Dietary intake and anthropometric status of 7 to 9 year old children in economically disadvantaged communities in Ontario.

There is limited information on the nutritional health of Canadian children, particularly those living in poverty. Our purpose was to assess the dietary and anthropometric status of economically disadvantaged children as part of the longitudinal, multidisciplinary prevention project, Better Beginnings, Better Futures.

We obtained 24-hour dietary recalls and measurements of height, weight, triceps skinfolds and mid-arm circumference from children (n = 178) aged 7 to 9 years in three urban communities. Information on demographic characteristics was obtained through a parent interview.

Linear growth appeared adequate with both boys (chi 2 = 44.1, p < .001) and girls (chi 2 = 10.8, p < .01) taller compared to NCHS reference data. The proportion of children > 90th percentile for weight-for-height (23.2%) and upper arm fat area (14.3%), suggests a tendency to excess fat; 21.1% were < 10th for percentile upper arm muscle area. Median nutrient intakes, except for calcium and vitamin A, exceeded the Canadian Recommended Nutrient Intake (RNI); however, median energy intake was well below the RNI. Energy and macronutrient intakes were similar across Z score categories of weight-for-height, upper arm muscle area, and upper arm fat area.

The tendency to inadequate muscle mass and excess fat in the presence of low energy intake may reflect low levels of physical activity.     

Dietary calcium intakes of urban children at risk of lead poisoning.

Dietary calcium is well known to decrease gastrointestinal lead absorption and thereby reduce the risk for lead poisoning. Because children in economically deprived urban centers are especially likely to have excessive lead exposure, we surveyed dietary calcium intakes of 314 children from the greater Newark, New Jersey, area. The areas of Newark and adjacent communities studied had been previously identified as containing significant sources of environmental lead by geographic information systems technology. An abbreviated National Cancer Institute Health Habits and History Questionnaire, modified to focus on foods high in calcium, was used to determine dietary calcium. Calcium intakes were then compared to the new Dietary Reference Intake (DRI) guidelines. The respondents were primarily the parents of African-American and Hispanic children ranging in age from 1 to 8 years, with a mean age of 3.5 years. The most recent blood lead concentration was 11.4 +/- 0.8 microg/dL (mean +/- standard error), and 48.6% had concentrations at or above the current guideline of 10 microg/dL. Quintiles of calcium intake were: 221 +/- 13; 488 +/- 9; 720 +/- 6; 885 +/- 6; and 1,389 +/- 49 mg/day. Fifty-five of 175 (31.4%) children aged 1-3 years had calcium intakes below the DRI, as did 82 of 139 (59.0%) children aged 4-8 years. The percentage of mothers reporting lactose intolerance in their children was 2.5%. The observation that the children in the highest quintile easily exceeded the DRIs for calcium suggests that urban parents who include dairy foods in their childrens' meals can provide a diet that meets the DRI guidelines. Children in the lowest quintiles are at risk of increased absorption of the environmental lead to which they are inevitably exposed, as well as other problems associated with a low intake of dietary calcium. The data suggest that both lead exposure and low dietary calcium continue to pose significant health risks to urban minority children.     

Dietary intake and nutritional status of vegetarian and omnivorous preschool children and their parents in Taiwan

