2007 Children Survey Findings 2

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2007 National Australian

ChildrensNutrition and Physical

Activity Survey:

South Australian Findings


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ContentsContents .................................................................................................................................................. 2List of Figures..........................................................................................................................................6List of Figures..........................................................................................................................................6Abbreviations .......................................................................................................................................... 7Acknowledgements ................................................................................................................................. 8Executive Summary .............................................................................................................................. 10Overview ............................................................................................................................................... 10Main Findings ........................................................................................................................................ 101 Introduction .................................................................................................................................... 142 Methodology

2.1 Sample Design......................................................................................................................... 152.2 Contacting Households............................................................................................................152.3 Recruiting Participants .............................................................................................................162.4 Survey Methodology ................................................................................................................172.5 Survey Methodology Issues.....................................................................................................22

3 Demographic Characteristics3.1 Caregivers................................................................................................................................ 233.2 Children.................................................................................................................................... 233.3 Households .............................................................................................................................. 243.4 Socio-Economic Status............................................................................................................24

4 Food and Nutrients4.1 Food and Drinks.......................................................................................................................254.2 Nutrients................................................................................................................................... 294.3 Nutritional Supplements...........................................................................................................444.4 Eating Pattern ..........................................................................................................................44

5 Physical and Sedentary Activities5.1 Physical Activity Guidelines ..................................................................................................... 475.2 Pedometer Steps .....................................................................................................................485.3 Screen Time.............................................................................................................................50

6 Body Size and Shape6.1 Body Mass Index .....................................................................................................................536.2 Waist Girth ...............................................................................................................................536.3 Height and Weight ...................................................................................................................54

7 Linking Nutrition, Activity and Body Size........................................................................................ 568 Comparing South Australian Data and National Data ................................................................... 589 Socio-Economic Status ..................................................................................................................6110 Health Regions...............................................................................................................................73

11 School Days, Weekends and Holidays ..........................................................................................8112 Weight Status, Physical Activity and Screen Time ........................................................................ 8813 Conclusion and Recommendations ...............................................................................................8914 References ..................................................................................................................................... 91

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List of Tables

Table 1: Telephone contact attempts using random digit dialling (RDD) to obtain the SouthAustralian sample.................................................................................................................................. 16

Table 2: Recruitment of South Australian participants through RDD....................................................16Table 3: South Australian participants by age and gender ................................................................... 17

Table 4: Weekday distribution of CATI and CAPI interview days in the South Australian sample.......18

Table 5: Demographic characteristics of South Australian caregivers (unweighted data) ................... 23

Table 6: Demographic characteristics of South Australian children (unweighted data) ....................... 23

Table 7: Incomes of South Australian households (unweighted data) .................................................24

Table 8: Percentage of South Australian children classified in the four SES bands by health region(unweighted data) .................................................................................................................................24

Table 9: Mean daily consumption (g) of major food groups 1 in South Australian children ...................26

Table 10: Proportion (%) of total dietary energy intake (including energy from fermentable fibre) ofSouth Australian children obtained from major food groups 1 ............................................................... 27

Table 11: Selected sub-major food groups consumption 1 in South Australian children by age andgender group ...................................................................................................................................... 28

Table 12: Median intake of energy (kJ) (including energy from fermentable fibre) in SouthAustralian children compared with EER, and proportions outside the upper and lower bounds ofEER ....................................................................................................................................................... 32

Table 13: Mean intake 1 of energy, macronutrients and total moisture/fluid in South Australian children.............................................................................................................................................................. 34

Table 14: Mean percentage (%) contribution of macronutrients to total energy intake in SouthAustralian children................................................................................................................................. 35

Table 15: Mean intake 1 of micronutrients and caffeine in South Australian children............................37

Table 16: Proportion (%) of South Australian children meeting EAR for selected nutrients usingestimate of usual nutrient intakes derived from two days of intake data collected by 24-hour recallat both CAPI and follow-up CATI ..........................................................................................................39

Table 17: Methodology to compare intakes with dietary guidelines .....................................................41

Table 18: Proportion (%) of South Australian children meeting the serve recommendations of theAustralian Guide to Healthy Eating based on the dietary guidelines 1,2 .................................................43

Table 19: Percentage of South Australian children who consumed at least one supplement on theday prior to the interview ....................................................................................................................... 44

Table 20: Proportion (%) of South Australian children eating breakfast on a school day 1 by age andgender group ......................................................................................................................................... 45

Table 21: Estimated number of eating occasions 1 per day in South Australian children by age andgender group ...................................................................................................................................... 46

Table 22: Proportion (%) of South Australian children who met the physical activity guidelines usingfour different methods of interpreting the guidelines............................................................................. 48

Table 23: Breakdown of the South Australian sample in the pedometer study by gender and agegroup ..................................................................................................................................................... 48

Table 24: Mean number of steps taken per day by South Australian boys and girls aged 5-8, 9-13and 14-16, and the percentage reaching or exceeding recommended thresholds ..............................49

Table 25: Mean for PAL (METs) and the mean time South Australian children spent participating in

MVPA minutes per day ......................................................................................................................... 49

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Table 26: Proportion (%) of South Australian children who met the screen time guidelines using fourdifferent methods of interpreting the guidelines .................................................................................... 51

Table 27: Mean number of minutes South Australian children engaged in screen time, televisionviewing, computer use and video game playing ................................................................................... 52

Table 28: Proportion (%) of South Australian children classified as underweight, normal weight,

overweight and obese ........................................................................................................................... 53Table 29: Mean waist girths (cm) and proportion (%) of South Australian children with waist girths>50% of height ......................................................................................................................................54

Table 30: Mean height (cm) of South Australian children.....................................................................54

Table 31: Mean weight (kg) of South Australian children ..................................................................... 55

Table 32: Mean PAL for underweight, normal weight, overweight and obese children in the SouthAustralian sample.................................................................................................................................. 56

Table 33: Energy intake (total kJ, including energy from fermentable fibre) by physical activity level(PAL) for South Australian children.......................................................................................................57

Table 34: Mean energy intake (total kJ) (including energy from fermentable fibre) by weight status 1

for all South Australian children ............................................................................................................ 57Table 35: Comparison of South Australian Children (SA) and National Survey children for selectedcharacteristics by age and gender ........................................................................................................59

Table 36: Proportion (%) of South Australian children and National Survey children meeting EAR forselected nutrients and dietary guidelines using estimate of usual intakes derived from two days ofintake data collected by 24-hour recall at both CAPI and follow-up CATI............................................60

Table 37: Percentage of South Australian children classified as obese, overweight, and obese oroverweight, across the four SES bands................................................................................................61

Table 38: Fruit and vegetable consumption 1 in South Australian children by age group and SES 2.....62

Table 39: Consumption 1 of selected major and sub-major food groups in South Australian children

by age group and SES2

......................................................................................................................... 64Table 40: Consumption 1 of selected nutrients in South Australian children by age group and SES 2 ..66

Table 41: Proportion (%) of South Australian children eating breakfast 1 on a school day by agegroup and SES 2 .................................................................................................................................... 68

Table 42: Estimated number of eating occasions 1 per day in South Australian children by age andSES 2 ...................................................................................................................................................... 69

Table 43: Physical activity patterns of South Australian children across the four SES bands .............70

Table 44: Screen time patterns of South Australian children across the four SES bands ................... 70

Table 45: Relationship between aspects of family structure and weight status, physical activity andsedentary behaviour variables in South Australia.................................................................................72

Table 46: Fruit and vegetable consumption 1 by age group and SA health regions..............................74

Table 47: Consumption 1 of selected major and sub-major food groups by age group and SA healthregions................................................................................................................................................... 76

Table 48: Consumption 1 of selected nutrients by age group and SA health regions ...........................77

Table 49: Proportion (%) of South Australian children eating breakfast 1 on a school day by agegroup and SA health regions ................................................................................................................ 79

Table 50: Estimated number of eating occasions 1 per day by age group and SA health regions....... 79

Table 51: Means for selected physical activity variables by health region ...........................................80



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Table 54: Mean time (minutes/day) South Australian children spent in MVPA and sport on schooldays, weekend days, and holidays .......................................................................................................81

Table 55: Mean time (minutes/day) South Australian children spent in screen time and videogameplaying, and mean PAL on school days, weekend days, and holidays ...............................................81

Table 56: Proportion (%) of total energy (including energy from fermentable fibre) consumed by

South Australian children during and outside school hours1

by age and gender groups .....................82Table 57: Proportion (%) of total energy (including energy from fermentable fibre) consumed bySouth Australian children during and outside school hours 1 by age and SES .....................................83

