environment where more
people than ever before are eating out and food allergies are on the rise.
Acknowledging this trend the Chartered Institute of Environmental Health (CIEH)
has launched a new DVD to raise awareness of food allergens.
Addressing legal requirements to keep customers safe and to help avoid expensive
liability claims for businesses, the DVD provides clear guidance for food businesses
on how to manage allergens in food production and the knowledge required by staff to
answer customer enquiries competently.
The Caterers Guide to Food Allergy DVD, sponsored by the CIEH, aims to reduce
the risks faced by the UKs 1.5 million food allergy sufferers an element of the Food
Standards Agencys Safer Food, Better Business campaign.
Speaking on behalf of the CIEH, policy officer Jenny Morris said: Peanut allergy,
for example, has risen dramatically in recent years and only small amounts of the nut
can cause fatal or near fatal reactions.
While businesses are currently reviewing their food safety management
procedures, to comply with new legislation, it is an ideal time to ensure that those
procedures address the serious risk allergens can pose.
The DVD provides guidance on the common types of food allergens, such as nuts,
milk, egg, fish and shellfish, soya wheat and sesame. Common causes of concern, such
as unintentional cross contamination, proper cleaning, the safe preparation and
cooking of foodstuffs, are explained.
Training of staff, so that they have knowledge of ingredients in products they sell,
and their potential to harm allergy sufferers, is also an essential ingredient of the
DVD.
To obtain a copy please email AMT productions, makers of Action for
Anaphylaxis, at: dvd@amtproductions.co.uk
For further information and to view a clip of the film please visit: www.
amtproductions.co.uk
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LACA
School caterers plan to use a national television campaign to convince parents that
Jamie Oliver is not the only cook capable of serving up healthy school meals.
A spokeswoman for the Local Authority Caterers Association (LACA), Hazel Green,
said the TV chef was to blame for the slump in demand for school meals. Ms Green
said caterers would use the adverts to prove to parents that their school meals were
equally as healthy as Olivers creations.
Jamies School Dinners was seen as the driving force behind the governments
decision to introduce tough new nutritional standards in the autumn. Since the show
was launched, in March last year, school meals have fallen from favour, threatening to
put some caterers out of business.
LACA, which represents the suppliers of 85 per cent of school meals, says there has
been a 12.5 per cent drop in the consumption of dinners since Olivers show first aired.
Vol. 36 No. 5, 2006
pp. 365-380
She said Oliver may have correctly identified a few bad school meals" but most Emerald Group Publishing
Limited
E
caterers only used fresh raw ingredients.
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The adverts, will focus on the new standards school caterers will be following,
which include limiting chips to twice a week and serving at least two portions of fresh
fruit and vegetables a day.
Ms Green said: What we want to do is make parents aware of these standards and
the importance of school meals in providing quality nutritional food.
Recycling milk cartons
Tetrapak provide 200 million school milk cartons each year and work with the Milk
Development Council. Along with other dairy industry partners, we help fund the
School Milk Project under which a team of facilitators visit schools to promote the
uptake of school milk.
http://www.tetrapakrecycling.co.uk/07.htm
Danone Institute
The Danone Institute have produced information on Novel concepts in the
developmental origins of adult health and diseases which is available on their
website. More information can be obtained from Barbara Vanheule, Protein Health
Communications, Av Louise 287, Box 5, 1050 Brussels Belgium.
Chestnut flour
Chestnut flour is an ideal substitute for wheat flour. It is 100 per cent natural; gluten
free; moderate carbohydrate (mostly starch, moderate energy); high sugar content
(natural sugar of 25 Brix); low fat and no cholesterol; and is very fine powder (about
70 per cent pass 200 mesh) plus very useful fibre, protein, minerals and vitamins
all of which enhance health in general.
You can contact us by email: xd-robert@263.net or wxdrobert@gmail.com
Mountglory Food Corporation, Shijiazhuang, Hebei, China, Web: www.chestnutchina.com.
President HCA
Lady Caroline Waldegrave has agreed to become the President of the Hospital
Caterers Association. Lady Waldegrave is a fellow caterer who was previously
involved at Guys Hospital.
She is a published author and was a Founder President and Managing Director of
Leiths School of Food and Wine who appreciates and understands the issues
surrounding hospital catering and the challenges of hospital caterers.
I understand that Lady Waldegrave will attempt to attend at least some of our
Conference, prior commitments allowing.
Real choice
New companies have registered with the Health Education Trusts Real Choice
healthy vending scheme: see www.healthedtrust.com/pages/realchoice for further
details.
Food in hospitals
The above seminar papers have just been published, and are available to order now.
The Westminster Diet and Health Forum (WDHF) seminar papers contain the text
of all speeches made, together with transcripts of the Q&A sessions, and additional
articles from interested parties.
Food in Hospitals discusses progress in hospital food service since the