The aim of this study was to assess and compare dietary intake and nutritional status of vegetarian and omnivorous preschool children and their parents. Fifty-six omnivores (28 children and 28 parents) and 42 vegetarians (21 preschool children with 18 lacto-ovo-vegetarians and 3 ovo-vegetarians; 21 parents with 16 lacto-ovo-vegetarians, 2 ovo-vegetarians, 1 lacto-vegetarian, and 2 vegans) were recruited. Anthropometric measurements were taken; body mass index and weight-for-height index (WHI) were calculated. Nutrient intake was recorded using 3-day dietary records. Fasting venous blood samples were obtained to estimate hematologic and vitamin status parameters. Height, weight, body mass index, WHI, and triceps skinfold thickness value differences between omnivores and vegetarians in both parent and child groups were not found. Both omnivorous parents and their children had significantly higher fat and lower fiber intakes than vegetarian parents and children. Omnivorous children had significantly higher protein and lower vitamin C intakes than vegetarian children, whereas omnivorous parents had significantly lower vitamin A and iron intakes than vegetarian parents. Vegetarians and omnivores in both parent and child groups had mean calcium consumption less than 75% of the Taiwan dietary intakes. All mean hematologic and biochemical nutrient status indices were within the reference range in any groups. However, both vegetarian parents and children had significantly lower mean total cholesterol and serum ferritin concentrations than those of omnivorous parents and children. Our vegetarian and omnivorous preschool children had normal growth and adequate nutritional status. However, both parents and children had inadequate calcium intakes, which may potentially affect bone health, especially for preschool children in the growing stage.     

Nutritional content of school meals in Hull and the East Riding of Yorkshire: a comparison of two schools

BACKGROUND: In April 2004 Hull City Council introduced free healthy school meals for primary and special schools pupils (approximately 20,500 children) in an attempt to reduce health inequalities. The meals aimed to meet the Caroline Walker Trust (CWT) nutritional guidelines for primary schools. The study assesses the nutritional content of the meals, including children's actual intake. The Hull school is compared with a neighbouring school with no such initiative. METHODS: 64 children aged 9-10 years participated from 2 primary schools. Fieldwork was undertaken over 5 days in each school. 320 meals were weighted and photographed before and after consumption to assess actual intake. RESULTS: Hull children consumed (p < 0.001) less total fat, sugar and sodium than neighbouring children. Both schools exceeded the CWT recommendations for these nutrients. Statistically significant (p < 0.001) differences were observed between nutrient intakes of energy, iron, zinc, folate and magnesium (p < 0.001) with Hull children consuming less than neighbouring children. Children's intake at both schools did not meet recommended guidelines for 11 of the 17 nutrients assessed. CONCLUSION: Although Hull's school meals aimed to provide children with adequate nutritional intake, findings demonstrate that, on average, children are served and consume inadequate levels of many nutrients.     

Improved diet quality with peanut consumption

OBJECTIVE: To evaluate the diet quality of free-living men, women, and children choosing peanuts and peanut products. DESIGN: Using data reported in the Continuing Survey of Food Intake by Individuals and Diet and Health Knowledge Survey (CSFII/DHKS) from 1994-1996, food codes were used to sort respondents by use or nonuse of peanuts. SUBJECTS: A nationally representative sample of 4,751 men, 4,572 women, and 4,939 children (boys and girls, 2-19 yrs) who completed 2-day intake records. Measures of Outcome: The two-sample t test was used to analyze differences between peanut users and nonusers for energy, nutrient intakes, Health Eating Index (HEI) scores, and body mass index (BMI). RESULTS: Peanut users (24% of CSFII/DHKS) had higher intakes (p < 0.001) of protein, total fat, polyunsaturated fat (PUFA), monounsaturated fat, (MUFA) (p < 0.01), fiber, vitamin A, vitamin E, folate, calcium, magnesium, zinc, and iron. Percent of energy from saturated fat was not significantly different for men, women or girls and was slightly lower (p < 0.01) for boys. Dietary cholesterol of peanut users was lower for all population groups; this decrease was significant for both men (p < 0.01) and children (p < 0.001). The HEI was calculated as a measure of overall nutrient profile of the diets and was significantly greater for peanut users (men 61.4, women, 65.1, children 66.8) compared to nonusers (men 59.9, women 64.1, children 64.7) for men (p = 0.0074) and children (p < 0.001). Energy intake was significantly higher in all population groups of peanut users (p < 0.001; boys: p < 0.01); however mean BMI for peanut users was lower for all gender/age categories (women: p < 0.05; children: p < 0.001). CONCLUSIONS: These results demonstrate improved diet quality of peanut users, indicated by the higher intake of the micronutrients vitamin A, vitamin E, folate, calcium, magnesium, zinc, and iron and dietary fiber, and by the lower intake of saturated fat and cholesterol. Despite a higher energy intake over a two-day period, peanut consumption was not associated with a higher BMI.     

