A SURVEY OF THE NUTRITIONAL STATUS OF SCHOOLCHILDREN Relation between Nutrient Intake and Socio-economic Factors

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1 Brit J prev soc Med (1973), 27, SURVEY OF THE UTRITIOL STTUS OF SCHOOLCHILDRE Reltion between utrient Intke nd Socio-economic Fctors JUDITH COOK, D G LTM, DI M C MOORE, SOI G TOPP, D W W HOLLD Deprtment of Clinicl Epidemiology nd Socil Medicine, St Thoms's Hospitl Medicl School, London SEJ This study ws designed to exmine the dietry intke of schoolchildren, to investigte its reltionship to helth nd socio-economic fctors, nd to explore the extent nd nture of poor nutrition The techniques employed were bsed on those used by the Ministry of Helth (1968) in their study of pre-schoolchildren The relibility nd problems of these hve been discussed previously (Topp, Cook, nd Elliott, 1972) The following informtion ws sought for ech child prticipting in the study: (1) one-week weighed diet record closely supervised by trined fieldworker (Topp et l, 1972); (2) socio-economic questionnire* dministered by the sme fieldworker This included informtion on fmily structure, fther's occuption, mother's eduction nd working sttus, the child's helth history nd eting pttern, nd the prents' heights; (3) medicl exmintion to ssess cliniclly the nutritionl sttus of the child, to look for clinicl evidence of vitmin deficiency, nd to obtin mesurements of height, weight, triceps nd subscpulr skinfold thickness, rm circumference, nd pek expirtory flow rte (PEFR) The medicl ssessments were crried out by one of two medicl officers who were trined together nd frequently discussed criteri in the field in order to minimize vrition in both the mesurement techniques nd the clinicl ssessment This pper will not discuss the findings of the medicl exmintion, which will be reported seprtely But it should be mentioned here tht no overt clinicl evidence of nutritionl deficiency ws found in ny child Copies of this questionnire my be obtined from the uthors ELLIOTT County Medicl Officer, Kent County Council 91 SMPLE The smple ws drwn from children who hd tken prt in the Kent Schoolchild Respirtory Survey (Hollnd, Hlil, Bennett, nd Elliott, 1969) It consisted of 1,298 children residing in four res of Kent nd ttending Locl uthority schools in those res The res presented cross-section of urbn nd rurl chrcteristics Children born in nd were included in the smple which ws strtified by socil clss, fmily size, nd weight (s recorded in the erlier study) The smpling frctions were higher for children from lrger fmilies nd from lower socil clsses, nd lso for children with no fther, in order to hve dequte numbers in those groups suspected of hving the gretest likelihood of deficiency Children were drwn rndomly from ech fmily size nd socil clss group, nd where the number in the cell ws lrge enough hlf of the smple ws tken from the 2% of children with the lowest weight (Tble I), gin to mximize the chnces of detecting deficiencies Of the originl smple, 1,17 were found to be eligible for inclusion in the study (Tble II) Resons for ineligibility included removl from the re or schools in the re, leving school, the deth of the mother (nd no permnent mother substitute), ttendnce t specil or privte school, illness t the time of the study, nd, very rrely, the deth of the child The ineligible children were excluded from ll the nlyses FIELDWORK D DT PREPRTIO The study took plce between September 1968 nd Mrch 197 The diet recording nd socio-economic questionnire were completed during the sme week nd the medicl exmintion ws completed within three-month period before or fter this Br J Prev Soc Med: first published s 11136/jech27291 on 1 My 1973 Downloded from on 4 September 218 by guest Protected by