implementation of the Better Hospital Food programme, and aims to share best
practice and move forward thinking on improving patients experience. Issues
discussed include the role of food in treatment and recovery, progress in hospital
nutrition and the future of hospital food, with a focus on practical solutions including
the introduction of snacks, upgrading food for visitors and staff, and improvement of
menus and supply chains.
If you would like to order copies of the briefing papers, please contact us again via
beth.allen@westminsterforumprojects.co.uk.
MEND
The MEND programme is a family-based prevention and treatment programme for
obesity, aimed at children aged 712 and their parents/carers. MEND emphasises
practical, hands-on learning about healthy living and exercise, expressly designed to
deliver sustained improvements in families diets, fitness levels and health for life.
The randomised control trial is currently averaging an attendance rate of 92 per cent
across five sites largely due to its relevance to the everyday lives of participants, the
research-based design of the 18 6 2 hour sessions and the fact that it is fun.
A high level of interest in implementing the MEND programme is from PCTs,
Local Authorities and other local or national bodies either as a pilot or, in some
cases, as a multi-year multi-site implementation for hundreds of families (in fact we
are starting one such project in May). This is despite, or possibly because, of the
current tightening of budgets in the NHS. One of the major benefits of the MEND
programme is that it is a relatively straightforward way to implement a multidisciplinary/agency intervention cost-effectively. Our train the trainer approach,
coupled with the detailed trainers manual, allows a number of people to devote a
small portion of their time, e.g. one hour per week, to the project thus minimising
impact on peoples stretched time and finances. The detailed training and manual
also allow non-specialists to become trainers, further reducing the costs. It does not
need a large team or even full-time attention from one person. Where Choosing
Health money has been retracted or reduced and a full obesity team cannot be put
in place for some time MEND allows PCTs to begin to make immediate progress
towards their PSA targets. In addition MEND can be deployed as both a treatment
and a prevention.
MEND programme, 3rd Floor Norvin House, 4555 Commercial Street, London E1
6BD, United Kingdom. www.mendprogramme.org
Randomized control trial (RCT)
The multi-site RCT being conducted into the efficacy of the MEND programme as an
obesity treatment programme for children is continuing at the Institute of Child
Health, University College London. At the end of May, we will have 6-month data on
92 families and will begin the analysis and write-up of the RCT results. The RCT will
continue to run after May, with additional childrens data being added to the sample,
and with additional follow-up assessments being conducted on all the children at 6
and 12 months. We believe that this RCT will constitute one of the largest sets of data
on a community child obesity intervention in the UK.
While we are not permitted to release any comparative data between control and
intervention groups from the RCT prior to completion (i.e. not before June/July), I have
Food facts
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attached a slide containing some preliminary results from 41 children who have
completed the MEND programme intervention. Statistically significant results were
achieved in most of the key outcome measures, including BMI reduction and waist
circumference reduction (see attached). A notable point to mention is that across all
five sites participating in the RCT, over a period of a year, only 3 of the 92 children
recruited dropped out. This, combined with an overall mean attendance rate of 92 per
cent is both impressive and unusual in such a long programme (ten weeks; twice
weekly for two hours). Furthermore, we were pleased to see that these preliminary
results show very similar health improvements to the successful results achieved on
MENDs initial research pilot, conducted in 20022003.
MEND rolls out across PCTs in London, Suffolk, Essex and Northamptonshire
We continue to receive a significant amount of interest in the MEND programme from
PCTs, Local Authorities and other local partners looking to implement obesity
treatment (or prevention) programmes. (It is important to note that while the RCT is
focusing on treatment of obesity, the MEND programme is also suitable for use as a
prevention programme, as it is expressly NOT a diet but rather a healthy lifestyle
programme teaching children and parents about sustained behavioural change,
healthy eating and the benefits of exercise).
MEND is currently running at two sites in Lewisham (London) and in Southwark
(London) and Waveney (Suffolk), with new programmes anticipated to start
Essex, London and Northamptonshire in May. Many other PCTs are in active
discussions with us about implementing MEND in their local areas. (See Private
sector sponsorship below for details of more programmes running and starting in
May.)
PCTs and LAs are pursuing varying strategies in relation to rolling out MEND at
the moment. Some are engaging in quite extensive multi-year programmes involving
multiple sites and total numbers of families covered in the 60300 range. Others,
(often due to budgetary constraints) are initially implementing MEND on a pilot basis
(1215 families) as a starting point to develop an evidence base, with the idea to then
use this evidence base to substantiate funding for a more comprehensive roll-out
thereafter.
Based on feedback we have been getting from PCTs running the MEND
programme, it is becoming increasingly evident that that the key differentiating
attributes of the MEND programme as an obesity solution (as compared to other
locally-administered obesity programmes) are:
N Statistically significant results achieved in key outcome measures such as BMI,
Waist circumference and cardiovascular fitness.
N Recruitment of children and families has been relatively straightforward.
Indeed, programmes are often over-subscribed.
N Very high retention and attendance rates: Average attendance and retention
achieved on MEND programmes completed to date is 92 per cent with only
three drop-outs.
N Quality-assurance and standardisation: The MEND teaching manual consists of
almost 300 pages, comprising 18 structured sessions, all of which are lessonplanned, contain plenaries and are accompanied by multiple handouts to
reinforce key messages. MEND trainers are also required to go through four
days of MEND training and satisfy a test of knowledge before being approved
to run the programme.
Food facts
N External monitoring and evaluation: MEND analyses the measurement data