A comparison of nutrient intake between infants and toddlers with and without cystic fibrosis

OBJECTIVE: To compare the micronutrient and energy intake of infants and toddlers with cystic fibrosis (CF) to the intake of matched control children and dietary reference index (DRI) levels. DESIGN: A two-group comparison study. Nutrient and energy intakes were measured via 3-day diet diaries. Anthropometric data were collected within 1 week of study enrollment. SUBJECTS/SETTING: A clinical sample of 35 infants and toddlers with CF (mean=18.6, SD=8.1 months) matched to a community sample of 34 healthy controls. STATISTICAL ANALYSES PERFORMED: Children with CF and controls were compared on anthropometric and nutrient data using independent sample t tests. Mean nutrient and energy intake for children in each group were compared with the age-appropriate DRI for targeted nutrients using percentages. RESULTS: Children with CF and controls were similar on measures of growth (height, weight, or weight-for-height percentile). Four children with CF were at or below the 10th percentile for weight-for-height, compared with one control child. Children with CF and controls did not differ on average daily protein, calcium, zinc, and energy intake. Overall, children met or exceeded DRI levels for nutrient intakes. A notable exception was iron, for which mean intakes were lower for control children. Toddlers with CF consumed only 89% of the RDA per day for energy. APPLICATIONS/CONCLUSIONS: Infants and toddlers with CF are likely obtaining adequate micronutrient intakes from food. Interventions to increase total energy intake in infants and toddlers with CF are needed. Dietitians may want to focus more on calorie intake and percent calories from fat than on micronutrient intake in their nutrition counseling in young children with CF.     

Predictors of cardiovascular risk factors in Tehranian adolescents: Tehran Lipid and Glucose Study

INTRODUCTION: Cardiovascular disease (CVD) is one of the major health and social problems in Iran. The aim of this study is to determine the predictors of CVD risk factors in adolescents residing in district 13 of Tehran. METHODS: Dietary intake assessment was undertaken with two separate 24-hour recall interviews with adolescents aged 11-18 years, selected from among 15005 subjects who were participants of the Tehran Lipid and Glucose Study. After excluding the under- and over-reporters, 290 adolescents remained in the study. Data related to cigarette smoking was collected. Height and weight were assessed and body mass index (BMI) was calculated. Blood pressure was measured twice at intervals in a seated position. Serum cholesterol, triglycerides, and high-density lipoprotein (HDL) concentrations were measured in a blood sample after 12 hours of fasting, and low-density lipoprotein (LDL) was calculated. To determine the predictors of CVD risk factors stepwise linear regression was used. RESULTS: There were strong positive correlations between BMI and both systolic and diastolic blood pressure in girls: (beta = 1.8, p < 0.001; beta = 0.8, p < 0.001) and boys (beta =0.04, p < 0.001; beta = 0.05, p < 0.01). There was an inverse association between calcium intake and systolic (beta = -0.16, p < 0.05) and diastolic blood pressure in boys (beta = -0.36, p < 0.01), as well as inverse association between calcium intake and systolic (beta = -1.2, p < 0.05) and diastolic blood pressure (beta = -0.05, p < 0.05) and serum triglycerides (beta = -0.1, p < 0.01) in girls. Positive correlations were found between BMI and cholesterol in girls (beta = 0.2, p < 0.01) and boys (beta = 0.31, p < 0.01). CONCLUSION: Certain dietary and life style factors predict CVD risk factors in Tehranian adolescents.     

