Nutritionists in industry can play a key role in helping to achieve Health of the Nation targets for nutrition.

Nutritionists working in food manufacturing and retailing are potentially in a more powerful position than any other professional group to contribute towards achieving the national targets for nutrition and the reduction of nutrition-related diseases, set out in The Health of the Nation (DoH, 1992) and in Scotland's Health, A Challenge to Us All (Scottish Office, 1993). The present paper sets out the details of this argument. First, a review is given of the functions and types of activities carried out by nutritionists in industry. Then a number of key practical ways in which nutritionists, through their activities and functions, can help towards achieving national targets for nutrition and nutrition-related diseases are described. Finally, suggestions are made about the knowledge, skills, and personal attributes needed by nutritionists who intend making successful careers in industry and who wish, at the same time, to contribute towards improving the health of the nation.

Role of dietary carbohydrate and frequent eating in body-weight control.

Despite widespread interest in body-weight control, the prevalence of obesity continues to rise worldwide. Current public health advice for obesity prevention is clearly failing. The present paper examines the appropriateness of current public health advice for body-weight control, i.e. to reduce consumption of fatty foods, to reduce consumption of sugar and to avoid snacking between meals. An increase in carbohydrate: fat ratio should improve body-weight control, as high-carbohydrate low-fat diets are less likely to lead to overeating, and if overeating does occur, less of the excess energy is likely to be stored as fat. However, it is suggested that for the long-term prevention of weight gain, advice to increase consumption of carbohydrate-rich foods may be more effective than advice which focuses on reducing consumption of fatty food. Moreover, in view of the inverse relationship between fat and sugar intakes, sugar may have a positive role to play in body-weight control in facilitating an increase in carbohydrate: fat ratio. Snacking for most individuals appears not to adversely affect body-weight control, and for some it may improve control. This situation may exist because frequent eating helps appetite control, thus preventing overeating at meals, and as snacks overall tend to be higher in carbohydrate and lower in fat than meals, frequent eating may be a strategy for increasing carbohydrate: fat ratio. It is also suggested that eating 'little and often' may be a more compatible pattern of eating for a physically-active lifestyle than eating large meals. Perhaps the most appropriate advice on food intake that would work synergistically with concurrent advice to increase physical activity is to eat more carbohydrate, and to eat frequently.

Assessment of obesity in a community sample of prepubertal children.

The aims of this study were to quantify the effect of obesity definition on estimates of prevalence, and to determine the sensitivity and specificity of three commonly used definitions of overweight/obesity in children: body mass index (BMI) s.d. score > 2.00; BMI s.d. score > 1.04; weight > 120% ideal. A representative community sample of children in Edinburgh, Scotland (n=240, 124 boys and 116 girls; mean age 8.5 s.d. 0.4y) was recruited. Obesity was defined by a criterion method based on % body fat: > 25% fat in boys; > 32% fat in girls. Sensitivity of BMI s.d. score > 2.00 was relatively poor in both sexes (60% in girls; 36% in boys) but had high specificity (98%). Sensitivity of the other two clinical definitions was higher, and was better in girls than boys, but with lower specificity. Choice of definition had a profound effect on prevalence estimates. In conclusion, sensitivity of the definitions of obesity currently recommended for children, when tested in this sample, was heavily dependent on the definition used and differed between boys and girls. This should be considered when choosing a definition of obesity in clinical practice and epidemiology.

Body composition of healthy 7-and 8-year-old children and a comparison with the 'reference child'.

