The food and nutrient intake and physical activity of Australian Aboriginal and Torres Strait Islander and non-Indigenous rural children

Abstract

Research Doctorate - Doctor of Philosophy (PhD)Wide disparities in health between Aboriginal and Torres Strait Islander and non-Indigenous Australians persist, with chronic diseases responsible for much of this gap. Type 2 diabetes is one of the key chronic diseases suffered by Aboriginal and Torres Strait Islander peoples, at a rate of at least 3.4 times that of non-Indigenous Australians. It is also a growing health problem for the non-Indigenous population and is associated with the increasing rates of obesity seen internationally over the past 10 to 20 years. Poor food habits and physical inactivity are the modifiable lifestyle risk factors for both type 2 diabetes and obesity. Little, however, little is known about these in Australian Aboriginal and Torres Strait Islander children or in rural children from disadvantaged areas in general. It is recognised that these risk factors track from childhood into adulthood, and that childhood offers an important opportunity to implement appropriate preventative health strategies. Appropriate programs to address poor food habits and physical inactivity cannot be developed without a thorough understanding of the risk factors pertinent to each population group. A search of the literature (Chapter 1) reveals that such information is very limited for Australian rural Aboriginal and Torres Strait Islander children and to a somewhat lesser extent for rural children in general, with evidence still very limited and little intervention research reported. Monitoring and evaluation of interventions to address risk factors require the use of validated population-level measurement tools. Currently, there are no such tools available for measuring Aboriginal and Torres Strait Islander children’s dietary intake and only one for measuring their physical activity. This severely compromises the capacity of health professionals to monitor this population’s health and to rigorously evaluate the effect of health strategies. There are urgent calls for research to evaluate the effect of interventions conducted in Aboriginal and Torres Strait Islander communities, with little evidence currently available in any field of health. In response to the issues raised above, the series of studies which constitute this thesis explores the physical activity characteristics and the food and nutrient intake of rural Aboriginal and Torres Strait Islander and non-Indigenous primary school-aged children (Chapters 3 and 5). The studies also validate a 7-day self-report physical activity recall questionnaire and a short food frequency questionnaire with the same populations (Chapters 2 and 4). Aboriginal and Torres Strait Islander children were found to provide self-report data regarding both physical activity and food intake that were at least as valid as those for non-Indigenous children, provided they received appropriate cultural support (detailed in the methods section of the relevant chapters). These results indicate that the measurement tools validated in this series of studies can be used with either group. All children were found to more than meet Australian guidelines for daily physical activity levels, with Aboriginal and Torres Strait Islander children demonstrating a tendency for higher activity than their non-Indigenous counterparts. All children who participated in this series of studies were found to possess excessive intakes of energy-dense nutrient-poor (EDNP) foods, with Aboriginal and Torres Strait Islander children demonstrating clinically important higher intakes than non-Indigenous children. Macro-nutrient and sodium intakes of Aboriginal and Torres Strait Islander children were significantly higher than those of their non-Indigenous counterparts. Finally, in response to findings of the studies, further research and intervention strategies are suggested in the conclusions (Chapter 6). A description of the community-controlled governance structure that guided and supported this program of research is provided