collected on the programme and reports the data back in concise, statistical
reports, providing the requisite monitoring and evaluation required to justify
(further) results-based funding.
It is interesting to note that PCTs are being very creative how they go about financing
MEND in the current climate of budgetary pressure and uncertainty combined with a
lack of ring-fenced obesity funds. They often engage in multi-agency collaboration
with Local Authorities, local leisure centres and schools, and tap into a combination of
different funding sources, including, for example pump prime funding through
LPSA/LAA stretch targets for obesity; using obesity training money to pay for the
training element of the MEND costs; combining Choosing Health money and Health
Inequalities money to fund MEND (since the incidence of obesity has been shown to
be higher in areas of greater social deprivation), tapping into NRF and NDC funding in
areas of social deprivation, etc. If you are interested in running a MEND programme
in your area, we would be pleased to facilitate a brainstorm on this issue and provide
you with examples of innovative practice.
MEND as a practical and cost-effective means to achieve the governments PSA target
Tackling child obesity first steps, the joint report by the National Audit Office, the
Audit Commission and the Healthcare Commission warns that there is a risk that
the Governments target to halt the rise in obesity in under-11s will not be met. The
research-based MEND programme has been specifically developed to ensure that it
can be rolled out rapidly and cost-effectively in a standardised manner it is literally
a solution in a box. It is this investment and its multi-disciplinary nature that allow
rapid implementation. Multi-agency working can be fraught with difficulty and
frustration, especially if the solution has to be invented by the team before it can be
delivered. However, MEND allows you to bypass this due to the clarity of its training
materials, including a 300 page manual with 100 handouts per participant. In
Waveney, Suffolk, the Public Health Clinician said, Everyone gave a little bit to
deliver the whole Programme, yet it met everybodys individual targets. The 2 6 2
hours per week Programme was delivered by two PE teachers from Education,
one Counsellor from Social Services and a Nutritionist and a Dietitian from the PCT,
each contributing about an hour per week a case-study of multi-agency good
practice.
MEND believes strongly that the private sector bears the same responsibility as the
public sector in being part of the solution to the obesity crisis and to financially
supporting community-based programmes like MEND that will allow as many
families as possible nationwide to benefit from learning about how to bring about
long-term improvements in their nutrition, fitness and health. In this respect, we will
continue to work to secure private sector sponsorship for MEND.
MEND receives positive feedback from government departments, agencies and the
charitable sector
In recent months, we have had positive and encouraging cross-departmental policy
discussions with senior officers leading on obesity at the Department of Health,
Department for Education and Skills and the Department for Culture, Media and
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Sport, who have expressed great interest in MEND and community-based obesity
programmes like MEND. Furthermore, positive discussions have been held with
senior Healthy Schools representatives, and Sport England has indicated a willingness
to match-fund an emerging MEND project being planned for East London.
MEND has received endorsement from The Obesity Awareness and Solutions
Trust and has had discussions with several charities regarding the possibility of
engaging in (further) joint research into obesity and obesity-related illnesses and is
also engaging in the current public consultation on NICE Guidelines regarding child
obesity.
Consistently positive feedback received from children and parents who have been on the
MEND programme
Please take a look at the attached testimonials for examples of the type of
representative feedback that both children and parents/carers consistently give us
about their experiences both on (and, more importantly, several months after) the
MEND programme. We believe strongly that it is much more powerful to hear directly
from the beneficiaries themselves, in what ways they feel they have benefited from
MEND, than anything we could say.
New services
N Obesity management solution. We are increasingly being asked by PCTs about
the possibility of being able to offer MEND as a managed solution i.e. where
MEND would employ and provide the staff and run the programme for you, as
well as do all the recruiting, assessments (pre and post) the programme and the
monitoring and evaluation, thereby negating the need for any internal PCT
management time or resources to implement MEND. We are able to offer this to
those interested although we would strongly advise that this is not generally the
best solution it is preferable, where finances allow, to train local staff to run a/
several MEND programme(s).
N One-day obesity training for health-care professionals (HCPs). At the request of
several PCTs seeking to invest their obesity training funds in the most
meaningful manner, we have created a one-day obesity training session for
training front-line staff/HCPs on obesity (see attached outline). The training
incorporates and explains the current guidelines contained in the Department of
Healths Obesity Care Pathway Booklet as well as Measuring childhood
obesity: guidance to primary care trusts. In addition the training provides
knowledge and a selection of practical insights learned from the MEND Pilot
Study as well as the current MEND RCT. The cost for this is 50 per person for
up to 30.
Weight management
The Weight Management Guide has now been finalised and launched at:
www.weightmanagementguide.co.uk
IFST
The IFST has re-launched its website (www.ifst.org). The new-look site has been
completely rewritten and rebuilt using a content management system to provide
improved functionality and navigation. The website will provide many extra facilities
such as easy access to information services, on-line membership application and

publication ordering via the online shop.
An additional feature is the exclusive Member Only area which will provide many
new services including:
Food facts
N downloads including the latest keynote and food science and technology
meetings;
N a young members area which includes information on employability skills,
exam techniques, graduate recruitment and revision techniques amongst many
others;
N facilities to update your membership details and pay your subscription online.
Water for health