Predictors of blood lead levels in agricultural villages practicing wastewater irrigation in Central Mexico

To investigate whether the agricultural use of untreated wastewater (i.e. crop irrigation) was associated with elevated blood lead levels in a farming population in the Mezquital Valley and which risk factors, other than exposure to untreated wastewater, were associated with elevated blood lead levels, lead levels were measured in venous blood obtained from 735 individuals. Blood samples were analyzed by atomic absorption spectrophotometry. Food habits and dietary intake were gathered by interview, using a semi-quantitative food-frequency questionnaire. The average blood lead level was 7.8 microg/dL (SD 4.66 microg/dL; range 1.2-36.7 microg/dL). 23% of the study population had blood lead levels exceeding 10 microg/dL. The use of lead-glazed ceramics (LGC) was significantly associated with elevated lead levels (p = < 0.001). Other significant variables included age, gender (males), and non-farming-related occupations (e.g., technicians, factory workers). p = 0.005, 0.08, and 0.001, respectively. When the analysis was stratified by the use of LGC for food preparation, an inverse relationship between higher daily calcium intake and blood lead level was detected (beta = - 0.040, p = < 0.05). Thus, blood lead levels were positively associated with the use of LGC. Calcium intake showed a protective effect, maybe by decreasing absorption of lead in the gastrointestinal tract. No association between occupational exposure to untreated wastewater or crop consumption and blood lead levels was detected. Further environmental and health surveillance is recommended.     

Dietary adherence and associated glycemic control in families of young children with type 1 diabetes

OBJECTIVE: This study examined the dietary intake, dietary adherence, and associated daily glycemic control of young children (mean age 5.6+/-1.6 years) with type 1 diabetes in 33 families. DESIGN: This was a one-sample cross-sectional study. Children's nutrient and energy intakes were measured using 3-day diet diaries. Children's mean daily blood glucose levels were assessed prospectively for 2 weeks using the FreeStyle (TheraSense, Inc, Alameda, CA) home blood glucose meter. STATISTICAL ANALYSIS: Means, standard deviations, and frequencies described the sample. Associations between dietary adherence and glycemic control were examined by one-tailed Pearson correlations. RESULTS: Mean nutrient intakes were less than the Dietary Reference Intake for children's intake of vitamin B-12 and calcium. Children's dietary deviations revealed better-than-predicted adherence to the number and timing of feedings per day and number of carbohydrate units consumed per meal. In contrast, children's daily carbohydrate intake was approximately 80%+/-21% of the recommended levels based on their weight and age. In addition, children's energy intake was only 78%+/-18% of the recommended levels based on age. Correlations revealed a positive association between poor dietary adherence and higher blood glucose levels. CONCLUSIONS: Young children with type 1 diabetes are likely to have adequate dietary intake of most micronutrients. However, their adherence to specific carbohydrate and energy intake recommendations may be lower. Because the preschool years represent a period of rapid growth, diet plans for preschoolers with diabetes need to be revised often for optimal management of type 1 diabetes. Close adherence to dietary recommendations is one behavior that may improve blood glucose control in young children with diabetes.     

Dietary and biochemical indices of nutritional status in male athletes and controls.

To determine whether physical exercise affects biochemical indices of nutritional status, we compared four groups of male athletes (total n = 427) with two control groups (n = 150). Data about their nutrient intake for 1 month were obtained from a 122-item food frequency questionnaire. An estimate for leisure energy expenditure (EE) was calculated from a 15-item physical activity questionnaire. Athletes were grouped according to their EE (ModEE and HighEE athletes) and weight (light = less than 75 kg; heavy = greater than or equal to 75 kg), and controls according to their weight. Mean energy intake in ModEE and HighEE athletes was 2805-3260 kcal/day. Leisure EE significantly (p less than 0.0001) affected energy and nutrient intakes. Energy, riboflavin and calcium intakes were also higher in heavy subjects (P = 0.0006-0.03). The estimated percentage of subjects with deficient dietary intakes, calculated from probability analyses, was 0-6, depending on group and nutrient. Erythrocyte transketolase activation coefficient (E-TKAC) was highest in controls (1.17 +/- 0.0008; p = 0.001). Serum magnesium was highest (p = 0.01) in ModEE athletes (0.85 +/- 0.006 mmol/L). No intergroup differences were found for plasma ascorbic acid, serum zinc or serum ferritin concentration, whereas blood hemoglobin was lowest (p less than 0.001) in HighEE athletes (149 +/- 0.5 g/L). Ten percent of the control subjects had E-TKAC greater than 1.24. Percentage of other values outside reference range was 0-4, depending on group and indicator. Since lowered blood hemoglobin concentration can be explained by hemodilution, we conclude that sports training did not have a negative effect on biochemical indices of thiamin, vitamin C, magnesium, iron, or zinc status in Finnish male athletes.     