Table 58: Proportion (%) of total energy (including energy from fermentable fibre) consumed duringand outside school hours 1 by age and SA health regions ....................................................................83

Table 59: Proportion (%) of total fruit and vegetables (including legumes) consumed by SouthAustralian children during and outside school hours 1 by age and gender groups................................84

Table 60: Proportion (%) of total fruit and vegetables (including legumes) consumed by SouthAustralian children during and outside school hours 1 by age and SES................................................85

Table 61: Proportion (%) of total fruit and vegetables (including legumes) consumed by South

Australian children during and outside school hours1

by age and SA health regions ..........................85Table 62: Comparison of weekday and weekend day intakes 1 of energy, total fat, saturated fat andsodium in South Australian children by age group ...............................................................................86

Table 63: Comparison of weekday and weekend day intakes 1 of energy, total fat, saturated fat andsodium in South Australian children by SES 2 .......................................................................................87

Table 64: Comparison of weekday and weekend day intakes 1 of energy, total fat, saturated fat andsodium in South Australian children by SA health regions ................................................................... 87

Table 65: Mean number of steps per day and mean time (minutes/day) spent in MVPA, sport andfree play for South Australian children of different weight categories...................................................88

Table 66: Mean time (minutes/day) spent in screen time, television and videogames, and meanPAL for South Australian children of different weight categories..........................................................88

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List of FiguresFigure 1: Contribution of energy from core and non-core foods 1,2,3 (including mean intake ofnon-core food) in South Australian children by age and gender group ................................................29

Figure 2: Mean one-day energy intake (including energy from fermentable fibre) of South Australianboys and girls (24-hour recall taken at CAPI, population weights applied) .......................................... 30

Figure 3: Pattern of energy consumption 1 in South Australian children over a 24-hour period............46

Figure 4: Age- and gender-related patterns in MVPA and some of its components [free play, sport,and AT] in the South Australian sample................................................................................................50

Figure 5: Age- and gender-related patterns in screen time and its components (television,computers and video games) in the South Australian sample.............................................................52

Figure 6: Contribution of energy from core and non-foods 1,2,3 (including mean intake of non-corefood) in South Australian children by age and SES..............................................................................67

Figure 7: South Australian health regions.............................................................................................73

Figure 8: Contribution of energy from core and non-core foods 1,2,3 (including mean intake ofnon-core food) by age and SA Health regions...................................................................................... 78

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Abbreviations

ACMA Australian Communication and Media Authority

AGHE Australian Guide to Healthy Eating

AI Adequate Intake

ABS Australian Bureau of Statistics

AT Active Transport

BMI Body Mass Index

BMR Basal Metabolic Rate

CAPI Computer Assisted Personal Interview

CATI Computer Assisted Telephone Interview

CSIRO Commonwealth Scientific and Industrial Research Organisation

DoHA Commonwealth Department of Health and Ageing

EAR Estimated Average Requirement

EER Estimated Energy Requirement

EI Energy Intake

FSANZ Food Standards Australia and New Zealand

g grams

ISAK International Society for the Advancement of Kinanthropometry

kJ kilojoules

MARCA Multimedia Activity Recall for Children and Adults

g micrograms

mg milligrams

MVPA Moderate to Vigorous Physical Activity

NRVs Nutrient Reference Values

NHMRC National Health and Medical Research Council

PAL Physical Activity Level

RDD Random Digit Dialling

RDI Recommended Dietary IntakeRE Retinol Equivalents

SEIFA Socio Economic Indicator for Area

SES Socio-Economic Status

SD Standard Deviation

VPA Vigorous Physical Activity

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Acknowledgements

The Project Team implemented all aspects of the survey.

The members of the Project Team were:

University of South Australia

Professor Timothy Olds, BA (Hon), BSpSc (Dist), PhD (Syd), PhD (UNSW)

Dr James Dollman, BS, MSc, DipEd, PhD

Mr Tim Kupke, BAppSc, BAppSc (Hons)

Ms Emily Vaughton, BHlthSc

Flinders University

Professor Lynne Cobiac, BSc, PhD, MBA (Adv), Post Grad Dip Nut Diet

Dr Michelle Miller, BSc, MNutDiet, PhD

Ms Lily Chan, BPharm, BNutDiet, BSc (Hon)

Commonwealth Scientific and Industrial Research Organisation (CSIRO)

Dr Jane Bowen, BSc, BNut & Diet (Hons), PhD

Ms Jill Burnett, BSc, Dip Nut & Diet, DipEd

Ms Julie Syrette, BSc

Mr James Dempsey, BInfTech(Eng)

Mr Shane Bailie, Dip IT (Software Dev)

Dr Carlene Wilson, BA (Hons), PhD, MBA, MAPS

Ms Ingrid Flight, BA, MPH

Mr Norm Good, Dip IT

Prof Ian Saunders, BA (Hons), DipMathStats, PhD

I-view Pty Ltd

Ms Kylie Brosnan, BBus, Dip MRSA

Mr Daniel Pole, BA

Ms Mary Plumridge

Steering Group

Ms Jenny Bryant, First Assistant Secretary, Population Health Division, Department of Health andAgeing

Mr Andrew Stuart, former First Assistant Secretary, Population Health Division, Department of Healthand Ageing

Ms Margaret Lyons, former First Assistant Secretary, Population Health Division, Department ofHealth and Ageing

Mr Richard Souness, General Manager, Food Policy and Safety Branch, Department of Agriculture,Fisheries and Forestry

Mr Dick Wells, Chief Executive Officer, Australian Food and Grocery Council

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Associates

Ms Jennifer McDonald, former Assistant Secretary, Population Health Division, Department of Healthand Ageing

Dr Geoffrey Annison, Australian Food and Grocery Council

Dr David Roberts, Australian Food and Grocery Council

Steering Group Project Officer: Ms Caroline Arthur, Acting Director Nutrition Section, Department ofHealth and Ageing.

The Technical Reference Group supplied guidance and advice to the Project Team.

The members of the Technical Reference Group were:

Professor A. Stewart Truswell, AO, MD, DSC, FRCP, FRACP, FPHN, Emeritus Professor of HumanNutrition, University of Sydney

Professor Katrine Baghurst, BSc, PhD, Adjunct Professor, Department of Medicine, University ofAdelaide

Professor Jennie Brand Miller, BSc (Hons), (Food Tech), PhD, FAIFST, FNSA, Professor of HumanNutrition, University of Sydney

Ms Ingrid Coles-Rutishauser, BSc (Nutrition), MSc (Epidemiology), RPHNutr, Coles and RutishauserConsultants

Professor Wendy Brown, BSc (Hons), GradDip Phys Ed, MSc, PhD, FASMF, Professor of PhysicalActivity and Health, School of Human Movement Studies, University of Queensland

Professor Robert Newton, BHMS (Hons), MHMS, PhD, AEP, CSCSD, FAAESS, FoundationProfessor, Exercise and Sport Science, Edith Cowan University

Professor Martin Silink, AM, MB, BSc (Hons), MD, FRACP, Professor of Paediatric Endocrinology,University of Sydney

Dr Ann Cowling, PhD

Ms Janis Baines, BA (Hons, Chemistry), MSc (Human Nutrition), Section Manager, Food composition,Evaluation and Modelling Section, FSANZ

Dr Amanda Lee, Manager Nutrition and Physical Activity, Health Promotion Unit, Queensland Health

The Food Composition Team prepared the food composition database

The members of the Food Composition Team were:

Food Standards Australia and New Zealand (FSANZ)

Ms Janis Baines, BA (Hons, Chemistry), MSc (Human Nutrition), Section Manager, FoodComposition, Evaluation and Modelling Section

Dr Judy Cunningham, BSc (Food Tech), PhD Food Composition StudiesMs Renee Sobolewski, BAppSc (Human Nutrition)

Mr Charles Wannop, Database Support, IT Contractor Millpost Technologies Pty Ltd

Therapeutic Goods Administration (TGA)

Mr Shaun Flor ELF Technical Manager, Listed Medicines and Communication Section, Office ofComplementary Medicines, TGA

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Executive Summary

OverviewThe 2007 Australian Childrens Nutrition and Physical Activity Survey (ChildrensSurvey) was commissioned by the Commonwealth Department of Health and Ageing(DoHA), the Department of Agriculture, Fisheries and Forestry, and the AustralianFood and Grocery Council.

The objective of the Childrens Survey was to assess: food and nutrient intakes, useof time and to measure the weight, height and waist circumference in a sample ofchildren aged 2-16 years randomly selected from across Australia.