Two new key Alliance members join the work to improve hydration, Sport Relief 2006
has water at its heart; water as a basic nutrient; tap water at conferences and bottled
water in Governments; community initiatives from regional water companies.
Royal College of Nursing join Alliance
Building on the Water for Health Alliance work to improve hydration in NHS
hospitals, we are delighted to advise that the Royal College of Nursing have now
joined the group, and they will be active in building and promoting the message of
good hydration to patients and to staff. The RCN represents nurses and nursing,
promotes excellence in practice and shapes health policies. They lobby governments
and others to develop and implement policy that improves the quality of patient care,
and builds on the importance of nurses, health care assistants and nursing students to
health outcomes. Provision of fresh drinking water is an important part of their
approach to good health and nutrition, and RCN believe water can contribute
positively to patient recovery. www.rcn.org.uk
Consumer Council for Water join Alliance
The Consumer Council for Water (CCWater) has joined the Water for Health Alliance,
bringing with them very welcome direct representation for the many consumers in
England and Wales. CC Water is independent of both the water industry and its
regulators, and its Chair is respected health professional, Dame Yve Buckland. CC
Water advise that Water is a valuable and precious health resource for society, and
having water on tap a safe, secure, reliable supply of water is absolutely essential
for maintaining a healthy lifestyle, and a wholesome diet. CCWater are very active in
ensuring that customers are empowered with the information they need, to be able to
demand the best value from their water suppliers. They advise that Helping
consumers to recognise the important health benefits of their water supply, and
promoting the significance of remaining well hydrated throughout the day is central
to this work. www.ccwater.org.uk
Water a key partner of Sport Relief 2006
The 2006 Sainsburys Sport Relief Mile is about to be launched by the BBC and Comic
Relief, supported by many of the UKs top celebrities, sports stars and comedians. As
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part of the Water for Health work, the UK water industry has joined together to
become a partner to the event, and tap water is now the official drink of this high
profile occasion. In 2004, 81,000 people donned a single red sock and took part in the
first ever Comic Relief led Sport Relief Mile. It incorporated 14 national and 125 local
events, raised 5 A316 million, involved 253 celebrities and attracted 8.2 million
viewers to the Sport Relief programme on the BBC. The people who went the extra
mile on the day included Prince William, and Prince Harry, Prime Minister Tony
Blair, Sir Steve Redgrave, Jonathan Ross, Dame Tanni Grey Thompson, Frank Bruno,
Chris Moyles, Rachel Stevens, Gordon Ramsay, Jo Brand and many, many more. This
years Sainsburys Sport Relief Mile will be even bigger, with 15 BBC televised events
across the UK, 200,000 registered participants and UK wide support from
personalities. Water and all the positive health messages of good hydration will be
featured prominently in the Promotional material, water companies will provide fresh
tap water to each televised flagship event, tap water will be provided to the related TV
programmes such as Ready Steady Cook, Blue Peter and A Question of Sport Relief
and the health benefits of drinking water will be endorsed by high profile celebrities
who have fully backed the work to improve the nations health. Past beneficiaries of
funds raised by Sport Relief have included Water for Health Alliance members
WaterAid and Action on Elder Abuse. www.sportrelief.com
Scottish Water leap the water hurdle
Lee McConnell, the UKs number one four hundred metre sprinter is backing the
Scottish Water On Tap campaign for Scots to drink more tap water. Underlining the
importance of drinking enough water, she advises As I have a degree in Sports
Science and Nutritional Management I am very aware of what is and isnt good for
me. Drinking the right amount of water helps keep you hydrated and keep
concentration and energy levels at their peak. Drinking water is so important to
everyone, but as an athlete its vital. Your muscles need to be well hydrated at all
times to make sure they function properly and when youre training and sweating
you need to make sure that you replace the fluid youre losing. But, you dont have to
train like a professional athlete to achieve a healthier lifestyle. Everyone can
help boost their memory and energy levels with the turn of the tap. http://www.
scottishwater.co.uk
Wise up on Water
medical evidence leaflets now available direct Water for Health Alliance members
have been contacting Water UK recently to ask how they can get printed copies of
the Wise up on Water leaflets, and also the brand new Hydration Best Practice
Toolkit for Care Homes to use at their conferences, meetings and to support their
policy work. Having investigated the requirements of the Alliance, Water UK has
developed two methods of obtaining the literature. All documents are now available
to download free of charge from the Alliance website www.waterforhealth.org.uk/
and conference teams can simply download what they need for delegate packs,
meetings etc.
Water Aid Drink More Water Campaign
Committed Water for Health Alliance supporters, Water Aid, are continuing to raise
the profile of the important links between good hydration and good health through
their Drink More Water campaign. The excellent initiative is actively encouraging
UK companies to promote tap water provision for the health of their employees in the
workplace, and to use that educational platform to raise money for those who have no
safe water provision at all. In support of the latest part of this campaign, Bodyshop
founder Anita Roddick says Water is elemental, life-giving and sustaining. It flows
out of our taps so easily that we rarely give it a second thought, yet many of us do not
drink enough. Water really does help you at work, rest and play for our health and
beauty what could be simpler than to drink more water? The developing WaterAid
work can be seen www.wateraid.org/uk/get
NHS Direct hydration advice on line
The NHS internet and telephone advice service has increased its advice on the subject
of hydration www.nhsdirect.nhs.uk
NHS Good Practice in Continence Services
For carers, incontinence is sometimes the last straw and is often a major reason for the
breakdown of the caring relationship which can then lead to admission to residential
or nursing home care. Often dehydration can play a major part and increase the
likelihood of soiling incidents, as concentrated and highly acidic urine is expelled
automatically by the body. NHS has issued its latest guidance for best practice in
continence care and it reinforces the important role of the Availability of accessible,
clean, fresh-water drinking facilities The full information is available from the NHS
response line 0541 555 455.
Scotland increase water provision for oral health
In its Action Plan for improving oral health and modernising NHS dental services, the
Scottish Executive has again increased its focus on healthy fluids and its expectations
