The chimera of choice in UK food policy 1976-2018

Purpose This paper presents a critical discourse analysis of “choice” as it appears in UK policy documents relating to food and public health. A dominant policy approach to improving public health has been health promotion and health education with the intention to change behaviour and encourage healthier eating. Given the emphasis on evidence-based policy making within the UK, the continued abstraction of choice without definition or explanation provoked us to conduct this analysis, which focuses on 1976 to the present. Design/methodology/approach The technique of discourse analysis was used to analyse selected food policy documents and to trace any shifts in the discourses of choice across policy periods and their implications in terms of governance and the individualisation of responsibility. Findings We identified five dominant repertoires of choice in UK food policy over this period: as personal responsibility, as an instrument of change, as an editing tool, as a problem and freedom of choice. Underpinning these is a continued reliance on the rational actor model, which is consonant with neoliberal governance and its constructions of populations as body of self-governing individuals. The self-regulating, self-governing individual is obliged to choose as a condition of citizenship. Research limitations/implications This analysis highlights the need for a more sophisticated approach to understanding “choice” in the context of public health and food policy in order to improve diet outcomes in the UK and perhaps elsewhere

Understanding the role of carbohydrates in optimal nutrition

In recent years, the regulation of carbohydrate intake has become regarded as essential to achieve a balanced diet, with a range of health benefits attributed to low-carbohydrate diets. However, much of the advice on reduced carbohydrate intake does not reflect government-led dietary guidelines. As a result of this conflicting information, patients requiring assistance with weight management or glycaemic control may become confused about the appropriate carbohydrate intake, or be encouraged to experiment with ‘fad’ diets. As front-line healthcare professionals, nurses are in a prime position to advise patients on carbohydrate intake, as well as signposting them to evidence-based dietary resources. This article outlines the constituents of dietary carbohydrate, considers the health benefits of carbohydrates, and explains their importance as part of a healthy and balanced diet

Iodine status in pre-school children prior to mandatory iodine fortification in Australia

The iodine status of children between the ages of 5 and 15 years has been routinely assessed in many countries, but few studies have examined iodine status in pre-school children. We conducted a cross-sectional study of pre-school children living in Adelaide, South Australia, between 2005 and 2007. Children 1–5 years old were identified using a unique sampling strategy to ensure that the study population was representative. A 3-day weighed diet record, a blood sample and a urine sample were obtained from each child. The median urinary iodine concentration (UIC) of the children (n = 279) was 129 µg L⁻¹, indicating iodine sufficiency (normal range: 100–199 µg L⁻¹), but 35% of the children had a UIC < 100 µg L−1. The median thyroglobulin concentration of children (n = 217) was 24 µg L⁻¹ and thyroglobulin concentration declined with increasing age (P = 0.024). The mean daily iodine intake was 76 µg. The intake of iodine was lower than expected and highlights difficulties in accurately assessing iodine intakes. Further studies are needed to monitor dietary changes and iodine status in this age group since the implementation of mandatory fortification of bread with iodised salt in Australia in 2009.Sheila Skeaff, Ying Zhao, Robert Gibson, Maria Makrides, Shao Jia Zho

A novel online food recall checklist for use in an undergraduate student population : a comparison with diet diaries

Peer reviewedPublisher PD

Calcium to phosphorus ratio, essential elements and vitamin D content of infant foods in the UK: possible implications for bone health

Adequate intake of calcium and phosphorus in the appropriate ratio of 1–2:1 (Ca:P), in addition to magnesium and vitamin D, is vital for bone health and development of infants. In this feasibility study, the ratio of Ca:P in conjunction with vitamin D and other essential elements (Cu, Fe, K, Mg, Na, and Zn) in a range of commercial infant food products in the UK was investigated. The elemental analysis was carried out using inductively coupled plasma optical emission spectrometry, and vitamin D levels were determined using an enzyme-linked immunosorbent assay. The quantitative data were further evaluated, based on a standardised menu, to measure the total daily intake of an infant aged 7–12 months against the Reference Nutrient Intake. The results from the study show that the Ca:P ratio of the infant's total dietary intake was within the recommended range at 1.49:1. However, the level of intake for each of the nutrients analyzed, with the exception of sodium, was found to be above the Reference Nutrient Intake, which warrants further investigation in relation to both micronutrient interactions and in situations where the intake of fortified infant formula milk is compromised. Finally, as the study is the first to include consumption of infant snack products, the level of total calorie intake was also calculated in order to assess the total daily estimated energy intake; the results indicate that energy intakes exceed recommendations by 42%, which may have implications for obesity

