2007 Children Survey Findings 2

2007 National Australian
Childrens
Nutrition and Physical
Activity Survey:
South Australian Findings
Contents
Contents .................................................................................................................................................. 2
List of Figures.......................................................................................................................................... 6
List of Figures.......................................................................................................................................... 6
Abbreviations .......................................................................................................................................... 7
Acknowledgements ................................................................................................................................. 8
Executive Summary .............................................................................................................................. 10
Overview ............................................................................................................................................... 10
Main Findings ........................................................................................................................................ 10
1 Introduction .................................................................................................................................... 14
2 Methodology
2.1 Sample Design......................................................................................................................... 15
2.2 Contacting Households............................................................................................................ 15
2.3 Recruiting Participants ............................................................................................................. 16
2.4 Survey Methodology ................................................................................................................ 17
2.5 Survey Methodology Issues..................................................................................................... 22
3 Demographic Characteristics
3.1 Caregivers................................................................................................................................ 23
3.2 Children.................................................................................................................................... 23
3.3 Households .............................................................................................................................. 24
3.4 Socio-Economic Status............................................................................................................ 24
4 Food and Nutrients
4.1 Food and Drinks....................................................................................................................... 25
4.2 Nutrients................................................................................................................................... 29
4.3 Nutritional Supplements........................................................................................................... 44
4.4 Eating Pattern .......................................................................................................................... 44
5 Physical and Sedentary Activities
5.1 Physical Activity Guidelines ..................................................................................................... 47
5.2 Pedometer Steps ..................................................................................................................... 48
5.3 Screen Time............................................................................................................................. 50
6 Body Size and Shape
6.1 Body Mass Index ..................................................................................................................... 53
6.2 Waist Girth ............................................................................................................................... 53
6.3 Height and Weight ................................................................................................................... 54
7 Linking Nutrition, Activity and Body Size........................................................................................ 56
8 Comparing South Australian Data and National Data ................................................................... 58
9 Socio-Economic Status .................................................................................................................. 61
10 Health Regions............................................................................................................................... 73
11 School Days, Weekends and Holidays .......................................................................................... 81
12 Weight Status, Physical Activity and Screen Time ........................................................................ 88
13 Conclusion and Recommendations ............................................................................................... 89
14 References ..................................................................................................................................... 91
List of Tables
Table 1: Telephone contact attempts using random digit dialling (RDD) to obtain the South
Australian sample.................................................................................................................................. 16
Table 2: Recruitment of South Australian participants through RDD.................................................... 16
Table 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 in South Australian children ................... 26
Table 10: Proportion (%) of total dietary energy intake (including energy from fermentable fibre) of
1 South Australian children obtained from major food groups ............................................................... 27
Table 11: Selected sub-major food groups consumption in South Australian children by age and
gender group ...................................................................................................................................... 28
Table 12: Median intake of energy (kJ) (including energy from fermentable fibre) in South
Australian children compared with EER, and proportions outside the upper and lower bounds of
EER ....................................................................................................................................................... 32
Table 13: Mean intake of energy, macronutrients and total moisture/fluid in South Australian children
.............................................................................................................................................................. 34
Table 14: Mean percentage (%) contribution of macronutrients to total energy intake in South
Australian children................................................................................................................................. 35
Table 15: Mean intake of micronutrients and caffeine in South Australian children ............................ 37
Table 16: Proportion (%) of South Australian children meeting EAR for selected nutrients using
estimate of usual nutrient intakes derived from two days of intake data collected by 24-hour recall
at 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 the
1,2 Australian Guide to Healthy Eating based on the dietary guidelines ................................................. 43
Table 19: Percentage of South Australian children who consumed at least one supplement on the day prior to the interview ....................................................................................................................... 44
Table 20: Proportion (%) of South Australian children eating breakfast on a school day by age and
gender group ......................................................................................................................................... 45
Table 21: Estimated number of eating occasions per day in South Australian children by age and gender group ...................................................................................................................................... 46
Table 22: Proportion (%) of South Australian children who met the physical activity guidelines using
four different methods of interpreting the guidelines............................................................................. 48
Table 23: Breakdown of the South Australian sample in the pedometer study by gender and age group ..................................................................................................................................................... 48
Table 24: Mean number of steps taken per day by South Australian boys and girls aged 5-8, 9-13
and 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
1 1 1 1 1 1
Table 26: Proportion (%) of South Australian children who met the screen time guidelines using four different methods of interpreting the guidelines .................................................................................... 51
Table 27: Mean number of minutes South Australian children engaged in screen time, television
viewing, computer use and video game playing ................................................................................... 52
Table 28: Proportion (%) of South Australian children classified as underweight, normal weight, overweight and obese ........................................................................................................................... 53
Table 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 South
Australian 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 for all South Australian children ............................................................................................................ 57
Table 35: Comparison of South Australian Children (SA) and National Survey children for selected
characteristics by age and gender ........................................................................................................ 59
Table 36: Proportion (%) of South Australian children and National Survey children meeting EAR for
selected nutrients and dietary guidelines using estimate of usual intakes derived from two days of intake 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 or
overweight, across the four SES bands................................................................................................ 61
Table 38: Fruit and vegetable consumption in South Australian children by age group and SES ..... 62
Table 39: Consumption of selected major and sub-major food groups in South Australian children
2 by age group and SES ......................................................................................................................... 64
Table 40: Consumption of selected nutrients in South Australian children by age group and SES .. 66
Table 41: Proportion (%) of South Australian children eating breakfast on a school day by age
2 group and SES .................................................................................................................................... 68
Table 42: Estimated number of eating occasions per day in South Australian children by age and
2 SES ...................................................................................................................................................... 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 and
sedentary behaviour variables in South Australia................................................................................. 72
Table 46: Fruit and vegetable consumption by age group and SA health regions.............................. 74
Table 47: Consumption of selected major and sub-major food groups by age group and SA health
regions................................................................................................................................................... 76
Table 48: Consumption of selected nutrients by age group and SA health regions ........................... 77
Table 49: Proportion (%) of South Australian children eating breakfast on a school day by age
group and SA health regions ................................................................................................................ 79
Table 50: Estimated number of eating occasions per day by age group and SA health regions....... 79
Table 51: Means for selected physical activity variables by health region ........................................... 80
1 1 1 1 1 1 1 1 2 1 1 2 1
Table 54: Mean time (minutes/day) South Australian children spent in MVPA and sport on school
days, weekend days, and holidays ....................................................................................................... 81
Table 55: Mean time (minutes/day) South Australian children spent in screen time and videogame
playing, and mean PAL on school days, weekend days, and holidays ............................................... 81
Table 56: Proportion (%) of total energy (including energy from fermentable fibre) consumed by
1 South Australian children during and outside school hours by age and gender groups ..................... 82
Table 57: Proportion (%) of total energy (including energy from fermentable fibre) consumed by
1 South Australian children during and outside school hours by age and SES ..................................... 83
Table 58: Proportion (%) of total energy (including energy from fermentable fibre) consumed during
1 and outside school hours by age and SA health regions .................................................................... 83
Table 59: Proportion (%) of total fruit and vegetables (including legumes) consumed by South
1 Australian children during and outside school hours by age and gender groups................................ 84
1 Australian children during and outside school hours by age and SES................................................ 85
1 Australian children during and outside school hours by age and SA health regions .......................... 85
Table 62: Comparison of weekday and weekend day intakes of energy, total fat, saturated fat and
sodium in South Australian children by age group ............................................................................... 86
2 sodium in South Australian children by SES ....................................................................................... 87
sodium 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 and
free play for South Australian children of different weight categories................................................... 88
Table 66: Mean time (minutes/day) spent in screen time, television and videogames, and mean
PAL for South Australian children of different weight categories.......................................................... 88
1 1 1
List of Figures
Figure 1: Contribution of energy from core and non-core foods (including mean intake of non-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 Australian
boys and girls (24-hour recall taken at CAPI, population weights applied) .......................................... 30
Figure 3: Pattern of energy consumption 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
(including mean intake of non-core
Figure 6: Contribution of energy from core and non-foods food) in South Australian children by age and SES .............................................................................. 67
Figure 7: South Australian health regions............................................................................................. 73
(including mean intake of
Figure 8: Contribution of energy from core and non-core foods non-core food) by age and SA Health regions...................................................................................... 78
1,2,3 1,2,3 1 1,2,3
Abbreviations
ACMA AGHE AI ABS AT BMI BMR CAPI CATI CSIRO DoHA EAR EER EI FSANZ g ISAK kJ MARCA g mg MVPA NRVs NHMRC PAL RDD RDI RE SEIFA SES SD VPA Australian Communication and Media Authority Australian Guide to Healthy Eating Adequate Intake Australian Bureau of Statistics Active Transport Body Mass Index Basal Metabolic Rate Computer Assisted Personal Interview Computer Assisted Telephone Interview Commonwealth Scientific and Industrial Research Organisation Commonwealth Department of Health and Ageing Estimated Average Requirement Estimated Energy Requirement Energy Intake Food Standards Australia and New Zealand grams International Society for the Advancement of Kinanthropometry kilojoules Multimedia Activity Recall for Children and Adults micrograms milligrams Moderate to Vigorous Physical Activity Nutrient Reference Values National Health and Medical Research Council Physical Activity Level Random Digit Dialling Recommended Dietary Intake Retinol Equivalents Socio Economic Indicator for Area Socio-Economic Status Standard Deviation Vigorous Physical Activity
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 and Ageing Mr Andrew Stuart, former First Assistant Secretary, Population Health Division, Department of Health and Ageing Ms Margaret Lyons, former First Assistant Secretary, Population Health Division, Department of Health 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
Associates
Ms Jennifer McDonald, former Assistant Secretary, Population Health Division, Department of Health
and 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 of
Health 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 Human
Nutrition, University of Sydney
Professor Katrine Baghurst, BSc, PhD, Adjunct Professor, Department of Medicine, University of
Adelaide
Professor Jennie Brand Miller, BSc (Hons), (Food Tech), PhD, FAIFST, FNSA, Professor of Human
Nutrition, University of Sydney
Ms Ingrid Coles-Rutishauser, BSc (Nutrition), MSc (Epidemiology), RPHNutr, Coles and Rutishauser
Consultants
Professor Wendy Brown, BSc (Hons), GradDip Phys Ed, MSc, PhD, FASMF, Professor of Physical
Activity and Health, School of Human Movement Studies, University of Queensland
Professor Robert Newton, BHMS (Hons), MHMS, PhD, AEP, CSCSD, FAAESS, Foundation
Professor, 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, Food Composition, Evaluation and Modelling Section Dr Judy Cunningham, BSc (Food Tech), PhD Food Composition Studies Ms 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 of Complementary Medicines, TGA
Executive Summary Overview

The 2007 Australian Childrens Nutrition and Physical Activity Survey (Childrens Survey) was commissioned by the Commonwealth Department of Health and Ageing (DoHA), the Department of Agriculture, Fisheries and Forestry, and the Australian Food and Grocery Council. The objective of the Childrens Survey was to assess: food and nutrient intakes, use of time and to measure the weight, height and waist circumference in a sample of children aged 2-16 years randomly selected from across Australia. Data was collected on two occasions involving 4,487 participants from February to August 2007. A computer assisted personal interview (CAPI) was conducted in the childs home. This was then followed up 7-21 days later by a computer assisted telephone interview (CATI). SA Health commissioned a booster sample of 400 children to increase the number of South Australian children surveyed to 877. This report relates to all South Australian children sampled either in the main study or in the South Australian booster sample. The corresponding national results are also presented [in parenthesis] for comparison where applicable.
Main Findings
Foods
In 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, dairy
or dairy substitutes, meat or meat substitutes, non-alcoholic beverages, snack and confectionery foods > Older children (14-16 years) generally consumed the least amount (g) of fruit compared to children in any other age group
> Older children reported eating almost twice the amount (g) of vegetables compared to the younger
children (2-3 years)

> The intake of milk products was highest amongst the girls 2-3 years compared to girls of other age
groups. Comparison with Dietary Guidelines for Children and Adolescents in Australia:
> Most South Australian children (90%) [National: 90%] had been breastfed at least some time during
their infancy
> Achieving guidelines relating to saturated fat, sugar, vegetables and cereals was problematic for
South 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 adequate
for most nutrients, without the need to take additional supplements 10
> Few children (7%) [National: 8%] consumed dietary supplements, the most common being
multivitamin and or mineral supplements

> Across all age groups, about half (47-50%) [National: 48-50%] of the total energy intake (EI) was
supplied by carbohydrate, 29-33% [National: 31%] by total dietary fat and 15-18% [National: 16 18%] 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 including
thiamin, riboflavin, niacin, and vitamin C, suggesting that these nutrients are not at risk of inadequacy across the population o 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 not meet 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 the
EAR 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 the EAR), 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%] did not 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 and
potassium were generally at or above the AI for each nutrient, suggesting that it is unlikely that there will be a high prevalence of children not consuming enough of these nutrients. In fact, the consumption 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 both
nutrients. Whilst these findings may suggest that a significant number of children may not be consuming 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 very
little 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 consuming
breakfast on a school day was lower than boys. As age increased the proportion of children consuming 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 year
olds 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 of MVPA 11
> 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 of screen 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 the
remaining, 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 normal
weight
> 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 child
accumulating 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 quartiles compared to the 1st and 2nd quartiles (20-22%)
> There were few differences across SES bands in the amount of physical activity adolescents
experienced, 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 SES
quartile 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, number
and age of siblings, marriage status)