2 92 COOK, LTM, MOORE, TOPP, HOLLD D ELLIOTT TBLE I UMBERS I POPULTIO D STUDY SMPLE BY GE, SEX, SOCIL CLSS, D UMBER OF SIBLIGS () FEMLES 8-11 YERS Socil Clss I-II Socil Clss III Socil Clss IV-V Ftherless Totl o of I - Siblings Popn Smple Popn Smple Popn Smple Popn Smple Popn Smple ,2 22 2* 585 2* * , , * Totl , (b) MLES 8-11 YERS Socil Clss I-Il Socil Clss III Socil Clss IV-V Ftherless Totl o of I- Siblings Popn Smple Popn Smple Popn Smple Popn Smple Popn Smple , * 642 2* * , , * Totl , (c) FEMLES YERS Socil Clss I-il Socil Clss M Socil Clss IV-V Ftherless Totl o of Siblings Popn Smple Popn Smple Popn Smple Popn Smple Popn Smple , * , Totl (d) MLES YERS Socil Clss I-II Socil Clss Im Socil Clss IV-V Ftherless Totl oof Siblings Popn Smple Popn Smple Popn Smple Popn Smple Popn Smple , * * , Totl *In these cells hlf of the smple ws drwn from the lowest quintile by weight nd the other hlf from the upper four quintiles Br J Prev Soc Med: first published s 11136/jech27291 on 1 My 1973 Downloded from on 4 September 218 by guest Protected by

3 SURVEY OF THE UTRITIOL STTUS OF SCHOOLCHILDRE TBLE II UMBERS OF CHILDRE I ECH GE-SEX GROUP Mle Femle Totl ge b c ge b c Totl ,298 b ,17 c =originl smple; b=eligible for study; c=prticipting in study The fieldwork ws crried out by tem of 18 helth visitors, district nurses, nd midwives from the Kent County Council Helth Deprtment Close supervision of the fieldwork nd the stndrd of diet recording ws mintined by the two dietitins The methods of dt preprtion hve been described (Topp et l, 1972) IVESTIGTIO OF THE REFUSL GROUP The diet record ws n essentil prt of the dt required for the study If the diet record hd not been completed child ws considered to belong to the refusl group irrespective of whether or not the other prts of the study hd been stisfctorily completed Of 1,17 eligible children, 239 refused ccording to this criterion (Tble III) Resons given to the fieldworkers for refusl to cooperte in the study re given in Tble IV The response rte of 76 5 % (of those eligible) is high for study of this nture This is thought to be lrgely due to the enthusism nd persevernce of the fieldworkers, nd to the interest roused mong prents in the helth nd nutrition of their children However, it is essentil to exmine the chrcteristics of the refusers s they my be n typicl group TBLE III PERCETGE OF CHILDRE COOPERTIG, PRTILLY COOPERTIG D REFUSIG TO PRTICIPTE I THE STUDY (UMBERS I PRETHESES) Complete 72-% (732) coopertion* Diet record nd 76 5% (778) socio-economic cooperted completed questionnire only 45 ' (46) Diet record not 14-3% (145) completed 1235% (239) o informtion refused obtined 9*2% (94) J *Children for whom diet record, socio-economic questionnire nd medicl exmintion were ll obtined TBLE IV RESOS GIVE TO FIELDWORKERS FOR REFUSL TO PRTICIPTE I THE UTRITIO STUDY Mother too busy or could not cope 49 (2-5) Domestic or emotionl problems 29 (I2o 1 %) lredy tken prt in survey (either the erlier respirtory study or the pilot study) or lredy bd child in the nutrition study 23 (9 6) Refused specificlly becuse of food record 17 (71 %) Child overweight 7 (2 9%) o reson given 114 (47 7%) Totl 239 (99 * 9%O) For fmilies refusing to prticipte n ttempt ws mde to collect dt on socil clss, fmily size, nd mother's work sttus t the time of the fieldworker's visit This informtion ws obtined from 153 of the 239 who refused (64 %) In ddition, there ws lrge mount of dt on prticipnts nd nonprticipnts vilble from the erlier respirtory study crried out in The distributions of sex, ge, height, weight, PEFR, socil clss, number of siblings, nd mother's work sttus were very similr in the two groups one of the differences ws sttisticlly significnt (P> 5) UTRIET ITKE COMPRED WiTH RECOMMEDED LLOWCES Mens nd stndrd devitions of dily intke were clculted for nutrients given in the Deprtment of Helth nd Socil Security's recommended intkes (DHSS, 1969) for the corresponding ge-sex groups Both sets of dt re shown in Tble V For ll groups the energy intke (kiloclories) ws below the recommended level, notbly for the older girls Intke of vitmins nd C ws much higher thn tht recommended Intke of clcium ws lso high, prticulrly for the boys Intke of the other nutrients quoted corresponds firly closely to DHSS recommended levels However, the suggestions of the Pnel on Recommended llownces