are that by 2007 NHS and Local Authorities should expand oral health programmes to
ensure that All schools have supporting healthy eating and drinking (water)
policies. The Executive have already increased childrens access to fresh drinking
water by 600 per cent, and have funded improved water facilities through increases in
the school meal funding system. Further information on the guidance can be seen by
ordering ISBN 0-7559-4557-8.
Office of the Deputy Prime Minister swing to tap
Just before Christmas, the ODPM/MITIE launched a re-usable bottle scheme for the
water provided at official Government meetings. General guidance within
Government offices is now to move away from bottled water, although while this
particular scheme has both financial and environmental benefits, ODPM has recently
advised their staff that these are not being met because bottles are going missing or
are not being returned after use. Details of the scheme can be obtained from Andy
Barnes andy.barnes@odpm.gsi.gov.uk
Netherlands say Neau to expensive bottled water
Sold as an empty bottle, that requires the buyer to fill it up from their own tap, there is
a new brand of water in the Netherlands that is rapidly making a name for itself. Neau
is positioning itself explicitly against the bottled mineral water trend by advertising
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the fact that Netherlands tap water is of renowned and excellent quality; and tastes
good. And that is exactly the crux of Neau, says Menno Liauw, of Amsterdam-based
advertising bureau Vandejong and Stichting Neau (the Neau Foundation). Neau is
being sold in empty bottles that you can fill with drinking water, over and over, as
often as you like, he explains. The Neau brand has a dual effect: It makes people
conscious of the worldwide water problem, and its revenues are spent in drinking
water projects in underdeveloped countries in Africa, Vietnam, Peru, and other poor
parts of the world. These drinking water projects are being coordinated by wellknown Dutch charity organizations like Unicef Nederland and Plan Nederland, with
whom Neau cooperates. Neau is being sold in the form of a firm, clear blue plastic
bottle at the price of regular mineral water. However, the bottle is empty. Instead of
water it contains a rolled-up Neau flyer, a message in a bottle that explains Neaus
position. Liauw explains. When you drink a bottle of Neau, he continues. You
indirectly provide a refugee camp in Sudan with seventeen litres of clean drinking
water.
Tap water offered at all future conferences?
Following a recommendation from the last Water for Health Alliance meeting, the
Chartered Institute of Environmental Health, UKPHA, Water UK and an active
Primary Care Trust are now working together to develop guidance for conference
organisers to have fresh, iced tap water served at conferences. Many organisers have
either been pressured in to buying large volumes of bottled water, or have simply felt
they do not have the option of tap at large commercial venues. In practice many
venues are very happy to meet the needs of their clients as long as they fully
understand what is required of them, and the implications of not simply providing pre
packaged water. Where venues do not offer tap water, or advise that they can not, a
little effort can see this turned round. Campaigner of the month award goes to UKPHA
Chief Executive and Water for Health Alliance supporter Angela Mawle for an
incredible job in getting tap water supplied across their huge national conference in
Telford recently. In the face of many dubious objections by the venue owners, Angela
pursued the point on the grounds of sustainability, good hydration and the protection
of public health and eventually had the entire event served with iced tap water.
Angela has inspired us all to build iced tap water into our conference contracts from
the start and insist on it at the point before we place the order.
Fresh water for delegates at Bournemouth Care Conference
Following an invitation from Alliance members, the National Association of Care
Catering, Water UK spoke on the importance of hydration at the Care Home
Conference and local water supplier Bournemouth and West Hampshire Water
provided a tap water tasting for all the delegates. Fresh tap water was consumed in
large quantities and received excellent feedback on the taste, as the Bournemouth
Water Company innovatively served it to delegates directly within the main
auditorium. The team encouraged people to adopt water as part of healthy nutrition
and offered side servings of freshly prepared strawberrys, pineapple, oranges and
melon. www.bwhwater.co.uk
Thames Water bring hydration to older people in Nunhead
Thames Water have been working in partnership with Age Concern Southwark to
promote the Nunhead Healthy Ageing Centre to people living in the local area. At a
recent launch event, Thames hosted an open day, inviting local residents aged 55 and
over to attend activities including exercise classes, a sing along with the Pearly King
and a talk and walk presentation by the Southwark Primary Health Care Trust
aimed at promoting the benefits of walking for exercise. Water was made available
throughout the day and local residents were given encouragement to take on board
the health benefits of drinking more fluid. The main aim of the open day was to
encourage people to make greater use of the valuable services provided by Age
Concern, and to raise awareness of the importance of healthy ageing, in particular the
benefits of drinking water for good hydration. www.thameswater.co.uk
Top Chef says water is an important part of nutrition
Top chef and restaurateur Anthony Worrall Thompson has agreed to support the
objectives of the Water for Health Alliance, and has kindly given the work a
supporting statement to help encourage people to ask for tap water when the eat in
restaurants and cafes. He advises that The way we give our customers an enjoyable
dining experience is to give them what they want we wouldnt have any problem in
serving fresh tap water in our restaurant, and we have done so for years. Water is an
important part of good nutrition, and drinking enough each day is an essential
ingredient for a healthy life. Alliance members are working hard to give the public
the knowledge and confidence they will need to simply ask for tap water with their
meals, and to help overcome their beliefs that they will be frowned upon if they choose
not to order bottled water. More supporting statements will follow as UK chefs
endorse the health drive.
Nutrition for Life says Get in to the habit of drinking water
Nutrition for Life. In its pages it advises that water is an essential part of the diet,
the best drink to quench thirst and that we all need to drink six to eight glasses of
water each day, with more when it is hot or when we are exercising. The diet manual
advises on the high quality of UK tap water and ensures that readers understand the
importnace of water to the body. Involved in every function of the body, water
controls body temperature; gives you energy, assists in weight control....and is needed
for all digestive, absorptive, circulatory and excretory functions. ISBN 1-4053-03069520.
Northern Ireland MP flabbergasted over bottled water bill
The Northern Ireland Office has landed itself in hot water after admitting spending a
