Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research...
Transcript of Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research...
![Page 1: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/1.jpg)
Toddler Diets and Long Term Health
Julie LaniganPrincipal Research Dietitian
Childhood Nutrition Research CentreUCL Institute of Child Health
![Page 2: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/2.jpg)
Aims of Discussion
• What do we expect toddlers to eat?
• What are toddlers eating?
• What are the consequences?
• What can be done?
![Page 3: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/3.jpg)
• Not a clearly defined age-group– 1 - 2’s– 1 - 3’s– 1 - 5’s– Preschoolers
What is a toddler?
![Page 4: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/4.jpg)
• Age surveyed varies
• 1½ - 4 ½ (NDNS 95)• 1½ - 3 (NDNS 2011)
Measuring toddler diets
![Page 5: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/5.jpg)
– Difficult age group to work with!
– Not good communicators of dietary information
– Reliant on parents– Throw food around
Trouble with toddlers...
![Page 6: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/6.jpg)
Aims of Discussion
• What do we expect toddlers to eat?–Dietary guidelines–Evidence behind them
![Page 7: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/7.jpg)
Are they consistent?
– UK Dietary Reference Values– US Dietary Reference Intakes– WHO expert consultations
Guidelines
![Page 8: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/8.jpg)
Dietary Guidelines
![Page 9: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/9.jpg)
Guidelines for toddlers
• Vary widely• Energy & Protein• Higher in UK and US
compared with WHO• Vitamin D lower
![Page 10: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/10.jpg)
Are they evidence based?• Research based• Extrapolation
• Adult studies
Guidelines
![Page 11: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/11.jpg)
• Few studies of nutritionalintake in toddlers
• Based on adult studies e.g. Fibre
• Dietary surveys
Guidelines
![Page 12: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/12.jpg)
Aims of Discussion
• What are toddlers eating?–What informs us?–Which foods and nutrients are problems?
![Page 13: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/13.jpg)
Survey of the food consumption, nutrient intakes and nutritional
status of people aged 1.5 years and older living in
private households in the four countries of the UK
UK Dietary Surveys
![Page 14: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/14.jpg)
• New Rolling Survey• Intakes of all vitamins
(except D) met RNI• Mean D intake = 1.9 µg/day• (27% of RNI, 33% inc.
supps)
NDNS 2008-2012
![Page 15: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/15.jpg)
• Iron and Zinc improved–8% below LRNI for Iron–6% below LNRI for Zinc
NDNS 2008-2012
![Page 16: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/16.jpg)
• Iron intake• 1995 84% below RNI (6.9 mg/d)• 2008-12 Median 6.1 mg/day
– 88% of RNI• 1995 13% anaemic• ALSPAC 17% anaemic• 2008-12 Blood data awaited
Trends in Iron
![Page 17: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/17.jpg)
– Ethnicity – high prevalence in UK Asian families
– Vegetarians or exclusions– Due to diet itself or displacement
of iron-rich foods?– Phytate, tannins– Cows milk
At Risk - Iron
![Page 18: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/18.jpg)
• Observational studies–Anaemia
•Impairs development?–Studies conflicting–Comparisons difficult
At Risk - Iron
![Page 19: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/19.jpg)
• Randomised Controlled Trials–No immediate benefits on psychomotor development
–Possible long-term effects?