Data was collected on two occasions involving 4,487 participants from February toAugust 2007. A computer assisted personal interview (CAPI) was conducted in thechilds home. This was then followed up 7-21 days later by a computer assistedtelephone interview (CATI).

SA Health commissioned a booster sample of 400 children to increase the number ofSouth Australian children surveyed to 877. This report relates to all South Australianchildren sampled either in the main study or in the South Australian booster sample.The corresponding national results are also presented [in parenthesis] forcomparison where applicable.

Main Findings

FoodsIn the South Australian sample on the day prior to the interview:

> Children in general consumed a wide variety of foods including cereals, fruit sand vegetables, dairyor dairy substitutes, meat or meat substitutes, non-alcoholic beverages, snack and confectioneryfoods

> Older children (14-16 years) generally consumed the least amount (g) of fruit compared to childrenin any other age group

> Older children reported eating almost twice the amount (g) of vegetables compared to the youngerchildren (2-3 years)

> The intake of milk products was highest amongst the girls 2-3 years compared to girls of other agegroups.

Comparison with Dietary Guidelines for Children and Adolescents in Australia:

> Most South Australian children (90%) [National: 90%] had been breastfed at least some time duringtheir infancy

> Achieving guidelines relating to saturated fat, sugar, vegetables and cereals was problematic forSouth Australian children.

Nutrients

In the SA sample on the day prior to the interview:

> Children generally consumed foods and drinks that provided sufficient energy and were adequatefor most nutrients, without the need to take additional supplements

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> Few children (7%) [National: 8%] consumed dietary supplements, the most common beingmultivitamin and or mineral supplements

> Across all age groups, about half (47-50%) [National: 48-50%] of the total energy intake (EI) wassupplied by carbohydrate, 29-33% [National: 31%] by total dietary fat and 15-18% [National: 1618%] by protein.

Comparison with Dietary Guidelines for Children and Adolescents in Australia:

> The majority of children in all age groups met the EAR for protein and some vitamins includingthiamin, riboflavin, niacin, and vitamin C, suggesting that these nutrients are not at risk ofinadequacy across the populationo The possible exception was for vitamin A expressed as retinol equivalents where 19% [National:

21%] of 14-16 year old boys and 9% [National: 14%] of girls aged between 14-16 years did notmeet the EAR

o Dietary folate intake was also below the EAR in 8% [National: 14%] of boys and 18% [National:29%] of girls aged 14-16 years

> Younger children met the EAR for most minerals. The percentage of children with intakes below theEAR for older children was notable for calcium, magnesium, phosphorus and iodine.o Girls (12-16 years) appeared to be most at risk of not meeting their dietary requirements for

calcium (only 9-27% met and 73-91% did not meet the EAR) [National: 11-18% met and 82-89%did not meet the EAR].

o Other nutrients that also appeared to be potentially at risk included - phosphorus (15%[National: 19%] of 9-13 year olds and 8% [National: 14%] of 14-16 year olds did not meet theEAR), iodine (29% [National: 26%] of 14-16 year olds did not meet the EAR) and magnesium(46% [National: 56%] of 14-16 year olds did not meet the EAR)

o

Boys (14-16 years) were more likely to not reach their EAR for calcium (47% [National: 44%] didnot meet EAR) and magnesium (25% [National: 34%] did not meet the EAR)

> For all age and gender groups the mean usual intake for total fluid, dietary fibre, sodium andpotassium were generally at or above the AI for each nutrient, suggesting that it is unlikely thatthere will be a high prevalence of children not consuming enough of these nutrients. In fact, theconsumption of sodium in all age groups exceeded the recommended upper level of intake

> The estimated usual intakes of vitamin E and D were considerably less than the AI for bothnutrients. Whilst these findings may suggest that a significant number of children may not beconsuming sufficient amounts of vitamin E and D, a definitive conclusion cannot be reached.

Eating Pattern

> For all age groups there was a clear pattern of eating at traditional meal and snack times with verylittle energy consumed between the hours of 22:00 and 06:00

> The majority of children consumed breakfast on a school day. The proportion of girls consumingbreakfast on a school day was lower than boys. As age increased the proportion of childrenconsuming breakfast on a school day decreased

> In general, the number of serves of non-core foods consumed increased with increasing age.

Physical Activity

> The majority of children aged 9-16 years met the Physical Activity Recommendations for 5-12 yearolds and 12-18 year olds, for moderate to vigorous physical activity (MVPA). On any given day,there was a 67% [National: 69%] chance that any given child would get at least 60 minutes ofMVPA

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> Children aged 5-16 years took approximately 11,500 steps [National: 11,800 steps] per day> Few children aged 9-16 years met the guidelines for electronic media use. On any given day, there

was only a 26% [National: 33%] chance that any given child would get no more than 120 minutes ofscreen time

> Adolescent girls achieved much lower levels of physical activity than adolescent boys.

Height and Weight

> The majority of children (71%) [National: 72%] were of healthy weight for their height. Of theremaining, 4-5% [National: 5%] were underweight, 17% [National: 17%] overweight and 7%[National: 6%] obese.

Linking Nutrition, Activity and Body Size

> Obese children tended to have a lower PAL than children of normal weight

> Overweight and obese children tended to report lower energy intakes than children of normalweight

> There was no clear association between reported energy intake and level of physical activity.

South Australian Data Versus National Data

> Overall, the prevalence of overweight and obesity was similar in South Australian children (24.2%)and in Australian children in general (22.9%). Levels of physical activity were also similar

> There were, however, significant differences in screen time, with the average South Australian childaccumulating 28 minutes more screen time than Australian children in general.

Socio-Economic Status

> The prevalence of overweight and obesity increased as SES decreased. There were significantly

more children classified as overweight or obese in the 3rd (26.5%) and 4th (31.5%) SES quartilescompared to the 1st and 2nd quartiles (20-22%)

> There were few differences across SES bands in the amount of physical activity adolescentsexperienced, however, adolescents from higher SES households were involved in more sport

> There were significant differences in screen time across the SES bands. Children in the lowest SESquartile accumulate 30-50 minutes more screen time each day than children in the other quartiles.

> Across all age groups, children from families of high SES consumed more fruit products and dishes(g) than children from families of lower SES.

Family Structure

> Weight status was relatively unrelated to family structure (number and age of caregivers, numberand age of siblings, marriage status)

> Physical activity was greater in households where there were more children, where there weresiblings close in age and of the same gender, and where there were more adults

> Screen time was also lower in households where there were more children, particularly of the samegender

> The marriage status (married/de facto/single) of the caregivers did not impact on any of theoutcomes.

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Type of Day

> Screen time was much higher on weekends and holidays than on school days, and overall energyexpenditure was lower

> Approximately one third of the total energy intake was consumed during school hours for all

children on a school day> The energy intake was similar between weekdays and weekend days for all age groups> Total fat (including saturated fat) was consistently higher on weekend days compared to weekdays

for all age groups> On weekend days, the consumption of energy, fat (including saturated fat) and sodium increased

with increasing SES.

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1 Introduction

The 2007 Australian National Childrens Nutrition and Physical Activity Survey (Childrens Survey)was commissioned by the Commonwealth Department of Health and Ageing, the Department ofAgriculture, Fisheries and Forestry, and the Australian Food and Grocery Council. State HealthDepartments were invited to participate, and SA Health sponsored a booster sample of SouthAustralian participants. Households were randomly selected from around the state, and children andadolescents were interviewed between February and August 2007. This report details findings for theSouth Australian children and adolescents who participated in either the main (national) or boostersamples.

The Commonwealth Scientific and Industrial Research Organisation (CSIRO) and the University ofSouth Australia conducted the survey with I-view Pty Ltd undertaking the survey fieldwork. TheProject Team acknowledges the contribution of Flinders University in the analysis of the dietary data.

Prior to this survey the last national nutrition and physical activity surveys were conducted in 1995(Australian Bureau of Statistics 1998) and 1985 (Department of Community Services and Health1988, 1989) respectively. The intervening years have seen significant changes in the Australian foodsupply and eating habits, an increasing use of technologies that facilitate sedentary behaviour suchas videogames and the internet; along with a changing family life and structure. All of these factorsare likely to impact on what children eat, how they use their time, and on their bodyweight. TheChildrens Survey was undertaken in recognition of the need to have national data on childrensweight status, dietary intake and activity levels for monitoring purposes. This information is alsoimportant for assessing the nutritional adequacy and the physical activity participation of the childrensurveyed.