significant on bottled water in the last year.
Severn Trent aid bottle water purge at Council
Thanks to the Alliance members for the BBC report (20 February 2006) that a purge
on lunch time perks at Gloucestershire County Council has so far seen the taxpayers
bill for county councillors lunches fall by two-thirds. Councillor Barry Dare, leader of
Gloucestershire County Council, said the drop was thanks to several measures
introduced by the Tory administration. Since the Conservatives took control we have
banned free lunches for councillors and are looking to change council rules to prevent
councillors claiming expenses for lunches. We are also working on replacing bottled
water with tap water at council meetings which should save even more money.
Director of customer relations at the water provider Jonathan Bailey said using tap
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water saved the taxpayer thousands. It would cost 73p a year for a person to drink
eight glasses of Severn Trent water a day.
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Oh! Sushi
An observant Alliance member sent in this web consumer feedback contribution
criticising the well known Sushi Company for its bottled water charges in restaurants.
The clearly irritated customer advised The food was fair value for money.
What infuriated me was that you charge for still or carbonated filtered tap water.
I didnt see that there was a charge, until I came to pay the bill. If I went into a
restaurant and asked for a jug of tap water I would not pay for it under any
circumstances.
Ofsted on Healthy Eating in Schools
As preparation for a major survey of food in schools to be carried out in 2006/07, Her
Majestys Inspectors of Schools (HMI), accompanied by nutritionists appointed by the
Food Standards Agency (FSA), undertook a small scale survey, including visits to ten
schools from clusters of primary and secondary schools in three local authorities. It
notes the success of introducing drinking water in to the top performing schools, but
fails to draw the obvious conclusions in its summary. The report also fails to link the
expectation of the Secretary of State that free, fresh water should be provided, with the
fact that in many schools it is simply not available. Additional evidence was gathered
from over 50 reports of school inspections that had been conducted under the new
framework for inspection, from reports on personal, social and health education
(PSHE) and from reports on schools visited as part of a survey on learners. health and
well-being. The report assesses how schools have responded to guidance on school
meals and healthier eating. It uses case studies as examples of how schools have
improved pupils healthier eating and the quality of school meals
Primary Schools www.ofsted.gov.uk/publications
Food Technology in Secondary Schools www.ofsted.gov.uk/publications
Parliamentary Questions on water in the schools
Paul Burstow MP has asked the Secretary of State for Education and Skills:
pursuant to the answer of 14 December 2005, Official Report, column 2,074 W, on
drinking water, whether she plans to issue guidance to schools on drinking water
provision in relation to the aims of her healthy schools policy. Jacqui Smith
responded: In order to keep properly hydrated throughout the day, children need
access to water at school. The promotion of good hydration is included within the
Governments Food in Schools programme (www.dh.gov.uk/PolicyAndGuidance/
HealthAnd SocialCareTopics/FoodInSchools), which supports the National Healthy
Schools Standard (www.wiredforhealth.gov.uk). It advises that good quality
drinking water should be available to pupils throughout the day and not from
taps or drinking fountains located in toilet areas (http://foodinschools.datacenta.
uk.net
Care Directions
Care Directions has written to advise the Alliance that, as an internets guide to care
and the rights of older people, they are now publishing the hydration message for
older people. They say that gradual, steady loss of body water is a factor of ageing
and older people do become dehydrated more easily. Dehydration can then be a major
complicating factor of illness and can have a negative effect upon recovery prospects.
Fear of the likelihood of urinary incontinence and the need for visits to the toilet, will
also mean that many older people will be reluctant to drink as much as they should.
This frame of mind is, of course, made worse when diuretic medications (water
tablets) have been prescribed. Care Directions advise that whatever the reluctance to
drink, the effort really must be made. Water intake is vital, as dehydration can result
in illness, mental confusion, and can speed the ageing process generally. Care
Directions recommend that older people should drink at least eight cups of fluids a
day. It is worth noting that tea, coffee, fizzy drinks or worse, alcohol, actually contain
dehydrating agents. They advise older people that for every alcoholic drink you
consume, you will lose the same volume of water from your body. www.caredirections.co.uk
Water related malnutrition in care
Water for Health Alliance members, The English Community Care Association, has
welcomed the National Institute for Clinical Excellences latest guideline on tackling
malnutrition in the NHS, but wants to ensure that there is a properly co-ordinated
approach between NICE and CSCI who are the body responsible for regulating care
services. The National Institute for Clinical Excellence (NICE) and the National
Collaborating Centre for Acute Care have launched a clinical guideline to help the NHS
identify patients who are malnourished or at risk of malnutrition. It recommends that
all people in care homes should be screened on admission and when there is clinical
concern. It also recommends that all healthcare professionals who are directly
involved in patient care should receive education and training on the importance of
providing adequate nutrition. ECCA advised NICE that the training and education
could benefit from the hydration toolkit for care homes produced by the Alliance. The
toolkit provides fact sheets, checklists and advice to enable care homes to improve
water consumption with older people and care home staff. ECCA said ECCA
members strive to provide high quality care and nutritious food. Malnutrition is a
complex issue and although the NICE guideline is welcome, it is essential that CSCI
inspectors have the relevant training and experience to examine malnutrition on a
case by case basis rather than a statistical basis which may not allow for differing
circumstances.
Fresh tasting water
Three Valleys Water Company has advised us of their guide to ensuring that the
public in their region continue to get great tasting tap water. Keep your water tasting
fresh covers everything from household plumbing to chilling water in the fridge.
www.3valleys.co.uk/pdf/water_tasting_fresh.pdf
Health Professions Council
The Health Professions Council (HPC) consulted on proposals for a new Returners to
practice process from 1st July 2005 until 9th September 2005. When all the responses
were received (49 responses from organisations and 17 from individuals) they were
analysed and assessed in order to draw out the key themes. As part of the
consultation process, the HPC also investigated the various approaches taken by other
