DR EVELYN HANNON Hannon Nutrition Consultancy, Ireland

THE BENEFITS OF COMMUNITY BASED BREAKFAST PROGRAMS FOR CHILDREN AND YOUNG PEOPLE IN EUROPE?

Breakfast Programmes and Nutrition

Dr. Evelyn Hannon, Nutritionist May 13th 2016

Project goals

1. Dietary Assessment of Lower Socioeconomic Status Groups in Europe

2. Assessment of potential contribution of foods provided via Breakfast Programmes to

nutrient intakes & health

Dietary Assessment of Lower Socioeconomic Status Groups in Europe*

- Overweight prevalence

- Micronutrient intakes/status

- Macronutrient intakes

- Food group intakes

- Breakfast skipping

*Ireland, UK, Spain, Germany, Sweden, Italy

Overweight – Higher prevalence in low SES groups (measured)

25

29

38

29 32

23

28

11.5

19 18

12

23

13

17

0

5

10

15

20

25

30

35

40

UK (10-11yrs)

Ireland (M) Ireland (F) IDEFICS(Europe,2-9yrs)

Spain (M) Spain (F) Sweden6 yrs

%

Low SES High SES

(9 yrs) (10-15 yrs)

UK - National Child Measurement Programme, Obese only; Ireland - Growing up in Ireland Study, n=9570 (Williams et al, 2009); IDEFICS - Identification and Prevention of Dietary and Lifestyle induced Health Effects in Children and Infants Study, 8 countries, n=18,745, (Ahrens et al, 2014); Spain – National Health Survey 2007, (Miqueleiz et al, 2014); Sweden – Cross Sectional Study, Stockholm, n=621, Henriksson et al, 2016

Micronutrients – Evidence of low intakes/status across Europe

Ireland - 5-12 yr. old girls 52% (iron), 37% (calcium),

36% (folate), 13% (riboflavin) have

inadequate intakesa

Germany – 61% of 6 to 10 yr. old girls have low iodine

intakesb

Spain – > 90% have low

vitamin D intakesb, 40% insufficient calcium

intakesc, 9.3% low folate intakes (girls)b (≤11yrs.)

UK – Evidence of low intakes/status of vitamin D (2-18 yrs.), riboflavin & iron

(11-18 yrs., girls)d

Italy– 59% deficient vitamin D status, 2-17

yr. oldse

a. National Children’s Food Survey, www.iuna.net; b. Mensink et al, 2013; c. Ortega et al. 2012; d. Low income National Diet and Nutrition Survey, Nelson et al, 2007; e. Stagi et al, 2014.

Study Type Geography Population group

Key finding Reference

Systematic review (18 studies, Intakes &/or status)

Western Europe

Adults, Children, Elderly

• Lower values for all micronutrients examined (folate, vitamin B12, iron, zinc, iodine, vitamin C, vitamin D, calcium, selenium and copper) in the lower vs. higher SES category, with the exception of vitamin B12.

• Largest relative differences between SES groups observed for calcium, vitamin C, folate and vitamin D (2–29%, 5–47%, 7–22% and 4–31 %, respectively).

Novakovic et al, (2014)

Literature Review (Global)

Multiple European countries, Canada, Australia, USA

All • Higher SES groups had consistently higher intakes of most vitamins and minerals and fibre vs. lower SES groups.

• SES did not affect either total energy intakes or the macronutrient composition of the diet.

Darmon and Drewnowski (2008)

Micronutrients – Differences across socioeconomic groups

Micronutrients only

Overall dietary quality

Food groups – Lower fruit & vegetable intakes in lower SES groups

238 246

178 186

0

50

100

150

200

250

300

Boys Girls

g

Q1 Q5

* *

Similar trend reported in Ireland (9 yr. olds) (Kelly et al, 2012), Germany (≤ 17 yr. olds) (Finger et al, 2015) Spain (2-24 yrs) (Aranceta et al, 2003), Sweden (6 yr. olds) (Safasten et al, 2016)

e.g. UK National Diet and Nutrition Survey, 4 to 10 year olds (Bates et al, 2014)

Q5 (lowest), Q1 (highest) quintile of equivalised income, * Significantly higher (P<0.05)

Breakfast skipping

Adapted from: Breakfast consumption and its socio-demographic and lifestyle correlates in schoolchildren in 41 countries participating in the WHO Health Behaviour in School aged Children (HBSC) study, 11- 15 yrs, Base category – high family affluence, Bold denotes significance (Vereecken et al, 2009).