were bsed prtly on 1947 figures for energy intke nd energy expenditure s energy expenditure my well hve diminished pprecibly due to incresed trnsport fcilities nd sedentry musements (especilly television) the recommended vlues my represent too high n energy intke for current conditions It should be noted tht the study smple ws strtified by socil clss, fmily size, nd weight (Tble I); in Tble V no djustment hs been mde for these weighting fctors In order to mesure the bis in the figures in Tble V study mens nd popultion 93 Br J Prev Soc Med: first published s 11136/jech27291 on 1 My 1973 Downloded from on 4 September 218 by guest Protected by

4 94 COOK, LTM, MOORE, TOPP, HOLLD D ELLIOTT TBLE V COMPRISO OF VERGE DILY UTRIET ITKE WITH DHSS RECOMMEDTIOS (1969) Energy Protein Thimin Riboflvin icotinic Vit C Vit Vit D Clcium Iron umber of (kcl) (g) (mg) (mg) cid (mg) (mg) (iu) (iu) (mg) (mg) Children Rec 2, , Child 7-8 Men 2, , SD Rec 2, , Boys 9-11 Men 2, , SD , Rec 2, , Boys Men 2, , , SD , Rec 3, , Boys Men 2, , , SD , Rec 2, , Girls 9-11 Men 2, , SD , Rec 2, , Girls Men 2, , SD , Rec 2, , Girls Men 2, , SD , Rec=DHSS recommended intke; SD=stndrd devition ote: Children in this study were in the ge rnges 8-11 nd only estimtes were clculted for the four ge-sex groups (s shown in Tble I) The differences were of the order of 1 % Study mens re given in Tble V s the nture of the strtifiction prevents the clcultion of popultion estimtes for the smll ge rnges used by the DHSS UTRIET ITKE D SoCIo-ECOOMIC FCTORS nlyses were undertken to explore the influence of vrious fctors on nutrient* intke using multiple regression so tht the independent influence of ech fctor could be exmined Fctors considered were sex, ge, weight, socil clss, number of siblings, nd mother's work sttus For these nlyses the 8 to 1 1-yer-olds were considered s one ge group nd the 13 to 15-yerolds s nother: ge ws not treted s continuous vrible Only 696 children were included in the regression s 82 children of unknown socil clss or with no fther were excluded Sex, ge, nd weight were ll found to be ssocited with highly significnt differences in verge dily nutrient intke for nerly ll nutrients (Tbles VI nd VII) For ll nutrients the boys hd higher *For convenience, dded sugr is included in this group lthough it is not nutrient In this study dded sugr ws defined s 'ny supr s such dded during cooking, preprtion or mnufcture, s distinct from the nturlly occurring crbohydrte of the bsic foods' intke thn the girls The older children hd higher intke thn the younger, nd the hevier children hd higher intke thn the lighter Socil clss, number of siblings, nd mother's work sttus were not in generl found to be ssocited with highly significnt differences in verge dily nutrient intke However, niml protein nd riboflvin intke fell significntly from the higher to the lower socil clsses nd from smller to lrger fmilies This my hve some link with the differences in height nd weight of the sme popultion of children by socil clss nd fmily size found in the exmintion of dt from the erlier respirtory survey (Topp, Cook, Hollnd, nd Elliott, 197) The previous nlyses were repeted replcing verge dily nutrient intke by verge dily nutrient intke/i, kcl The results obtined were quite different (Tbles VIII nd IX) Sex nd ge differences were not mrked nd there ws vrition in the direction of differences in contrst to the consistent direction of vrition shown in verge dily nutrient intke (Tble VI) In prticulr, clcium, thimin, nd riboflvin intke/l, kcl ws higher for younger thn for older children Vitmin intke/1, kcl ws higher for the girls thn for the boys These differences were ll highly significnt lso intke of ft/1, kcl ws significntly higher for the older thn for the younger ge group, nd intke of niml protein nd crbohydrte/1, kcl ws significntly higher for Br J Prev Soc Med: first published s 11136/jech27291 on 1 My 1973 Downloded from on 4 September 218 by guest Protected by

