Australian Health Promotion Association

Christine Innes-Hughes, Louise L. Hardy, Kamalesh Venugopal, Lesley A. King, Luke Wolfenden and Anna Rangan

Introduction: Intakes of energy-dense, nutrient-poor (EDNP) foods, such as fast food and processed snack foods, along with low intakes of fruit and vegetables, have been identified as markers of poor diet quality in young children.1 Poor diet quality, in turn, has been associated with higher rates of childhood overweight and obesity,2 the prevalence of which is unacceptably high in Australia and in many other developed nations.2-4 Specific nutritional concerns regarding the frequent consumption of EDNP foods include their high fat and sugar content, which contributes to high energy density5-6 and makes these foods an important focus in the prevention of childhood obesity.7-9

Australian studies have reported that many children have high intakes of EDNP foods such as fried potatoes, biscuits, cakes, soft drinks and ice cream.1,6-7,10-11 This finding is congruent with other overseas studies that have also reported that the diets of preschool and school-aged children are characterised by low intakes of fruit and vegetables and high intakes of EDNP foods.12-14 Similarly, studies among adolescents also show their dietary patterns are characterised by high intakes of EDNP foods and low intakes of fruit and vegetables.15-18

Most studies have investigated young people’s consumption of specific EDNP foods, rather than whether this occurs as a pattern, with associations between consumption of a mix of EDNP foods. For example, even if not consumed at the same time, there may be associations between consumption of EDNP foods such as soft drinks and salty snacks, or fast food and fried potato products. The consumption of EDNP products increases energy intake, and associated additional consumption of EDNP foods or drinks provides an extra caloric burden and a further increased risk of unhealthy weight gain.

Furthermore, research is required to determine the extent to which certain EDNP foods and beverages are associated with low intakes of fruit and vegetables. The aim of this study was to examine first, whether children’s consumption of one EDNP food product influences the consumption of another EDNP food category and second, whether particular EDNP foods are more likely to be associated with low intakes of fruit and vegetables, in a population of Australian children aged 2 to 16 years.

Issue addressed: Many children consume excessive amounts of energy-dense, nutrient-poor (EDNP) or ‘extra’ foods and low intakes of fruit and vegetables. The aim of this study was to examine the associations between EDNP foods and ascertain whether certain EDNP foods and beverages are more likely to be eaten in association with other EDNP foods.
Methods: A cross-sectional representative population survey of children in preschool (n=764), and of school students in Years K, 2 and 4 (n=1,560) and in Years 6, 8 and 10 (n=1,685) residing in the Hunter New England region of New South Wales, Australia. Dietary data were collected using a short food frequency questionnaire. Multivariate logistic regression models examined the association between EDNP foods and fruit and vegetable intake. Data were stratified by sex and age cohort.
Results: More frequent consumption of some EDNP food types was significantly associated with more frequent consumption of other EDNP foods. Fast food and soft drinks consumption were associated with each other as well as with fried potato and salty snacks; and with lower intakes of fruit and vegetables in some but not all age groups.
Conclusion: The positive associations found between EDNP foods point towards the existence of a high-risk group of children who frequently consume a variety of EDNP foods and drinks.
So what? Public health messages need to concurrently promote a reduced intake of a variety of EDNP foods, particularly snack foods and fast food, as well as an increase in fruit and vegetable consumption.

Health Promotion Journal of Australia 2011; 22: 210-6