Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years) A background paper Draft for Consultation Ministry of Health. 2010. Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years): A background paper: Draft for Consultation. Wellington: Ministry of Health. Published in October 2010 by the Ministry of Health PO Box 5013, Wellington 6145, New Zealand ISBN 978-0-478-36696-9 (print) ISBN 978-0-478-36699-0 (online) HP5250 This document is available on the Ministry of Health’s website: http://www.moh.govt.nz Preface Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years): A background paper – Draft for Consultation is one in a series of five population-specific background papers on food and nutrition. The population groups targeted in other papers are healthy infants and toddlers; adults; older people; and pregnant and breastfeeding women. The Draft for Consultation aims to provide up to date, evidence-informed policy advice and technical information for health practitioners working with children and young people (aged 2–18 years). This includes nurses, dietitians, doctors, nutritionists, health promoters and educators. The Draft for Consultation has been developed from the update and amalgamation of the Food and Nutrition Guidelines for Healthy Children (Aged 2–12 years): A Background Paper (1997) and the Food and Nutrition Guidelines for Healthy Adolescents: A Background Paper (1998). In recognition of the many influencing factors on the food choice of children and young people, some topics additional to these previous guidelines have been included. For example, new sections outline considerations for selected population subgroups, the influence of environmental factors on food choice, and related topics such as physical activity and oral health. Your comments on this Draft for Consultation (Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2-18 Years: A background paper) are welcome. How to have your say Please use the submission booklet to complete your submission. There is a hard copy booklet at the back of this document. Please note: only submissions written in or attached to this booklet, either as electronic or hard copy, will be accepted handwritten comments written within the draft background paper for consultation will not be read or accepted. Either post your completed submission booklet to: Jane Anderson Ministry of Health PO Box 5013, WELLINGTON Marked: ‘Submission – Food and Nutrition Guidelines for Healthy Children and Young People: A background paper’ Or complete the electronic submission booklet available online at: www.moh.govt.nz and email to: [email protected] All submissions must be received no later than 5 pm on Monday 13 December 2010. Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years) iii Acknowledgements The Clinical Trials Research Unit at the University of Auckland prepared the initial draft of the Food and Nutrition Guidelines for Children and Young People: A background paper for the Ministry of Health. Maria Turley wrote the draft background paper, with technical advice and input from Dr Cliona Ni Mhurchu, Delvina Gorton, Helen Eyles and Dr Andrew Jull. This was followed by further development of the document by the Nutrition and Physical Activity Policy Team at the Ministry of Health, to produce this Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years): A background paper (Draft for Consultation). The following stakeholders provided feedback on the proposed structure and content of the background paper: the New Zealand Dietetic Association, the Paediatric Society of New Zealand, Public Health Nurses, Plunket, the Home Economics & Technology Teachers’ Association of New Zealand, Te Hotu Manawa Māori, the Pacific Island Food and Nutrition Advisory Group (PIFNAG), the Asian Health Foundation, and the Health Sponsorship Council. The following external peer reviewers provided constructive feedback on the second draft of the background paper: Dr Clare Wall, Kate Sladden, Kathy Hamilton, Eruera Maxted (Māori section), PIFNAG (Pacific section) and Geeta Gala (Asian and other section). iv Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years) Contents Preface iii Acknowledgements iv Introduction 1 Aim 1 Description of the population 1 New Zealand policy context 2 International context 3 Food and nutrition for children and young people 4 Structure of this paper 4 Part 1: New Zealand Food and Nutrition Guidelines 6 1.1 The New Zealand Food and Nutrition Guideline Statements, including Physical Activity 6 1.2 Food groups and recommended serving sizes 7 1.3 Nutrient reference values for Australia and New Zealand 13 Part 