> Physical activity was greater in households where there were more children, where there were
siblings 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 same
gender
> The marriage status (married/de facto/single) of the caregivers did not impact on any of the
outcomes.
12
Type of Day
> Screen time was much higher on weekends and holidays than on school days, and overall energy
expenditure 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.
13
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 of Agriculture, Fisheries and Forestry, and the Australian Food and Grocery Council. State Health Departments were invited to participate, and SA Health sponsored a booster sample of South Australian participants. Households were randomly selected from around the state, and children and adolescents were interviewed between February and August 2007. This report details findings for the South Australian children and adolescents who participated in either the main (national) or booster samples. The Commonwealth Scientific and Industrial Research Organisation (CSIRO) and the University of South Australia conducted the survey with I-view Pty Ltd undertaking the survey fieldwork. The Project 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 Health 1988, 1989) respectively. The intervening years have seen significant changes in the Australian food supply and eating habits, an increasing use of technologies that facilitate sedentary behaviour such as videogames and the internet; along with a changing family life and structure. All of these factors are likely to impact on what children eat, how they use their time, and on their bodyweight. The Childrens Survey was undertaken in recognition of the need to have national data on childrens weight status, dietary intake and activity levels for monitoring purposes. This information is also important for assessing the nutritional adequacy and the physical activity participation of the children surveyed. The Childrens Survey measured dietary intakes of food and beverages, use of supplements during the previous 24 hours, selected food habits, heights, weights and body mass index (BMI), waist circumference, time spent in physical activity and sedentary activity (screen time), number of daily steps 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 Health contributed towards a booster sample (n = 400) for South Australian children. Ethics approval was obtained from the National Health and Medical Research Council (NHMRC) registered Ethics Committees of CSIRO and the University of South Australia. Households with children were randomly selected using random digit dialling (RDD) from South Australia 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 (computer assisted 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. In collaboration with Food Standards Australia and New Zealand (FSANZ), the food and beverage intake data was translated to daily nutrient intake data using the most recent Australian nutrient composition database. Food habit questions were asked of each child and/or parent during the CAPI in relation to the usual consumption of fruits, vegetables, type of milk, use of salt and earlier infant feeding practices. Physical activity was measured in two ways. Time use was measured in children aged 9-16 years using 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 were also used to measure the average number of steps taken daily over six days by children aged 5-16 years. Weight, height and waist circumference were measured for all participants during the CAPI.
14
Methodology
The sampling, interview and analytical methodologies were essentially identical for the national and South 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 with respect to age, energy intake, daily energy expenditure, number of steps per day, minutes of moderate-to-vigorous physical activity, or daily screen time. There were significant differences in socio-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 capital city/rest of state), and secondly by households within selected postcodes using RDD of telephone numbers. 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 the population identified as Indigenous in the 2001 Australian Bureau of Statistics (ABS) Census were also excluded from the initial sampling frame. Households were contacted and those with children aged 2-16 years (eligible) were identified and asked to participate in the survey. One child within the household was selected as the study child for the purpose of the survey. The base national sample in South Australia was supplemented by 400 an additional to allow more detailed estimates for the state. A total of 4,487 children completed the entire survey, of which 877 were from South Australia. The sampling, selection and recruitment methodology are comprehensively reported in the Users Guide (DoHA 2008) and should be considered when interpreting data.
2.2 Contacting households

The random generation of telephone numbers produced viable numbers, numbers that were not functional (dead) and numbers that have never existed (unattached). Additionally, viable telephone numbers either belonged to a residential household or to a non-residential address such as a business or an organisation. 12.4 percent of the total were not finalised as there was either no answer, 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 the survey as phone numbers are now portable. They were included in the location cluster and recruited into 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 calls on a week night and one call made on a weekday during the day. If no contact was made after six call attempts the phone number was excluded from further call attempts. If contact was made with the household and a request was made to call back there was no limit to the number of call attempts.
15
Table 1: Telephone contact attempts using random digit dialling (RDD) to obtain the South Australian sample
Number of 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, or engaged Total eligible households 36,637 11,457 4,288 13,695 4,526 2,671 % of total telephone numbers 100.0 31.3 11.7 37.4 12.4 7.3
2.3 Recruiting Participants

Of the 2,671 eligible households, 1,219 households agreed to participate in the study. Fifty three were not required as their age group quota was full, therefore these households were not recruited into the study. After the initial recruitment, 245 of the households were not interviewed as the relevant age quota had been met in their postcode cluster. Once recruited, 5.2% of the households withdrew, with the majority stating that they had insufficient time to commit to the survey or had lost interest in completing 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 survey relevant for their age group (demography, dietary recall use of time). There were 877 complete data sets included in the final database and analysed in this report. Pedometer data was reported from a subset of eligible participants.
Table 2: Recruitment of South Australian participants through RDD Number of households

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 Recruited, completed all parts of the survey relevant for age group
1 2
% of total households
100.0 40.5 45.6 4.3 20.1
1 1 1 1
2,671 1,081 1,219 53 245 63 10 877
5.2 0.8 71.9
1,2
Calculated as a percentage of the total that agreed to participate Pedometer data collected from a subset
To maximise the response rate, there was press coverage at the start of the survey and potential participants were provided with information which included a website and written material that clearly outlined the survey expectations and requirements. Being too busy (due to work and family commitments) or not having the time to do the survey were the main reasons stated by parents of eligible households for not participating at recruitment. To facilitate the participation of busy families interviewers offered flexible appointment times and accommodated requests made by the participating families.
16
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 acknowledge their contribution. Since stratified sampling with non-proportional samples was used, a weight was applied to each participants record. The weight for each participant was proportional to the number of similar children in the Australian population. Similar was defined according to factors likely to influence nutrition 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 gender groups were used to estimate the number of similar children in the population. Data from the survey was used to estimate the sample numbers and hence the weights for each individual child. These weights enabled the survey data to provide estimates for the whole population of Australian households with children in scope. The resulting numbers of children in the South Australian sample of 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 across Australia in each of the age and gender groups covered by the nutrient reference values (NRVs) to allow sufficient numbers to make statistical comparisons of intakes with recommendations. The South Australian Department of Health contributed towards a booster sample (n = 400) for South Australian children. 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 different types of days (for example weekdays versus weekend days and school versus non-school days). In order to capture intakes and activity patterns that would represent all types of days, the CAPI and the CATI were collected on different day types when feasible (see Table 4). Attempts were made to collect information on school and non-school days (including holidays) in proportion to the number of such days that occurred over the sampling period.
17
Table 4: Weekday distribution of CATI and CAPI interview days in the South Australian sample
Day of CATI Day of CAPI Mon Tues Wed Thurs Fri Sat Sun Total
1
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
CATI Not Complet e 5 4 6 5 7 4 0 31
Total
22 21 25 19 28 23 11 149
28 20 29 13 25 20 16 151
20 28 22 21 16 10 12 129
12 18 27 30 22 23 13 145
12 10 19 19 17 21 11 109
14 11 15 25 21 21 15 122
10 13 13 13 15 17 15 96
123 125 156 145 151 139 93 932
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. Software from the Life in New Zealand (LINZ24) survey was modified for the Childrens Survey to reflect the Australian 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 the amounts 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 the dietary recall. Dietitians checked all of the 24-hour recalls for their content and whether or not they appeared a reasonable consumption pattern. Any unusual intakes were queried and modified if appropriate. In collaboration with FSANZ, a food coding system was developed to reflect the current food supply and to maintain comparability with the food groups used in the 1995 National Nutrition Survey (ABS 1998). Additional food groups were added for infant foods, was formulae and dietary supplements. In addition the food, beverage and supplement intake data were translated to daily nutrient intake data using 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, saturated fat, monounsaturated fat, polyunsaturated fat, alpha-linolenic acid, linoleic acid, long chain omega-3 fatty acids, cholesterol, total carbohydrates, starch, sugars, dietary fibre, alcohol, total vitamin A, pre formed 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 linoleic acid, 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 South Australian version of the Main Findings report as the initial focus is to determine the nutrients provided to children by consumption of food and beverages alone.
18
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 usual intake is needed and in which case both the CAPI and CATI dietary intake data are used (i.e. two days 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 usual nutrient intakes of children can be compared with recommended nutrient intakes established by NHMRC (NHMRC 2006). It must be considered that these are only estimates of potential dietary intake inadequacy as individual requirements for each nutrient can be quite variable and this report has not included nutrients provided by dietary supplements. To definitively determine whether children are consuming sufficient amounts of nutrients to meet their own individual and specific requirements would require measures of nutrient status such as blood or serum biochemical tests, which is beyond the scope of this survey. The estimated average requirement (EAR) is the daily nutrient intake level estimated to meet the needs of half of the children in their particular life stage and gender group. The percentages of children whose usual nutrient intakes are less than the EAR provide an estimate of the prevalence of potential intake inadequacy in each age and gender group. If there are large percentages of children with usual intakes below the EAR for a particular nutrient, it is indicative that a number of children may not be consuming sufficient amounts of that nutrient to meet their requirements, however as noted above it is not definitive. When setting the NRVs, EARs could not be determined for all nutrients due to limited scientific evidence being available. AIs were established instead, based on the median intake reported in the 1995 National Nutrition Survey and assuming that they had a sufficient intake. An AI is defined as the average daily nutrient intake level based on observed or experimentally-determined approximations of estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate. Comparisons of the nutrient intakes of the Childrens Survey participants with AIs cannot 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 of potentially 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 low prevalence of inadequate intakes. If the AI is based on median intakes, this assessment of childrens intake is made with less confidence. The NHMRC Dietary Guidelines for Children and Adolescents (NHMRC, 2003) and the Australian Guide to Healthy Eating (AGHE) (Smith et al 1998) provide some specific dietary and food recommendations. The dietary intakes from the Childrens Survey were compared against a combination of food and nutrient guidelines or recommended intakes. For some foods, in order to make comparisons with guidelines, the number of serves of foods consumed by children were calculated using firstly the food sub-groups and secondly the serving sizes 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 inadvertently missed and a more detailed analysis is warranted. The major types of foods will have been included and 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 usual consumption of fruits, vegetables, type of milk, use of salt and earlier infant feeding practices. The only data from these questions presented in this South Australian version of the Main Findings report are whether or not the survey participants had ever been breast fed. Encouraging mothers to breastfeed is one of the NHMRC Dietary Guidelines for Children and Adolescents (NHMRC 2003). Eating occasions and consumption patterns were analysed using thirty-minute intervals.
19
Physical Activity
Physical activity was measured in two ways. Time use was measured in children aged 9-16 years using a previously validated computerised 24-hour recall using the MARCA (Ridley et al 2006). Each child recalled four days, two days prior to the CAPI and two days prior to the CATI. Children reported everything they did in the previous 48 hours in time-slices as fine as five minutes. Each activity reported was linked to an energy cost (Ridley & Olds 2008). Total energy expenditure was calculated based on the reported activities. This is expressed as a PAL which is a multiple of resting metabolic rate, or the amount of energy a child would expend if he or she were to sit still all day. In order to determine the overall daily activity patterns of children, it is necessary to take into account both physically active and sedentary behaviours. Activity data collected as part of the Childrens Survey included each childs PAL and the number of minutes per day spent in the following categories, MVPA, organised sport and play, free play, active transport, 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 these activities was totalled for each child on each of the four sampled days. The average daily number of minutes children spent in MVPA and average screen time are included in this report. MVPA is usually defined as any activity that requires at least three times as much energy as the child uses when sitting quietly. In practice, this amounts to anything at or above a brisk walk. Screen time refers to the amount 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 for other 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 physical activity. Children who recorded at least six days of measurements and had the pedometer off for no more 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 period was calculated for each child.
Comparison with Physical Activity Guidelines

The average amount of time the children spent in the physical and sedentary activities were compared to the Commonwealth Department of Health and Ageings recommendations for physical activity for children and youth (DoHA 2004a, DoHA 2004b). This also includes guidelines for the amount of entertainment screen time and has been included in this South Australian Main Findings report. Currently there are no national guidelines for children regarding the recommended number of steps to be 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 tape respectively. Height, weight and waist girth were measured by interviewers trained by anthropometrists 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 iliac crest. 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 most commonly used index of weight for height in children. It has been widely used as an estimate of fatness.
20
Weight Status
Children were categorised into weight classes (underweight, normal weight, overweight and obese) according to international standards of age- and gender-specific BMI cut-offs (Cole et al. 2007). These cut-offs, which are based on combined international datasets, are designed to correspond to 2 2 adult values of 25 kg.m (for overweight) and 30 kg.m (for obesity). The percentage of children falling into each weight class was calculated. There are no generally agreed cut-offs for waist girth, however it has been suggested that abdominal fatness is excessive in school-aged children when the ratio of waist girth to height exceeds 50% (Ashwell 2005).
Demographics
Demographic information about the households of the participants included in the Childrens Survey was collected at the CAPI, including information about the children and the parents or up to two caregivers. The general term caregiver is used in this report to denote adults who are present in the household and who take responsibility for the study child. Data on where the caregivers and children were born, whether they were of Indigenous origin, whether or not another language was spoken at home, the number of caregivers in the households and the household annual incomes are presented in Table 5, Table 6 and Table 7. SES was indicated by Socio-Economics Indexes for Areas (SEIFA; Index of Relative Socio-Economic Disadvantage) and health regions were classified by postcodes.
Population Weights
The survey was conducted on 4,487 children and weights were applied to each individuals response to more closely reflect the whole Australian child population. Population weights were added as appropriate for stratified sampling with non-proportional sampling used in recruitment. Weights for age, gender and region (state/territory and capital city/rest of state) were used. Refer to the Users Guide (DoHA 2008) for additional information. Population weights were applied to all of the results tables for nutrients and to all of the activity and anthropometric data. Population weights were not applied to Table 5, Table 6, Table 7 and Table 8.
Valid Self-Reports
The determination of the ratio of energy intake (EI) to basal metabolic rate (BMR) (EI:BMR) helps to identify dietary recalls that are potentially of poor validity or, as this is more usually described, to determine the number of potential under-reporters. A very low EI to BMR ratio can theoretically be used to exclude participants from the Childrens Survey on the basis that such low intakes could be:
> Due to under-reporting > Not representative of usual intakes > Implausibly low and not sustainable over the long term.
Cut-off limits have been established to identify implausibly low intakes. The Goldberg cut-off EI/BMR of 0.87 (ABS 1998, Goldberg et al 1991) using an estimated PAL 1.55 was used for all age groups. This calculation revealed that less than 4% of children aged 2-13 years [National: less than 2% in children aged 2-8 years; 5-6% in children aged 9-13 years] appeared to have potentially invalid selfreports of dietary intakes. In the older age group (14-16 years), 7-10% [National: 8-16%] had potentially implausibly low intakes. Equally, participants may over-report both their food intake and their physical activity but there has been no attempt to identify potential over-reporters. For this South Australian version of the Main Findings report as in the case of the national report, no dietary intakes were excluded on the basis of their EI:BMR ratio. Including reported intakes from children who appear to have implausibly low energy intake or who have provided records of poor validity, can lead to an overestimate of the percentage in the population with nutritionally inadequate intakes (Mackerras & Rutishauser 2005). Additional analyses needs to be undertaken in the future to determine the impact of these potentially implausibly low intakes on the estimates of possible inadequate nutritional intakes.
21
2.5 Survey Methodology Issues