5 SURVEY OF THE UTRITIOL STTUS OF SCHOOLCHILDRE zz LUt OH <, U o~ U > - < U > > UcJ >-L Z LU oz "du g CD c - z u to,c) to 3 -' ci co 2 ~ U E 2 -, o- -, 4 5: ow z3 V"s ; 4 men enm om MC CO co co MCO m %t O I _os _(7 en t WIen _ % - M*l I _ ~oo_ - M% -v I IWnc M oi O%I i6 vo t- -o in ~ - co en M MM ~4 It O;; I? T% - en W O% O% IOw C EL O o _ r e %O %1 I? - % co O- r r ;rl IT _ t! en~ _7 - i m_ *% _ ~ MM O- "? mne, o oo M% OI M I % M (MI co M * I? ;-$ e*" % ~o oo %,*OM 'I f o fn (4 % Y mccoc - OMoc %%s M MO Ooo V%Mt %O %%% %% %O MM MM "Oo% " % - M M M 42%("( eno t co o ~o _ t_- % eo MM %ooo%- km_oo _ %O en % - M MM M- O- F o * * O%% t ' -'%t V ** ~% %On oo Ic _ o + io-* Z ItEn V_ M - - % - om M % % - O* - % %F SM o o Me O%' M * M O%M- M I I_ D oc I= t 13-2 C) U 11!P, 3 2 C) * C C: :2 U) do Zo C i 3 o o Z, U&6 zo _z 5 Fo C3 Sl 2g *4 #39 Lc ' _3 84 -D 4 ci * * 1111 *I* 1* I ** III * I:* : * * * *** I I ::I ** 1*I 4F** ::::: I *** I II 8 V V I? V 1 o ow V 4 I r qc3 I 95 Br J Prev Soc Med: first published s 11136/jech27291 on 1 My 1973 Downloded from on 4 September 218 by guest Protected by

6 96 oz Ue z z 2> 4 Oo~ z C omf 2 LZJ g ;44 COOK, LTM, MOORE, TOPP, HOLLD D ELLIOTT ~OCg 6 *O w,>; =3 9:,! s L l -14- ',3 S_ ^ W I Io 4 z on I " I i t en so 4'*r * wme te' (4' rr co % I~ -% 1 "enc co - V4tt MM -" "- 1( cm' T ' I 1 T WWe "" "rs co SW coo oo 1* %I - % % oo O oo oo ' ES $*- coo * in CU) '% nc O%- O -O % mo en e MM - -' -% %O- ' v- O % C C14 O "~ 4 " t ; j X 3 I) o -E ne % F1 F r-t- _oem% tor"r O 'o '' ^ -O' %- % fcof * ' ' '%C4' %E >O % % E ' --- %VF- C %- to'rw to % ' % o_o-o ' - ' % VC) _' Gn u) co U91= ( m 1% O'U _>(4 't% ~ Wo enc oo ' '' * 'IO - o %WI e 1 - O ef4 %%O 4~ q g Io + o eo z -4 -o % moo" cooo oe~ c %Go - t- - O*% ' ' oo CU) 'r C %') r') ) VI X Go z$v t;s-2 4- _8 v C O : _2 ) ' 2 9:c i L -J Vv 1fi 11 V v 11 V C11 ā Br J Prev Soc Med: first published s 11136/jech27291 on 1 My 1973 Downloded from on 4 September 218 by guest Protected by

7 SURVEY OF THE UTRITIOL STTUS OF SCHOOLCHILDRE the younger thn for the older children Weight ws significnt fctor only for dded sugr intke/1, kcl for which the hevier children hd lower intke thn the lighter children Of the three socio-economic fctors considered, mother's work sttus hd little influence on the verge dily intke/1, kcl, greeing with the finding for verge dily nutrient intke However, fmily size nd socil clss differences were more mrked thn those found for verge dily nutrient intke Children from smll fmilies hd higher intke of ll nutrients/i,ooo kcl except for crbohydrte nd dded sugr These differences were significnt for bout hlf of the nutrients In generl, children from the higher socil clsses hd higher intke of nutrients/1, kcl thn those from the lower socil clsses The differences were less striking for minerls nd vitmins The exceptions were gin crbohydrte nd dded sugr intke/1, kcl which were higher in the lower socil clsses Ftherless children cn be considered s n 't risk' group with respect to nutrition In order to investigte this group, the previous nlysis ws repeted compring the ftherless group of 69 children with the 696 children with fthers whose socil clss ws known (there were 13 children of unknown socil clss) Except for crbohydrte nd dded sugr intke/1,ooo kcl the ftherless group hd higher intke of ll nutrients/1, kcl lthough they hd lower verge dily intke Few of these differences were significnt, but the consistent pttern cn be tken to demonstrte higher qulity of diet mong the ftherless children (Tble X) TBLE X ME ITKE OF UTRIETS,I, kcl: COMPRISO BETWEE FTHERLESS CHILDRE D CHILDRE OF KOW SOCIL CLSS DJUSTED FOR EFFECTS OF GE, SEX, WEIGHT, UMBER OF SIBLIGS, D MOTHER'S WORK STTUS (Excluding 13 children of unknown socil clss) Ftherless Socil utrient/i, kcl Children Clsses I-V Significnce Energy vlue (kcl) *6 niml protein (g) Totl protein (g) *15 * Ft (g) 43* Crbohydrte (g) * Clcium (mg) Iron (mg) Vitmin (iu) 1 592* 1496 *9 Thimin (mg) * Riboflvin (mg) 732 *67 * icotinic cid (mg) 5* ** Vitmin C (mg) Vitmin D (iu) Pyridoxin (mg) * dded sugr (g) =P>5; *=P< 5; **-P<1; ***=P<1 DISCUSSIO There hve been few recent