The Childrens Survey measured dietary intakes of food and beverages, use of supplements duringthe previous 24 hours, selected food habits, heights, weights and body mass index (BMI), waistcircumference, time spent in physical activity and sedentary activity (screen time), number of dailysteps taken and demographic characteristics. The data was gathered on children aged 2-16 years (n= 4487) between 22 February 2007 and 30 August 2007. The South Australian Department of Healthcontributed towards a booster sample (n = 400) for South Australian children. Ethics approval was

obtained from the National Health and Medical Research Council (NHMRC) registered EthicsCommittees of CSIRO and the University of South Australia.

Households with children were randomly selected using random digit dialling (RDD) from SouthAustralia in metropolitan, rural and remote areas. The data was collected at a face-to-face home visit(computer-assisted personal interview, CAPI) and a subsequent telephone interview (computerassisted telephone interview, CATI) conducted 7-21 days after the CAPI.

Food, beverage and supplement intakes were collected for all participants using a standardised,computer-based, three-pass 24-hour recall methodology during the CAPI and the CATI. Incollaboration with Food Standards Australia and New Zealand (FSANZ), the food and beverageintake data was translated to daily nutrient intake data using the most recent Australian nutrientcomposition database. Food habit questions were asked of each child and/or parent during the CAPIin relation to the usual consumption of fruits, vegetables, type of milk, use of salt and earlier infantfeeding practices.Physical activity was measured in two ways. Time use was measured in children aged 9-16 yearsusing a validated computerised 24-hour recall, the Multimedia Activity Recall for Children and Adults(MARCA), during the CAPI and the CATI. Children recalled a total of four days. Pedometers werealso used to measure the average number of steps taken daily over six days by children aged 5-16years.

Weight, height and waist circumference were measured for all participants during the CAPI.

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2 Methodology

The sampling, interview and analytical methodologies were essentially identical for the national andSouth Australian booster samples. The South Australian Booster sample was surveyed slightly later in

the year than the main sample. This may have affected physical activity patterns, use of time and diet,however, South Australian children from the main sample and the booster sample did not differ withrespect to age, energy intake, daily energy expenditure, number of steps per day, minutes ofmoderate-to-vigorous physical activity, or daily screen time. There were significant differences insocio-economic status (SEIFA for Relative Disadvantage for booster sample = 1003, for main sample= 978, p = 0.0006) and BMI z-score (booster sample = +0.56, main sample = 0.26, p < 0.0001).

2.1 Sample Design

The survey sample was randomly selected firstly by postcode (stratified by state/territory and capitalcity/rest of state), and secondly by households within selected postcodes using RDD of telephonenumbers. Very remote areas were excluded from the survey due to budgetary and time restrictions.The survey was not designed to collect information on representative samples of children of

Indigenous origin. Consequently postcodes covering areas where there were more than 50% of thepopulation identified as Indigenous in the 2001 Australian Bureau of Statistics (ABS) Census werealso excluded from the initial sampling frame.

Households were contacted and those with children aged 2-16 years (eligible) were identified andasked to participate in the survey. One child within the household was selected as the study child forthe purpose of the survey.

The base national sample in South Australia was supplemented by 400 an additional to allow moredetailed estimates for the state. A total of 4,487 children completed the entire survey, of which 877were from South Australia. The sampling, selection and recruitment methodology arecomprehensively reported in the Users Guide (DoHA 2008) and should be considered wheninterpreting data.

2.2 Contacting households

The random generation of telephone numbers produced viable numbers, numbers that were notfunctional (dead) and numbers that have never existed (unattached). Additionally, viable telephonenumbers either belonged to a residential household or to a non-residential address such as abusiness or an organisation. 12.4 percent of the total were not finalised as there was either noanswer, use of answering machines or the number was engaged.

A small number of participants lived in a postcode that was not selected in the sampling frame for thesurvey as phone numbers are now portable. They were included in the location cluster and recruitedinto the study if the participant lived within less than 100km of the selected postcode.

To ensure that all families had an equal opportunity to participate each telephone number was

attempted six times across a nine day period. At least three calls were made on a weekend, two callson a week night and one call made on a weekday during the day. If no contact was made after six callattempts the phone number was excluded from further call attempts. If contact was made with thehousehold and a request was made to call back there was no limit to the number of call attempts.

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Table 1: Telephone contact attempts using random digit dialling (RDD) to obtain the South Australiansample

Number of telephone numbers % of total telephone numbers

Total telephone contact attempts

Dead or unattached phone lines

Not a residence

No children aged 2-16 in the house

No answer, answering machine, orengaged

36,637

11,457

4,288

13,695

4,526

100.0

31.3

11.7

37.4

12.4

Total eligible households 2,671 7.3

2.3 Recruiting Participants

Of the 2,671 eligible households, 1,219 households agreed to participate in the study. Fifty three werenot required as their age group quota was full, therefore these households were not recruited into thestudy. After the initial recruitment, 245 of the households were not interviewed as the relevant agequota had been met in their postcode cluster. Once recruited, 5.2% of the households withdrew, withthe majority stating that they had insufficient time to commit to the survey or had lost interest incompleting the survey. A further 0.8% of the sample did not complete all parts of the survey.

A complete data set was defined as a participant that provided data for all aspects of the surveyrelevant for their age group (demography, dietary recall use of time). There were 877 complete datasets included in the final database and analysed in this report. Pedometer data was reported from asubset of eligible participants.

Table 2: Recruitment of South Australian participants through RDD

Number ofhouseholds

% of totalhouseholds

Total eligible households

Total refused to participate at recruitment

Total agreed to participate

Eligible, not recruited - quota full

Recruited, not completed - quota full

Recruited, not completed - refused

Recruited, completed some parts of the survey

2,671

1,081

1,219

53

245

63

10

100.0

40.5

45.6

4.3 1

20.1 1

5.2 1

0.8 1

Recruited, completed all parts of the survey relevant forage group 877 71.9 1,2

1 Calculated as a percentage of the total that agreed to participate2 Pedometer data collected from a subset

To maximise the response rate, there was press coverage at the start of the survey and potentialparticipants were provided with information which included a website and written material that clearlyoutlined the survey expectations and requirements.

Being too busy (due to work and family commitments) or not having the time to do the survey werethe main reasons stated by parents of eligible households for not participating at recruitment. Tofacilitate the participation of busy families interviewers offered flexible appointment times andaccommodated requests made by the participating families.

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Contact was made at least three times throughout the survey to help with participant retention.Participants were sent a Healthy Food Fast cookbook at the completion of the survey to acknowledgetheir contribution.

Since stratified sampling with non-proportional samples was used, a weight was applied to eachparticipants record. The weight for each participant was proportional to the number of similarchildren in the Australian population. Similar was defined according to factors likely to influencenutrition and physical activity (age, gender and state of residence).

Data from the ABS 2006 Census on postal area and state by capital/rest-of-state for age and gendergroups were used to estimate the number of similar children in the population. Data from the surveywas used to estimate the sample numbers and hence the weights for each individual child. Theseweights enabled the survey data to provide estimates for the whole population of Australianhouseholds with children in scope. The resulting numbers of children in the South Australian sampleof participants according to age and gender are displayed in Table 3.

Table 3: South Australian participants by age and gender

Age Group (years)

2-3

4-8

9-13

14-16

All ages

Number of boys

109

115

104

107

435

Number of girls

108

110

112

112

442

Total number of children

217

225

216

219

877

2.4 Survey Methodology

The stratified quota approach was adopted to provide at least 500 boys and 500 girls from acrossAustralia in each of the age and gender groups covered by the nutrient reference values (NRVs) toallow sufficient numbers to make statistical comparisons of intakes with recommendations. The SouthAustralian Department of Health contributed towards a booster sample (n = 400) for South Australianchildren.

The data was collected at a face-to-face home visit (CAPI) and a subsequent telephone interview(CATI) conducted 7-21 days after the CAPI. Intakes and activity can vary markedly over differenttypes of days (for example weekdays versus weekend days and school versus non-school days). Inorder to capture intakes and activity patterns that would represent all types of days, the CAPI and theCATI were collected on different day types when feasible (see Table 4). Attempts were made tocollect information on school and non-school days (including holidays) in proportion to the number of

such days that occurred over the sampling period.

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Table 4: Weekday distribution of CATI and CAPI interview days in the South Australian sample

Day of CATI

Day ofCAPI Mon Tues Wed Thurs Fri Sat Sun

CATINot

Complete

Total

Mon 22 28 20 12 12 14 10 5 123

Tues 21 20 28 18 10 11 13 4 125

Wed 25 29 22 27 19 15 13 6 156

Thurs 19 13 21 30 19 25 13 5 145

Fri 28 25 16 22 17 21 15 7 151

Sat 23 20 10 23 21 21 17 4 139

Sun 11 16 12 13 11 15 15 0 93

Total 149 151 129 145 109 122 96 31 932

1

From this total of 932, 877 provided complete data sets from both the CAPI and CATI interviews

Food and Nutrients

Food, beverage and supplement intakes were collected for all participants using a standardised,computer-based, three-pass 24-hour recall methodology during the CAPI and the CATI. Softwarefrom the Life in New Zealand (LINZ24 ) survey was modified for the Childrens Survey to reflect theAustralian food supply. Details of the modifications are included in the Users Guide (DoHA 2008).