BACKGROUND: There are few longitudinal data on body composition in healthy children. This has prompted a reliance on notional standards such as the 'reference child', to validate new methods of determining body composition and comparing cross-sectional height, weight and fatness data. OBJECTIVES: These were twofold-to provide normative longitudinal data on changes in body composition in healthy pre-pubertal children, and to compare measures of growth and body composition with the appropriate age-specific reference child. DESIGN: A sample of healthy Scottish children aged 7-8y (n = 257) was recruited during 1991/1992. Data on height, weight, skinfold thickness and resistance from bioelectrical impedance analysis were collected twice, 12 months apart. Percentage body fat was estimated from both skinfolds and bioelectrical impedance. RESULTS: Fat and fat-free mass, but not body mass index, differed between boys and girls. All measurements increased significantly over the 12 month period except percentage body fat from skinfolds in boys. The reference child comparison revealed that our sample was taller, heavier and fatter and gained weight and fat mass at a greater rate than the Fomon standards. CONCLUSIONS: Data from the children in this study suggest that the reference child has a body composition which is now out of date. This may have important implications for body composition methodology. New references for height and weight may be required, but an upgrading of the body fat reference may conflict with public health aims to reduce obesity.

Evidence that eating frequency is inversely related to body weight status in male, but not female, non-obese adults reporting valid dietary intakes.

OBJECTIVE: To investigate the relationships between eating frequency (EF) and body weight status and to determine whether these relationships can be explained in terms of differences in physical activity levels, macronutrient intakes or energy compensation. DESIGN: Cross-sectional design; free-living subjects, 48 men and 47 women (aged 20-55 y, body mass index (BMI) 18-30), recruited in a workplace setting. MEASUREMENTS: Height and weight; skinfold thickness (four sites); EF, energy and macronutrient intakes (food diary, unweighed, recorded for seven consecutive days); physical activity (7 d activity diary and heart rate monitoring over 48 h period). RESULTS: In men there was a significant negative correlation between EF and body weight, and an inverse relationship with body mass index (BMI). EF was positively correlated with % energy from carbohydrate, although not with total energy intake. In women, there was no relationship between EF and body weight status; however, there were significant positive correlations between EF and total energy intake, and between EF and intakes of total carbohydrate and sugars. For both men and women, there were associations between EF and physical activity levels, approaching statistical significance. CONCLUSIONS: In men, the association between increased EF and lower body weight status may have been influenced by increased physical activity levels. As energy intake did not increase with EF, men appear to have compensated by reducing the mean energy consumed per eating episode. Energy compensation did not take place in women, with women who ate most frequently having the highest energy intakes, although this did not lead to higher BMIs. Physical activity, through participation in active leisure pursuits, may have been an important factor in weight control in women. The % contribution of carbohydrate to total energy was positively correlated with EF in both men and women, and further analysis showed that snack foods provided a higher proportion of carbohydrate than did foods eaten as meals. These results indicate that a high EF is likely to lead to a high carbohydrate diet, which may be favourable for weight control. Our findings suggest that in this population, a high EF was associated with leanness in men, and there was no link between EF and body weight status in women.

Breakfast: a review of associations with measures of dietary intake, physiology and biochemistry.

The present paper reviews the literature on breakfast to consider reported association between breakfast and nutritional, physiological and biochemical variables. The contribution of breakfast to achieving nutrition targets for fat, carbohydrate and dietary fibre intakes is also examined as are the potential effects of fortified breakfast cereals on intakes of micronutrients and nutritional status. Breakfast consumption, particularly if the meal includes a breakfast cereal, is associated with lower intakes of fat and higher intakes of carbohydrate, dietary fibre and certain micronutrients. These findings may be relevant to population groups which could be at risk from low intakes of certain micronutrients, but further clarification of benefit is needed from studies of nutritional status. Associations between breakfast consumption and lower cholesterol levels have been reported, while lower body weights have been seen amongst breakfast eaters. It is concluded that breakfast consumption is a marker for an appropriate dietary pattern in terms of both macro- and micronutrients, particularly if breakfast cereals are included in the meal.

Dietary fat reduction achieved by increasing consumption of a starchy food--an intervention study.