The RDD method is a time and cost effective approach to recruitment and has been previously used to generate survey samples for population health studies. When this method is combined with a quota system three important methodological issues should be considered. Firstly, RDD with a quota affects the probability of selection of children. One child per eligible household was randomly selected to take part in this survey. It is desirable to have each child in the total sample frame have an equal chance of selection in the sample drawn. With RDD and household sampling, children who are the only child or who have fewer siblings aged 2-16 years have more chance 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 age groups. 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 participate and those who were excluded due to the quota system. This information is needed to estimate any potential 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 accessing current telephone number information and should have as complete coverage as possible. It is estimated that at least 95% of Australian households have a landline (ABS 2003), with some households choosing to replace a landline connection with a mobile phone (ACMA 2008). Portability of telephone numbers as people move across geographic locations can result in recruitment outside the selected postcodes. An advantage of RDD is that silent, unlisted and recently listed numbers can be included by chance. Data was collected between February and August 2007, resulting in limited information on variance of intakes with changing seasons.
22
Demographic Characteristics
Demographic information of all of the survey participants and their families was collected at the initial CAPI. The following tables describe the demographics of the households in South Australia that participated in the survey (Table 5, Table 6, Table 7 and Table 8). These tables do not have population weights applied however provide an indication of how the characteristics of the South Australian households that were actually surveyed compare to the characteristics of the total Australian population provided in 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 Indigenous origin. Most households (85%) had at least two caregivers. The Childrens Survey, in the main, has collected data from couples who may have similar characteristics and may thus not be representative of 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 is non tertiary1 No second caregiver
1
Caregiver 1 (n) 163 54 10 592 143
Caregiver 2 (n) 156 52 7 549 -
Caregivers in SA survey (%) 18.5 6.1 1.0 66.2 15.3
Includes up to Year 12 and Certificate III and IV
3.2 Children
Table 6: Demographic characteristics of South Australian children (unweighted data)
Childrens Characteristics
Born overseas Speak another language at home Indigenous Medical conditions (at least one)
Children (n) 50 50 17 218
Children in SA survey (%) 5.7
5.7 1.9 24.9
23
3.3 Households
Table 7: Incomes of South Australian households (unweighted data)
Household Characteristics $15,00 or more per week ($78,000 or more per year) $600 - $14,99 per week ($31,200 - $77,999 per year) $1 - $599 per week ($1 -$31,199 per year) Dont Know Other (no income, negative income, refused) Households (n) 432 406 56 27 11 Households (%) 49.3 46.3 6.4 3.1 1.3
3.4 Socio-Economic Status

Table 8: Percentage of South Australian children classified in the four SES bands by health region (unweighted data)
Highest SES Health Region Central Northern Adelaide Southern Adelaide Country 1 quartile (%) 9.2 51.0 0.7
st
Lowest SES 2
nd
quartile (%) 25.5 10.4 18.1
3 quartile (%) 35.1 30.9 73.0
rd
4 quartile (%) 30.1 7.6 8.2
th
24
Food and Nutrients
4.1 Food and Drinks

The food and drinks that children consume provide essential nutrients important for health, normal growth and development as well as physical and mental well-being. The occasions where food and drinks are consumed also provide an important opportunity for social and cultural interactions in family, school and other settings. Children can also obtain nutrients from supplements however these are not included in this current report. See Table 19 for frequency of supplement consumption in the Childrens Survey. All food and drinks that children reported they consumed over the 24 hour period prior to the interview were totalled and assigned to major types of foods or major food groups. For each of the age and gender groups for the Childrens Survey, the mean intakes of the major food groups are shown in Table 9 with population weights applied to the data. Key Findings: On the day prior to the interview:
> Apart from non-alcoholic beverages, milk products and dishes were generally consumed in the
greatest quantities
> Older children (14-16 years) consumed the least amount (g) of fruit compared to children in any
other age group

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

> The intake of milk products was highest amongst the youngest girls (2-3 years) compared to girls of
other age groups

> Meat, poultry and game intakes increased as the age groups of the children increased, particularly
in boys o Older boys (14-16 years) consumed almost three times as much meat/poultry/game as the younger boys (2-3 years) o Older girls (14-16 years) consumed almost twice as much meat/poultry/game as the younger girls (2-3 years).
25
Table 9: Mean daily consumption (g) of major food groups in South Australian children
Boys Age group 2-3 4-8 9 - 13 14 - 16 2-3 Girls 4-8 9 - 13 14 - 16
Non-Alcoholic Beverages Cereals & Cereal Products Cereal-Based Products & Dishes Fats & Oils Fish & Seafood Products & Dishes Fruit Products & Dishes Egg Products & Dishes Meat, Poultry & Game Products & Dishes Milk Products & Dishes Dairy Substitutes Soup Seed & Nut Products & Dishes Savoury Sauces & Condiments Vegetable Products & Dishes Legume & Pulse Products & Dishes Snack Foods Sugar Products & Dishes Confectionery & Cereal Bars Alcoholic Beverages Special Dietary Foods Miscellaneous Infant Formulae & Foods
1
664 136 72 8 7 162 7 67 426 21 23 1 17 100 4 6 17 12 0 4 3 20
998 185 115 9 10 173 8 88 327 3 15 2 22 93 11 16 15 28 0 2 4 0
1357 196 168 8 5 150 8 109 442 2 24 3 29 205 8 13 24 29 0 5 5 1
1827 286 219 9 15 117 10 198 435 0 33 5 51 240 12 16 17 25 0 5 5 0
668 140 47 6 7 170 2 63 427 18 12 2 10 101 14 3 10 10 0 0 4 10
870 139 98 7 12 170 6 77 291 22 13 1 16 112 4 8 20 26 0 3 3 2
1230 175 153 8 12 147 5 98 249 0 43 3 29 162 4 9 18 29 1 2 4 0
1486 224 118 8 11 119 9 127 318 0 28 3 38 211 3 14 11 27 3 3 4 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 the major 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 products
contributed 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 energy
either between gender or across age groups

> Younger children (2-3 years) achieved at least 5% more energy from milk products and dishes
compared to older children. Dairy substitutes were not consumed by those children aged >8 years for either gender.
26
Table 10: Proportion (%) of total dietary energy intake (including energy from fermentable fibre) of 1 South Australian children obtained from major food groups
Boys Age group (years) 2-3 4-8 9 - 13 14 - 16 2-3 Girls 4-8 9 - 13 14 - 16
Non-Alcoholic Beverages Cereals & Cereal Products Cereal-Based Products & Dishes Fats & Oils Fish & Seafood Products & Dishes Fruit Products & Dishes Egg Products & Dishes Meat, Poultry & Game Products & Dishes Milk Products & Dishes Dairy Substitutes Soup Seed & Nut Products & Dishes Savoury Sauces & Condiments Vegetable Products & Dishes Legume & Pulse Products & Dishes Snack Foods Sugar Products & Dishes Confectionery & Cereal Bars Alcoholic Beverages Special Dietary Foods Miscellaneous Infant Formulae & Foods
1
4.7 19.7 13.2 3.2 1.0 7.1 0.7 9.0 24.1 0.8 0.7 0.6 1.0 5.5 0.3 1.8 1.6 3.3 0.0 0.4 0.3 1.1
5.5 23.2 16.7 3.1 1.0 5.6 0.9 9.6 15.9 0.1 0.4 0.6 1.3 3.8 0.5 4.0 1.5 6.2 0.0 0.1 0.3 0.1
7.6 19.5 19.1 2.1 0.4 3.7 0.6 9.8 17.1 0.0 0.6 0.6 1.3 7.0 0.3 2.7 2.2 5.2 0.0 0.2 0.1 0.0
7.9 21.6 17.4 2.1 1.2 2.5 0.7 14.0 13.9 0.0 0.6 1.0 1.8 7.0 0.4 2.7 1.3 3.6 0.0 0.2 0.2 0.0
5.0 21.8 11.2 2.6 1.1 8.3 0.3 8.8 25.8 0.7 0.6 0.7 0.9 5.4 0.8 0.9 1.2 3.0 0.0 0.0 0.4 0.5
6.1 19.1 16.7 2.6 1.3 6.4 0.6 10.6 16.6 0.8 0.4 0.4 0.9 5.6 0.3 2.4 1.9 6.6 0.0 0.2 0.3 0.1
7.8 20.0 19.6 2.5 1.0 4.0 0.5 10.6 12.4 0.0 1.1 0.9 1.7 6.9 0.2 2.3 2.1 6.2 0.0 0.1 0.2 0.0
7.0 21.1 15.4 2.3 0.7 3.3 0.6 11.4 15.1 0.0 0.7 0.8 1.9 9.3 0.2 3.1 1.1 5.4 0.1 0.1 0.3 0.0
One day food intake data collected at personal interview, population weights applied
27
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 non alcoholic beverages, fruit and vegetable juices and drinks and their contribution to total energy intake are presented in Table 11. Key Findings:
> 2-3 year old children were consuming less confectionery, including proportion of total energy from
confectionery, than children of any other age

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

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

1
Table 11: Selected sub-major food groups consumption in South Australian children by age and gender group
Boys Age group (years) 24-hour intake of confectionery2 (g) Proportion of total energy from confectionery (%) 24-hour intake of sugar-sweetened non-alcoholic beverages3(g) Proportion of total energy from sugar-sweetened non-alcoholic beverages (%) 24-hour intake of fruit and vegetable juices & drinks (g) Proportion of total energy from fruit and vegetable juices & drinks (%)
1 2
Girls 9-13 24.6 3.8 261.0 4.9 160.7 2.5 14-16 17.8 2.6 358.4 6.4 158.4 1.8 2-3 7.0 1.9 36.4 2.3 104.5 2.7 4-8 19.6 5.1 102.9 3.7 120.8 2.6 9-13 21.9 4.3 220.2 5.2 148.1 2.7 1416 19.5 4.1 193.5 4.2 167.0 2.8
2-3 8.1 2.2 46.1 2.9 77.7 2.0
4-8 19.2 4.5 105.7 3.0 117.0 2.3
One-day food intake data collected at personal interview, population weights applied, n=877. Excluded cereal, fruit, nut and seed bars 3 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 are classified as non-core or extra foods. Some non-core foods can be high in fat, salt and sugar and likely to contribute to excess energy intake. Figure 1 shows the contribution of energy from core and non-core foods as well as the number of serves of non-core food consumed in the 24 hours prior to the interview. Where possible, only the healthier options were included in the calculation of contribution of energy from core foods. Caution is required when interpreting this data as the classification 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. The
proportion of energy contributed by non-core foods increased with age from 2-13 years and decreased slightly in the 14-16 years old children.
28

1,2,3
Figure 1: Contribution of energy from core and non-core foods food) in South Australian children by age and gender group
80
74%
9 70%

% energy from core food
70
62%
8 Number of serves of non-core food
60
7.4 57%
5.2
7.8 61%
60%
55%
6.3
57%
6.6
% of total energy 50
4.5
40
% energy from non-core food
3.2 30
4 2.5
Number of serves of non-core food
20
10
0 Age group 2-3 years 4-8 years 9-13 years14-16 years
2-3 years 4-8 years 9-13 years14-16 years
Gender
Males
Females
1 2
One-day food intake data collected at personal interview, population weights applied, n=877. 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 where possible, 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 or flavoured; mixed dishes where cereal is major component (not hamburgers); all fish and seafood products and dishes; all fruit products and dishes; egg products and dishes; all meat, poultry and game products and dishes (not organ meat/offal products and dishes, not sausage/frankfurts/saveloys); all milk, yoghurt and cheese (dairy or non-dairy); all soups; seeds and seeds products; nuts and nut products; potato (not chips, wedges or gems); all other vegetables and dishes; legumes and pulses products 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 or micronutrients.
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 normal physiological processes. They include protein, carbohydrate, fat and dietary fibre. Protein, carbohydrate and fat are the major dietary contributors to energy intake. It is necessary to obtain energy from our food and drinks to carry out the basic functions of everyday living including breathing, the normal functioning of our heart, brain and other key organs, to carry out digestion and to perform physical activity. The energy obtained from food and drinks, as well as estimates of energy intake are measured and reported in kilojoules (kJ). Dietary carbohydrate is comprised mainly of starch and sugars. Total starch and total sugars intake are presented in this South Australian Main Findings report. Total sugars, such as lactose, sucrose and fructose are comprised of those naturally present in our foods and those added during processing
29
and preparation. The amounts of total sugars in the Childrens Survey presented in the following tables 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. The total 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 Childrens Survey as the mean or average for age and gender groups (Table 13) and the mean contribution to total dietary energy intake (Table 14) and these have been obtained from one day of intake collected from the 24-hour recall undertaken during the CAPI. When nutrient intakes have been compared against recommended intakes, two days of intake data have been utilised to obtain an estimate of usual intake (See Table 16).
Energy
Average daily intake data for the age and gender groups of participants in the South Australian component of the Childrens Survey are based on one day of intake (CAPI) and are presented in Figure 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 differences
between 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 boys and girls (24-hour recall taken at CAPI, population weights applied)
Mean energy intake
Boys
14,000
12,242
Girls
12,000
9,962
10,000
7,894 8,409 6,935 5,730
9,212
8,000
kJ
6,304
6,000 4,000 2,000 0
2-3 yrs
4-8 yrs
9-13 yrs
14-16 yrs
Age group
30
Comparison with Energy Requirements