All interviewers received training in conducting the 24-hour recall. To assist with estimating theamounts of foods and beverages consumed, standard measuring cups and spoons were provided,along with a Food Model Booklet that had life-size diagrams and drawings depicting different serving

sizes of foods and different sized food containers to assist the participants and the interviewers in thedietary recall. Dietitians checked all of the 24-hour recalls for their content and whether or not theyappeared a reasonable consumption pattern. Any unusual intakes were queried and modified ifappropriate.

In collaboration with FSANZ, a food coding system was developed to reflect the current food supplyand to maintain comparability with the food groups used in the 1995 National Nutrition Survey (ABS1998). Additional food groups were added for infant foods, was formulae and dietary supplements. Inaddition the food, beverage and supplement intake data were translated to daily nutrient intake datausing the most recent Australian nutrient composition database. The Users Guide (DoHA 2008)provides detailed information on this process.

Nutrient intake data estimated in the Childrens Survey included energy, protein, total fat, saturatedfat, monounsaturated fat, polyunsaturated fat, alpha-linolenic acid, linoleic acid, long chain omega-3fatty acids, cholesterol, total carbohydrates, starch, sugars, dietary fibre, alcohol, total vitamin A, preformed and provitamin A, thiamin, riboflavin, total niacin equivalents, preformed niacin, vitamin C, D,E, total folate, dietary folate equivalents, potassium, sodium, phosphorus, calcium, magnesium, iron,zinc, iodine and caffeine. The time and place of consumption of foods and drinks were also recorded.The intakes of the following nutrients have not been included in this report alpha-linolenic and linoleicacid, long chain omega-3 fatty acids, cholesterol, pre-formed and provitamin A, or preformed niacin.

Nutrient data derived from supplements have been excluded from the analyses for this SouthAustralian version of the Main Findings report as the initial focus is to determine the nutrients providedto children by consumption of food and beverages alone.

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Comparison with Food Guidelines and Dietary Recommendations

Reported mean food and nutrient intakes are based on the CAPI data only (i.e. one day of data).When comparing food and nutrition intake with recommendations or guidelines, an estimate of usualintake is needed and in which case both the CAPI and CATI dietary intake data are used (i.e. twodays of data). The software package, C-SIDE, V 1.0, Iowa State University, suitable for estimating

intake distribution was used for this purpose. Details of the analyses are provided in the Users Guide(DoHA 2008).

To estimate the prevalence of potentially inadequate nutrient intakes in population groups the usualnutrient intakes of children can be compared with recommended nutrient intakes established byNHMRC (NHMRC 2006). It must be considered that these are only estimates of potential dietaryintake inadequacy as individual requirements for each nutrient can be quite variable and this reporthas not included nutrients provided by dietary supplements. To definitively determine whether childrenare consuming sufficient amounts of nutrients to meet their own individual and specific requirementswould require measures of nutrient status such as blood or serum biochemical tests, which is beyondthe scope of this survey.

The estimated average requirement (EAR) is the daily nutrient intake level estimated to meet theneeds of half of the children in their particular life stage and gender group. The percentages ofchildren whose usual nutrient intakes are less than the EAR provide an estimate of the prevalence ofpotential intake inadequacy in each age and gender group. If there are large percentages of childrenwith usual intakes below the EAR for a particular nutrient, it is indicative that a number of children maynot be consuming sufficient amounts of that nutrient to meet their requirements, however as notedabove it is not definitive.

When setting the NRVs, EARs could not be determined for all nutrients due to limited scientificevidence being available. AIs were established instead, based on the median intake reported in the1995 National Nutrition Survey and assuming that they had a sufficient intake. An AI is defined as theaverage daily nutrient intake level based on observed or experimentally-determined approximations ofestimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed tobe adequate. Comparisons of the nutrient intakes of the Childrens Survey participants with AIscannot be used to determine the prevalence of potential nutrient intake inadequacy. Unlike the EAR,

the proportion of children having intakes less than the AI, does not estimate the prevalence ofpotentially inadequate intakes. If the mean usual intake of children for a nutrient is at or above the AI,or if more than 50% of children have usual intakes at or greater than the AI, it implies a lowprevalence of inadequate intakes. If the AI is based on median intakes, this assessment of childrensintake is made with less confidence.

The NHMRC Dietary Guidelines for Children and Adolescents (NHMRC, 2003) and the AustralianGuide to Healthy Eating (AGHE) (Smith et al 1998) provide some specific dietary and foodrecommendations. The dietary intakes from the Childrens Survey were compared against acombination of food and nutrient guidelines or recommended intakes.

For some foods, in order to make comparisons with guidelines, the number of serves of foodsconsumed by children were calculated using firstly the food sub-groups and secondly the servingsizes outlined in the AGHE. Where a number of serves of foods has been calculated for this report,

such data should be considered as indicative only as some foods may have been inadvertentlymissed and a more detailed analysis is warranted. The major types of foods will have been includedand so should provide a reasonable estimate at the population level.

Food Habits and Other Questions

Food habit questions were asked of each child and/or caregiver during the CAPI in relation to usualconsumption of fruits, vegetables, type of milk, use of salt and earlier infant feeding practices. Theonly data from these questions presented in this South Australian version of the Main Findings reportare whether or not the survey participants had ever been breast fed. Encouraging mothers tobreastfeed is one of the NHMRC Dietary Guidelines for Children and Adolescents (NHMRC 2003).Eating occasions and consumption patterns were analysed using thirty-minute intervals.

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Physical Activity

Physical activity was measured in two ways. Time use was measured in children aged 9-16 yearsusing a previously validated computerised 24-hour recall using the MARCA (Ridley et al 2006). Eachchild recalled four days, two days prior to the CAPI and two days prior to the CATI. Children reportedeverything they did in the previous 48 hours in time-slices as fine as five minutes. Each activityreported was linked to an energy cost (Ridley & Olds 2008).

Total energy expenditure was calculated based on the reported activities. This is expressed as a PALwhich is a multiple of resting metabolic rate, or the amount of energy a child would expend if he or shewere to sit still all day.

In order to determine the overall daily activity patterns of children, it is necessary to take into accountboth physically active and sedentary behaviours.

Activity data collected as part of the Childrens Survey included each childs PAL and the number ofminutes per day spent in the following categories, MVPA, organised sport and play, free play, activetransport, out of school hours screen time, total screen time, television, videogames, computer use,passive transport, non-screen sedentary behaviour and sleep. The number of minutes spent in theseactivities was totalled for each child on each of the four sampled days. The average daily number ofminutes children spent in MVPA and average screen time are included in this report. MVPA is usuallydefined as any activity that requires at least three times as much energy as the child uses when sittingquietly. In practice, this amounts to anything at or above a brisk walk. Screen time refers to theamount of time children spent watching television including videos and digital video discs (DVDs),playing computer games on videogame consoles or on personal computers, and using computers forother purposes.

Children aged 5-16 years wore a pedometer (New Lifestyles (NL) 1000), a device that counts steps,for up to seven consecutive days. This is considered to be a more objective measure of physicalactivity. Children who recorded at least six days of measurements and had the pedometer off for nomore than four hours during waking hours on any day (for example, for bathing or contact sports)were included in the analysis. The average number of steps completed in the six- or seven-day periodwas calculated for each child.

Comparison with Physical Activity GuidelinesThe average amount of time the children spent in the physical and sedentary activities werecompared to the Commonwealth Department of Health and Ageings recommendations for physicalactivity for children and youth (DoHA 2004a, DoHA 2004b). This also includes guidelines for theamount of entertainment screen time and has been included in this South Australian Main Findingsreport.

Currently there are no national guidelines for children regarding the recommended number of steps tobe taken daily. Comparisons have been made in this report using published criteria.

Anthropometry

Weight, height and waist circumference were measured for all participants during the CAPI using

calibrated Tanita HD332 Scales, Invicta Height Measure Stadiometer and Lufkin W606PM metal taperespectively. Height, weight and waist girth were measured by interviewers trained byanthropometrists accredited by the International Society for the Advancement of Kinanthropometry(ISAK). Waist girth was located half-way between the bottom of the tenth rib and the top of the iliaccrest.