Country Medium Family Affluence

Low Family Affluence

Ireland 0.95 0.7

UK 0.93 0.79

Spain 0.87 0.78

Germany 0.79 0.55

Italy 0.97 0.87

Sweden 0.93 0.78

Association of daily breakfast consumption with family affluence: OR (95 %CI)

Case study – 11 year old girl from lower SES group in Spain

Prevalence of inadequate intakes among 11 to 17 year old girls in Spain (Mensink et al, 2013)*

% contribution of a bowl of Kellogg’s Corn Flakes and milk to DRVs for an 11 year old Spanish female

*Calcium values obtained from Ortega et al, 2012, 7-11 year old representative sample

Case study – 11 year old girl from lower SES group in Spain

% contribution of a banana (100g) to selected DRVs for an 11 year old Spanish female

18 18 18 17

0

2

4

6

8

10

12

14

16

18

20

Fibre Folate Iron Magnesium

%

% contribution of 2 slices of wholegrain bread (61g), olive oil (7g) and tomato (75g) to selected DRVs for an 11 year old Spanish female

Conclusion

Lower compared to high SES groups may have:

Higher levels of overweight

Lower fruit & vegetable consumption

Lower daily breakfast consumption

Lower micronutrient intakes

Foods provided via Kellogg’s Breakfast Programmes may make important contributions to intakes of key nutrients that are lacking among children & young people in Europe

Food groups Ahrens et al. (2014) Prevalence of overweight and obesity in European children below the age of 10. Int. J. Obes. 38: S99

Aranceta et al. (2003) Sociodemographic and lifestyle determinants of food patterns in Spanish children and adolescents: the enKid study. Eur. J. Clin. Nutr. 57:S40

Bates et al. (2014) National Diet and Nutrition Survey: UK Department of Health, Food Standards Agency.

Darmon and Drewnowski (2008) Does social class predict diet quality?. Am. J. Clin. Nutr. 87:1107

Finger et al. (2015) Dietary behaviour and parental socioeconomic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS). BMC Public Health. 15:498

Kelly et al. (2012) The Irish Health Behaviour in School-aged Children (HBSC) Study 2010: Department of Health and National University of Ireland, Galway.

Mensink et al. (2013) Mapping low intake of micronutrients across Europe. Br. J. Nutr. 110(4):755

Miqueleiz et al. (2009) Trends in the prevalence of childhood overweight and obesity according to socioeconomic status: Spain, 1987–2007. Eur. J. Clin. Nutr. 68:209

Nelson et al. (2007) Low Income Diet and Nutrition Survey. London: The Stationery Office.

Novakovic et al. (2014) Socio-economic determinants of micronutrient intake and status in Europe: a systematic review. Public Health Nutr. 17(5):1031

Ortega et al. (2012) Food sources and average intake of calcium in a representative sample of Spanish schoolchildren. Nutr. Hosp. 27(3):715

Safsten et al (2016) The intake of selected foods by six-year-old Swedish children differs according to parental education and migration status. Acta Pædiatrica 105: 421

Stagi et al. (2014) Determinants of Vitamin D Levels in Italian Children and Adolescents: A Longitudinal Evaluation of Cholecalciferol Supplementation versus the Improvement of Factors Influencing 25(OH)D Status. Int. J. Endocrinol. Volume 2014, Article ID 583039, 13 pages

Vereecken et al. (2009) Breakfast consumption and its socio-demographic and lifestyle correlates in schoolchildren in 41 countries participating in the HBSC study. Int. J. Public Health 54(2):180

Vliet et al. (2015) Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study. BMC Public Health 15:628

Williams et al. (2009) Growing Up in Ireland, National Longitudinal Study of Children: Office of the Minister for Children and Youth Affairs

References