At Risk - Iron
![Page 20: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/20.jpg)
• Zinc intake–1995 72% < RNI (5 mg/d)–2008-12 median 5.1 mg/d
•>100% RNI
Trends in Zinc
![Page 21: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/21.jpg)
• Overweight & Obesity• 2-15 years• Highest in 2-3 year olds
NDNS 2008-2012
![Page 22: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/22.jpg)
• Overweight & Obesity• 2-3 years
–I in 2 overweight or obese•Boys 20% OWT & 34% Obese•Girls 29% OWT & 21% obese
NDNS 2008-2012
![Page 23: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/23.jpg)
• Resurgence– Excessive sun protection– Lack of supplementation– Belief milk is high in vitamin D
• Risk factors– Darker skin– Higher vitamin D requirement– 20-40% prevalence in UK Asian toddlers
(Lawson & Thomas, 1998)
Vitamin D Deficiency
![Page 24: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/24.jpg)
• NDNS survey–Many toddlers’ intake
inadequate
• Supplements• Increase intake by 24-33%• But only 17-19% uptake (IFS 2005)
Vitamin D in the UK
![Page 25: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/25.jpg)
• Dietary–Few sources: oily fish, egg yolk,
infant formula, fortified foods• Sunlight
• 90% from sun exposure• Converts to active form
Vitamin D Sources
![Page 26: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/26.jpg)
• Exposure to sunlight–20 – 30 minutes 2-3 times per
week in summer• Sunscreens
• Overly used• Avoid redness/burning
Vitamin D Sources
![Page 27: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/27.jpg)
• Healthy Start Scheme (2006)• Families receiving benefits
– Pregnancy/lactation• Vitamins C, D and Folic Acid
– Children up to 4 years A, D and C• Food vouchers:
– Formula– Cow’s Milk– Fruit & Veg
Vitamin Supplements
![Page 28: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/28.jpg)
In UK toddlers up to 1/3rd of total daily calories comes from sugar
- much of this is added sugar
Excess Energy
![Page 29: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/29.jpg)
• NDNS 1 ½ - 2 ½ year olds (1995) –Sugar 29% energy
• Non-milk sugar 19%• Most children consumed
above recommendations
Sugar Calories
![Page 30: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/30.jpg)
• About 100 kcals/day•Energy intake
•Age 1.5-3 years - 1127kcal/day•About 10% energy from non-milk sugar
•Hidden sugar – not yet in NDNS
Energy from Sugar
![Page 31: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/31.jpg)
• Dental decay in toddlers–Sweets age 1 – 3 years leads to
caries before age 3.5y–Soft drinks and Fruit juices
• Source of energy–Energy dense foods–Fat’s best buddy!
Problems with Sugar
![Page 32: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/32.jpg)
•Carbohydrate•51% energy
•Protein (Major source - milk)•15% energy
•Fat•34% energy
Energy from Food Groups
![Page 33: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/33.jpg)
Cereals and cereal products•Pizza – equivalent of 1 portion per day
•Milk•Whole milk most common
Foods Consumed
![Page 34: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/34.jpg)
•Meat and Meat Dishes•Mainly white meat •55% chicken/turkey
•Fish•Total fish 8g/day•Oily fish 1g/day
Foods Consumed
![Page 35: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/35.jpg)
•Vegetables•73g/day•Portions not defined•Increased 18g (33%)
•Fruit•Total 108g/day•Higher than other child age groups
Foods Consumed
![Page 36: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/36.jpg)
•Diet has improved•Fewer deficiencies
•Vitamin D main concern•Fruit & Vegetables increased•Energy
•Macronutrient proportions OK• Why is obesity increasing?
Summary
![Page 37: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/37.jpg)
•Energy requirements•COMA 1991
•Based on WHO 1985•Based on average needs
•910 – 1380 kcal/day for boys & girls aged 1 – 3 years
Estimating Needs
![Page 38: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/38.jpg)
•WHO growth chart centiles•Females•Revised down (95-83 kcal/kg)
•Based on range (25th – 75th pc)•747 – 1195 kcal/day for boys & girls aged 1 – 3 years
A Revised Estimate
![Page 39: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/39.jpg)
Does the energy
source in toddlers
affect later obesity?
Preschool Obesity
![Page 40: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/40.jpg)
In 7/14 studies protein
intake associated with
greater obesity risk later in
childhood (up to double)Lanigan et al. (unpublished)
Systematic Review
![Page 41: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/41.jpg)
Childhood Obesity
• How ‘big’ is the problem ?
• What are the early causes ?
• What are the consequences?
• What can be done?
![Page 42: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/42.jpg)
(International Obesity Taskforce (IOTF), 2010)
A Global Problemup to 200 million school aged children are either overweight or obese, of those 40-50 million are
classified as obese.
![Page 43: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/43.jpg)
(WHO, 2010)
A Global Problem
Nearly 43 million children under the age of five were
overweight in 2010.
![Page 44: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/44.jpg)
Childhood Obesity
• How ‘big’ is the problem ?
• What are the early causes ?