The NHMRC EER provide a range of suggested requirements needed for children, with variation in energy 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 survey were 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 range
for EER
> Between 11-21% [National: around 20%] of older (14-16 years) boys estimated usual intake was
not 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 fewer achieved higher energy intakes than the upper bound of the EER.
31
Table 12: Median intake of energy (kJ) (including energy from fermentable fibre) in South Australian children compared with EER, and proportions outside the upper and lower bounds of EER
Median usual intake (kJ) Proportion consuming less than the lower bound of the EER range (%) Proportion consuming more than the upper bound of the EER range (%)
Years
EER (kJ)
Boys
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
4,400 4,900-6,900 5,200-7,300 5,500-7,800 5,800-8,200 6,100-8,700 6,400-9,200 6,800-9,700 7,300-10,400 7,700-11,000 8,200-11,600 8,700-12,400 9,300-13,200 9,900-14,000 10,300-14,700 4,200 4,500-6,400 4,800-6,800 5,100-7,200 5,400-7,600 5,700-8,100 6,000-8,600 6,400-9,100 6,700-9,500 7,000-10,000 7,400-10,600 7,800-11,100 8,100-11,500 8,200-11,700 8,400-11,900
6060 6297 6670 7268 7331 9085 9053 9731 9196 10156 10206 10057 11355 12171 12809 5421 5903 6734 6660 6913 6884 7326 7662 8794 8536 8603 8170 8836 9703 8688
8 11 11 6 2 2 0 1 0 11 5 11 18 21 11 10 2 10 6 0 9 3 13 11 1 19 37 29 17 42
32 33 34 15 59 38 51 2 37 15 2 22 28 18 25 48 20 2 17 4 19 34 2 12 1 4 13 2
Girls
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Population weights applied For girls aged 5, 7 and 9 years a negative estimate of usual intake variance was achieved hence data presented was calculated using the average of two-day energy intake data from food and beverages only (no supplements) collected at CAPI and 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 metabolic ratio (BMR) can be used as an indicator of under-reporting. The mean EI:BMR was 1.8 and 1.7 for 2 3 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]. As demonstrated in Valid Self-Reports (Section 2.4), the estimated proportion of under-reporters was highest 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 each
successive 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 children
aged 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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Table 13: Mean intake of energy, macronutrients and total moisture/fluid in South Australian children
Unit (kJ) (kJ) (g) 2-3 6174.6 6304.0 1443.5 Age Group (years) 4-8 9 - 13 7733.1 9769.7 7894.3 9961.7 1702.0 2260.7 14 - 16 12011.2 12241.7 2873.7
Boys
Girls
Energy Energy - including fermentable 2 fib re Moisture Macronutrients Protein Total fat3 Saturated fat Monounsaturated fat Polyunsaturated fat Cholesterol Total carbohydrate4 Total sugars Total starch Alcohol Fibre Energy Energy - including fermentable 2 fib re Moisture Macronutrients Protein Total fat3 Saturated fat Monounsaturated fat Polyunsaturated fat Cholesterol Total carbohydrate4 Total sugars Total starch Alcohol Fibre Energy Energy - including fermentable 2 fib re Moisture Macronutrients Protein Total fat3 Saturated fat Monounsaturated fat Polyunsaturated fat Cholesterol Total carbohydrate4 Total sugars Total starch Alcohol Fibre
(g) (g) (g) (g) (g) (mg) (g) (g) (g) (g) (g) (kJ) (kJ) (g) (g) (g) (g) (g) (g) (mg) (g) (g) (g) (g) (g) (kJ) (kJ) (g) (g) (g) (g) (g) (g) (mg) (g) (g) (g) (g) (g)
62.0 53.7 25.6 17.7 6.6 174.7 188.4 99.0 87.9 0.0 16.1 5603.6 5730.2 1412.3 56.1 45.1 21.4 14.7 5.6 142.5 179.2 96.4 81.2 0.0 15.8 5894.0 6022.0 1428.2 59.1 49.5 23.5 16.2 6.1 158.8 183.9 97.7 84.6 0.0 16.0
74.6 65.6 29.9 22.7 8.2 203.6 242.5 114.2 125.7 0.0 20.1 6796.6 6934.6 1530.4 61.5 58.9 27.0 20.1 7.6 167.9 215.0 109.2 103.2 0.0 17.2 7257.2 7406.6 1614.8 68.0 62.2 28.4 21.4 7.9 185.4 228.5 111.7 114.3 0.0 18.7
88.5 85.4 40.1 29.1 10.1 248.4 307.5 156.9 148.0 0.0 23.9 8235.3 8408.7 1929.5 77.1 70.8 31.1 25.4 9.3 205.6 258.8 125.5 130.3 0.0 21.6 9020.3 9203.2 2099.0 82.9 78.3 35.7 27.3 9.7 227.5 283.7 141.6 139.3 0.0 22.8
126.9 103.7 45.4 37.2 13.8 347.6 361.5 163.6 195.1 0.1 28.8 9026.0 9211.8 2275.1 88.2 82.2 35.9 29.2 11.2 251.4 269.3 128.1 139.0 0.1 23.2 10521.8 10729.9 2575.0 107.6 92.9 40.7 33.2 12.5 299.6 315.5 145.9 167.1 0.1 26.0
Total Children
One-day nutrient intake data from food and beverages only (no supplements) collected at CAPI, population weights applied Fluids derived from food and beverages 3 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 sterols 4 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 the total carbohydrate value.
2
34
Table 14 shows the percentage contribution of macronutrients to total energy intake in South Australian children.
Key Findings:
> Carbohydrates contributed approximately half of the total energy. The proportion contributed by
carbohydrates 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 varying
proportions. 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 this situation 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%] than monounsaturated (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 boys
aged 14-16 years having the highest protein intakes

Table 14: Mean percentage (%) contribution of macronutrients to total energy intake in South Australian children
Age Group (years) Boys Protein Total fat3 Saturated fat Monounsaturated fat Polyunsaturated fat Total carbohydrate4 Total sugars Total starch Girls Protein Total fat
3
2-3 16.8
4-8 16.1
9 - 13 15.3
14 - 16 17.7
30.9 14.6 10.2 3.9 48.2 25.5 22.3 16.6 29.0 13.7 9.5 3.7 50.1 27.0 22.7 16.7 30.0 14.1 9.9 3.8 49.2 26.2 22.5
30.3 13.8 10.5 3.8 49.5 23.5 25.3 15.0 31.0 14.2 10.6 4.0 50.0 25.4 24.1 15.6 30.7 14.0 10.6 3.9 49.7 24.5 24.7
31.4 14.6 10.7 3.8 49.4 24.5 24.5 15.5 30.9 13.5 11.2 4.1 49.4 23.9 25.0 15.4 31.1 14.0 11.0 4.0 49.4 24.2 24.8
31.0 13.5 11.2 4.1 47.4 21.5 25.6 16.3 32.5 14.1 11.6 4.5 47.1 22.5 24.3 17.0 31.7 13.8 11.4 4.3 47.3 22.0 24.9
Saturated fat Monounsaturated fat Polyunsaturated fat Total carbohydrate4 Total sugars Total starch Total Children Protein Total fat3 Saturated fat Monounsaturated fat Polyunsaturated fat Total carbohydrate4 Total sugars Total starch
1
One-day nutrient intake data from food and beverages only (no supplements) collected at CAPI, population weights applied, n =877. Calculations based on total energy that includes energy derived from fermentable fibre Alcoholic beverage intake was low in this population and alcohol as a percent of energy was zero for all age groups 3 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 sterols
2
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For some foods, data for total carbohydrates includes 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 the total carbohydrate value.
Micronutrients
Micronutrients are required and present in foods and drinks in relatively small amounts (milligrams (mg) or micrograms, (g)) and provide dietary components that are essential for normal physiological processes. Micronutrients are presented in this report as the mean intakes derived from one day of intake collected from the 24-hour recall completed at the CAPI (Table 15). The NHMRC established a set of nutrient reference values (NRVs) for planning and assessing diets for Australia and New Zealand (NHMRC 2006). Estimates of usual intake are needed for comparison with NRVs. The usual nutrient intake data, derived from only food and beverages, excluding supplements, were compared to the EAR or the Adequate Intake (AI) where an EAR did not exist. Estimated usual intakes were calculated from a 24-hour recall collected at both the CAPI and the CATI, using statistical modelling software (C-SIDE, V 1.0, Iowa State University). Key Findings: On the day prior to the interview:
> In general, the mean of the micronutrients tended to increase from the youngest to the oldest age
groups for both boys and girls. This increase in nutrient intake is related, at least in part, to increasing quantities of foods consumed and higher energy intakes that occur with increasing age. With more food being consumed, more micronutrients are likely to be present in the diet
> The differences in micronutrient intakes between boys and girls in the younger age groups (2-3
years) were relatively small. The differences in intakes between boys and girls were more pronounced in the 14-16 year olds with older boys consuming greater amounts of micronutrients compared to older girls. Intakes of sodium, iodine and caffeine were estimated for the first time in a national survey. On the day prior to the interview:
> Sodium intakes ranged from 1509 to 4004 mg/day [National: 1658 to 3672 mg/day], increasing with
the age of the children being surveyed

> Iodine intakes did not increase consistently across the age groups as most of the other
micronutrients did
> Estimated caffeine intake was low in the youngest children but increased in the 14-16 year olds to a
mean of 58 mg [National: 47mg] for boys and 35mg [National: 36mg] for girls. Estimated caffeine intake was consistently higher across all age groups for boys compared to girls.
36
Table 15: Mean intake of micronutrients and caffeine in South Australian children
Unit (mcg) (mg) (mg) (mg) (mcg) (mcg) (mg) (mcg) (mg) (mg) (mg) (mg) (mg) (mg) (mg) (mcg) (mg) (mg) (mcg) (mg) (mg) (mg) (mcg) (mcg) (mg) (mcg) (mg) (mg) (mg) (mg) (mg) (mg) (mg) (mcg) (mg) (mg) (mcg) (mg) (mg) (mg) (mcg) (mcg) (mg) (mcg) (mg) (mg) (mg) (mg) (mg) (mg) (mg) (mcg) (mg) (mg) 23 703 1 2 33 340 397 84 3 5 876 1182 231 8 8 2307 127 1717 4 604 1 2 30 352 413 76 3 4 792 1078 226 7 7 2169 119 1509 3 654 1 2 31 346 405 80 3 4 835 1131 228 8 8 2239 123 1614 4 Age Group (years) 4-8 9 - 13 707 915 2 2 3 3 40 47 423 439 508 506 87 131 3 3 5 6 834 1004 1275 1530 263 319 11 13 10 12 2436 3153 114 153 2524 3025 10 25 695 784 2 2 2 2 33 40 375 405 450 474 93 103 3 3 5 6 752 752 1106 1289 235 271 9 11 8 10 2207 2605 98 111 2121 2663 9 19 701 851 2 2 2 3 37 43 399 423 479 490 90 117 3 3 5 6 792 881 1190 1412 249 296 10 12 9 11 2320 2885 106 132 2319 2848 10 22 14 16 1034 3 4 68 553 662 138 5 8 1141 2032 403 17 16 3899 171 4004 58 840 2 3 47 451 538 147 3 8 903 1484 315 12 11 3051 124 2862 35 937 2 3 57 502 600 143 4 8 1022 1759 359 14 13 3476 147 3434 46
Boys
Girls
Total Children
Vitamin A (RE) Thiamin Riboflavin Niacin equivalents Total Folate Folate equivalents Vitamin C Vitamin D Vitamin E Calcium Phosphorous Magnesium Iron Zinc Potassium Iodine Sodium Caffeine Vitamin A (RE) Thiamin Riboflavin Niacin equivalents Total Folate Folate equivalents Vitamin C Vitamin D Vitamin E Calcium Phosphorous Magnesium Iron Zinc Potassium Iodine Sodium Caffeine Vitamin A (RE) Thiamin Riboflavin Niacin equivalents Total Folate Folate equivalents Vitamin C Vitamin D Vitamin E Calcium Phosphorous Magnesium Iron Zinc Potassium Iodine Sodium Caffeine
One day nutrient intake data from food and beverages only (no supplements) collected at CAPI, population weights applied
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Estimated Average Requirements

