ckelleher

Children and Food Poverty: 

Children and Food Poverty Professor Cecily Kelleher National Nutrition Surveillance Centre, School of Public Health and Population Science University College Dublin

Background and ContextFriel et al, WP 04/01 Combat Poverty Agency 2004: 

Background and Context Friel et al, WP 04/01 Combat Poverty Agency 2004 Achieving a healthy diet is a major challenge to people in poverty Access to good quality, reasonably priced and nutritious food is a real issue Socially disadvantaged eat less well but spend relatively more on food A two parent two child family on lowest income spends 40% weekly on food, compared to 17% in highest income group

Factors contributing to Dietary Habits: 

Factors contributing to Dietary Habits Knowledge, Behaviour, Attitude Food Consumption Health Impact Food Supply Environment Social

Household Food Purchasing Patterns : 

Household Food Purchasing Patterns Household Budget Surveys 1951-1994, Central Statistics Office, Ireland

Household Purchasing: Fresh Fruit: 

Household Purchasing: Fresh Fruit Household Budget Surveys 1951-1994, Central Statistics Office, Ireland Social Class

Food Poverty and Health: Findings from Health Behaviour in School-aged Children (HBSC) in Ireland Molcho et al (2005): 

Food Poverty and Health: Findings from Health Behaviour in School-aged Children (HBSC) in Ireland Molcho et al (2005) 16% of Irish pupils (19% boys and 14% girls) report food poverty Associated with poorer diet generally More frequent mental and somatic symptoms, poor health and low life satisfaction

Social position As a Risk Factor for ill-health: 

Social position As a Risk Factor for ill-health

Infant Mortality and its Causes Woodbury RM, 1926: 

Infant Mortality and its Causes Woodbury RM, 1926

The midwife, the coincidence and the hypothesisBarker D, BMJ 2003; 327:1428-1430: 

The midwife, the coincidence and the hypothesis Barker D, BMJ 2003; 327:1428-1430 Do adverse conditions in utero increase the risk of cardiovascular diseases in later life? Retrospective cohort study of 15,000 men and women born in Hertfordshire before 1930, followed up for disease-specific mortality through NHS registry a half century later

Barker Hypothesis (1995): 

Barker Hypothesis (1995) Fetal undernutrition in middle to late gestation, which leads to disproportionate fetal growth, programmes later coronary heart disease

The database established by Ethel Margaret Burnside from 1911: 

The database established by Ethel Margaret Burnside from 1911 Weight at birth and at 1 year old using spring balance Health visitor records illnesses and developmental milestones on a card Recorded in ledgers and maintained today at University of Southhampton

The Fetal Origins Hypothesis-10 years onBMJ 2005; 330:1096-1097: 

The Fetal Origins Hypothesis-10 years on BMJ 2005; 330:1096-1097 Highest risk of CHD is for individuals born small who become heavier in childhood Stunted children are a high risk of becoming overweight Adult diseases are not programmed as such, but the tendency towards a disease is programmed Events pre birth are important but we need to consider later modifiers too

Life-course epidemiology: 

Life-course epidemiology Age adjusted RR mortality for men with manual worker fathers: 1.52 CHD 1.83 stroke 1.65 lung cancer 2.06 stomach cancer 2.01 respiratory disease

Why is Cross-generation Transmission important to Public Health?: 

Why is Cross-generation Transmission important to Public Health? It elucidates possible patho-physiological explanations for disease-specific outcomes across the life-course It provides a more complete contextual explanation for the determinants of health and well-being It has policy implications for mother and child services generally

Pregnancy and NutritionGambling & McCardle, Proc Nut soc 2004; 63: 553-62: 

Pregnancy and Nutrition Gambling & McCardle, Proc Nut soc 2004; 63: 553-62 Pregnancy is a period of rapid growth and cell differentiation for both mother and fetus Consequently, both are vulnerable to changes in dietary supply, especially of those nutrients marginal in normal circumstances In developed countries where calorie intake is adequate, this vulnerability applies mainly to micronutrients