Effects of high compared with low calcium intake on calcium absorption and incorporation of iron by red blood cells in small children.

BACKGROUND: The potential benefits of increasing calcium intake in small children must be balanced with the potential risk to iron utilization from high calcium intakes. OBJECTIVE: This study was designed to evaluate the relation between calcium intake and calcium absorption and iron incorporation into red blood cells. DESIGN: We performed a multitracer, crossover study of the absorption of calcium and red blood cell incorporation of iron in 11 preschool children aged 3-5 y who had been adapted for 5 wk to low- (502 +/- 99 mg) and high- (1180 +/- 117 mg) calcium diets. Stable-isotope studies were performed by using 44Ca and 58Fe given orally with meals and 46Ca given intravenously. RESULTS: Iron incorporation into red blood cells 14 d postdosing was similar (6.9 +/- 4.2% compared with 7.9 +/- 5.5%; NS) with the low- and high-calcium diets, respectively. Total calcium absorption (181 +/- 50 compared with 277 +/- 91 mg/d; P = 0.002) was greater in children with the higher calcium intake. CONCLUSIONS: Our findings indicate that small children may benefit from calcium intakes similar to those recommended for older children without adverse effects on dietary iron utilization.     

Diets and lead blood levels of children who practice pica

Diets of 43 children from 1 to 6 years of age were assessed and nutrient intakes were compared to blood lead values. Children with low (12–29 μg%), moderate (30–49 μg%), and high (50–67 μg%) blood lead levels had average daily calcium intakes of 615, 593, and 463 mg, respectively. Thirty-three per cent of children in the low blood lead group consumed less than 70% of the recommended amounts of calcium compared to 83% of children in the high blood lead group. Blood lead values of individual children were negatively correlated (r = ?0.327, P < 0.05) with number of servings from the group of foods classified as a milk group. The incidence of pica was higher in children with moderate and high blood lead levels than in those with low blood lead levels. Average zinc intake for all children was 63% of levels recommended (RDA) with a greater percentage of children with high blood lead consuming less than 55% of RDA than children with low and moderate levels.     

Dietary lead intakes for mother/child pairs and relevance to pharmacokinetic models.