2: Growth and Body Size 16 2.1 Growth 17 2.2 Body size 22 2.3 Obesity 24 2.4 Underweight 28 Part 3: Energy and Nutrients 30 3.1 Introduction 30 3.2 Energy 31 3.3 Carbohydrate 34 3.4 Dietary fibre 37 3.5 Fat 40 3.6 Protein 45 3.7 Vitamin A 47 3.8 Riboflavin (vitamin B2) 49 3.9 Folate 50 3.10 Vitamin D 53 3.11 Calcium 57 3.12 Iodine 60 3.13 Iron 64 3.14 Selenium 67 3.15 Sodium 69 3.16 Zinc 72 Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years) v Part 4: Fluids 74 4.1 Introduction 75 4.2 Recommended intake 75 4.3 Current levels of intake 76 4.4 Sources of fluid in the diet 76 Part 5: The Home Environment and Its Influence on What Children and Young People Eat 82 5.1 Introduction 84 5.2 Physical, economic and sociocultural factors within the home environment 84 5.3 Meal patterns 91 Part 6: The Wider Environment and Its Influence on What Families and Individuals Eat 97 6.1 Introduction 97 6.2 The broader determinants of health and their influence on family/whānau dietary choices 98 6.3 The wider food environment 99 Part 7: Physical Activity 105 7.1 Introduction 105 7.2 Health effects of physical activity 106 7.3 Sedentary behaviour 107 7.4 Physical activity recommendations 107 7.5 Physical activity and sedentary behaviour levels in children and young people 108 7.6 Increasing physical activity levels 109 7.7 Types of physical activity 110 7.8 Barriers to and motivators for physical activity 112 7.9 Safety considerations 113 Part 8: Considerations for Māori Tamariki, Rangatahi and their Whānau 114 8.1 Introduction 115 8.2 Nutrition and health indicators 117 8.3 A Māori world view of health 119 8.4 Traditional foods and cultural practices 120 8.5 Working with Māori tamariki, rangatahi and their whānau 120 Part 9: Considerations for Pacific Children, Young People and Their Families 123 9.1 Introduction 124 9.2 Nutrition and health indicators 126 9.3 Concepts of health 129 9.4 Traditional foods and cultural practices 132 9.5 Working with Pacific peoples 133 vi Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years) Part 10: Considerations for Asian and Other Populations 135 10.1 Introduction 135 10.2 Health status 139 10.3 Nutrition and health indicators 140 10.4 Traditional foods and cultural practices 142 10.5 Access to health care 142 10.6 Working with Asian and other populations 143 Part 11: Special Dietary Considerations 145 11.1 Vegetarian eating 145 11.2 Food allergy 149 11.3 Pregnancy and breastfeeding 154 Part 12: Other Issues 155 12.1 Body image, disordered eating and eating disorders 155 12.2 Oral health 161 12.3 Alcohol 164 12.4 Dietary supplementation 168 12.5 Food safety 170 12.6 Food additives 172 12.7 Intense sweeteners 176 12.8 Caffeine 180 Glossary 185 Abbreviations 195 Appendices Appendix 1: New Zealand Policy Context 196 Appendix 2: International Policy Context 199 Appendix 3: Nutrient Reference Values 202 Appendix 4: New Zealand–WHO Growth Charts 216 Appendix 5: Three-day Sample Meal Plans 219 Appendix 6: Drinking-water 225 Appendix 7: Summary of New Zealand Studies 226 References 228 Submission Booklet: Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years): A background paper 253 Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2–18 Years) vii List of Tables Table 1: Food groups, specific foods in each group, advice and serving size examples 11 Table 2: Definitions of nutrient reference values 14 Table 3: Uses of nutrient reference values 15 Table 4: Mean height, weight and body mass index for New Zealand children and young people 22 Table 5: Prevalence of obesity in children and young people 26 Table 6: Components of energy expenditure 32 Table 7: Median daily energy intake for children and young people 33 Table 8: Classification of major dietary carbohydrates 35 Table 9: Median carbohydrate intake for children and young people 36 Table 10: Adequate intake for dietary fibre for children and young people 38 Table 11: Median dietary fibre intake for children and young people 39 Table 12: Polyunsaturated fatty acids that must be obtained in the diet 42 Table 13: Adequate intake for fatty acids for children and young people 43 Table 14: Recommended dietary intake for protein for children and young people 46 Table 15: Median daily protein intake for children and young people 46 Table 16: Recommended dietary intake and upper level of intake for vitamin A for children and young people 48 Table 17: Median daily vitamin A intake for children and young people 48 Table 18: Recommended dietary intake for riboflavin for children and young people 49 Table 19: Median riboflavin intake for children and young people 50 Table 20: Recommended dietary