All survey participants were measured in light indoor clothing, without shoes.

Body mass index (BMI=weight in kilograms divided by the square of height in metres) is the mostcommonly used index of weight for height in children. It has been widely used as an estimate offatness.

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2.5 Survey Methodology Issues

The RDD method is a time and cost effective approach to recruitment and has been previously usedto generate survey samples for population health studies. When this method is combined with a quotasystem three important methodological issues should be considered.

Firstly, RDD with a quota affects the probability of selection of children. One child per eligiblehousehold was randomly selected to take part in this survey. It is desirable to have each child in thetotal sample frame have an equal chance of selection in the sample drawn. With RDD and householdsampling, children who are the only child or who have fewer siblings aged 2-16 years have morechance of selection than children living with a larger number of siblings aged 2-16 years. Furthermore,the application of the predetermined age quotas (1,000 for each age group, i.e. 2-3 years, 4-8 years,9-13 years and 14-16 years) were disproportionate to the population across each of these agegroups. Consequently children aged 2-3 years and 14-16 years had a higher chance of selection,compared to those aged 4-8 years or 9-13 years.

Secondly, it was not possible to gather demographic information on those who refused to participateand those who were excluded due to the quota system. This information is needed to estimate anypotential non-response bias. It is not possible to allow for non-response bias in this survey.

Thirdly, to obtain a representative sample of the population, the RDD method relies on accessingcurrent telephone number information and should have as complete coverage as possible. It isestimated that at least 95% of Australian households have a landline (ABS 2003), with somehouseholds choosing to replace a landline connection with a mobile phone (ACMA 2008). Portabilityof telephone numbers as people move across geographic locations can result in recruitment outsidethe selected postcodes. An advantage of RDD is that silent, unlisted and recently listed numbers canbe included by chance.

Data was collected between February and August 2007, resulting in limited information on variance ofintakes with changing seasons.

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3 Demographic Characteristics

Demographic information of all of the survey participants and their families was collected at the initialCAPI.

The following tables describe the demographics of the households in South Australia that participatedin the survey (Table 5, Table 6, Table 7 and Table 8). These tables do not have population weightsapplied however provide an indication of how the characteristics of the South Australian householdsthat were actually surveyed compare to the characteristics of the total Australian population providedin the latest Australian Bureau of Statistics Census data ( ABS, 2006)

3.1 Caregivers

The majority of caregivers in the South Australian households in this survey were born in Australia,with 18.5% born overseas. Only 6% spoke another language at home and 1% were of Indigenousorigin. Most households (85%) had at least two caregivers. The Childrens Survey, in the main, hascollected data from couples who may have similar characteristics and may thus not be representativeof the total Australian adult population.

Table 5: Demographic characteristics of South Australian caregivers (unweighted data)

Caregiver Characteristics

Born overseas

Speak another language at home

Indigenous

Highest level of education achieved isnon tertiary 1

No second caregiver

Caregiver 1 (n)

163

54

10

592

143

Caregiver 2 (n)

156

52

7

549

-

Caregivers in SAsurvey (%)

18.5

6.1

1.0

66.2

15.3

1 Includes up to Year 12 and Certificate III and IV

3.2 Children

Table 6: Demographic characteristics of South Australian children (unweighted data)

Children s Characteristics Children (n) Children in SA survey (%)

Born overseas

Speak another language at home

Indigenous

Medical conditions (at least one)

50

50

17

218

5.7

5.7

1.9

24.9

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3.3 Households

Table 7: Incomes of South Australian households (unweighted data)

Household Characteristics Households (n) Households (%)

$15,00 or more per week ($78,000 or more peryear)$600 - $14,99 per week ($31,200 - $77,999 peryear)

$1 - $599 per week ($1 -$31,199 per year)

Dont Know

Other (no income, negative income, refused)

432

406

56

27

11

49.3

46.3

6.4

3.1

1.3

3.4 Socio-Economic StatusTable 8: Percentage of South Australian children classified in the four SES bands by health region(unweighted data)

Highest SES Lowest SES

Health Region 1st quartile (%) 2 nd quartile (%) 3 rd quartile (%) 4 th quartile (%)

Central NorthernAdelaide 9.2 25.5 35.1 30.1

Southern Adelaide 51.0 10.4 30.9 7.6

Country 0.7 18.1 73.0 8.2

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- - - - - - - -

Table 9: Mean daily consumption (g) of major food groups 1 in South Australian children

Boys Girls

Age group 2 3 4 8 9 13 14 16 2 3 4 8 9 13 14 16

Non-Alcoholic Beverages 664 998 1357 1827 668 870 1230 1486Cereals & Cereal Products 136 185 196 286 140 139 175 224

Cereal-Based Products & Dishes 72 115 168 219 47 98 153 118Fats & Oils 8 9 8 9 6 7 8 8Fish & Seafood Products & Dishes 7 10 5 15 7 12 12 11Fruit Products & Dishes 162 173 150 117 170 170 147 119Egg Products & Dishes 7 8 8 10 2 6 5 9Meat, Poultry & Game Products &Dishes 67 88 109 198 63 77 98 127Milk Products & Dishes 426 327 442 435 427 291 249 318Dairy Substitutes 21 3 2 0 18 22 0 0Soup 23 15 24 33 12 13 43 28Seed & Nut Products & Dishes 1 2 3 5 2 1 3 3Savoury Sauces & Condiments 17 22 29 51 10 16 29 38

Vegetable Products & Dishes 100 93 205 240 101 112 162 211Legume & Pulse Products & Dishes 4 11 8 12 14 4 4 3Snack Foods 6 16 13 16 3 8 9 14Sugar Products & Dishes 17 15 24 17 10 20 18 11Confectionery & Cereal Bars 12 28 29 25 10 26 29 27Alcoholic Beverages 0 0 0 0 0 0 1 3Special Dietary Foods 4 2 5 5 0 3 2 3Miscellaneous 3 4 5 5 4 3 4 4Infant Formulae & Foods 20 0 1 0 10 2 0 1

1 One day food intake data collected at personal interview, population weights applied

Food and Energy

Foods provide us with the energy (kJ) we need for daily living. The percentage contribution of themajor food groups to total energy intake is presented in Table 10.

Key Findings:On the day prior to the interview:

> In younger children (2-3 years), milk products and dishes and cereals and cereal productscontributed to over 40% [National: over 45%] of the total energy

> There was little variation in the contribution of cereal-based products and dishes to total energyeither between gender or across age groups

> Younger children (2-3 years) achieved at least 5% more energy from milk products and dishescompared to older children. Dairy substitutes were not consumed by those children aged >8 yearsfor either gender.

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- - - - - - - -

Table 10: Proportion (%) of total dietary energy intake (including energy from fermentable fibre) ofSouth Australian children obtained from major food groups 1

Boys2 3 4 84.7 5.5

19.7 23.2

13.2 16.7

3.2 3.1

1.0 1.0

7.1 5.6

0.7 0.9

9.0 9.6

24.1 15.9

0.8 0.1

0.7 0.4

0.6 0.6

1.0 1.35.5 3.8

0.3 0.5

1.8 4.0

1.6 1.5

3.3 6.2

0.0 0.0

0.4 0.1

0.3 0.3

1.1 0.1

9 13 14 167.6 7.9

19.5 21.6

19.1 17.4

2.1 2.1

0.4 1.2

3.7 2.5

0.6 0.7

9.8 14.0

17.1 13.9

0.0 0.0

0.6 0.6

0.6 1.0

1.3 1.87.0 7.0

0.3 0.4

2.7 2.7

2.2 1.3

5.2 3.6

0.0 0.0

0.2 0.2

0.1 0.2

0.0 0.0

Girls2 3 4 85.0 6.1

21.8 19.1

11.2 16.7

2.6 2.6

1.1 1.3

8.3 6.4

0.3 0.6

8.8 10.6

25.8 16.6

0.7 0.8

0.6 0.4

0.7 0.4

0.9 0.95.4 5.6

0.8 0.3

0.9 2.4

1.2 1.9

3.0 6.6

0.0 0.0

0.0 0.2

0.4 0.3

0.5 0.1

9 13 14 167.8 7.0

20.0 21.1

19.6 15.4

2.5 2.3

1.0 0.7

4.0 3.3

0.5 0.6

10.6 11.4

12.4 15.1

0.0 0.0

1.1 0.7

0.9 0.8

1.7 1.96.9 9.3

0.2 0.2

2.3 3.1

2.1 1.1

6.2 5.4

0.0 0.1

0.1 0.1

0.2 0.3

0.0 0.0

Age group (years)

Non-Alcoholic Beverages

Cereals & Cereal Products

Cereal-Based Products & Dishes

Fats & Oils

Fish & Seafood Products & Dishes

Fruit Products & Dishes

Egg Products & DishesMeat, Poultry & Game Products &DishesMilk Products & Dishes

Dairy Substitutes

Soup

Seed & Nut Products & Dishes

Savoury Sauces & CondimentsVegetable Products & Dishes

Legume & Pulse Products & Dishes

Snack Foods

Sugar Products & Dishes

Confectionery & Cereal Bars

Alcoholic Beverages

Special Dietary Foods

Miscellaneous

Infant Formulae & Foods

1 One day food intake data collected at personal interview, population weights applied

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- - - - - - --

Consumption of Selected Sub-Major Food Groups and Core and Non-Core Foods

The intake of confectionery (excluding cereal, fruit, nut and seed bars), sugar-sweetened nonalcoholic beverages, fruit and vegetable juices and drinks and their contribution to total energy intakeare presented in Table 11.