regulators.
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Article 19(3) of the Health Professions Order 2001 allows the HPC to, require
persons who have not practised for or during a prescribed period to undertake such
education or training or to gain such experience as it shall specify in standards... The
inclusion of the phrase in standards means that the HPC cannot carry out individual
assessments of returners requirements. The standards can make different provision
for different classes of returner. The following decisions have been made with regards
to those returning to practise after a period out of practice:
Health professionals who have been out of practice will be required to complete
a period of updating before they can come back onto the register. They should
complete this period before they apply for readmission. The period required are as
follows:
N 02 years out of practice: no requirements;
N 25 years out of practice: 30 days updating;
N 5 or more years out of practice: 60 days updating.
For further information about the consultations, please contact Rachel Tripp on 020
7840 9760 or email rachel.tripp@hpc-uk.org
Snacks and drinks
www.swipevending.com There you will find comparisons and analysis of the
nutritional value and ingredients of popular snacks and drinks vended in the UK.
Cholesterol lowering cheese
Fayrefield Foods, the UKs largest independent dairy company, is launching
heartfelt+, a fully flavoured 12 per cent fat cheese, in the UK. Heartfelt+ cheese has
been specifically developed to help people who want to lower their cholesterol and
maintain a healthy diet, while continuing to enjoy the taste of cheese.
Heartfelt+ contains ReducolTM, a well established and clinically proven ingredient
for lowering cholesterol safely and naturally. Reducol is a unique ingredient
containing plant sterols and stanols, which was developed by the Canadian company,
Forbes Medi-Tech Inc. Reducol is incorporated into foods such as milk, spreads and
yoghurts, to offer cholesterol lowering benefits to consumers who want to continue to
enjoy those products. It is supported by numerous reviewed clinical studies (see
www.reducol.com) and is supplied to manufacturers as an odourless, tasteless powder
that contains no fat, protein or carbohydrates. The combination of a prudent diet and
consumption of products containing the recommended amount of Reducol may help
consumers to lower their cholesterol by up to 24 per cent.
HPC introduce CPD
The Health Professions Council (HPC) will require all health professionals on the
Register to undertake Continuing Professional Development (CPD) from 1st July 2006.
This will now be a legal requirement for the future registration of 170,000 health
professionals across the UK. The first audit of these standards will take place in July
2008 with chiropodists and podiatrists being the first profession to be audited,
followed by operating department practitioners. The 11 other professions currently on
the HPC register, will be audited during 2009/2010.
The standards mean that health professionals will have to provide evidence of CPD
relating to their previous two years of practice from summer 2008. The evidence will
have to show that the CPD an individual has undertaken has contributed to the
quality of their practice and demonstrates that it benefited the service user. The
standards apply not only to those in clinical practice, but also to those working in
research, management or education.
Speaking about the CPD standards, Professor Norma Brook, President of the Health
Professions Council said:
This is an important event in the development of self-regulation. We believe that it
is a vital part of our basic function, which is to protect the public, that we require
individual registrants commit themselves to their own professional development and
that employers, too, recognise the importance of CPD. We will therefore be requiring
all of our registrants to undertake CPD and be seeking to ensure that the CPD carried
out by our professions is robust and effective.
The HPC offers a clear framework with flexibility at the centre of our decisions,
but CPD will be the responsibility of the individual.
The Health Professions Council is an independent, UK-wide health regulator set up
by the Health Professions Order (2001).
Hospitality Leadership Excellence Survey
The 2006 Hospitality Leadership Excellence Survey. This involves conducting indepth interviews with up to 25 of the top leaders in the UK hospitality industry to
identify how they approach their leadership role and what makes them so successful.
The Chartered Management Institute recently asked over 1,000 mid-ranking
managers what they thought about their work. The respondents, more than 40 per
cent of them women, came from a mix of private and public sector companies and
organisations, including some industry big players.
Nearly 80 per cent felt that a major influence on job satisfaction for managers was
to have autonomy. It was clear from the research that senior managers who give their
junior colleagues a free hand are those that are respected.
http://www.hospitalityleadership.com
New standards for school food
The new standards for school food were announced on Friday 19 May. This is a
robust set of standards which will make an important contribution towards improving
our childrens health. You can view them on the DfES website:
www.teachernet.gov.uk/wholeschool/healthyliving
www.schoolfoodtrust.org.uk
FSA meeting
The FSA board meeting was in Bristol on 15th June. You might like to see agenda
papers on eating for health strategy.
http://www.food.gov.uk/news/newsarchive/2006/jun/bristol
4th International School Milk Conference
The full conference programme is available on internet: http://www.schoolmilksa.
co.za/
Time permitting, all delegates will be encouraged to participate in the conference
by: making a country presentation; making a presentation on a specific school milk
related issue; having a poster/display presentation.
See the registration form for details.
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MIP
MIP Technologies has just brought out a highly innovative way of detecting the
presence of beta-blockers in water using molecularly imprinted polymers separation
technology.
N A wide variety of pharmaceutical compounds have been detected at low levels
(10400 mg/L) in aquifers, sewage treatment plant effluent, and rivers in several
areas of Europe, that could pose a threat to living organisms.
N Often the improper disposal of unused or expired pharmaceuticals leak out of
landfills and infiltrate water supplies.
N Pharmacokinetic studies have shown that more than half of all pharmaceutical
compounds consumed are excreted unchanged from the body into wastewater.
These compounds can potentially survive sewage treatment systems because of
their high stability against biological degradation. While the potential effects of
these compounds on humans and aquatic organisms are unknown, a method
of detection would be the first step in the investigation toward defining the
potential risks.
Book reviews
Book reviews
Micronutrient Deficiencies in the First Months of Life
Francois M. Delange and Keith P. West Jr
Karger-Nestle Nutrition CV 4358
381
This is a very specialised book consisting of a series of papers on international studies