• What are the consequences?
• What can be done?
![Page 45: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/45.jpg)
Why does it happen?
• Complex problem•Genetics•Environment
–Diet–Physical Activity–Sleep Patterns
![Page 46: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/46.jpg)
Energy intake > expenditure
Genes Environment
Childhood Obesity
![Page 47: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/47.jpg)
Obesity = Energy intake > expenditure
Genes Environment
Development
![Page 48: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/48.jpg)
Why does it happen?
• Early nutrition•Infant feeding
–Breastfeeding–Formula feeding
•Weaning
![Page 49: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/49.jpg)
Energy intake > expenditure
Diet Exercise
Why does it happen?
![Page 50: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/50.jpg)
Why does it happen?• Reduced physical activity• Increased sedentary behaviours
•TV viewing and computer games
•Car use
![Page 51: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/51.jpg)
Why does it happen?
• Dietary Behaviours• High energy density diets• Eating away from home• Increased portion size• Frequent snacking• Parental practice
![Page 52: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/52.jpg)
Who does it affect?National Child Measurement
Programme
Measures the height and weight of children aged 4−5 years
(Reception) and 10−11years (Year 6).
![Page 53: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/53.jpg)
Who does it affect?• Highest Prevalence
–Multicultural City Life–Disadvantaged Urban
Communities–Certain ethnic groups
• Bangladeshi, Black African, and Black Caribbean
![Page 54: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/54.jpg)
Toddler Diet
Critical period for
development of dietary and behavioural
habits
![Page 55: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/55.jpg)
Dietary patterns: emerge during early childhood - by age 3 years – ALSPAC study
(North & Emmett, 2000)
Young mumseducation
Veg’n mumseducation
Females &Singletons
Well off &Older sibs
![Page 56: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/56.jpg)
Dietary Patterns• Established early• Track through childhood• Transition to adult diet
–Fear of new foods–Picky eaters
• Adequate intakes
![Page 57: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/57.jpg)
Importance of Portions•Long awaited portion size data•Based on what toddlers do eat•Not related to health or growth outcomes
Judy More & Pauline Emmett
Support from ITF
![Page 58: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/58.jpg)
Importance of Portions
•Has portion size changed?•US Surveys
•CSFII 1994 -1998•Little change for most foods•Increases for milk, bread, cereal, juice and peanut butter
McConably et al, (2002)
![Page 59: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/59.jpg)
Importance of Portions•US Surveys
•NFCS, CSFII & NHANES 1977 -2006•Energy dense foods•28% energy intake at 2-6 y•Pizza highly implicated!
Piernas & Popkin, (2011)
![Page 60: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/60.jpg)
Trends in Energy•Has energy intake increased?
•Up 179kcal/day 1977-2006•Energy eating outside home
•Up from 23.4 to 33.9%•Take aways and “store bought” foods increased•Impact of convenience foods
Poti & Popkin, (2011)
![Page 61: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/61.jpg)
Does Portion Size Matter
•Increasing portion size•Increases energy intake from portion and total meal•Body weight positively related to energy intake and portion size•Children regulate energy intake through portion size
Rolls et al. (200), Fisher et al, (2003)
![Page 62: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/62.jpg)
What should we advise?
•Range of portion sizes•Based on actual intake•Relation to outcome?
•Unknown•Meet UK EAR for energy•RNI for nutrients
![Page 63: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/63.jpg)
Childhood Obesity
• How ‘big’ is the problem ?
• What are the early causes ?
• What are the consequences?
• What can be done?
![Page 64: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/64.jpg)
Why is it important?
• Obesity Associated With–Increased Morbidity
–Short Term–Long Term
![Page 65: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/65.jpg)
Why is it important?
• Short Term Risk –Sleep Apnoea–Low self-esteem–Low Physical Activity
![Page 66: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/66.jpg)
Obesity Tracking And CVD Risk
Childhood obesity tracks throughout childhood and
is likely to persist into adulthood
![Page 67: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/67.jpg)
Why is it important?
