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THE OFFICIAL JOURNAL OF THE BRITISH DIETETIC ASSOCIATION
Editor: Simon Langley-Evans
Journal of
Human Nutrition
and
Dietetics
VOLUME 30 ISSUE 4 AUGUST 2017
CHILDREN AND ADOLESCENTS
DIETETIC PRACTICE
OBESITY AND RELATED DISORDERS
INBORN ERRORS OF METABOLISM
DIETARY ASSESSMENT AND FOOD BEHAVIOURS
jjhn_V30_I4_Issueinfo.indd 1hn_V30_I4_Issueinfo.indd 1 330-06-2017 11:43:480-06-2017 11:43:48
Journal of
Human Nutrition and Dietetics
The Offi cial Journal of the British Dietetic Association
Editor-in-Chief Editorial Board
Professor Simon Langley-Evans A. Anderson, Centre for Public Health Nutrition Research, University of Dundee, UK
Deputy Head of School of Biosciences T. Baranowski, Bayor College of Medicine, USA
University of Nottingham, J. Bauer, School of Human Movement Studies, University of Queensland, Australia
UK. T. Burrows, University of Newcastle, Australia
E-mail: simon.langley-evans@nottingham.ac.uk J. Coad, Massey University, New Zealand
Associate Editors C. Collins, University of Newcastle, Australia
S Burden, University of Manchester, UK P. Collins, Faculty of Health, Queensland University of Technology, Australia
C Green, Nutricia, The Netherlands K. Davison, Simon Fraser University, Canada
J. Harvey, University of Vermont, USA
M. Hickson, Faculty of Medicine, Imperial College London, UK
J. Hodgson, University of Western Australia, Australia
M. Kiely, CountyCollege Cork, Ireland
F. Kolahdooz, University of Alberta, Canada
I. Lemieux, Quebec Heart Institute, Laval University, Canada
S. Lennie, School of Pharmacy and Life Sciences, Robert Gordon University, UK
A. Madden, School of Health and Emergency Professions, University of Hertfordshire, UK
M. McInley, Queens University Belfast, UK
D. Mellor, University of Canberra, Australia
C. Nowson, Deakin University, Australia
T. Ong, Sao Paolo University, Brazil
A. OSullivan, Institute of Food and Health, University College Dublin, Ireland
M. Pakseresht, University of Alberta, Canada
Y. Probst, University of Wollongong, Australia
A. Roefs, Faculty of Psychology, Maastricht University, The Netherlands
J. Swift, School of Biosciences, University of Nottingham, UK
M. Taylor, School of Biomedical Sciences, University of Nottingham, UK
K. Whelan, Kings College London, UK
L. Williams, Department of Oncology, University of Sheffi eld, UK
L. Wood, University of Newcastle, Australia
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jjhn_V30_I4_Issueinfo.indd 2hn_V30_I4_Issueinfo.indd 2 330-06-2017 11:43:480-06-2017 11:43:48
Journal of Human Nutrition and Dietetics
CHILDREN ANDADOLESCENTS
Dietary strategies for achieving adequate vitamin D and
iron intakes in young children in Ireland
1 1 2 2 1
L. Kehoe, J. Walton, B.A. McNulty, A.P. Nugent & A. Flynn
1
School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
2
UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland
Keywords Abstract
dietary strategies, fortification, iron,
supplementation, vitamin D. Background: Inadequate intakes of vitamin D and iron have been reported
in young children in Ireland. The present study aimed to identify the main
Correspondence foods determining vitamin D and iron intakes and to model the impact of
J. Walton, School of Food and Nutritional dietary strategies to improve adequacy of these micronutrients in young
Sciences, University College Cork, Republic of children.
Ireland, Cork, Ireland. Methods: The present study is based on the Irish National Pre-School
Tel.: +353 (0) 214903387
Fax: +353 (0) 21 4270244 Nutrition Survey (NPNS), which estimated food and nutrient intakes in a
E-mail: janette.walton@ucc.ie representative sample (n = 500) of children (aged 1–4 years) using a 4-day
©
weighed food record. Dietary strategies were modelled using DaDiet soft-
Howtocite this article ware (Dazult Ltd, Co. Kildare, Republic of Ireland) and the usual intake dis-
Kehoe L., Walton J., McNulty B.A., Nugent A.P. tribution, prevalence of inadequate intakes and risk of excessive intakes
& Flynn A. (2017) Dietary strategies for were estimated using the National Cancer Institute method.
achieving adequate vitamin D and iron intakes in Results: Fortified foods and nutritional supplements were the key foods
young children in Ireland. J Hum Nutr Diet. 30, 1
405–416 influencing the intakes of vitamin D and iron. Adding a 5 lg day vitamin
doi: 10.1111/jhn.12449 Dsupplement, fortifying cow’s milk (CM) with vitamin D or replacing CM
with growing-up milk (GUM) would modestly increase intakes of vitamin
D. A combined strategy of fortifying CM with vitamin D or replacing CM
1
with GUM plus a 5 lg day vitamin D supplement would increase mean
1 1
intakes of vitamin D (from 3.5 lg day at baseline to ≥11 lg day ) and
substantially reduce the prevalence of inadequate intakes (from >95% to
12–36%). Fortifying CM with iron or replacing CM with GUM would
1 1
increase mean intakes of iron (from 7.3 mg day to >10 mg day ),
achieving adequate intakes across all ages.