OBJECTIVE: To test t he hypothesis that increased consumption of foods in rich in starch, such as breakfast cereals, will enable a substantial reduction in the percentage dietary energy derived from fat. DESIGN: Parallel experimental design, with matched subjects allocated randomly to an intervention or a control group. SETTING: Free-living subjects (mean age 20 y), undergraduate students at a college for higher education. SUBJECTS: Sixty-two enrolled, 59 completed the study; 7 d weighed intakes at baseline, 4 weeks and 12 weeks. INTERVENTION: The intervention group were required to eat 60 g breakfast cereal daily with semi-skimmed milk. Pre-weighed portions of three types of cereal were distributed without charge at the beginning of each week of the study; subjects were reimbursed for the cost of milk used. No other dietary advice was given. RESULTS: At baseline, total energy intake and percentage energy from macronutrients was very similar in both the intervention and control group. After four weeks of intervention there was a significant reduction in % energy from fat (-5.4%) in the experimental group, maintained at the 12 weeks follow-up. There was a corresponding rise in energy from CHO: a significant increase of 5.5% after four weeks had reached 6.5% by 12 weeks. Total energy remained virtually unchanged, indicating a replacement of fat energy by carbohydrate energy. These changes were not found in the control group. CONCLUSIONS: A simple dietary intervention to increase consumption of breakfast cereal led to a 5% reduction in % dietary fat energy, with a beneficial effect on micronutrient intakes. The results support the case for positive advice to increase consumption of complex carbohydrate, as a strategy for dietary fat reduction in the wider population.

Relationships between social class, nutrient intake and dietary patterns in Edinburgh schoolchildren.

Social class may have an important influence on dietary intakes and health. Information on specific nutrient differences between children of high and low social classes may help explain health inequalities and identify target areas for nutrition education. In this study, energy and nutrient intakes were estimated in 136 7-8-year-olds, from a range of social backgrounds, using 7-day weighed inventories. A structured questionnaire was used to establish social class. Lower social class children had significantly lower daily intakes of many micronutrients, which nevertheless met dietary reference values, and a higher percentage energy from fat. In addition, lower social class children consumed less breakfast cereal, more full fat milk, were more likely to take school meals and received a greater proportion of energy and nutrients from snacks than higher social class children. Lower social class children were significantly shorter, but this association was independent of diet. The results suggest that lower social class children are a vulnerable group nutritionally. Nutrition education should focus on influencing the dietary patterns of lower social class children to favour a decrease in percentage energy from fat.

The contribution of breakfast to the diets of a sample of 136 primary-schoolchildren in Edinburgh.

The contribution of breakfast to mean daily energy and nutrient intakes was investigated in a sample of 7-8-year-old children recruited by letter from five Scottish schools. After eighteen families dropped out of the study and three dietary records were discarded, the final sample numbered 136 (51%). Dietary data were collected using the 7 d weighed inventory, while a questionnaire was used to classify children into manual or non-manual social class groups. Mean daily energy intakes were close to estimated average requirements (Department of Health, 1991), while intakes of most micronutrients were in excess of reference nutrient intakes (RNI; Department of Health, 1991). The most popular breakfast consumed by the children was one including a ready-to-eat breakfast cereal (RTEBC). Differences in macronutrient content were seen between breakfasts of boys and girls, while manual-social-class children ate breakfasts which were lower in energy, NSP and certain micronutrients than those of non-manual-class children. Breakfast contributed 14% of energy and 9-36% of micronutrient intakes to the overall diets. Breakfasts including RTEBC contributed significantly more energy and nutrients than other types of breakfast. Children who ate RTEBC nearly every day had overall diets which had a higher nutrient density and were lower in fat than those of children who ate RTEBC less frequently or not at all. Intakes of most micronutrients were above the RNI in both these groups, with the exception of folate, Fe and vitamin A, which were below the RNI for those consuming RTEBC infrequently. However, the type of breakfast eaten did not appear to influence energy and nutrient intakes at other meals during the day. Nevertheless, it was concluded that breakfast, particularly one containing RTEBC, had a strong influence on the daily energy and nutrient intakes of 7-8-year-old children, particularly by reducing the proportion of energy from fat.