The EAR is the average daily nutrient intake level that is estimated to meet the nutrient requirements of half of the children in each of the age and gender groups. The proportions of children in each age group having usual intakes greater than the EAR (ie the percentage of children meeting the EARs for select nutrients) are shown in Table 16. The proportions of each age group having usual intake estimates less than the EAR can be used to estimate the prevalence of potentially inadequate intakes. Key Findings:
> The majority of children in all age groups met the EAR for protein and some vitamins including
riboflavin and niacin, suggesting that these nutrients are not at risk of inadequacy across the population o The exception was for vitamin A expressed as retinol equivalents for whom 19% [National: 21%] of 14-16 year old boys and 9% [National: 14%] of girls aged between 14-16 years did not meet the EAR o Vitamin A as retinol is found in foods derived from animals. Provitamin A (eg -carotene is found in plant foods) and is metabolised to form retinol. It is not yet clear whether or not consumption of vitamin A-rich foods were low in the 14-16 year old boys, but they have a relatively high EAR target to reach by dietary means, increasing the risk of potentially inadequate intakes. More analyses will be required in the future in this area 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 but the percent of children with intakes below the
EAR for older children were notable for calcium, magnesium, phosphorus (specifically girls 9 years) 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]. Dairy foods are one of the richest dietary sources of calcium and the intake of these foods was relatively low for girls of this age o For boys, 41% [National: 50%] of 12-13 year olds and 53% [National: 56%] of the 14-16 year olds met the EAR, suggesting that there is also an increased risk for older boys of an inadequate calcium intake in these age groups o Other nutrients also appear to be potentially at risk in the older girls (14-16 years) - magnesium (46% [National: 56%] did not meet the EAR), phosphorus (8% [National: 14%] did not meet the EAR) and iodine (29% [National: 26%] did not meet EAR) Magnesium is found in both plant and animal sources vegetables, nuts, unrefined cereals and some shellfish Cereals, cereal products/dishes and vegetables/legumes are dietary sources of folate Seafood or iodised salt and sometimes milk are rich dietary sources of iodine o The older boys (14-16 years) were more likely to not reach their EAR for magnesium (25% [National: 34%] did not meet EAR) and iodine (7% [National: 5%] did not reach EAR).
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Table 16: Proportion (%) of South Australian children meeting EAR for selected nutrients using estimate of usual nutrient intakes derived from two days of intake data collected by 24-hour recall at both CAPI and follow-up CATI
Age (years)
Boys
Protein Vitamin A retinol equivalent Thiamin Riboflavin Niacin equivalent Folate (dietary folate equivalents) Vitamin C Calcium Phosphorus Magnesium Iron Zinc Iodine 2-3 100 4-8 100 9-13 100 14-16 100
99 100 100 100 100 95 97 100 100 99 100 90 100 100 100 100 100 100 96 98 100 100 98 100 88 100 99 100 100 100 100 95 98 100 100 98 100 89
100 100 100 100 100 95 98 100 100 100 100 95 100 99 100 100 100 97 98 88 100 100 92 100 85 100 99 100 100 100 98 96 93 100 100 96 100 90
99 99 100 100 95 100 76, 41 99 98 100 100 97 100 98 100 100 100 95 97 33, 9 85 97 99 100 97 100 99 100 100 100 95 98 54, 26 92 98 100 100 97
1, 2 1 1
81 100 100 100 92 95 53 100 75 99 95 93 100 91 97 99 100 82 99 27 92 54 92 99 71 100 86 99 100 100 87 97 40 96 65 96 97 82
Girls
Protein Vitamin A retinol equivalent Thiamin Riboflavin Niacin equivalent
Folate (dietary folate equivalents)

Vitamin C Calcium Phosphorus Magnesium Iron Zinc Iodine Total Children Protein Vitamin A retinol equivalent Thiamin Riboflavin Niacin equivalent
Folate (dietary folate equivalents)

Vitamin C Calcium Phosphorus Magnesium Iron Zinc Iodine
1
EARs exist for 9-11 years and for 12-13 years. 76% and 33% for boys and girls respectively represents percentage of children who met the EAR for 9-11 year olds; 41% boys and 9% girls met the EAR for the 12-13 year olds Assuming that the age of the children in this group was evenly distributed, then 40% of the children met the EAR for calcium Population weights applied For girls aged 4-8 years a negative estimate for usual intake variance was achieved for iron hence data presented is calculated using the average of two-day energy intake data from food and beverages only (no supplements) collected at CAPI and CATI. Population weights applied.
39
Adequate Intakes
If EARs could not be determined for nutrients due to limited scientific evidence being available, AIs were established instead, often but not always based on the median intake reported in the 1995 National Nutrition Survey and assuming that the children surveyed in 1995 had a sufficient intake. An AI is defined as the average daily nutrient intake level based on observed or experimentallydetermined approximations of estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate. Comparisons of the nutrient intakes of the Childrens Survey participants with AIs cannot 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 of potentially 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 low prevalence of inadequate intakes. If the AI is based on median intakes, this assessment of childrens intake is made with less confidence. Key findings:
> For all age and gender groups the mean usual intake for total fluid, dietary fibre, sodium and
potassium were generally at or above the AI for each nutrient, suggesting that it is unlikely that there will be a high prevalence of children not consuming enough of these nutrients
> The estimated usual intakes of vitamin E and D were almost always less than the AI for both
nutrients. Whilst these findings may suggest that a significant number of children may not be consuming sufficient amounts of vitamin E and D, a definitive conclusion cannot be reached o The AI for vitamin D was set at 5.0 g/day, based on estimates of vitamin D needed to prevent deficiency in children with limited sunlight exposure. Estimated usual intakes ranged from 2.5 to 4.7 g/day. A requirement of 2.5 g/day may be sufficient (NHMRC 2006). Food composition data may also be limited o The accuracy of estimates of vitamin E intake are dependent on comprehensive and high quality food composition data and this may be a potentially limiting factor for the Childrens Survey to estimate vitamin E intakes from Australian foods. The AI was based on median intakes of New Zealand children (Ministry of Health 2003) and therefore limits its use in recommending dietary targets.
Food Guide and Dietary Guidelines

The NHMRC Dietary Guidelines for Children and Adolescents (NHMRC 2003) and the AGHE (Smith et al 1998) provide a basis for evaluating the eating patterns of Australian children as measured in the Childrens Survey. In order to make comparisons with the recommendations, the following operational definitions were used and calculations were made from the weighted average of food and nutrient data from the two 24-hour recalls. Criteria used for judging eating patterns of children in the Childrens Survey to meet the recommendations of the Dietary Guidelines of Children and Adolescents (NHMRC 2003) and the AGHE (Smith et al 1988) are indicated in Table 17.
40
Table 17: Methodology to compare intakes with dietary guidelines
Dietary Guidelines Encourage and support breastfeeding Children and adolescents need sufficient nutritious foods to grow and develop normally Eat plenty of fruits
Indicator/Operational Definition From 24-hour Recall Data Mother recalled/reported ever breastfeeding her child during infancy (food habits question asked of caregiver /parent during CAPI). Energy intakes greater than the lower bound of EER as recommended in the NRVs Based on two days intake data, estimating usual intake.
Eat plenty of vegetables, including legumes
Eat plenty of cereals (including breads, rice, pasta and noodles), preferably wholegrain
Include lean meat, fish, poultry and/or alternatives
Include milks, yoghurts, cheese and/or alternatives Choose water as a drink Limit saturated fat and moderate total fat intake Choose foods low in salt Consume only moderate amounts of sugars and foods containing added sugars
Meeting the age specific recommendations (*where they exist) for fruit intake in the AGHE. Age groups in the AGHE differ to those for the Childrens Survey, the following serves for each age group were used: 2-3yrs= 1 serve: No guidelines in the AGHE *4-8yrs= 1 serve *9-13 yrs= 1 serve *14-16 yrs= 3 serves One serve of fruit was calculated to be 150 g of fruit as specified in AGHE juice Based on two days intake data, estimating usual intakes, average of consumers and nonconsumers for entire age and gender group. Meeting the age specific recommendations (*where they exist) for vegetable intake in the AGHE. Age groups in the AGHE differ to those for the Childrens Survey. The following serves for each age group were used: 2-3yrs= 2 serves : No guidelines in the AGHE *4-8yrs=2 serves *9-13yrs =3 serves *14-16yrs= 4 serves One serve of vegetables was calculated to be 75g of vegetables as specified in AGHE potato Based on two days intake data, estimating usual intakes, average of consumers and nonconsumers for entire age and gender group. Meeting the age specific recommendations (*where they exist) for cereal intake in the AGHE. Age groups in the AGHE differ to those for the Childrens Survey, the following serves for each age group were used: 2-3yrs= 3 serves: No guidelines in AGHE *4-8yrs=3 serves *9-13yrs =4 serves *14-16yrs= 4 serves One serve of cereals was calculated to be 60g (2 slices) of bread, 40g breakfast cereals, 180 g of rice/pasta, as specified in AGHE Based on two days intake data, estimating usual intakes, average of consumers and nonconsumers for entire age and gender group. Meeting the age specific EAR for protein, iron and zinc. Based on two days intake data, estimating usual intake. Meeting the age specific recommendations (*where they exist) for meat, fish, poultry intake in the AGHE. Age groups in the AGHE differ to those for the Childrens Survey. The following serves for each age group were used: 2-3yrs=0.5 serves *4-8yrs=0.5 serves *9-13yrs =1 serve *14-16yrs= 1 serve One serve of meat/fish/poultry was calculated to be 82.5g, an average of the specification in the AGHE. Meeting the age specific EAR for calcium. Based on two days intake data, estimating usual intake. Fluid intake greater than the age-specific AI for total water which included all fluids from food and beverages. Less than 10% of total energy intake as saturated fat. (One day CAPI intake utilised). More than the age specific AI for sodium. Dietary guidelines report that up to 15-20% of total energy supplied by total sugars is not incompatible with a healthy diet. Less than 20% of total energy intake as sugars. (One day CAPI intake utilised).
41
Key Findings: The following are the highlights of the comparison of eating patterns with dietary guidelines as shown in Table 18.
> Achieving guidelines relating to, saturated fat, sugar, vegetables and cereals was problematic for
South Australian children

> Most South Australian children (90%) [National: around 90%] had been breastfed at least sometime
during their infancy

> There are no national guidelines recommending specific numbers of foods for children 2-3 years of
age. For this initial analyses, the recommendations for the 4-7 years were used for the 2-3 year olds but these intake levels could be too high a target for the very young children
> Children in the older age groups (14-16 years) were less likely to meet the guideline for consuming
sufficient quantity of nutritious foods than any other age group. The older age group also had the highest level of potential under-reporting than any other age group
> A large proportion of children did not meet the recommendations for fruit serves, especially the
older children in whom only 2-3 % [National: 1-2%] appeared to consume three serves of fruit if juice was not included in the count as a fruit serve. Compliance increased to 17-23% [National: 19 25%] in this group if juice was included as a fruit serve
> For all age groups and genders (except for 9-13 year old boys), less than one-quarter of children
met the guideline for vegetable intake [National: about one quarter of children in the younger age groups and 1-11% in the older age groups]. If potatoes are excluded from the count as a vegetable, fewer children complied due to the relatively high consumption of potato compared to other vegetables
> The older girls (12-16 years) appeared to be most at risk of not meeting their dietary requirements
for calcium (only 9-27% [National: 11-18%] met and 73-91% [82-89%] did not meet the EAR). This is likely to reflect the substantial decline in milk intake through childhood and replacement with sweetened beverages
> Close to half of children in all age groups met the AI for fluid/water intake, suggesting consumption
may be adequate
> A minority of children met the guidelines for limiting saturated fat intake, and having a moderate
intake of sugar
> All children met the recommendation for sodium intake and consumed greater than the AI level. In
fact, the consumption of sodium in all age groups exceeded the recommended upper level of intake.
42
Table 18: Proportion (%) of South Australian children meeting the serve recommendations of the Australian 1,2 Guide to Healthy Eating based on the dietary guidelines
Boys
DIETARYGUIDELINES Encourage, support breastfeeding Sufficient nutritious foods to grow and develop normally Eat plenty of fruits3 Eat plenty of vegetables5
Parameter2 Ever been breast fed Usual intake>lower bound EER 1-3 serves/d excluding juice 1-3 serves/d including juice 2-4 serves/d excluding potatoes 2-4 serves/d including potatoes 3-4 serves/day % >EAR for protein, iron, zinc 0.5-1 serve/day %>Calcium EAR %>fluid AI %<10% energy from saturated fat %>sodium AI %<20% energy from total sugars Ever been breast fed Usual intake>lower bound EER 1-3 serves/d excluding juice 1-3 serves/d including juice 2-4 serves/d excluding potatoes 2-4 serves/d including potatoes 3-4 serves/day % >EAR for protein, iron, zinc 0.5-1 serve/day %>Calcium EAR %>fluid AI %<10% energy from saturated fat %>sodium AI %<20% energy from total sugars Ever been breast fed Usual intake>lower bound EER 1-3 serves/d excluding juice 1-3 serves/d including juice 2-4 serves/d excluding potatoes 2-4 serves/d including potatoes 3-4 serves/day % >EAR for protein, iron, zinc 0.5-1 serve/day %>Calcium EAR %>fluid AI %<10% energy from saturated fat %>sodium AI %<20% energy from total sugars 2-3 92 89-92 (61) (87)4 (2)4 (11)4 (7)4 99-100 (52)4 97 49 5 100 25 90 90-98 (64)4 (91)4 (10)4 (23)4 (7)4 98-100 (54)4 98 49 9 100 19 91 89-98 (63)4 (89)4 (5)4 (17)4 (7) 98-100
4 4
Age group (years) 4-8 9-13 94 90 89-100 60 90 7 12 26 100 70 98 60 3 100 34 84 90-100 55 87 2 18 0 92-100 54 88 40 4 100 22 89 89-100 57 89 3 15 11 96-100 62 93 50 16 100 28 89-100 51 91 6 46 11 100 46 76, 419,10 52 2 100 28 89 63-99 52 91 2 21 1 99-100 40 33, 99,10 52 3 100 33 89 63-100 52 90 4 32 5 100 43 54, 269,10 52 14 100 30
14-16 90 79-89 2 23 1 1 39 95-100 68 53 55 3 100 41 93 58-83 3 17 0 3 4 92-100 56 27 53 1 100 43 91 58-89 2 21 0 3 22 96-100 62 40 54 20 100 42
Girls
Eat plenty of cereals6 Include lean meat, fish, poultry and/or alternatives Meat, fish and poultry intake7,8 Include milks, yoghurts, cheese and/or alternatives Choose water as a drink Limit saturated fat and moderate total fat intake Choose foods low in salt Consume only moderate amounts of sugars Encourage, support breastfeeding Sufficient nutritious foods to grow and develop normally Eat plenty of fruits3 Eat plenty of vegetables5
Total Children
Eat plenty of cereals6 Include lean meat, fish, poultry and/or alternatives Meat, fish and poultry intake7,8 Include milks, yoghurts, cheese and/or alternatives Choose water as a drink Limit saturated fat and moderate total fat intake Choose foods low in salt Consume only moderate amounts of sugars Encourage, support breastfeeding Sufficient nutritious foods to grow and develop normally Eat plenty of fruits3 Eat plenty of vegetables5
Eat plenty of cereals Include lean meat, fish, poultry and/or alternatives Meat, fish and poultry intake7,8 Include milks, yoghurts, cheese and/or alternatives Choose water as a drink Limit saturated fat and moderate total fat intake Choose foods low in salt Consume only moderate amounts of sugars
(53)4 98 49 16 100 22
43
Population weights applied, two day data, except for percentage of total energy as fat and sugar which has been calculated with CAPI data
2 Information on how intake data were operationalised to compare against guidelines are outlined in Table 17.
3 Included intakes from fresh fruit, dried and preserved fruit, mixed dishes where fruit is the major component, and with or without
juice (Juice includes fruit and vegetable juices and drinks)
4 No national recommendations or guidelines available for this age group, percentage in parentheses ( ) calculated based on
recommendations for the 4-7 year olds
5 Included intakes from cabbage/cauliflower and similar brassica vegetables, carrot and similar root vegetables, leaf and stalk vegetables, peas and beans, tomato and tomato products, other fruiting vegetables, other vegetables and vegetable combinations, dishes where vegetable is the major component, mature legumes and pulses, mature legumes and pulse (products and dishes), and with or without potatoes. 6 Included intakes from flours and other cereal grains and starches, regular breads and bread rolls (plain/unfilled/untopped varieties), English-style muffins/flat breads and savoury and sweet breads, pasta and pasta products, breakfast cereals and bars (unfortified and fortified varieties), breakfast cereal (hot porridge type), mixed dishes where cereal is the major component. 7 Included intakes from fin fish (excluding commercially sterile), crustacean and molluscs (excluding commercially sterile), packed (commercially sterile) fish and seafood, fish and seafood products (homemade and takeaway), mixed dishes with fish or seafood as the major component, muscle meat, game and other carcase meats, poultry and feathered game, organ meats and offal (products and dishes), mixed dishes where beef/veal/lamb is the major component, mixed dishes where pork/bacon/ham is the major component, mixed dishes where poultry/game is the major component 8 For serves of meat/fish/poultry a negative estimate for usual intake variance was achieved hence data presented is calculated using the average of two-day meat/fish/poultry intake data collected at CAPI and CATI, population weights applied 9 EARs exist for 9-11 years and for 12-13 years. 76% and 33% for boys and girls respectively represents percentage of children who met the EAR for 9-11 year olds; 41% boys and 9% girls met the EAR for the 12-13 year olds 10 Assuming the age of the children in this group was evenly distributed, then 40% of the children were calculated to meet the EAR for calcium
4.3 Nutritional Supplements