Examples of Dietary deficiencies relevant to intra-uterine growth in pregnancy: 

Examples of Dietary deficiencies relevant to intra-uterine growth in pregnancy Neural tube defects associated with folate deficiency especially in first trimester Iron (Fe) deficiency, especially during second and third trimesters Copper (Cu) deficiency shown to have neurological consequences in animal studies More recent interest in omega-3 fatty acids (e.g. from fish) associated with various long-term health outcomes

Diet during Pregnancy, Neonatal outcomes and later healthMoore & Davies Reprod Fertil Dev 2005; 17:341-8: 

Diet during Pregnancy, Neonatal outcomes and later health Moore & Davies Reprod Fertil Dev 2005; 17:341-8 Animal experiments clearly show that maternal diet can influence offspring birth size, adult health and lifespan Among western society women maternal smoking is key Consequences of inadequate maternal nutrition may depend on timing during gestation, reflecting critical windows for fetal development

Examples of Longitudinal studies: 

Examples of Longitudinal studies 1947, 1958 and UK Millenium Birth cohorts ALSPAC and ELSPAC studies New millenium cohorts in Denmark, France, US, Australia, Netherlands Lifeways Study National longitudinal study of Children in Ireland

Aims and Objectives of Lifeways: 

Aims and Objectives of Lifeways Determine health status, diet and lifestyle To establish patterns and links across generations To document primary care utilisation patterns across the social spectrum and across generations To examine how indicators of social position, particularly means-tested GMS eligibility influences health status during first 5 years of life

Lifeways Study Design : 

Lifeways Study Design Sample: 1124 mothers-to-be recruited during their first ante-natal visit in the University College Hospital in Galway (West) and the Coombe Hospital in Dublin (East) between October 2001 and January 2003 1055 babies 355 fathers and 1231 grandparents

Data Collected to Date: 

Data Collected to Date Instruments: Health, lifestyle and nutrition questionnaire all adults 2001 and 2006 (self-completed) Electronic mother and child ante-natal/birth hospital record (Euroking) HSE Immunisation record of all infants and children Parent held child study record on baby’s health events during the 5 first years (self-completed in sub-sample) General Practice follow-up data in 628 general practices around country

Lifeways’ mothers: 

Lifeways’ mothers 29.4 years-old (+/- 5.98) Range: 14 to 43 years 24 % smokers 18% hold a medical card 64% are married Household net weekly Income: € 343 (S.D. 196) 24% below 60% poverty line 31% West 69% East

The Cardiovascular Risk Factor Profile of Grandparents and its Contribution to Infant Birth-weight in the Life-ways Cross-generation Cohort StudyKelleher CC et al., Prevention and Control 2005; 1(1): 54.: 

The Cardiovascular Risk Factor Profile of Grandparents and its Contribution to Infant Birth-weight in the Life-ways Cross-generation Cohort Study Kelleher CC et al., Prevention and Control 2005; 1(1): 54. Birth weight : Range: 840 – 5360 grams Mean: 3491 grams (S.D. 584.4) What predicts baby birth weight ? Mother: Age, smoking status, education, GMS, marital status, BMI Maternal Grandmother: BMI, Maternal Grand-Parent Education

Lifeways Babies at a glance: 

Lifeways Babies at a glance 49.7% = male 50.3% = female 12 sets of twins All turn 4 at next birthday

Data structure: 

Data structure Mothers’ clinical records Age Breastfeeding Smoking Mothers’ questionnaires Nutrition Education Income, medical insurance Exposure to smoke in home Pollution Mould & damp in home Social support Marital status Self-rated health Babies’ clinical records Sex Birthweight Birth hospital Babies’ GP records ASTHMA GMS eligibility Baseline (birth) 3 years Time

Multivariate Analysis to predict asthma in children at 3 years : 

Multivariate Analysis to predict asthma in children at 3 years Babies with low and high birth-weights were at higher risk of asthma than those in the middle of the range. Boys at higher risk of asthma than girls. Babies born in Dublin at higher risk than those born in Galway Babies born to families in the lowest income quartile (<£300/week) at higher risk of asthma Babies born to mothers who reported consuming low levels of added fats and high levels of fruit and vegetables were at lower risk of asthma.