Energy and nutrient intakes in a sample of 136 Edinburgh 7-8 year olds: a comparison with United Kingdom dietary reference values.

Energy and nutrient intakes were assessed in 136 children, aged 7-8 years and living in and around Edinburgh, using the 7 d weighed inventory technique. The results were compared with UK dietary reference values (DRV) for energy, macronutrients and micronutrients. NSP intakes were compared with a calculated reference value (CRV). Mean energy intakes were close to the estimated average requirement for both boys and girls. Mean percentages of food energy derived from fat and saturated fat were high in relation to DRV (37 and 14 compared with 35 and 11 respectively). Mean percentage of food energy derived from total carbohydrate was close to the DRV of 50 but intakes of starch appeared to be low and intakes of total sugars high (23 and 26% food energy respectively). Superficially, this suggests that there is a need to alter the balance of carbohydrate in favour of increasing starch and lowering total sugar. There was, however, a clear 'fat-sugar seesaw', i.e. children with a high percentage energy from total sugars had a low percentage energy from fat, and vice versa. In view of this finding, it is possible that efforts to reduce total sugar intake in children may result in a further increase in percentage energy from fat. Mean intakes of NSP were only 50% of the CRV, but this guideline may be set too high. Mean intakes of most micronutrients were above reference nutrient intakes. Reported low intakes of Zn and Se were treated with caution due to the perceived incompleteness of the data for these in the nutrient database. The authors concluded that targeting high intakes of total fat and saturated fat should be the health priorities in this age-group.

No adverse effects on growth seen in Scottish school children consuming either low fat diets or diets relatively high in non-starch polysaccharide.

This paper reports whether diets relatively high in non-starch polysaccharide (NSP) or those which meet Dietary Reference Values for percentage energy from fat are associated with poor growth and anthropometric status. Children aged seven to eight years (n = 136) were recruited from five schools in and around Edinburgh, selected randomly by Lothian Region's Education Department. Dietary intakes were estimated by their parents, using the seven day weighed inventory method. Height and weight were measured twice, with an interval of approximately 12 months, and expressed as standard deviation scores of 1990 UK population standards. There were no significant differences in mean height, weight, body mass index and height velocity between those children whose diets were relatively high in NSP or low in percentage energy from fat compared to the remainder of the sample. In addition, using multiple regression analysis, no associations were seen between growth and low fat diets or between growth and higher fibre diets. These results suggest that the low fat, higher fibre message can be applied to young children. However, further research is required to ensure that the results found in this sample apply to other groups of children.

Appraisal of the effectiveness of nutrition education in the context of infant feeding.

The need for objective evaluation of the effectiveness of nutrition education is discussed. The impact of Department of Health and Social Security recommendations published in 1974 aimed at improving infant-feeding practices is assessed. Education was effective in increasing breast-feeding, but was less successful at improving other infant-feeding practices. Suggestions are made for the improvement of nutrition education in the context of infant feeding.

EPSDT- one quarter million screenings in Michigan.

Since the spring of 1973, Michigan's EPSDT program has screened more than 300,000 children. The Department of Social Services contracted with the Department of Public Health to design the screening and referral parts of the program; in turn the Department of Public Health contracts with local health departments to do screening with one or more teams composed of a nurse, two technicians, and a clerk. The 72 teams screen 10,000 clients each month. More than one-half of these clients are referred for diagnosis and treatment. The highest percentage (27 per cent) of referral is for dental care; the second highest (26 per cent) is for immunization. Participation in the program of state and local social services departments, local health departments, and all groups of health providers has been excellent. There continues to be a high no-show for screening and a moderate no-show rate to providers for diagnosis and treatment. Evaluation of the program elements is needed.