on micronutrients and infants.
It would be of assistance to those studying in this area or developing products for
use in infant feeding.
Weight Matters for Young Children

Rachel Pryke
Radcliffe
ISBN 1-85775-772-6
Obesity is a major problem for children and young people and with approximately 30
per cent of children being overweight and obese, help in dealing with it is important.
Throughout this book, guidance is given for helping young people take
responsibility and work at helping themselves with various strategies to lose weight.
It will be useful for anyone dealing with overweight young people.
Nutritional Support For Adults and Children a Handbook for

Hospital Practice
Edited by Tim Bowling
Radcliffe
ISBN 1-85775-831-5
Nutritional support is critical in times of trauma and serious illness.
This is a very specialised book giving very clear guidance on how to feed patients
and procedures. It is an excellent resource for specialists such as dietitians in this area.

Vol. 36 No. 5, 2006
p. 381
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Conference reports
Hospital Caterers Association National Conference
April 2006
The Hospital Caterers Association held its Annual Conference in April 2006 at the
Hilton Birmingham Metropole Hotel on the National Exhibition Centre Campus. This
year the member organisations of Healthcare Caterers International (HCI) attended the
Conference.
The association was delighted to host HCIs 2nd International Symposium which
this year focused on nutritional care. The main topic of the symposium was on
dysphagia.
The conference included a large exhibition of more than 60 food and equipment
suppliers which was open and free of charge to non-delegates on Thursday 27 April
2006 from 10.30 am to 4.00 pm.
For further information, please contact www.hospitalcaterers.org
Chartered Institute of Environmental Health (CIEH)
The CIEH has produced a new level 2 qualification in Nutrition. This is a short course
culminating with an examination and covers a basic level of nutrition.
It is organising various training seminars around the country for trainers who wish
to deliver the course as well as providing course books and trainers notes and
information.
More information is available at: www.cieh.org/events or call the events department
on 020 7827 5856

Vol. 36 No. 5, 2006
pp. 382-383
0034-6659
Westminster Diet and Health Forum Consultation Seminar: Food

Promotion to Children
Timing: morning, 1 June 2006; venue: Westminster, SW1
This meeting brought together key stakeholders to discuss Ofcoms consultation on
food advertising to children. Timing of this seminar was arranged with Ofcom to tie in
with their consultation. Its purpose was to provide an opportunity to share opinions
and to help move forward thinking in this area.
The discussions were reported in a policy briefing document an extremely
important output from the day. This publication contains transcripts of all the
speeches and comments made during the day, together with further articles submitted
by interested parties. It was distributed to the key figures deciding policy in these
areas in Government and Parliament, as well as to all delegates.
Ian Blair, who is leading the consultation for Ofcom, agreed to take part, together
with Rosemary Hignett, Head of Nutrition Division at the Food Standards Agency.
Claire Phillips, Director of Policy and Research at the Office of the Childrens
Commissioner, gave a keynote address.
Other speakers included: Andrew Brown, Chairman, Broadcast Committee of
Advertising Practice; Malcolm Earnshaw, Director General, Incorporated Society of
British Advertisers (ISBA); Trish Fields, Consumer Impact Director, Cadbury
Schweppes; Richard D. North, Media Fellow, Institute of Economic Affairs; Kate
Stross, Commercial Director, Ofcom; and a senior representative from Which?.
Attendees, invited from the contacts of both the Westminster Diet and Health
Forum and the Westminster Media Forum, were a senior and informed group
numbering over 100, including members of both Houses of Parliament, officials
involved in this area of public policy and representatives of industry, the food,
healthcare, media and advertising sectors, interest groups, consumer groups and
academia.
The Westminster Diet and Health Forum, and its sister forum the Westminster
Media Forum, are impartial and cross-party, and have enjoyed considerable support
from within Parliament and government. They organise senior level seminars on
public policy in nutrition and health, and media, which receive prominent coverage in
the national and trade media. The Forums have no policy agenda of their own.
For more information, please contact www.dietandhealthforum.co.uk
Vitafoods International
911 May, Geneva PALEXPO
Vitafoods International was held again in Geneva.
This exhibition had 50 companies exhibiting the latest products in the dietary
supplement, functional food and functional drinks industries. There were also 350
exhibiting companies organised into seven international pavilions which made it a
truly global event.
For more information, please contact Charlie Hastings, Marketing Director,
Vitafoods International.
Conference
reports
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nfs cover (i).

Volume 36 Number 5 2006

Nutrition & Food

Nutrition & Food

Children and young people

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Editorial board ______________________________________

Gaps in the awareness of current nutrition issues as

Prevalence of dieting, overweight, body image

Generating effective change in school meals: a

Breakfast frequency and fruit and vegetable

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Impact of household food security and nutrition

Habitual dietary calcium intake and body weight in

Nutritional knowledge and dietary intakes of young

Probiotic acidophilus milk for infants and children

Cultured milk products for lactose-intolerant

Book reviews _______________________________________

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John J.B. Anderson, PhD

Nutrition & Food Science

David C. Nieman, DrPH MPH FACSM

Professor Winston Craig

Claire Seaman, BSc, MPhil, SRD

Marcel Hebbelinck, PhD

Margaret Thorogood, PhD

Ann Reed Mangels, PhD RD FADA

Dr Margaret Ashwell OBE

Nutrition & Food Science

Gaps in the awareness of current

Summit Middle School, Boulder, Colorado, USA

Nutrition & Food Science

Awareness of sensible diet composition

Awareness of foods that are good calcium sources

Awareness of the power

age (in years);

the highest level of education obtained.

C. Questions on diet composition

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particularly in Western culture and within particular groups such as adolescents

Note: *NS5Not significant

BMI groups (kg m22)

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Generating effective change in

Claire Seaman and Julia Moss

The importance of integrating a healthy eating programme.

Changes in the food served over the years.

The importance of integrating a healthy eating programme.

PE teacher and Parent

How the programme has affected the children.

Results and discussion

children themselves, is likely to be a key to the success of future projects and

To purchase reprints of this article please e-mail: reprints@emeraldinsight.com

Breakfast frequency and fruit

P. Mullie, P. Clarys, D. De Ridder, P. Deriemaeker, N. Duvigneaud

A.R. Grivegnee and P. Autier

Nutrition & Food Science

One to four Five to six