Blood and environmental samples, including a quarterly 6-day duplicate diet, for nine mother/child pairs from Eastern Europe have been monitored for 12 to >24 months with high precision stable lead isotope analysis to evaluate the changes that occur when the subjects moved from one environment (Eastern Europe) to another with different stable lead isotopes (Australia). The children were between 6 and 11 years of age and the mothers were between 29 and 37 years of age. These data were compared with an Australian control mother/child pair, aged 31 and 6 years, respectively. A rationale for undertaking this study of mother/child pairs was to evaluate if there were differences in the patterns and clearance rates of lead from blood in children compared with their mothers. Blood lead concentrations ranged from 2.1 to 3.9 microg/dl in the children and between 1.8 and 4.5 microg/dl in the mothers, but the mean of differences between each mother and her child did not differ significantly from zero. Duplicate diets contained from 2.4 to 31.8 microg Pb/kg diet; the mean+/- standard deviation was 5.5 +/- 2.1 microg Pb/kg and total daily dietary intakes ranged from 1.6 to 21.3 microg/day. Mean daily dietary intakes relative to body weight showed that the intake for children was approximately double that for the mothers (0.218 vs. 0. 113 microg Pb/kg body weight/day). The correlations between blood lead concentration and mean daily dietary intake either relative to body weight or total dietary intake did not reach statistical significance (p>0.05). Estimation of the lead coming from skeletal (endogenous) sources relative to the contribution from environmental (exogenous) sources ranges from 8 to 70% for the mothers and 12 to 66% for the children. The difference between mothers and children is not statistically significant (p = 0.28). The children do not appear to achieve the Australian lead isotopic profile at a faster rate than their mothers. These data provide evidence that the absorption or uptake of lead from dietary sources is similar in adult females and children of the age in this study. In spite of lower bone lead and faster bone remodeling and recycling in children compared with adult females, we see no differences between the mothers and their children in overall contribution of tissue lead to blood lead. Results from this study suggest that fractional absorption of ingested lead by children 6-11 years of age is comparable with absorption patterns observed among adult females in the 29-37-year-old age range. Because pharmacokinetic models apply a 40-50% absorption even for 7-year-old children, further investigations on fractional absorption of ingested lead by young children are warranted.Further investigations are especially needed in younger children than those who were subjects in the current study, particularly children in the 1-3-year-old age range. In addition, the effect of nutritional status and patterns of food intake on children's lead absorption require investigation, particularly given the increased prevalence of marginal nutritional status among low-income populations that are at increased risk of elevated blood lead levels.     

Effect of dietary calcium intake on lead exposure in Inuit children attending childcare centres in Nunavik

High blood lead levels (BLLs) can be found in Inuit from Nunavik. At the same time, various nutrients such as calcium could lower lead absorption and toxicity. We examined the effect of dietary calcium intakes on BLLs in 245 preschool Inuit children attending childcare centres in Nunavik. Calcium intake was assessed with one 24-h dietary recall and BLLs were determined by inductively coupled plasma mass spectrometry in whole blood samples. Multiple imputation was performed to deal with missing data. Median blood lead concentration was 0.08?μmol/L. A high proportion of children did not meet the Estimated Average Requirement for vitamin D intake (73?%) and, to a lower extent, for calcium (20?%). Calcium intake was negatively associated with BLLs (?p = 0.0001) while child’s age and energy intake were positively associated with BLLs (?p = 0.015 and p = 0.024, respectively). Consuming traditional foods rich in calcium as well as milk and alternatives may protect against lead exposure.     

Zinc intake of US preschool children exceeds new dietary reference intakes

BACKGROUND: The recent dietary reference intakes publication provides updated information on the physiologic and dietary requirements for zinc and proposes new tolerable upper intake levels. OBJECTIVE: We analyzed dietary intake data of US preschool children to determine the prevalence of inadequate and excessive intakes of zinc. DESIGN: Diets of 7474 nonbreastfeeding preschool children in the Continuing Survey of Food Intakes by Individuals (1994-1996 and 1998) were analyzed for the intakes of zinc and other dietary components, and factors associated with zinc intake were examined. RESULTS: The mean intakes of zinc by children aged < 1 y, 1-3 y, and 4-5 y were 6.6, 7.6, and 9.1 mg/d, respectively. Less than 1% of children had usual zinc intakes below the adequate intake or estimated average requirement. The percentages of children with intakes exceeding the tolerable upper intake level were 92% (0-6 mo), 86% (7-12 mo), 51% (1-3 y), and 3% (4-5 y). Controlling for age and energy intake, zinc intake was greater in 1998 than in 1994 (P < 0.0001) and was positively associated with participation in the Women, Infants, and Children Program (P < 0.001) and with the lowest income category (P < 0.001). CONCLUSIONS: Preschool children in the United States have dietary zinc intakes that exceed the new dietary reference intakes. Zinc intakes increased during the 4 y of the study. The present level of intake does not seem to pose a health problem, but if zinc intake continues to increase because of the greater availability of zinc-fortified foods in the US food supply, the amount of zinc consumed by children may become excessive.     