studies of nutritionl sttus in children in Gret Britin One such study in young children ws crried out by the Ministry of Helth in 1963 (Ministry of Helth, 1968) In this, for ech child weighed diet record ws kept, socio-economic questionnire completed, nd medicl nd dentl exmintions were crried out survey of the helth nd nutrition of Swedish children (Smuelson, 1971 nd 1971b; Smuelson, Grhnen, nd rvidsson, 1971) comprised 24-hour recll of food intke, food hbit history, socioeconomic questionnire, nd detiled medicl exmintion with nthropometric mesurements, hemtologicl tests, nd n ssessment of orl helth This pper gives the first results of study of Kent schoolchildren for which the dt comprise oneweek weighed diet record, socio-economic questionnire, nd medicl exmintion nlyses presented show the reltionship of verge dily nutrient intke (nd intke/1, kcl) to bsic socio-economic fctors (ge, sex, weight, socil clss, number of siblings, nd mother's work sttus) Older children, with lrger body size, hve higher energy requirements nd thus greter ppetites thn younger children In this study older children were found to hve higher intke thn younger children lso, in both ge groups, boys were found to hve higher intke thn girls This difference in intke between the sexes will be discussed lter Hevier children were found to hve higher verge dily nutrient intke thn lighter children, which my be due in prt to their lrger body size dded sugr ws the only nutrient for which there ws difference in intke/i, kcl between different weight groups, the hevier children hving lower intke thn the lighter children This finding is similr to tht of n erlier study (Johnson, Burke, nd Myer, 1956) in which obese girls hd lower energy intke thn the non-obese The explntion for this my be prtly in voluntry restriction of sugr mong children who re wre of being overweight Some children in the study were following diets to reduce their weight Since energy intke vries widely between individuls it is more meningful to exmine verge dily nutrient intke per thousnd kiloclories when qulity of diet is considered to be of importnce The use of nutrient intke expressed s vlue/, kcl elimintes the possible effects of body size nd ctivity These cn ffect the bsolute intkes of nutrients merely becuse more or less food is eten Further, n individul's diet my well be dequte 97 Br J Prev Soc Med: first published s 11136/jech27291 on 1 My 1973 Downloded from on 4 September 218 by guest Protected by

8 98 COOK, LTM, MOORE, TOPP, HOLLD D ELLIOTT s regrds energy intke but my, for exmple, be indequte s regrds protein intke diet low in protein is lso likely to be low in number of other nutrients nd vitmins, nd individuls with higher protein intke/1, kcl will tend to be better nourished thn those with lower intke However, this is not lwys true s high protein intke combined with n indequte energy intke results in prt of the protein being used for energy The differences between the two ge groups seen in verge dily nutrient intke were not present for intke/1, kcl This suggests tht these ge differences in verge dily nutrient intke re function of greter body size with resultnt incresed ppetite in the older children The qulity of diet of the older children is similr to tht of the younger children The bsence of differences between the verge dily intke/1, kcl of the two sexes is hrder to interpret It suggests tht the qulity of diet in the two sexes is similr, lthough boys hve higher verge dily nutrient intke thn girls The differences in totl intke re unlikely to be due to body size differences between the sexes s boys in the younger ge group re only slightly hevier nd tller thn girls (London County Council, 1961) s girls rech the pubertl growth spurt erlier thn boys they temporrily overtke boys in body size However, the lower proportion of body ft to body mss in boys nd their higher expenditure of energy in physicl ctivity re fctors which contribute to greter totl nutrient intke The negligible influence of socil clss, fmily size, nd mother's work sttus on