A qualitative exploration of stakeholder perspectives on a school-based multi-component health promotion nutrition programme

Background:  Food for Fitness is an on-going multi-component health promotion programme, delivered in primary and secondary schools by community nutrition assistants. The programme uses nutritional interventions aimed at promoting healthier eating practices for children. This service evaluation investigated the receipt and delivery of the programme, as perceived by local stakeholders who had experienced and administered the service. Methods:  Semi-structured interviews and focus groups were carried out with three key stakeholder groups: health professionals (n = 9), school teachers (n = 10) and senior health officials (n = 3). Qualitative data were transcribed verbatim and received thematic analysis with deductive and inductive processes. Results:  Stakeholders reported that the programme contributed to the development of food education and healthy-eating practices of children in the local area. Stakeholders considered that the main concern was the limited capacity and size of the service. They described problems with long-term sustainability in supporting schools with maintaining nutritional interventions, highlighting issues regarding contact, planning and organisation of several interventions. Conclusions:  The findings of the service evaluation inform service management, organisation and ground-level delivery. The use of stakeholder opinion provided contextualised information on the factors that impact on the implementation of the programme. The richness of the qualitative results can guide future planning and provision for similar health promotion nutrition programmes delivered in the school environment

Improving the Nutritional Quality of Charitable Meals for Homeless and Vulnerable Adults: A Mixed Method Study of Two Meals Services in a Large English City

Inadequate nutrition may contribute to poor health in homeless and vulnerable adults. Charitable meals are critical to this group’s nutrition. The nutrient content of charitable meals at 2 organizations was assessed. Ethnography investigated organizational practice; semistructured interviews explored influences on meal provision. Meals were adequate for energy and the majority of nutrients but exceeded thresholds of saturated fat, salt, and sugars and lacked vitamin D and selenium in both organizations. Organizations were constrained by budget, equipment, food donations, volunteer capabilities, and time. Organizational values influenced meal provision; strategies to reduce fat, salt, and sugar content may be resisted because of an ethos of hospitality and overprovision

Circulating 250HD, dietary vitamin D, PTH, and calcium associations with incident cardiovascular disease and mortality: The MIDSPAN Family Study

&lt;p&gt;Context: Observational studies relating circulating 25-hydroxyvitamin D (25OHD) and dietary vitamin D intake to cardiovascular disease (CVD) have reported conflicting results.&lt;/p&gt; &lt;p&gt;Objective: Our objective was to investigate the association of 25OHD, dietary vitamin D, PTH, and adjusted calcium with CVD and mortality in a Scottish cohort.&lt;/p&gt; &lt;p&gt;Design and Setting: TheMIDSPAN Family Study is a prospective study of 1040 men and 1298 women from the West of Scotland recruited in 1996 and followed up for a median 14.4 yr. Participants: Locally resident adult offspring of a general population cohort were recruited from 1972–1976.&lt;/p&gt; &lt;p&gt;Main Outcome Measures: CVD events (n &#61; 416) and all-cause mortality (n&#61;100) were evaluated.&lt;/p&gt; &lt;p&gt;Results: 25OHD was measured using liquid chromatography-tandem mass spectrometry in available plasma (n&#61;2081). Median plasma 25OHD was 18.6 ng/ml, and median vitamin D intake was 3.2 &#181; g/d (128 IU/d). Vitamin D deficiency (25OHD&#60;15 ng/ml) was present in 689 participants (33.1%). There was no evidence that dietary vitamin D intake, PTH, or adjusted calcium were associated with CVD events or with mortality. Vitamin D deficiency was not associated with CVD (fully adjusted hazard ratio&#61;1.00; 95% confidence interval&#61;0.77–1.31). Results were similar after excluding patients who reported an activity-limiting longstanding illness at baseline (18.8%) and those taking any vitamin supplements (21.7%). However, there was some evidence vitamin D deficiency was associated with all-cause mortality (fully adjusted hazard ratio&#61;2.02; 95% confidence interval&#61;1.17–3.51).&lt;/p&gt; &lt;p&gt;Conclusion: Vitamin D deficiency was not associated with risk of CVD in this cohort with very low 25OHD. Future trials of vitamin D supplementation in middle-aged cohorts should be powered to detect differences inmortality outcomes as well as CVD.(J Clin EndocrinolMetab97: 0000 –0000, 2012)&lt;/p&gt