Poor food and nutrient intake among Indigenous and non-Indigenous rural Australian children

Gwynn et al. BMC Pediatrics 2012, 12:12 http://www.biomedcentral.com/1471-2431/12/12 RESEARCH ARTICLE Open Access Poor food and nutrient intake among Indigenous and non-Indigenous rural Australian children Josephine D Gwynn1*, Victoria M Flood2,3, Catherine A D’Este1, John R Attia1, Nicole Turner4, Janine Cochrane5, Jimmy Chun-Yu Louie2 and John H Wiggers1 Abstract Background: The purpose of this study was to describe the food and nutrient intake of a population of rural Australian children particularly Indigenous children. Participants were aged 10 to 12 years, and living in areas of relative socio-economic disadvantage on the north coast of New South Wales. Methods: In this descriptive cross-sectional study 215 children with a mean age of 11.30 (SD 0.04) years (including 82 Indigenous children and 93 boys) completed three 24-hour food recalls (including 1 weekend day), over an average of two weeks in the Australian summer of late 2005. Results: A high proportion of children consumed less than the Australian Nutrient Reference Values for fibre (7484% less than Adequate Intake (AI)), calcium (54-86% less than Estimated Average Requirement (EAR)), folate and magnesium (36% and 28% respectively less than EAR among girls), and the majority of children exceeded the upper limit for sodium (68-76% greater than Upper Limit (UL)). Energy-dense nutrient-poor (EDNP) food consumption contributed between 45% and 49% to energy. Hot chips, sugary drinks, high-fat processed meats, salty snacks and white bread were the highest contributors to key nutrients and sugary drinks were the greatest per capita contributor to daily food intake for all. Per capita intake differences were apparent by Indigenous status. Consumption of fruit and vegetables was low for all children. Indigenous boys had a higher intake of energy, macronutrients and sodium than non-Indigenous boys. Conclusions: The nutrient intake and excessive EDNP food consumption levels of Australian rural children from disadvantaged areas are cause for concern regarding their future health and wellbeing, particularly for Indigenous boys. Targeted intervention strategies should address the high consumption of these foods. Background Indigenous peoples internationally suffer greater early mortality rates and poorer health status when compared with non-Indigenous peoples [1]. In Australia this gap is greater than for any other similar country, and particularly so for chronic diseases [1-3]. Rates of diabetes for Indigenous peoples are at least 3 times that of non-Indigenous Australians [3], and are especially high for Indigenous youth (6 times higher than for non-Indigenous youth) [4,5]. Poor nutritional status both in utero and during childhood is recognised as a key risk factor for the development of type 2 diabetes [2], and improving the diet of children is an acknowledged strategy for * Correspondence: 1 Faculty of Health, University of Newcastle, Callaghan 2308 NSW Australia Full list of author information is available at the end of the article reducing the risk of chronic diseases during childhood and in adulthood [6]. Similar to that of Indigenous populations internationally [7], dispossession of Australia’s Indigenous peoples has contributed to endemic disadvantage [3,8] and poor nutrition [3,9]. This is associated with the change of dietary patterns that occurred with European invasion, from consumption of traditional nutrient dense, low energy foods [2] to a dependence on poorer quality food handouts of staples such as white flour, sugar and rice [2]. Since then food intake for Indigenous peoples has been further compounded by many factors [8] including inadequate food access and availability [3,10], food insecurity [11] and financial stress [12], the last identified as a substantial barrier to a healthy diet [13,14]. It is acknowledged that good quality health data from Indigenous populations internationally are limited [8] © 2012 Gwynn et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Gwynn et al. BMC Pediatrics 2012, 12:12 http://www.biomedcentral.com/1471-2431/12/12 and this is also true for Australia’s Indigenous peoples [7,15], and for children and youth in particular [15,16]. Whilst the poorer nutritional status of Indigenous peoples relative to non-Indigenous peoples has been documented [5,7], internationally and nationally there are few studies comprehensively examining their food and nutrient intake [7,17], and even fewer involving children [2,7]. This represents a critical gap in the knowledge base required to develop effective health management strategies for this at-risk population [18]. The purpose of this study is to describe the food and nutrient intake of a population of Australian Indigenous and non-Indigenous rural children aged 10 to 12 years old, and who live in regions of relative social disadvantage, by examining 1) their mean daily intake of microand macro-nutrients and the percent contribution of macronutrients to energy; 2) the proportion of children with mean daily intakes of selected nutrients less than the estimated average requirement (EAR) or greater than the Upper Level (UL) of intake, as appropriate, and 3) the main food groups and sub-groups contributing to energy, fat, saturated fat, sugar, sodium and fibre. Indigenous communities who participated in this research prefer the term ‘Aboriginal and Torres Strait Islander’. This term is used from here on. Methods Setting This descriptive cross-sectional study was undertaken in 3 regional areas on the north coast of the Australian state of New South Wales (NSW) in the summer of late 2005 and early 2006. Participants In total, 11 Department of Education and Training (’government’) primary schools were selected to participate in this research. These schools were chosen as they had the highest enrolments of Aboriginal and Torres Strait Islander children in their areas. All schools were located in local government areas defined as areas of relative socio-economic disadvantage [19,20]. All children in years 5 and 6 at the selected schools in 2 of the areas were invited to participate, and in the third area only Aboriginal and Torres Strait Islander children were invited to ensure an adequate sample from this population. Aboriginal Health Workers (AHWs) (Aboriginal and Torres Strait Islander people who are employed to work with Indigenous communities regarding all aspects of health care) co-ordinated the information and consent process within their communities. Measures and Data Collection Procedures Height and Weight Research assistants recorded demographic information for each child including gender, date of birth and Page 2 of 14 Indigenous status. Height and weight were mea (...truncated)