totl nutrient intke is interesting Mny studies hve demonstrted the influence socil clss, fmily size, nd mother's work sttus hve on the height nd weight of children (Berry nd Cowin, 1954; Topp et l, 197; Dvie, Butler, nd Goldstein, 1972) nd these differences hve been ttributed in prt to differences in nutrition It my be tht qulity of diet, s ssessed by nutrient intke/1, kcl, is of more importnce in reltively prosperous countries thn totl nutrient intke in its influence on growth Certinly between individuls the proportion of energy derived from crbohydrte, ft, nd protein vries The higher the proportion of protein in the diet the greter will be its body-building potentil The reltive proportions of nutrients other thn crbohydrte, ft, nd protein my lso be of importnce here These more complex vribles hve not yet been studied in this group of children The vrition in intke of nutrients/i, kcl between different socil clss nd fmily size groups prllels the height nd weight differences found between socil clss nd fmily size groups in the nlyses of dt from the erlier respirtory study (Topp et l, 197) The finding tht children from lower socil clsses nd lrger fmilies hd lower intke of ll nutrients/i, kcl except crbohydrte nd dded sugr indictes tht these children hve diets tht rely on cheper nutrients s sources of energy rther thn more expensive protein nd fts Tht the nutrient intke/1, kcl did not differ by mother's work sttus suggests tht the differences in height nd weight previously found (Berry et l, 1954; Leys et l, 1963; Topp et l, 197) re unlikely to be due to differences in intke or qulity of nutrition However, study by Metheny, Hunt, Ptton, nd Heye (1962) found tht children of mothers who worked hd slightly better diet thn those whose mothers did not work The study smple contined higher proportion of ftherless children thn did the smpling frme becuse these children were considered to be vulnerble in socio-economic terms nd possibly in their nutrition The unexpected finding ws tht, lthough they hd lower energy intke thn children with fthers, the ftherless children hd better qulity of diet Possible explntions for this finding re tht within ftherless fmily the mother my ly more stress on the feeding of her children thn when husbnd is present In fmily where there is difficulty in meeting expenses the outly on foods my be considered much more crefully, in prticulr with respect to the reltive nutritionl vlue of vrious foods Further, the fther's likes nd dislikes hve been found to predominte in the choice of foods within fmily (UK Mrgrine nd Shortening Mnufcturers'ssocition, 1969) When no fther is present this role my be trnsferred to the child or children This might help to explin why the ftherless children hd higher intke/1, kcl thn children from the lower socil clsses (see Tbles VIII nd X) Further exmintion of dt on the income of the ftherless fmilies nd their pttern of intke of different foods my help to illuminte these differences The nthropometric dt re lso being exmined to see if the better qulity of diet of the children of ftherless fmilies cn be linked with greter ttined height nd weight Br J Prev Soc Med: first published s 11136/jech27291 on 1 My 1973 Downloded from on 4 September 218 by guest Protected by SUMMRY survey of the nutritionl sttus of schoolchildren ged 8-11 nd yers ws crried out in Kent between September 1968 nd Mrch 197 oneweek weighed diet record, medicl exmintion including nthropometric mesurements, nd

