Title: Nutritionally-based disease among young people in the
Key words: diet, obesity, young people, adolescents, children, energy, intake, school, exercise, socio-economic group, genetic, dietary, factors, growth velocity, puberty, cardiovascular disease CVD, syndrome X, hypertension, atherogenic, lipid, atherosclerotic, diabetes, type 2, fruit, vegetable, folate, vitamin B, mineral, hypertension, unsaturated fat, saturated fat, antioxidant, nutritional disease, iron deficiency, ferritin, vegetarian, cognitive function, teenage, ethnic, calcium, vitamin D, dental, inactivity, fibre, cancer, public health
Date: Sept 2006
Category: Life changes
Author: Morgan, G
Nutritionally-based disease among young people in the UK
Results of the latest National Dietary and Nutritional Survey (NDNS) for the 4-18 year old age group have highlighted the growing trend towards underactivity and obesity amongst children (Gregory 2000). This trend is matched by a continuing decrease in energy intake in this group amounting to some 600 Kcal. per day over the last 50 years (Boreham 2001). This figure encompasses the halving of the time spent on physical education in schools over the last 5 years (British Heart Foundation 2000), a drop in other forms of exercise including walking to school and cycle usage, and an increase in sedentary activities in the home (Buttriss 2002). How do these lifestyle and nutritional changes effect the health of the young and what may be the long-term consequences into adulthood ?
Obesity among the young remains a major concern. Weight data confirms a progressive upward trend (Cole 1995). In the US a 2-4 fold increase in BMI has been reported over the last 20 years (Williams 2002). Similar trends in the UK have led to a doubling of obesity in recent years (Chinn 2001), 15% of children now being overweight and 4% obese (Gregory 2000). Higher incidences have been reported in lower socio-economic groups and correlated with poor dietary practice, particularly with increased consumption of saturated fats, refined sugars and salt (Gregory 2000, Williams 2002). Being overweight at age 13 has been found to correlate most closely with adult obesity (Wright 2001), childhood obesity being associated with a doubling of the risk of developing adult obesity (Whitaker 1997). Genetic and dietary factors are implicated, fat parents tending to have fat children (Whitaker 1998). Growth velocity changes after birth and around puberty are most closely correlated with adult obesity (Lucas 1999, Yajnik 2000).
Many studies have now confirmed the link between childhood obesity and later cardiovascular disease. Raised blood pressure in children correlates with obesity (Prescott-Clarke 1998) and has been shown to track into adulthood (Nelson 1992). Two large American studies have recorded the evolution of the associated cardiovascular disease markers from early childhood into adulthood (Sinaiko 1999, Freedman 2001). These studies have charted the development of Syndrome X into adulthood with its cardinal features of obesity, hypertension, atherogenic lipid profile and insulin resistance. The atherosclerotic lesions typical of this syndrome have been found to be present from a relatively young age and correlate with obesity (Strong 1999). An increasing incidence of type 2 diabetes, now being recognised among children in the UK, follows this trend (Ehtisham 2000).
Nutritionally, increased incidences of cardiovascular disease markers in childhood correlate with low fruit and vegetable consumption and with low levels of vitamin, mineral and antioxidant intake. Increased unsaturated fat intake is associated with a sedentary lifestyle and is more prevalent in inactive obese children (Buttriss 2002). Folate and vitamin B deficiency have been linked to abnormal homocysteine metabolism and cardiovascular disease (Wald DS 2002). Poor mineral status has been associated with hypertension and cardiovascular disease in adults (Moore 1999). All of these factors have been shown to be prevalent among UK children, particularly in the 11-18 year old group (Gregory 2000), and prognosticate a risk of future cardiovascular disease.
Certain nutritional diseases identified in the NDNS correspond to specific childhood health problems. Iron deficiency and low ferritin levels occur in 27%, posing health problems in particularly to the 4-6 and 15-18 year old group. Subgroups, such as vegetarian teenage girls and South Asian ethnic communities, pose a special problem, iron deficiency rising to 43% in these groups (Nelson 1996). Iron deficiency at an early age poses a risk to normal cognitive development (Pollitt 1985, Buttriss 2002) and, during the teenage years, to the health of teenage mothers and their infants (Scholl 1992).
Nutritional deficiencies of calcium and vitamin D, more prevalent in 14-18 year olds (Gregory 2000), pose a threat to the development of optimum peak bone mass. Girls are at increased risk of future osteoporosis, also on account of their declining participation in any form of exercise. Dental bone health is also of concern due to the high consumption of refined sugar in the form of soft drinks and confectionery (Walker 2000). Epidemiological surveys have linked obesity, inactivity and poor fruit, vegetable, fibre and antioxidant intake with a range of cancers in adulthood (World Cancer Research Fund 1997).
Eating patterns learnt in childhood are generally carried into adulthood. The poor dietary practices showing up in the recent NDNS data must therefore be expected to be associated with the development of not only cardiovascular disease, diabetes and osteoporosis in adult life, but also with cancer. In the light of these findings, intensive educational and public health measures are obviously called for in order to reverse these trends.
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