Nutritional risk among Brazilian children 2 to 6 years old: A multicenter study

ObjectiveTo estimate the nutritional risk in children 2 to 6 y old.MethodsThe sample consisted of 3058 children enrolled in public and private schools in nine Brazilian cities. The assessment of nutrient intake was based on 1-d data combining direct individual weighing of foods and a food diary. A second evaluation of food consumption was conducted in a subsample to estimate the usual intake.ResultsThere was low prevalence of inadequate intake of vitamin B6 (<0.001%), riboflavin (<0.001%), niacin (<0.001%), thiamin (<0.001%), folate (<0.001%), phosphorus (<0.1%), magnesium (<0.1%), iron (<0.5%), copper (<0.001%), zinc (<0.5%), and selenium (<0.001%). However, 22% of children younger than 4 y and 5% of children older than 4 y consumed fiber quantities larger than the adequate intake. Approximately 30% of the sample consumed more saturated fat than recommended. The prevalence of inadequate vitamin E intake ranged from 15% to 29%. More than 90% of the children had an inadequate vitamin D intake. In children older than 4 y, the prevalence of inadequate calcium intake was approximately 45%. Sodium intake was higher than the upper intake level in 90% of children younger than 4 y and 73% of children older than 4 y.ConclusionsThe prevalence of inadequate dietary intake was low for most nutrients. However, fiber, calcium, and vitamin D and E intakes were lower than recommended. Moreover, children consumed large amounts of sodium and saturated fat.     

Exposure to environmental tobacco smoke and cognitive abilities among U.S. children and adolescents

We used the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994, to investigate the relationship between environmental tobacco smoke (ETS) exposure and cognitive abilities among U.S. children and adolescents 6-16 years of age. Serum cotinine was used as a biomarker of ETS exposure. Children were included in the sample if their serum cotinine levels were less than or equal to 15 ng/mL, a level consistent with ETS exposure, and if they denied using any tobacco products in the previous 5 days. Cognitive and academic abilities were assessed using the reading and math subtests of the Wide Range Achievement Test-Revised and the block design and digit span subtests of the Wechsler Intelligence Scale for Children-III. Analyses were conducted using SUDAAN software. Of the 5,365 6- to 16-year-olds included in NHANES III, 4,399 (82%) were included in this analysis. The geometric mean serum cotinine level was 0.23 ng/mL (range, 0.035-15 ng/mL); 80% of subjects had levels < 1 ng/mL. After adjustment for sex, race, region, poverty, parent education and marital status, ferritin, and blood lead concentration, there was a significant inverse relationship between serum cotinine and scores on reading (beta = -2.69, p = 0.001), math (beta = -1.93, p = 0.01), and block design (beta = -0.55, p < 0.001) but not digit span (beta = -0.08, p = 0.52). The estimated ETS-associated decrement in cognitive test scores was greater at lower cotinine levels. A log-linear analysis was selected as the best fit to characterize the increased slope in cognitive deficits at lower levels of exposure. These data, which indicate an inverse association between ETS exposure and cognitive deficits among children even at extremely low levels of exposure, support policy to further restrict children's exposure.     

The effect of soil abatement on blood lead levels in children living near a former smelting and milling operation