Key Findings:

> 2-3 year old children were consuming less confectionery, including proportion of total energy fromconfectionery, than children of any other age

> Sugar sweetened non-alcoholic beverages were consumed in greater amounts as age increasedexcept for girls in the 14-16 years age group

> As a proportion of total energy, fruit and vegetable juices contributed approximately 2% across girlsand boys of all ages

Table 11: Selected sub-major food groups consumption 1 in South Australian children by age and gendergroup

Boys Girls

Age group (years) 2 3 4 8 9 13 14 16 2 3 4 8 9 13 1416

24-hour intake of confectionery 2 (g) 8.1 19.2 24.6 17.8 7.0 19.6 21.9 19.5Proportion of total energy fromconfectionery (%) 2.2 4.5 3.8 2.6 1.9 5.1 4.3 4.1

24-hour intake of sugar-sweetenednon-alcoholic beverages 3(g) 46.1 105.7 261.0 358.4 36.4 102.9 220.2 193.5

Proportion of total energy fromsugar-sweetened non-alcoholicbeverages (%)

2.9 3.0 4.9 6.4 2.3 3.7 5.2 4.2

24-hour intake of fruit and vegetable

juices & drinks (g)77.7 117.0 160.7 158.4 104.5 120.8 148.1 167.0

Proportion of total energy from fruitand vegetable juices & drinks (%) 2.0 2.3 2.5 1.8 2.7 2.6 2.7 2.8

1 One-day food intake data collected at personal interview, population weights applied, n=877.2 Excluded cereal, fruit, nut and seed bars3 Included cordial; soft drinks and flavoured mineral water; electrolyte, energy and fortified drinks; other beverage flavourings

and prepared beverages but excluded fruit and vegetable juices and drinks

The AGHE is a food selection guide based on the five core food groups. The five groups are (1)bread, cereals, rice, pasta, noodles; (2) vegetables, legumes; (3) fruit, (4) milk, yoghurt, cheese; (5)meat, fish, poultry, eggs, nuts, legumes. Foods that do not fit into the five core food groups areclassified as non-core or extra foods. Some non-core foods can be high in fat, salt and sugar andlikely to contribute to excess energy intake. Figure 1 shows the contribution of energy from core andnon-core foods as well as the number of serves of non-core food consumed in the 24 hours prior tothe interview. Where possible, only the healthier options were included in the calculation ofcontribution of energy from core foods. Caution is required when interpreting this data as theclassification of core and non-core food is not always clear cut.

Key Findings:

> In general, the number of serves of non-core foods consumed increased with increasing age. Theproportion of energy contributed by non-core foods increased with age from 2-13 years anddecreased slightly in the 14-16 years old children.

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Figure 1: Contribution of energy from core and non-core foods 1,2,3 (including mean intake of non-corefood) in South Australian children by age and gender group

57% 61%62%

70%

57%55%

60%

74%

2.5

7.4

5.2

3.2

4.5

6.66.3

7.8

30

40

50

60

70

Age group 2-3 years 4-8 years 9-13 years 14-16 years 2-3 years 4-8 years 9-13 years 14-16 years

Gender Males Females

% of total energy

980

8

Number of serves of non-core food7

6

5

4

% energy from core food% energy from non-core food

Number of serves of non-core food

3

202

10 1

0 0

1 One-day food intake data collected at personal interview, population weights applied, n=877.2 Foods classified as core and non-core according to the AGHE. Caution is required when interpreting this data as the

classification of core and non-core food is not always clear cut. Non healthy option are not counted as core food wherepossible, for example potato is considered core food but not when consumed as chips or wedges; core foods included fruit

and vegetable juice (not drinks); flours and other cereal grains and starches; regular breads and rolls; all breakfast cereals,bars and porridge; English-style muffins, fancy bread, flat breads (not sweet bread/buns); savoury biscuits (not high fat orflavoured; mixed dishes where cereal is major component (not hamburgers); all fish and seafood products and dishes; all fruitproducts and dishes; egg products and dishes; all meat, poultry and game products and dishes (not organ meat/offal productsand dishes, not sausage/frankfurts/saveloys); all milk, yoghurt and cheese (dairy or non-dairy); all soups; seeds and seedsproducts; nuts and nut products; potato (not chips, wedges or gems); all other vegetables and dishes; legumes and pulsesproducts and dishes; formula dietary food; infant formulae, human breast milk, infant cereal products/custards/fruit juices;water

3 One serve of non-core food = 600kJ

4.2 Nutrients

Food and beverages provide a variety of nutrients that can be classified as either macronutrients ormicronutrients.

Macronutrients and Water

Macronutrients are required and present in foods and drinks in relatively large amounts (gram, (g))and are the key sources of energy, as well as providing dietary components essential for normalphysiological processes. They include protein, carbohydrate, fat and dietary fibre.

Protein, carbohydrate and fat are the major dietary contributors to energy intake. It is necessary toobtain energy from our food and drinks to carry out the basic functions of everyday living includingbreathing, the normal functioning of our heart, brain and other key organs, to carry out digestion andto perform physical activity. The energy obtained from food and drinks, as well as estimates of energyintake are measured and reported in kilojoules (kJ).

Dietary carbohydrate is comprised mainly of starch and sugars. Total starch and total sugars intakeare presented in this South Australian Main Findings report. Total sugars, such as lactose, sucroseand fructose are comprised of those naturally present in our foods and those added during processing

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k J

and preparation. The amounts of total sugars in the Childrens Survey presented in the followingtables do not distinguish between the different types of sugar in the diet.

Fat in our diet consists of three major types saturated, monounsaturated and polyunsaturated. Thetotal fat and the amount of these three major fats are presented in the following tables.

A small amount of energy can be obtained from fermentable dietary fibre and this has been included

in the total energy.Alcohol is a dietary component that can also supply energy.

Water or moisture is also necessary for life and is present in both food and drinks but on its own,without any added dietary components such as sugar, it does not contribute to energy intake.

Macronutrient intakes are presented in this South Australian Main Findings report for the ChildrensSurvey as the mean or average for age and gender groups (Table 13) and the mean contribution tototal dietary energy intake (Table 14) and these have been obtained from one day of intake collectedfrom the 24-hour recall undertaken during the CAPI. When nutrient intakes have been comparedagainst recommended intakes, two days of intake data have been utilised to obtain an estimate ofusual intake (See Table 16).

EnergyAverage daily intake data for the age and gender groups of participants in the South Australiancomponent of the Childrens Survey are based on one day of intake (CAPI) and are presented inFigure 2 .

Key Findings:

> The reported average daily energy intake was similar for younger boys and girls aged 2-3 years,averaging 6,022 kJ [National: 6,166kJ], (including energy from fermentable fibre)

> As expected energy intakes increased with increasing age of the children, and the differencesbetween boys and girls became more marked in the older age groups

> As expected boys aged 14-16 years had the highest energy intake at 12,242 kJ/day [National:

11,818 kJ/day] compared to 9,212 kJ/day [National: 8,608 kJ/day] for girls of the same age.

Figure 2: Mean one-day energy intake (including energy from fermentable fibre) of South Australian boysand girls (24-hour recall taken at CAPI, population weights applied)

Mean energy intake

14,000

12,000

10,000

8,000

6,000

4,000

2,000

0

6,304

7,894

9,962

12,242

5,7306,935

8,4099,212

2-3 yrs 4-8 yrs 9-13 yrs 14-16 yrs

Age group

Boys Girls

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Comparison with Energy Requirements

The NHMRC EER provide a range of suggested requirements needed for children, with variation inenergy requirements as a consequence of differences in age, gender, body size and physical activity.The usual energy intakes using intake data from the CAPI and the CATI of children in this surveywere compared with both the lower and upper bounds of the ranges of the EER (Table 12).