• Long Term Risk –Increased Morbidity
–Cardiovascular Disease•Diabetes
–Cancer–Joints/mobility
![Page 68: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/68.jpg)
Childhood Obesity And CVD Risk
Studies have found an increase in CVD risk
factors including hypertension,
atherosclerosis and insulin resistance
![Page 69: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/69.jpg)
Childhood Obesity
• How ‘big’ is the problem ?
• What are the early causes ?
• What are the consequences?
• What can be done?
![Page 70: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/70.jpg)
Preschool Obesity
Is diet important in the development of obesity
during the preschool years?
![Page 71: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/71.jpg)
• Programmes•Diet•Physical Activity•Behavioural Therapy•Family Involvement
Lifestyle Interventions
![Page 72: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/72.jpg)
Interventions in Preschool Children
•3 Systematic Reviews•7 RCTs•All Ineffective
![Page 73: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/73.jpg)
• Priority for UK Department of Health– Halt the rise in obesity by 2020
• Strategy –Multicomponent Interventions
• Include advice on healthy eating• Address lifestyle within family and social settings• Incorporate strategies for behavioural change• Involve family member/s
NICE Guidelines
![Page 74: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/74.jpg)
What is being done?
• Healthy Weight, Healthy Lives: A Cross Government Strategy for England (Jan 2008)
![Page 75: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/75.jpg)
What is being done?
• Healthy Lives, Healthy People: A Call to Action on Obesity in England (Jan 2011)
“Not enough” says Jamie Oliver
![Page 76: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/76.jpg)
What is being done?
• "Simply telling people what they already know - that they need to eat less and move more - is a complete cop out. The country's bill of health is shocking, and it's not going to get any better over the next 30 years if a clearly defined plan isn't put into place soon.
![Page 77: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/77.jpg)
• Addresses all elements of NICE guidelines
• Community and home based• Promotes
– Healthy Eating– Physical Activity– Positive diet and lifestyle
• Engages– Family & wider community
Institute of Child HealthPre-school Obesity Intervention
![Page 78: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/78.jpg)
A fun, interactive healthy lifestyle programme for
mothers, carers and children aged 1-5
Trim Tots
![Page 79: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/79.jpg)
Encourages physical activity through movement and
music, raises awareness of healthy eating and facilitates mother and child interaction in art and craft workshops
Trim Tots
![Page 80: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/80.jpg)
• Venue– Sure Start Children’s Centre
• South Oxhey, Watford• Partners
– Sensory Planet• Local arts organisation
– Herts PCT– Watford Recycled Arts
Trim Tots Pilot
![Page 81: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/81.jpg)
• Randomised Controlled Trial• Primary Outcome
–Body Mass Index z score
Trim Tots Pilot
![Page 82: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/82.jpg)
• 90 children recruited• 88 children randomised
–52 boys –36 girls
• Mean age 2.5 yrs • BMI 18.5
Trim Tots Pilot
![Page 83: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/83.jpg)
Group 1 InterventionImmediate Start
Group 2 WaitingList
InterventionDelayed Start
0 3 6 9 12 18Time (months)
Study Design
![Page 84: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/84.jpg)
Trim Tots Pilot Results
(Lanigan et al., Obesity, 2010)
•73% Completed Trial•Results
•BMI z-score lower in intervention group
•0.9 SD - More than one major centilespace on the growth chart
(Body Mass Index for age/sex)
![Page 85: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/85.jpg)
What can HCPs do?
• Practice the 3 R’s• Recognition• Referral• Research
![Page 86: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/86.jpg)
What can HCPs do?
• Recognition–Early growth
•Infancy–Promote breastfeeding–Advice re overfeeding
![Page 87: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/87.jpg)
What can HCPs do?• Recognition
–Use of growth charts
http://www.rcpch.ac.uk/child-health/research-projects/uk-who-growth-charts-early-years/uk-who-0-4-years-growth-charts-initi
![Page 88: Toddler Diets and Long Term Health · 2019-04-23 · Term Health. Julie Lanigan. Principal Research Dietitian. ... • Dental decay in toddlers –Sweets age 1 – 3 years leads to](https://reader035.fdocuments.in/reader035/viewer/2022070900/5f3606e1e9fa9c7c6d1cba80/html5/thumbnails/88.jpg)
What can HCPs do?
• Referral–MEND–Trim Tots
•March 2012–Others