Few (7%) [National: 8%] children consumed supplements on the day prior to the interview as shown
in Table 19. Multivitamin and or mineral supplements were most commonly consumed followed by oil
and single vitamin supplements. For all age groups (except 4-8 years), there were a greater
proportion of boys consuming supplements compared to girls. Overall the proportion of children
consuming supplements was relatively stable across age groups (7-8%).
Table 19: Percentage of South Australian children who consumed at least one supplement on the day prior to the interview
Age Group (years) 2-3 Boys Girls Total Children 4-8 9 - 13 14 - 16
Consumed at least one supplement Consumed at least one supplement Consumed at least one supplement
9 6 8
5 8 7
13 3 8
8 5 7
Data collected at CAPI Population weights applied
4.4 Eating Pattern

This survey allows us to look at intake patterns over a whole day as well as information relating to the time and location of consumption. Data reported here are one-day CAPI data only and the following assumptions/methodology were used: > Breakfast on a school day is any energy consumed between the hours of 05:01 to 09:00
> Any energy consumed within 30-minute time intervals across the day is considered as one eating
occasion. This includes the consumption of any energy providing food and/or beverages
> Pattern of consumption across the day was examined by charting the percentage of total energy
consumed in 30 minutes intervals.
44
Consumption of Breakfast
Table 20 below shows the proportion of children consuming breakfast on a school day by age and
gender.
Key Findings:
> The majority of children consumed breakfast on a school day
> The proportion of girls consuming breakfast on a school day was lower than boys
> As age increased the proportion of children consuming breakfast on a school day decreased.
Table 20: Proportion (%) of South Australian children eating breakfast on a school day by age and gender group
Age Group (years) 5-8 Boys Girls Total Children
1
9-13
14-16
100.0 98.0 99.0
98.4 85.2 92.3
89.4 77.5 83.7
One-day food intake data collected at personal interview from children 5 years, on a school day. Participants were considered to have consumed breakfast if food or beverages providing energy were consumed between 05.01 to 09.00 hours, population weights applied, n=329
Occasions of Eating
Table 21 shows the number of eating occasions per day in children by age and gender. Key findings:
> On average, children were eating and drinking energy containing food and beverages 6-8 times a
day
> The number of eating occasions per day (food only) decreased with increasing age for both girls
and boys. A similar trend was observed when consumption of beverages were included as an eating occasion
> As expected, inclusion of beverages as an eating occasion increased the number of total eating
occasions, but this increase was small.
45
Table 21: Estimated number of eating occasions1 per day in South Australian children by age and gender group
Gender
Boys
Age Group (years)

2-3 4-8 9-13 14-16 2-3
Number of eating occasions per day (Consumption of energy providing food only)
Number of eating occasions per day (Consumption of energy providing food and beverages)
7.5 6.5 6.2 5.7 7.0
7.8 6.8 6.8 6.2 7.2
Girls
4-8 9-13 14-16

Total Children 2-3 4-8 9-13
1
6.8
6.2
7.1
6.6
5.9
7.3 6.7 6.2
6.4
7.5 6.9 6.7
14-16 5.8 6.3 One-day food intake data collected at personal interview, energy consumed within 30-minute time intervals across the day is considered as one eating occasion, (e.g. 12:01 to 12:30, 12:31 to 13:00 etc) population weights applied, n=877.
Energy Intake Versus Time

Figure 3 shows the pattern of energy consumption in children over the 24-hour period prior to the interview. Key Findings: > For all age groups there was a clear pattern of eating at traditional meal and snack times with very little energy consumed between the hours of 22:00 and 06:00 > Children aged 14-16 years tended to consume a greater proportion of their EI late into the evening compared to younger children.
Figure 3: Pattern of energy consumption in South Australian children over a 24-hour period
10
7 % of total energy
6 2-3 years 4-8 years 9-13 years 14-16 years
0
0: 01 -0 1: :30 01 -1 2: :30 01 -2 3: :30 01 -3 4: :30 01 -4 5: :30 01 -5 6: :30 01 -6 7: :30 01 -7 8: :30 01 -8 9: :30 01 10 -9: 3 :0 1- 0 11 10: 3 :0 1- 0 12 11: 3 :0 1- 0 13 12: 3 :0 1- 0 14 13: 3 :0 1- 0 15 14: 3 :0 1- 0 16 15: 3 :0 1- 0 17 16: 3 :0 1- 0 18 17: 3 :0 1- 0 19 18: 3 :0 1- 0 20 19: 3 :0 1- 0 21 20: 3 :0 1- 0 22 21: 3 :0 1- 0 23 22: 3 :0 1- 0 23 :3 0
Time
46
One-day food intake data collected at personal interview, energy consumption calculated in 30-minute intervals, population weights applied, n=877.
Physical and Sedentary Activities
There is little doubt about the benefits of physical activity for the cardiovascular, metabolic, skeletal and psychological health of children. There is concern that children may be getting less physical activity than they did in previous decades (Dollman, Norton & Norton, 2005), and many may not be getting enough physical activity for optimal health. As a result of these concerns, in 2004 the DoHA issued Australias Physical Activity Recommendations for 5-12 years old and 12-18 years old (DoHA 2004a, DoHA 2004b). In order to determine the overall daily activity patterns of children, it is necessary to take into account both physically active and sedentary behaviours.
5.1 Physical Activity Guidelines

What Do the Guidelines Say?
The DoHA recommends that children aged 5-18 years accumulate at least 60 minutes, and up to several hours, of MVPA every day. Four criteria may be used to assess compliance with the guidelines (Olds et al. 2007): (1) A child meets the guidelines if he or she accumulates at least 60 minutes of MVPA on each of the four days sampled (All Days Method) 2) A child meets the guidelines if he or she accumulates at least 60 minutes of MVPA on most (i.e.
three or four) of the four days sampled (Most Days Method)
(3) A child meets the guidelines if he or she accumulates at least 60 minutes of MVPA per day when averaged across the four days sampled (Four-Day Average Method) (4) The level of compliance with the guidelines in the population is the probability that a randomly chosen child on a randomly chosen day will accumulate at least 60 minutes of MVPA on that day (Child x Day Method). Each of these methods yields different estimates of the prevalence of meeting the guidelines, and all are given in this report.
Compliance with Guidelines

Table 22 shows the percentage of children who complied with the physical activity guidelines using the four different methods. Key Findings:
> By most methods, the majority of children aged 9-16 years met the guidelines for MVPA. On any
given day, there was a 67% chance that any given child would get at least 60 minutes of moderate to vigorous physical activity
> Girls met the guidelines less often than boys, and there was a drop-off with age, which is very
marked in older girls.
47
Table 22: Proportion (%) of South Australian children who met the physical activity guidelines using four different methods of interpreting the guidelines
Boys Age Group (years) All Days Method Most Days Method 4 Day Average Method Child x Day Method 9-13 14-16 9-16 9-13 Girls 14-16 9-16 Total Children 9-13 14-16 9-16
40 72 91 77
29 60 84 69
35 67 88 74
25 46 81 67
12 25 56 48
20 38 71 60
32 59 86 72
21 43 70 59
28 53 80 67
Population weights applied
5.2 Pedometer Steps

Children aged 5-16 years wore a pedometer, a device which counts steps, for up to seven consecutive days. Children who recorded at least six days of measurements, and had the pedometer off for no more than four hours during waking hours on any day (for example, for bathing or contact sports), were included in the analysis. The total number of participants from the South Australian component of the Childrens Survey including the booster sample that met those criteria totalled 481 and are included in this section of the report. The numbers of children in each gender and age category are presented in the table below.
Table 23: Breakdown of the South Australian sample in the pedometer study by gender and age group
Age Group (years) 58 Males Females Total Children 9 - 13 14 - 16 Total Children
67 64 131
84 94 178
87 85 172
238 243 481
The average number of steps completed in the six- or seven-day period was calculated for each child. There are no generally recognised guidelines regarding how many steps children should take each day, however two common recommendations are that: (1) Boys get at least 13,000 steps each day, and girls at least 11,000 steps (Presidents Council on Fitness and Sport 2002); or (2) Boys get at least 15,000 steps each day, and girls 12,000 steps (Tudor-Locke et al. 2004). Table 24 shows the percentage of 5-16 year old children surveyed who met these two sets of guidelines. Key Findings:
> On average, children aged 5-16 years took approximately 11,500 steps per day > Girls were generally more likely to meet the daily step guidelines than boys (recalling that the cut
offs are less stringent for girls)

> The percentage meeting the daily step guidelines decreased with age, particularly in 14-16 year old
girls.
48
Table 24: Mean number of steps taken per day by South Australian boys and girls aged 5-8, 9-13 and 14 16, and the percentage reaching or exceeding recommended thresholds
Boys Age Group (years) Number of steps % above threshold 11 % above threshold 22
1 2
Girls 14-16 5-8 9-13 14-16 5-8
Total Children 9-13 14-16
5-8
9-13
14137 58 36
12445 40 20
10872 20 9
12446 73 64
10361 44 32
8752 18 13
13277
11403
9853
66 50
42 26
19 11
Threshold 1 = 13,000 steps for boys, and 11,000 steps for girls (Presidents Council on Fitness and Sport 2002)
Threshold 2 = 15,000 steps for boys, and 12,000 steps for girls (Tudor-Locke et al. 2004)
Age and Gender Related Patterns in Sport, Free Play and Active Transport
Across the ages 9-16 years, there were clear age- and gender-related patterns in both the quantity and the type of physical activity adolescents undertook. Overall energy expenditure (PAL) and minutes of MVPA declined with age and were higher in boys than in girls (Table 25).
Table 25: Mean for PAL (METs) and the mean time South Australian children spent participating in MVPA minutes per day
Boys Age Group (years) PAL1 (METs) MVPA (minutes/day)
1
Girls 9-16 9-13 14-16 9-16 9-13
Total Children 14-16 9-16
9-13
14-16
1.74 151
1.64 117
1.70 138
1.60 114
1.57 81
1.59 102
1.67 133
1.61 100
1.65 120
PAL = Physical Activity Level. It is the average rate of energy expenditure across the day. It is measured in METs multiples of the amount of energy expended when just sitting still Population weights applied.
49
Amount of Physical Activity

Figure 4 shows age- and gender-related trends in MVPA and some of its components (free play, sport and active transport). Key Findings:
> Girls reported lower levels of MVPA than boys
> The overall amount of MVPA decreased by about 10 minutes/day with each year of age.
Figure 4: Age- and gender-related patterns in MVPA and some of its components [free play, sport, and active transport (AT)] in the South Australian sample. The filled circles represent boys and the open circles represent girls.
MVPA(minutes/day)
180
160
140
120
100
play (minutes/day)
sport(minutes/day)
AT (minutes/day)
80
60
40
20
0
9 10 11 12 13 14 15 16 age
9 10 11 12 13 14 15 16 age
9 10 11 12 13 14 15 16
9 10 11 12 13 14 15 16 age
age
Mix of Activities
The mix of physical activities also varied with age and gender (Figure 4). Key Findings:
> Boys and girls experienced similar amounts of free play (unorganised games such as playground
games and mucking around) and active transport

> Boys spent more time playing sports (rule-governed games such as basketball or football) and
hence accumulated more MVPA

> The decrease in MVPA with age was mainly the result of a rapid decrease in free play.
5.3 Screen Time

Screen time refers to the amount of time children spent watching television including videos and digital video disc (DVDs), playing computer games on videogame consoles or on personal computers, and using computers for other purposes. Screen time was calculated for 9-16 year olds from the MARCA self-reports. The total amount of screen time reported each day was added up.
What Do the Guidelines Say?

Australias Physical Activity Recommendations recommend that 5-18 year olds accumulate no more than two hours of screen time a day for entertainment (i.e. excluding educational purposes) (DoHA 2004a, DoHA 2004b). In the Childrens Survey, we calculated the total amount of out-of-school-hours screen time, assuming that all in-school screen time was for educational purposes. While this way of interpreting the guidelines may miss some non-educational screen time at school, it will also miss some educational screen time out of school (for example, using the internet for homework).
50
How Did We Decide Whether Children Had Met the Guidelines?