Multivariate Analysis - results: 

Multivariate Analysis - results

Paediatric Percentile Growth Charts: 

Paediatric Percentile Growth Charts

Early adiposity rebound in childhood and risk of type 2 diabetes in adult lifeEriksson JG et al, Diabetologia 2003; 46: 190-194: 

Early adiposity rebound in childhood and risk of type 2 diabetes in adult life Eriksson JG et al, Diabetologia 2003; 46: 190-194 Type 2 Diabetes is associated with small body size at birth and a high BMI in later life Longitudinal follow-up of 8760 adults born in Helsinki 1934-1944 Each had 18 measurements of height and weight between birth and 12 years Cumulative incidence of adult type 2 diabetes decreased progressively from 8.6% to 1.8% depending on timing of adiposity rebound

Long term mortality after severe starvation during the 1941-1944 siege of Leningrad: Prospective Cohort StudySparen et al BMJ 2004; 328:11: 

Long term mortality after severe starvation during the 1941-1944 siege of Leningrad: Prospective Cohort Study Sparen et al BMJ 2004; 328:11 3905 men born 1916-35 in Leningrad, examined 1975-7 with mortality follow up to 1999 SBP 3.3 mm higher in siege exposed at puberty Relative risk of IHD 1.39, Stroke 1.67 and haemorrhagic stroke 1.71

Food Control or Food Democracy? Re-engaging Nutrition with Society and the Environment Tim Lang, Pub Health Nut 2005; 8(6a): 730-737: 

Food Control or Food Democracy? Re-engaging Nutrition with Society and the Environment Tim Lang, Pub Health Nut 2005; 8(6a): 730-737 Biologically reductionist versus social process models Misunderstanding of what drives the relationship between policy, evidence and practice Geo-spatial crisis over food supply Excess choice plus information overload may be nutrition’s problem, not solution

Predictors of Obesity (SLÁN, 2002): 

Predictors of Obesity (SLÁN, 2002)

Slide39: 

140 calories 350 calories 333 calories 590 calories 210 calories 610 calories

Slide40: 

Obesity in Children: a problem Compounded by “Victim Blaming”

Shopping for fruit for one person last week…: 

Shopping for fruit for one person last week… 5 Bananas (St Lucia) 1.99 400g Strawberries (Dublin) 4.49 400g Grapes (Greece)3.40 170g Raspberries (USA) 3.99 150g Blueberries (Australia) 4.90 4 Kiwis (NZ) 1.85 3 L Orange juice 11.40 240g Pineapple 2.99 Total = 36.61 Euros

High-Tech increases Body Weight: 

Cellular phones and remote controls deprive us from walking! 20 times daily x 20 m = 400 m Walking distance lost/year 400x365 = 146,000 m 146 km = 25 h of walking 1 h of walking = 113-226 kcal Energy saved =2800-6000 kcal Rössner, 2002 High-Tech increases Body Weight  0.4-0.8 kg adipose tissue

Child poverty in English-speaking Countries Mickelwright J (Innocenti Working Papers no. 94, June 2003): 

Child poverty in English-speaking Countries Mickelwright J (Innocenti Working Papers no. 94, June 2003) English-speaking countries notably higher rates of child poverty than continental European countries UK, Irl and NZ all saw large rises in child poverty in last 20 years and all have explicit commitment to problem Tax benefit simulations suggest between 1996/7 and 2003/4 resulted in 1 million fewer UK children below conventional poverty line

Heckman (2006): Ulysses Medal Lecture UCD : 

Heckman (2006): Ulysses Medal Lecture UCD

Acknowledgements: 

Acknowledgements The Lifeways cross-generation cohort study is grant supported by the Health Research Board of Ireland It is overseen by a multi-disciplinary steering committee from University College Dublin, National University of Ireland Galway, The Health Services Executive, The Coombe and UCHG Maternity Hospitals