9 SURVEY OF THE UTRITIOL STTUS OF SCHOOLCHILDRE detiled socio-economic questionnire were obtined from ech child tking prt The ims of the study were to exmine the dietry intke of schoolchildren, to investigte its reltionship to helth nd socio-economic fctors, nd to explore the extent nd nture of poor nutrition Of 1,17 children sked to prticipte, 778 cooperted, response rte of 76-5 % The fmilies who refused to tke prt were compred with those who cooperted using dt from n erlier study o differences were found In this pper the reltionship between verge dily nutrient intke nd some bsic socio-economic fctors is explored Sex, ge, nd weight were ll found to be independently ssocited with highly significnt differences in intke of most nutrients Socil clss, number of siblings, nd mother's work sttus were not in generl ssocited with significnt differences in intke However, these reltionships showed different trends when verge dily nutrient intke/1, kcl ws considered Sex nd ge differences were not consistently present nd weight differences were only pprent for dded sugr intke/1, kcl Mother's work sttus hd little influence on intke Children from the higher socil clsses hd higher intke of ll nutrients/1, kcl except crbohydrte nd dded sugr, nd those from smller fmilies hd higher intke of ll nutrients/1, kcl except crbohydrte The children from ftherless fmilies, when considered s seprte group, hd higher intke of nutrients/1, kcl thn the other children despite lower energy intke This work hs been supported in prt by grnt from the Deprtment of Helth nd Socil Security This study hs been mde possible by the support nd coopertion of mny people nd in prticulr by the stff of Kent County Council in the helth nd eduction services Specil thnks re due to the helth visitors, district nurses, nd midwives who crried out the survey field work nd to Mrs Melton nd Mrs B Winstnley who supervised the diet recording nd the completion of the socio-economic questionnires We lso wish to thnk Dr W T C Berry, Mrs M Disselduff, nd Dr S J Drke t the Deprtment of Helth nd Socil Security for their dvice nd guidnce; Dr S J Drke for her work in crrying out proportion of the medicl exmintions; Mr S G ichols for the preprtion of punched crds; Mrs Mulhollnd for writing the check progrms nd intricte conversion progrm; nd Miss S Dennis for her work on the nlysis The dt were nlysed using the University of London CDC 66 computer REFERECES BERRY, W T C, nd COWI, P J (1954) Conditions ssocited with the growth of boys, Brit med J 1, 847 DVIE, R, BUTLER,, nd GOLDSTEI, H (1972) From Birth to Seven The Second Report ofthe tionl Child Development Study Longmn, London DEPRTMET OF HELTH D SOCIL SECURITY (1969) Recommended intkes of nutrients for the United Kingdom Rep Publ Hlth med Subj o 12 HMSO, London HOLLD, W W, HLIL, T, BEETT, E, nd ELLIOTr, (1969) Fctors influencing the onset of chronic respirtory disese Brit med J 2, 25 JOHSO, M L, BURKE, BS, nd MYER, J (1956) Reltive importnce of inctivity nd overeting in the energy blnce of obese high school girls mer J clin utr, 4, 37 LEYS, D G, SMMRCO, B, CRTER, CO, CURRIE, P, CUCE, H, MXWELL, C M, nd SwIFT, P (1963) Mothers t work Brit J prev soc Med, 17, 145 LODO COUTY COUCIL (1961) Report on the heights nd weights (nd other mesurements) of school pupils in the County of London in 1959 LCC Report o 19 METHEY, Y, HUT, F E, PTTO, M B, nd HEYE, H (1962) The diet of pre-school children I utritionl sufficiency findings nd fmily mrketing prctices J Home Econ, 54, 297 MIISTRY OF HELTH (1968) pilot survey of the nutrition of young children in 1963 Rep Publ Hlth med Subj o 118 HMSO, London SMUELSO, G (1971) n epidemiologicl study of child helth nd nutrition in northern Swedish county I Food consumption survey ct pedit scnd Suppl (1971b) n epidemiologicl study of child helth nd nutrition in northern Swedish county III Medicl nd nthropometricl exmintions ct pedit scnd, 6, 653 -, GRHE, H, nd RVIDSSO, E (1971) n epidemiologicl study of child helth nd nutrition in northern Swedish county VI Reltionship between generl nd orl helth, food hbits, nd socioeconomic conditions mer J clin utr, 24, 1361 TopP, S G, COOK, J, nd ELLIOTT, (1972) Mesurement of nutritionl intke mong schoolchildren Brit J prev soc Med, 26, 16 HOLLD, W W, nd ELLIOTT, (197) Influence of environmentl fctors on height nd weight of schoolchildren Brit J prev soc Med, 24, 154 UK MRGRIE D SHORTEIG MUFCTURERS' ssocitio (1969) Food Fcts nd Fllcies UK Mrgrine nd Shortening Mnufcturers' ssocition 99 Br J Prev Soc Med: first published s 11136/jech27291 on 1 My 1973 Downloded from on 4 September 218 by guest Protected by