As with physical activity, four criteria may be used to assess compliance with the guidelines (Olds et al. 2007): (1) A child meets the guidelines if he or she accumulates no more than two hours of screen time on each of the four days sampled (All Days Method) (2) A child meets the guidelines if he or she accumulates no more than two hours of screen time on most (i.e. three or four) of the four days sampled (Most Days Method) (3) A child meets the guidelines if he or she accumulates no more than two hours of screen time when averaged across the four days sampled (Four-Day Average Method) (4) The level of compliance with the guidelines in the population is the probability that a randomly chosen child on a randomly chosen day will accumulate no more than two hours of screen time on that day (Child x Day Method).
Compliance with Guidelines

Table 26 shows the percentage of children who complied with the screen time guidelines using the four different methods. Key Findings:
> Levels of compliance with screen time guidelines were low > Few children aged 9-16 years met the guidelines for electronic media use. On any given day, there
was only a 26% chance that any given child would get no more than 120 minutes of screen time
> Younger children met the guidelines more often than older children. Table 26: Proportion (%) of South Australian children who met the screen time guidelines using four different methods of interpreting the guidelines
Boys Age Group (years) All Days Method Most Days Method 4 Day Average Method Child x Day Method 9-13 14-16 9-16 9-13 Girls 14-16 9-16 9-13 Total Children 14-16 9-16
5 17 22 28
0 8 11 21
3 13 18 25
2 9 15 25
5 15 17 31
3 11 16 27
3 13 18 26
2 11 14 26
3 12 17 26
Amount of Screen Time

Key Findings:
> Boys accumulated about 40 minutes more screen time each day than girls (Table 27) > Screen time rose rapidly until around the ages of 13-14, peaking at over 4.5 hours per day for boys
and 4 hours per day for girls, and then started to decline slowly (Figure 5).
51
Table 27: Mean number of minutes South Australian children engaged in screen time, television viewing, computer use and video game playing
Boys Age Groups (years) Screen (minutes/day) Television (minutes/day) Computer (minutes/day) Videogames (minutes/day) 9-13 14-16 9-16 9-13 Girls 14-16 9-16 Total Children 9-13 14-16 9-16
259 162 28 69
285 173 49 63
269 166 36 66
231 169 34 28
235 158 59 18
232 165 44 24
245 165 31 49
260 166 54 41
251 165 40 46
Figure 5: Age- and gender-related patterns in screen time and its components (television, computers and video games) in the South Australian sample. The filled circles represent boys and the open circles represent girls.
screentime (minutes/day)
350 300 250 200 150 100 50 0 9 10 11 12 13 14 15 16 age
TVtime (minutes/day)
computertime
(minutes/day)
videogametime
(minutes/day)
9 10 11 12 13 14 15 16 age
9 10 11 12 13 14 15 16 age
9 10 11 12 13 14 15 16 age
Age- and Gender-Related Patterns in Types of Screen Time

The quantity and the type of screen time adolescents experienced showed clear age- and genderrelated patterns. The difference in screen time between boys and girls was due mainly to boys use of video games. The amount of time boys and girls spent watching television and using computers was similar. Like overall screen time, television time peaked around puberty. Computer use increased linearly as boys and girls got older, at the rate of about six minutes/day with each year of age (Figure 5). As children got older, there was a relative shift from television and video games to computer use. The percentage of screen time constituted by television fell linearly from 75% at age nine to 60% at age 16. The percentage constituted by video game playing fell from 20% at age nine to 12% at age 16. Relative computer usage, on the other hand, increased from 5% at age nine to 25% at age 16. The mix of screen media also differed with gender. A larger proportion of girls screen time was made up by television viewing (71% vs 64% for boys), and by computer use (20% versus 14% for boys). Girls spent a smaller proportion of their screen time playing videogames (9% versus 22% for boys).
52
Body Size and Shape
6.1 Body Mass Index

Body mass index (BMI, weight in kilograms divided by the square of height in metres) is the most commonly used index of weight for height in children. It has been widely used as an estimate of fatness.
Prevalence of Underweight, Normal Weight, Overweight and Obesity

Table 28 shows the prevalence of overweight and obesity in boys and girls aged 2-16 years using international standard cut-offs to categorise children into one of the following: underweight, normal weight for height, overweight and obese (Cole et al 2007). Key Findings:
> Across all age groups, 4-5% of the children surveyed could be classified as underweight > 71% of the children as having a normal weight > 17% of the children as overweight > 7% as obese Table 28: Proportion (%) of South Australian children classified as underweight, normal weight, overweight and obese
Boys Age Group (years) Underweight Normal Overweight Obese 2-3 4-8 9-13 14-16 2-16 2-3 4-8 Girls 9-13 14-16 2-16
4.6 71.1 20.6 3.8
3.5 74.6 13.1 8.8
5.9 81.1 6.6 6.4
5.5 69.0 18.8 6.7
4.9 75.2 13.0 6.9
3.4 78.3 15.7 2.6
2.5 72.4 16.6 8.5
5.5 62.2 24.9 7.4
5.9 60.7 26.7 6.6
4.4 67.2 21.4 7.0
6.2 Waist Girth

In adults, there are clear associations between abdominal fatness and risk factors for cardiovascular and metabolic disease, independent of overall levels of fatness. Abdominal fatness is often assessed by measuring waist girth. Some studies have shown that waist girth in children is increasing faster than other girths that is, children are changing shape as well as getting fatter (Dollman & Olds 2006). There are no generally agreed cut-offs for waist girth, but it has been suggested that abdominal fatness is excessive in school-aged children (and adults) when the ratio of waist girth to height exceeds 50% (Ashwell 2005). Table 29 shows the percentage of surveyed children in each age group who exceed this cut-off and the mean waist girths for children of different ages. Key Findings:
> On average, about one child in six has a waist girth greater than the recommended ratio.
53
Table 29: Mean waist girths (cm) and proportion (%) of South Australian children with waist girths >50% of height
Boys Age Group (years) waist girth (cm) % > 50%
1
Girls 9-13 14-16 2-4 5-8 9-13 14-16
2-4
5-8
51.8
59.1 20
66.3 13
77.1 19
51.0
58.0 19
68.7 22
74.6 15
NA
NA
Note: there are no guidelines for children younger than five NA = not applicable Population weights applied.
6.3 Height and Weight

Children aged from 2-16 years will exhibit considerable growth and development as they progress from the youngest age group to the oldest, with expected increases in both height and weight. Key Findings:
> Average height increased from 97.0cm for 2-3 year olds to 172.5cm for 14-16 years for boys and
from 95.6 cm to 165.7cm for the same age groups for girls (Table 30)
> Average weight increased with age from 16.1kg for 2-3 year olds to 65.4kg for 14-16 years for boys
and from 15.2kg to 61.6kg for the same age groups for girls (Table 31).
Table 30: Mean height (cm) of South Australian children
Age Group (years)
2-3 Boys Mean 10%ile 25%ile 50%ile 75%ile 90%ile Girls Mean 10%ile 25%ile 50%ile 75%ile 90%ile Total Children Mean 10%ile 25%ile 50%ile 75%ile 90%ile
4-8
9-13
14-16
97.0 88.6 92.4 96.4 101.6 103.8 95.6 88.5 91.0 95.4 99.7 103.2 96.3 88.7 91.5 96.3 100.8 103.6
120.2 105.3 110.9 120.0 127.7 134.6 119.6 105.1 110.2 119.7 129.3 134.3 119.9 105.1 110.4 120.5 128.8 134.4
149.4 135.8 141.5 148.6 156.4 166.5 149.7 134.4 139.7 150.6 157.2 163.7 149.5 134.7 140.7 149.6 157.0 164.8
172.5 160.0 166.6 172.7 178.2 183.1 165.7 156.6 161.4 165.7 170.4 173.4 169.2 158.6 163.1 168.9 174.4 179.9
54
Table 31: Mean weight (kg) of South Australian children

Age Group (years) 2-3 Boys mean 10%ile 25%ile 50%ile 75%ile 90%ile Girls mean 10%ile 25%ile 50%ile 75%ile 90%ile Total Children mean 10%ile 25%ile 50%ile 75%ile 90%ile 4-8 9-13 14-16
16.1 13.0 14.0 15.7 17.9 19.4 15.2 12.4 13.7 14.9 16.7 17.9 15.7 12.7 13.9 15.6 17.3 18.7
25.2 17.4 19.5 24.3 27.2 32.4 24.8 17.0 19.5 22.4 29.4 35.9 25.0 17.0 19.5 23.6 28.2 33.8
42.6 29.2 32.9 40.6 50.5 58.7 46.1 29.4 36.4 44.0 53.6 65.9 44.3 29.4 33.7 43.2 51.9 61.5
65.4 49.8 56.2 62.6 72.7 81.7 61.6 46.4 53.6 59.9 69.1 79.5 63.5 48.6 55.1 61.0 70.8 81.7
Population weights applied.
55
Linking Nutrition, Activity and Body Size
The Childrens Survey was designed to measure both energy intake and energy expenditure in the
same individual and in most cases on at least one common day. Whilst it is recognised that energy
intake and expenditure are both short term measures, this survey allows us to look at associations
between these energy measures and weight or body size.
Childrens weight and body size are a result of a lifetimes balance or, in some cases, an imbalance, of energy intake (energy from food) compared to energy output (expenditure or activity). Thus the short-term measures of intake and activity over 1-4 days may not necessarily have any relationship to the longer term measure of weight or body size. Nevertheless it is of interest to note if there are any differences in intake and expenditure according to weight status.
Physical Activity Level (PAL) and Weight Status

The PALs of children of normal weight may provide useful information of the levels of physical activity compatible with sustaining a healthy weight. The NRVs quoted a PAL above 1.75 to be compatible with a healthy lifestyle for adults, but its relevance for adolescents and young children is uncertain. Key Findings:
> Obese children tended to have lower PALs than those children of normal weight (Table 32). Table 32: Mean PAL for underweight, normal weight, overweight and obese children in the South Australian sample
Boys Age Group (years) Underweight Normal weight Overweight Obese 9-13 14-16 Girls 9-13 14-16
1.92 1.74 1.70 1.57
1.52 1.65 1.64 1.65
1.65 1.58 1.65 1.46
1.50 1.59 1.59 1.42
1 Using International Obesity Task Force cut-offs (Cole et al 2007) Population weights applied.
Physical Activity Level (PAL) and Energy Intake

It might be expected that the more active children, (ie those with a higher PAL or higher energy expenditure) might also have a higher energy intake. There is no clear guideline on what is classified as low, medium or high PAL for children but for the purposes of this initial analyses, a low PAL was defined as <1.5 and a high PAL was 2. The actual number of children who had a PAL 2 was quite small and it would be expected that intakes and activity would be quite variable over individual days and therefore energy intake and energy expenditure would not always balance. Key Findings:
> There was no clear association between reported energy intake and level of physical activity (Table
33).
56
Table 33: Energy intake (total kJ, including energy from fermentable fibre) by physical activity level (PAL) for South Australian children
Boys Age Group (years) Low PAL1 Moderate PAL2 High PAL3,4
1
Girls 14-16 9-13 14-16
9-13
10048 9578 11288
13121 11735 12812
8674 8169 9306
8688 9710 9503
PAL< 1.5 2. PAL 1.5-1.993 PAL 2 4 Limited numbers Population weights applied.
Weight Status and Energy Intake

Energy intakes may vary with weight status. The mean intakes of energy estimated from one days intake (CAPI) should not be interpreted as causing children to be either under or overweight. It has been reported that there is a higher probability that overweight individuals under-report energy intakes compared to normal weight individuals. Key Findings:
> Obese children tended to report lower energy intakes than those children of normal weight (Table
34).
Table 34: Mean energy intake (total kJ) (including energy from fermentable fibre) by weight status for all South Australian children
Age Group (years) 2-3 Boys underweight
normal overweight obese
1
4-8
9-13
14-16
all ages
6922 6360 6186 5154 5004 5622 6412 5827 6116 5979 6282 5420
7324 8011 6899 8604 8502 6801 7226 7038 7827 7406 7085 7821
10071 9922 10786 9535 7975 8509 8460 7654 9078 9329 8956 8539
15122 12745 10825 8701 10048 9685 8373 7346 12539 11302 9405 8040
10310 9466 8663 8688 8385 7732 7942 7266 9410 8652 8215 7975
Girls
underweight
Total Children
underweight
Using International Obesity Task Force cut-offs (Cole et al 2007) Population weights applies.
57
Comparing South Australian Data and National Data
How does South Australian data compare to the national data? Table 35 and Table 36 show data on some of the key characteristics in relation to body size and shape, physical activity, screen time and dietary intake. While they have been weighted to reflect the age and gender distribution across the nation, and also to reflect the split between capital city and rest of state, the numbers have not been sufficient to adjust for SES. The average SES in the South Australian survey (976) was somewhat lower than the national average (996 in this survey), and this difference may account for some of the discrepancies between the South Australian and national data. In addition, the South Australian booster survey was conducted somewhat later in the year, so differences in the weather may have affected some results. Furthermore, the cell sizes for some of the South Australian data are fairly small, so the confidence limits are quite wide. Under these circumstances, it is not unusual to get anomalous results. Nevertheless, the differences are generally small and not statistically significant.
Body Size and Shape