Conclusions: Based on real food consumption data in a representative sam-
ple of Irish children, we have shown that through targeted dietary strategies
adequate intakes of iron are achievable and intakes of vitamin D could be
greatly improved.
Introduction Fortified foods and supplements can represent an
opportunity to improve intakes and adequacy of vitamin
Low intakes of vitamin D and iron (1–7) and biochemical D and iron in all population groups (14–20). The practical
evidence of poor vitamin D and iron status have been and theoretical impacts of vitamin D fortification of dairy
widely reported in young children in Ireland and across products have been widely investigated, demonstrating
Europe (8–11). As a result of the negative impact of inade- that it is an effective strategy for increasing dietary intake
quate vitamin D and iron status on childhood growth and serum 25-hydroxyvitamin D (25(OH)D) concentra-
and development and lifelong health status (12,13), effec- tions in many population groups (21–26). Furthermore, it
tive dietary strategies to improve the intakes of these has been frequently reported that the consumption of
nutrients in young children are required. breakfast cereals (primarily ready-to-eat breakfast cereals,
ª2016The British Dietetic Association Ltd. 405
Strategies for adequate vitamin D and iron intakes L. Kehoe et al.
which are commonly fortified with a number of nutrients (a) 06/07/10). Written informed consent was obtained
including iron), is associated with higher iron intakes and from parents/guardians.
a better dietary nutritional profile among all age groups
(18,27,28). Several countries, particularly those at Northerly
latitudes, currently recommend vitamin D supplements Sampling and recruitment methodology
for many population subgroups (29–32); however, despite Eligible participants were children aged between 12 and
recommendations for younger infants and older children 59 months, inclusive, who had not yet started primary
and adults in Ireland to take a vitamin D supplement school. A total sample of 500 participants (251 boys and
daily, there are currently no recommendations for young 249 girls) were selected from a database of names and
(33,34)
children aged 1–4 years . addresses compiled by ‘eumom’ an Irish parenting
For young children in particular (aged 1 and 2 years), resource or from randomly chosen childcare facilities in
fortified growing-up-milks (GUM), also known as young selected locations. A second level of recruitment was used
child formula (milk-based drinks intended for children in which names and addresses were compiled through
aged 12–36 months), can provide an effective approach referrals from participants and participation was invited
for improving intakes and adequacy of vitamin D and for those that were contactable. In all cases, participation
iron (among other nutrients). The association between was dependent on the prospective participant ‘opting in’.
GUM consumption and increased intakes and improved Demographic analysis of the sample has shown it to be
status of vitamin D and iron has been widely reported nationally representative of young Irish children with
(16,17,35–37) and a recent dietary modelling approach in the respect to age, sex and geographical location compared to
UK has demonstrated that replacing cow’s milk (CM) Irish Census 2006 data (39). The final sample contained a
with GUM would be an effective strategy for increasing higher proportion of children of professional workers and
intakes of vitamin D and iron and would also lead to a lower proportion of children of semi-skilled and
nutritional intakes more in line with recommendations in unskilled workers than the general population and all
(38)
young children . data reported in the present study were weighted to
The Irish National Pre-School Nutrition Survey adjust for these differences.
(NPNS) database contains detailed food consumption
data linked with updated food composition data as Food consumption data
required for theoretical modelling of dietary strategies.
The present study aimed to use the NPNS data to identify Food and beverage intake data were collected using a
the key sources and determinants of vitamin D and iron 4-day weighed food record. For all participants, the study
intake in Irish pre-school children and to model the period included at least 1 weekend day. The researcher
potential impact of dietary strategies for achieving recom- made three visits to the participant and the caregiver dur-
mended intakes of vitamin D and iron in Irish pre-school ing the 4-day recording period: an initial training visit to
children aged 1–4 years. demonstrate how to complete the food diary and use the
weighing scales; a second visit 24–36 h into the recording
Materials and methods period to review the diary, check for completeness and
clarify details regarding specific food descriptors and
Study sample quantities; and a final visit 1 or 2 days after the recording
Analyses for the present study were based on data from period to check the recording from the final days and to
the Irish National Pre-School Nutrition Survey, which collect the diary. Caregivers were asked to record detailed
was a cross-sectional survey conducted in the Republic of information regarding the amount, type and brand of all
Ireland in 2010–2011 by the Irish Universities Nutrition food, beverages and nutritional supplements consumed
Alliance (IUNA) units at University College Cork and by the child over the 4-day period and, where applicable,
University College Dublin with the aim of establishing a the cooking methods used, the packaging size and type
database of habitual food and beverage consumption in a and details of recipes and any leftovers. Participants were
representative sample of children aged between 1 and also encouraged to keep packaging of foods consumed to
4 years (n = 500). A detailed survey methodology is avail- provide further information.
able at www.iuna.net and an overview of the methods rel- A food quantification protocol established by the
(40)
evant to this study is provided below. The study was IUNA , which uses a hierarchical approach, was
conducted in accordance with guidelines laid down in the adapted for the NPNS. Further details can be found on
Declaration of Helsinki and ethical approval was obtained www.iuna.net . In summary, food was quantified by: (i)
from the Clinical Research Ethics Committee of the Cork being weighed by participants or based on manufacturer
Teaching Hospitals, University College Cork (Ref: ECM 4 weights (which was used to quantify 85% of foods and
406 ª2016The British Dietetic Association Ltd.
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