Key Findings:

> The majority of children reported consuming sufficient energy to meet the lower bound of the rangefor EER

> Between 11-21% [National: around 20%] of older (14-16 years) boys estimated usual intake wasnot sufficient to meet the lower bound of the range for EER

> Between 17-42% of older (14-16 years) girls [National: 38-50% of girls aged 13-16 years]estimated usual intake was not sufficient to meet the lower bound of the range for EER

> By contrast, reporting considerably higher energy intakes than the upper bound was common for

most age groups and across both genders, less notable for older girls (>11years) where fewerachieved higher energy intakes than the upper bound of the EER.

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Table 12: Median intake of energy (kJ) (including energy from fermentable fibre) in South Australianchildren compared with EER, and proportions outside the upper and lower bounds of EER

Years EER (kJ) Median usual intake(kJ)

Proportionconsuming less than

the lower bound ofthe EER range (%)

Proportionconsuming more

than the upperbound of the EER

range (%)

2 4,400 6060 8 -

3 4,900-6,900 6297 11 32

4 5,200-7,300 6670 11 33

5 5,500-7,800 7268 6 34

6 5,800-8,200 7331 2 15

7 6,100-8,700 9085 2 59

8 6,400-9,200 9053 0 38

9 6,800-9,700 9731 1 51

10 7,300-10,400 9196 0 2

11 7,700-11,000 10156 11 37

12 8,200-11,600 10206 5 15

13 8,700-12,400 10057 11 214 9,300-13,200 11355 18 22

15 9,900-14,000 12171 21 28

Boys

16 10,300-14,700 12809 11 18

2 4,200 5421 10 -

3 4,500-6,400 5903 2 25

4 4,800-6,800 6734 10 48

5 5,100-7,200 6660 6 20

6 5,400-7,600 6913 0 2

7 5,700-8,100 6884 9 17

8 6,000-8,600 7326 3 4

9 6,400-9,100 7662 13 19

10 6,700-9,500 8794 11 34

11 7,000-10,000 8536 1 2

12 7,400-10,600 8603 19 12

13 7,800-11,100 8170 37 1

14 8,100-11,500 8836 29 4

15 8,200-11,700 9703 17 13

Girls

16 8,400-11,900 8688 42 2

Population weights appliedFor girls aged 5, 7 and 9 years a negative estimate of usual intake variance was achieved hence data presented wascalculated using the average of two-day energy intake data from food and beverages only (no supplements) collected at CAPIand CATI.

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Ratio of Energy Intake to Basal Metabolic Ration (BMR)

It is well-known that under-reporting of intakes can occur. The energy intake (EI) to basal metabolicratio (BMR) can be used as an indicator of under-reporting. The mean EI:BMR was 1.8 and 1.7 for 23 year old boys and girls respectively [National: 1.8 for all 2-3 year olds]; 1.7 for all 4-8 year olds[National: 1.7 for all 4-8 year olds] ; 1.7 and 1.5 for 9-13 year old boys and girls respectively [National:1.6 and 1.5 for 9-13 year old boys and girls respectively]; and 1.6 and 1.5 for the older (14-16 years)boys and girls respectively [National: 1.6 and 1.4 for 14-16 year old boys and girls respectively]. Asdemonstrated in Valid Self-Reports (Section 2.4), the estimated proportion of under-reporters washighest in the 14-16 year olds at 7-10% [National: 8-16%]. Table 13 shows the mean intake of energy,macronutrients and total moisture/fluid in South Australian children.

Key Findings:

> The average intake of fibre was lowest in the younger children 2-3 years and increased in eachsuccessive age group. The lowest intake was in girls aged 2-3 (15.8 g/day) [National: 15.5g/day]and highest in boys aged 14-16 years (28.8 g/day) [National: 27.5g/day]

> Estimated fluid intakes (total from beverages and foods) were approximately 1.4 L/day for childrenaged 2-3 years [National: 1.4-1.5L/day], reaching up to 2.3-2.9 L/day [National: 2.2-2.7 L/day] for

the older (14-16 years) children.

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re

re

re

- - - -

Table 13: Mean intake 1 of energy, macronutrients and total moisture/fluid in South Australian children

2 3Age Group (years)

4 8 9 13 14 16UnitBoys Energy

Energy - including fermentableMoisture

MacronutrientsProteinTotal fat

Saturated fatMonounsaturated fatPolyunsaturated fat

CholesterolTotal carbohydrate

Total sugarsTotal starch

AlcoholFibre

(kJ)(kJ)(g)

(g)(g)(g)(g)(g)

(mg)(g)(g)(g)(g)(g)

6174.66304.01443.5

62.053.725.617.7

6.6174.7188.4

99.087.9

0.016.1

7733.1 9769.77894.3 9961.71702.0 2260.7

74.6 88.565.6 85.429.9 40.122.7 29.1

8.2 10.1203.6 248.4242.5 307.5114.2 156.9125.7 148.0

0.0 0.020.1 23.9

12011.212241.7

2873.7

126.9103.7

45.437.213.8

347.6361.5163.6195.1

0.128.8

Girls EnergyEnergy - including fermentableMoisture





AlcoholFibre

(kJ)(kJ)(g)

(g)(g)(g)(g)(g)

(mg)(g)(g)(g)(g)(g)

5603.65730.21412.3

56.145.121.414.7

5.6142.5179.2

96.481.2

0.015.8

6796.6 8235.36934.6 8408.71530.4 1929.5

61.5 77.158.9 70.827.0 31.120.1 25.4

7.6 9.3167.9 205.6215.0 258.8109.2 125.5103.2 130.3

0.0 0.017.2 21.6

9026.09211.82275.1

88.282.235.929.211.2

251.4269.3128.1139.0

0.123.2

TotalChildren

EnergyEnergy - including fermentableMoisture





AlcoholFibre

(kJ)(kJ)(g)

(g)(g)(g)(g)(g)

(mg)(g)(g)(g)(g)(g)

5894.06022.01428.2

59.149.523.516.2

6.1158.8183.9

97.784.6

0.016.0

7257.2 9020.37406.6 9203.21614.8 2099.0

68.0 82.962.2 78.328.4 35.721.4 27.3

7.9 9.7185.4 227.5228.5 283.7111.7 141.6114.3 139.3

0.0 0.018.7 22.8

10521.810729.9

2575.0

107.692.940.733.212.5

299.6315.5145.9167.1

0.126.0

1 One-day nutrient intake data from food and beverages only (no supplements) collected at CAPI, population weights applied2 Fluids derived from food and beverages3 The sum of the three fatty acid subtotals is less than the total fat value due to the contribution of the non-fatty acid

components in the triglyceride unit such as the glycerol backbone, possible phosphate groups and sterols4 For some foods, data for total carbohydrates included a contribution from glycogen, sugar alcohols and oligosaccharides

where the levels of these carbohydrates are known. For these foods, the sum of the total sugars and starch will not equal thetotal carbohydrate value.

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- - - -

Table 14 shows the percentage contribution of macronutrients to total energy intake in SouthAustralian children.

Key Findings:

>Carbohydrates contributed approximately half of the total energy. The proportion contributed bycarbohydrates was similar for all age groups (47.1-50.1%) [National: 48-49.5%]

> Of the carbohydrates consumed, starch and sugars contributed to total energy intake in varyingproportions. In the younger age group (2-3 years), there was more energy coming from sugars(25.5-27.0%) [National: 25.6-26.1%] than starch (22.3-22.7%) [National: 22.6-22.7%], but thissituation was reversed in the older age groups. For the 14-16 year old children, starch (24.3-25.6%)[National: 24.6-25.2%] contributed more to total energy than dietary sugars (21.5-22.5%) [National:22.1-23.6%]

> Total dietary fat contributed 29.0-32.5% [National: 30.2-30.8%] of total energy intake over the day.Saturated fat contributed more to total energy (13.5-14.6%) [National: 13.2-14.2%] thanmonounsaturated (9.5-11.6%) [National: 10.0-11.0%] and polyunsaturated fat (3.7-4.5%) [National:3.7-4.3%]

> Dietary protein contributed between 15.0-17.7% [National: 16.0-17.6%] of total energy with boysaged 14-16 years having the highest protein intakes

Table 14: Mean percentage (%) contribution of macronutrients to total energy intake in South Australianchildren

Age Group (years)2 316.830.914.610.2

3.948.225.522.3

4 816.130.313.810.5

3.849.523.525.3

9 131

Documents

2007 Children Survey Findings 2