OBJECTIVE: To evaluate the effect of soil abatement on children's blood lead concentrations and on environmental levels of lead and arsenic. METHODS: Two cross-sectional surveys were conducted. The first (1989) was of a random sample of 6- to 72-month-old children (n=112). The second (1998) included all 6- to 72-month-old children whose parents agreed to participate in the survey (n=215). From 1993 to 1996, soil abatement was conducted around homes with average soil lead concentration >500 parts per million (ppm). Venipuncture blood samples were taken, interviews were conducted, and samples of house dust, soil, water, and paint were tested for lead and arsenic, using identical protocols in both surveys. The expected decline in blood lead concentrations were calculated for children who lived in houses that were abated, compared with children who lived in houses that were not abated. RESULTS: Lead and arsenic in soil and interior dust in homes that underwent soil abatement declined significantly compared to unabated homes (p<.05). After adjustment for potential confounders, the blood lead concentration in children ages 6 to 72 months who lived in soil-abated housing declined 42.8% faster than children who lived in unabated housing (p=0.14). In children ages 6 to 36 months, the decline was 45.4% faster (p=0.03). The estimated reduction in blood lead for children ages 6 to 36 months was 3.5 micro g/dL for every 1,000 ppm reduction in soil lead concentration (95% confidence interval [CI]=2.4 micro g/dL, 4.6 micro g/dL). CONCLUSION: Soil abatement was associated with a significant decline in children's blood lead and indoor environmental levels of lead and arsenic.     

Association between composition of the diet and haemoglobin and ferritin levels in 18-month-old children

OBJECTIVE: To investigate the associations between composition of the diet at 18 months of age and ferritin and haemoglobin levels. DESIGN: Cross-sectional study. SUBJECTS: A total of 796 children taking part in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). MAIN OUTCOME MEASURES: Food and nutrient intakes and haemoglobin and ferritin levels at 18 months. METHODS: Diet was assessed by a 3-day unweighed food record. A heel-prick capillary blood sample was taken for measurement of ferritin and haemoglobin. RESULTS: Ferritin levels were negatively associated with the amount of cows' milk consumed (r = -0.2462, P < 0.001) and calcium intake (equivalent to a 4-5% drop in ferritin levels for a 100 mg increase in energy-adjusted calcium intake). Haemoglobin levels were positively associated with energy-adjusted vitamin C intake and were higher in children who ate any fruit (P = 0.024) or any vegetables (P = 0.030). The associations between nutrient intakes and ferritin and haemoglobin levels remained on adjustment for socio-demographic factors. The prevalence of low haemoglobin levels was higher in those children who consumed no meat or poultry (28.8% vs 19.0% overall, P = 0.044). CONCLUSIONS: Higher levels of milk and dairy product consumption are associated with lower ferritin levels in children of this age, and over-reliance on these foods should be avoided. Fruit and vegetable consumption should be encouraged, and the inclusion of a little meat or fish in the diet of small children is advisable.     

A comparison of micronutrient inadequacy and risk of high micronutrient intakes among vitamin and mineral supplement users and nonusers in Canada

Although supplement use is prevalent in North America, there is little information on how supplements affect the prevalence of nutrient adequacy or risk of intakes greater than the tolerable upper intake level (UL). The objectives of this study were to compare the prevalence of nutrient adequacy and percent of intakes greater than the UL from diet alone between supplement users and nonusers and determine the contribution of supplements to nutrient intakes. Dietary intakes (24-h recall) and supplement use (previous 30 d) from respondents ≥1 y in the Canadian Community Health Survey 2.2 (n = 34,381) were used to estimate the prevalence of nutrient adequacy and intakes greater than the UL. Software for Intake Distribution Evaluation was used to estimate usual intakes. The prevalence of nutrient adequacy from diet alone was not significantly higher among supplement users than nonusers for any nutrient. Based on diet alone, children 1-13 y had a low prevalence of nutrient adequacy (<30%) except for vitamin D and calcium. Among respondents ≥14 y, inadequacies of vitamins A and D, calcium, and magnesium were >30%. For other nutrients, there was a low prevalence of nutrient adequacy. There were no nutrient intakes greater than the UL from diet alone, except zinc in children. When supplements were included, ≥10% of users in some age/sex groups had intakes of vitamins A and C, niacin, folic acid, iron, zinc, and magnesium greater than the UL, reaching >80% for vitamin A and niacin in children. In conclusion, from diet alone, the prevalence of nutrient adequacy was low for most nutrients except for calcium, magnesium, and vitamins A and D. For most nutrients, supplement users were not at greater risk of inadequacy than nonusers; supplement use sometimes led to intakes greater than the UL.