Overall, the prevalence of overweight and obesity is similar in South Australian children (24.2%) and in Australian children in general (22.9%). There were fewer overweight or obese boys in this survey than in the national survey (19.9% versus 21.9%). This is largely due to the very low percentage of overweight 9-13 year old South Australian boys (6.6% versus 18.1%) nationally, a figure which is probably a statistical anomaly. Conversely, there are more overweight or obese girls in South Australia than nationally (28.4% versus 23.8%). This is mainly due to a higher prevalence of overweight in the 5-8 years (29.6% versus 20.0%) and 14-16 years (33.3% and 23.1%) age groups. While some of these differences are statistically significant, they should not be over-interpreted. Due to making a large number of comparisons, we would expect some differences to be statistically significant. Based on the data presented here, it appears that South Australian girls have higher levels of overweight and South Australian boys marginally lower levels of overweight than the general Australian population.
Physical Activity
While South Australian children spend slightly less time in MVPA and have slightly lower overall rates of energy expenditure (PAL), these differences are very small and are not significant.
Screen Time
There are, however, significant differences in screen time, with the average South Australian child accumulating 28 minutes more screen time. As a result, it is less probable that on any given day a South Australian child will meet the screen guidelines (26% probability) than will an Australian child in general (33% probability).
Food and Nutrients Intake

Consistent with other data from The 2007 Australian Childrens Nutrition and Physical Activity Survey, children from South Australia appeared to have similar intakes to the national data for protein and key micronutrients. The proportion of South Australian children meeting dietary guidelines was also similar to the national data with the exception of cereals. The proportion of South Australian children aged 4 13 years that met the guideline for cereals consumption was half of that of the national sample.
58

Table 35: Comparison of South Australian (SA) and National Survey (NS) children for selected characteristics by age and gender Age Group (years) Proportion (%) meeting PhysicalActivity guidelines (Child x Day Method) Mean number of steps per day
Boys Girls Total Children Boys Girls Total Children . . . . . . . . . . . . . . . . . . 5.4 72.1 17.7 4.8 3.4 81.1 14.0 1.5 4.4 76.5 15.8 3.2
2-4
SA . . . . . . . . . . . . . . . . . . 4.8 76.0 16.2 3.1 4.2 76.1 16.2 3.6 4.5 76.0 16.2 3.3 NS
5-8
SA . . . 14137 12446 13277 . . . . . . . . . . . . 2.4 74.9 13.0 9.7 2.2 68.2 18.3 11.3 2.3 71.5 15.7 10.5 NS . . . 13815 12086 12953 . . . . . . . . . . . . 4.0 77.7 12.4 5.8 4.0 76.0 13.7 6.3 4.0 76.9 13.0 6.1
9-13
SA 77 67 72 12445 10361 11403 1.74 1.60 1.67 151 114 133 28 25 26 259 231 245 5.9 81.1 6.6 6.4 5.5 62.2 24.9 7.4 5.7 71.8 15.6 6.9 NS 80 72 76 12961 10875 11909 1.76 1.64 1.70 159 129 144 30 39 35 233 194 214 6.2 69.2 18.1 6.5 5.0 65.3 22.7 7.0 5.6 67.3 20.4 6.7
14-16
SA 69 48 59 10872 8752 9853 1.64 1.57 1.61 117 81 100 21 31 26 285 235 260 5.5 69.0 18.8 6.7 5.9 60.7 26.7 6.6 5.7 64.9 22.7 6.7 NS 65 51 58 10877 9313 10091 1.65 1.55 1.60 116 83 100 24 39 31 272 205 239 4.7 70.7 19.0 5.6 4.8 72.2 16.3 6.8 4.8 71.4 17.7 6.1
9-16
SA 74 60 67 11836 9767 10817 1.70 1.59 1.65 138 102 120 25 27 26 269 232 251 5.8 76.4 11.3 6.5 5.6 61.6 25.6 7.1 5.7 69.1 18.3 6.8 NS 74 64 69 12159 10276 11210 1.72 1.61 1.66 142 112 127 28 39 33 248 198 223 5.7 69.7 18.5 6.1 4.9 67.9 20.3 6.9 5.3 68.8 19.3 6.5
2-16
SA . . . . . . . . . . . . . . . . . . 4.9 75.2 13.0 6.9 4.4 67.2 21.4 7.0 4.6 71.2 17.2 7.0 NS . . . . . . . . . . . . . . . . . . 5.0 73.1 16.5 5.4 4.5 71.7 17.7 6.1 4.8 72.4 17.1 5.8
Mean PAL (METs) MVPA (minutes/day) Proportion (%) meeting screen time guidelines (Child x Day Method) Screen (minutes/day) Proportion (%) by weight status (Boys)
Boys Girls Total Children Boys Girls Total Children Boys Girls Total Children Boys Girls Total Children Underweight Normal Overweight Obese
Proportion (%) by weight status (Girls)
Underweight Normal Overweight Obese
Proportion (%) by weight status (Total Children)
Underweight Normal Overweight Obese
59

Table 36: Proportion (%) of South Australian children (SA) and National Survey (NS) children meeting EAR for selected nutrients and dietary guidelines using estimate of usual intakes derived from two days of intake data collected by 24-hour recall at both CAPI and follow-up CATI Age Group (years)
2-3 4-8 National 100 100 100 100 100 100 96 100 100 99 100 93 SA 100 99 100 100 100 98 96 100 100 96 100 90 National 100 99 100 100 100 100 99 100 100 100 100 93 9-13 SA 100 99 100 100 100 95 98 92 98 100 100 97 National 100 94 100 100 100 94 99 88 94 99 100 94 14-16 SA 100 86 99 100 100 87 97 96 65 96 97 82 National 100 83 97 99 100 79 99 93 55 94 93 85
Selected Nutrients
Protein Vitamin A retinol equivalent Thiamin Riboflavin Niacin equivalent Folate (dietary folate equivalents) Vitamin C Phosphorus Magnesium Iron Zinc Iodine
SA 100 99 100 100 100 100 95 100 100 98 100 89
Selected Dietary Guidelines

Eat plenty of fruits
1-3 serves/d excluding juice 1-3 serves/d including juice 2-4 serves/d excluding potatoes 2-4 serves/d including potatoes 3-4 serves/d >EAR for protein, iron, zinc > calcium EAR <10% energy from saturated fat <20% energy from total sugars 632 89 5
2 2
682 90 5
2 2
57 89 3 15 11 96-100 93 16 28
61 93 3 22 20 100 89 19 29
52 90 4 32 5 100 54, 263 14 30
51 90 2 14 11 99-100 55, 313 19 33
2 21 0 3 22 96-100 40 20 42
1 24 0 5 25 93-100 38 22 39
Eat plenty of vegetables Eat plenty of cereals Include lean meat, fish, poultry and/or alternatives Include milks, yoghurts, cheese and/or alternatives Limit saturated fat and moderate total fat intake Consume only moderate amounts of sugars
1 2
172 7
2
142 5
2
98-100 98 16 22
99-100 99 16 21
Population weights applied, two-day data, except for percentage of total energy as fat and sugar which has been calculated with CAPI data No national recommendations or guidelines available for this age group, recommendations for 4-7 year olds applied 3 EARs exist for 9-11 years and for 12-13 years.
60
Socio-Economic Status
In adults in developed countries there are fairly consistent relationships between SES and anthropometric, use-of-time and dietary characteristics. The exact nature of the relationship will vary according to how SES is measured. The ways in which SES can be quantified include household income, type of employment and education levels. In general, low SES is associated with greater levels of fatness, lower levels of physical activity, greater screen time and poorer diet. In children, the relationships are not always so clear. In this section we examine the relationships between SES and the major characteristics this survey was designed to measure: body size and shape, physical activity, screen time, and dietary intake. We have chosen to use the Socio-Economic Indicators for Areas (SEIFA; Index of Relative Disadvantage) at the postcode level as our metric for SES. This is a measure used by the Australian Bureau of Statistics to characterise SES, and uses a series of indicators derived from the 2006 Census such as education and household income. The SEIFA has a national mean of 1000, and a Standard Deviation (SD) of 100. Each child has been assigned a SEIFA based on their postcode of residence, and SEIFA scores have been divided into quartiles specific to this survey. The four quartiles are: 1 quartile (highest SES): 2
nd rd th st
Greater than 1039 Greater than 976 to 1039 Greater than 948 to 976 948 or less
quartile:
3 quartile: 4 quartile (lowest SES):
The data shown here is weighted by age, gender and place of residence (capital city versus rest of state) to reflect national distributions. They are also adjusted where appropriate for age and gender.
Body Size and Shape

Table 37 shows the percentage of children classified as obese or overweight from the four SES rd th quartiles. There are significantly more children classified as overweight or obese in the 3 and 4 (lower) SES quartiles. In the lowest SES quartile, 10% more children were classified as overweight or obese than in the highest SES quartile. There was, however, no significant relationship between SES and waist girth (waist girth to height ratio).
Table 37: Percentage of South Australian children classified as obese, overweight, and obese or overweight, across the four SES bands
Highest SES 1 quartile % obese % overweight % obese or overweight
st
Lowest SES 2
nd
quartile
3 quartile
rd
4th quartile
6.5 15.4 21.9
5.6 14.0 19.6
7.9 18.6 26.5
8.4 23.1 31.5
61
Fruit and Vegetable Consumption

The consumption of fruit and vegetable in children across the four SES bands is presented in Table 38. Key Findings: > Across all age groups, children from families of high SES consumed more fruit products and dishes (g) than children from families of lower SES
> There were no identifiable patterns for proportion of children meeting recommendations for fruit
(with or without juice) or vegetables (with or without potato) according to SES.

Table 38: Fruit and vegetable consumption in South Australian children by age group and socio-economic 2 status (SES)
Socio-Economic status (SES) Age Group (years) 2-3 Food Group 24-hour intake of fruit products and dishes (g) % meeting recommendation4,5 for fruit, includes juices6 excludes juices6 (%) 24-hour intake of vegetable products and dishes7 (g) % meeting recommendation4,5 for vegetable, includes potato excludes potato (%) 4-8 24-hour intake of fruit products and dishes3 (g) % meeting recommendation4,5 for fruit, includes juices6 excludes juices6 (%) 24-hour intake of vegetable products and dishes7 (g) % meeting recommendation4,5 for vegetable, includes potato excludes potato (%) 9-13 24-hour intake of fruit products and dishes3 (g) % meeting recommendation4,5 for fruit, includes juices6 excludes juices6 (%) 24-hour intake of vegetable products and dishes7 (g) % meeting recommendation4,5 for vegetable, includes potato excludes potato (%) 14-16 24-hour intake of fruit products and dishes3 (g) % meeting recommendation4,5 for fruit, includes juices6 excludes juices6 (%) 24-hour intake of vegetable products and dishes7 (g) % meeting recommendation4,5 for vegetable, includes potato excludes potato (%)
1 3
1 quartile (highest SES) 194.1
st
nd
quartile
3 quartile
rd
151.9 72.8 55.5 115.5 33.0 16.2 154.8 79.3 48.7 93.2 24.9 11.7 151.7 71.8 39.1 128.8 24.8 4.1 105.9 15.3 7.3 191.0 10.5 2.2
165.9 83.0 56.6 94.3 24.4 8.0 136.1 84.0 48.2 95.8 30.3 5.2 125.2 68.9 36.7 216.1 34.7 11.9 131.0 30.9 3.7 260.1 32.0 9.6
4th quartile (lowest SES) 150.8
80.6 61.2 102.7 23.0 13.0 232.1 84.0 66.0 122.8 20.0 12.0 178.7 72.8 43.9 225.0 22.1 8.5 157.0 24.5 6.4 229.3 21.0 6.4
82.2 60.8 87.0 16.5 7.2 174.0 77.7 61.2 102.2 36.3 11.8 134.0 68.3 32.3 159.3 28.7 7.8 74.6 22.9 5.1 217.7 11.4 3.6
Mean daily intake estimated by using one-day food intake data collected at personal interview, two-day food intake data (more indicative of usual intake) were used to estimate proportion of children meeting requirements, population weights applied, n=874. 2 SES as indicated by SEIFA. 3 Included fresh fruit, dried and preserved fruit, mixed dishes where fruit is the major component but excluded fruit juices and drinks 4 Recommendation as per the AGHE as detailed in Table 17. When calculating percentage meeting recommendation for vegetable, intakes from vegetables and legumes were combined 5 C-SIDE programme was unable to produce a valid finding, which is likely to have been a result of small numbers in some categories, hence an alternative method of calculation (average of CAPI and CATI data) was used in obtaining proportion of children meeting recommendations in this table. 6 Juice included fruit and vegetables juices and drinks
62
Included potatoes, cabbage/cauliflower and similar brassica vegetables, carrot and similar root vegetables, leaf and stalk vegetables, peas and beans, tomato and tomato products, other fruiting vegetables, other vegetables and vegetable combinations and dishes where vegetable is the major component
Consumption of Other Selected Major and Sub-Major Food Groups, Nutrients, Core and Non-Core Foods
The intake of confectionery (excluding cereal, fruit, nut and seed bars), sugar-sweetened non alcoholic beverages, fruit and vegetable juices and drinks, snack foods and their contribution to total energy intake are presented in Table 39. Key Findings:
> Confectionery was consumed in greater amounts (g) by children from families of highest SES
across all age groups except for the 14-16 year olds
> Consumption of sugar-sweetened non-alcoholic beverages amongst older children (9 years) was
greatest for those children from families of lowest SES

> The percentage contribution to total energy from sugar-sweetened non-alcoholic beverages was
also highest in older children (9 years) from families of lowest SES

> In older children (9 years), the amount (g) of fruit and vegetable juices and drinks consumed
tended to be higher in those from families of lower SES

> There was no identifiable pattern for snack food consumption according to SES.
63
Table 39: Consumption1 of selected major and sub-major food groups in South Australian 2 children by age group and SES
Socio-economic status (SES) Age group (years) 2-3 Food group / Nutrient 24-hour intake of confectionery (g) % of total energy from confectionery 24-hour intake of sugar-sweetened non-alcoholic 4 beverages (g) % of total energy from sugar-sweetened non-alcoholic beverages 24-hour intake of fruit and vegetable juices & drinks (g) % of total energy from fruit & vegetable juices & drinks 24-hour intake of snack foods (g) % of total energy from snack foods 3 24-hour intake of confectionery (g) % of total energy from confectionery 24-hour intake of sugar-sweetened non-alcoholic 4 beverages (g) % of total energy from sugar-sweetened non-alcoholic beverages 24-hour intake of fruit and vegetable juices & drinks (g) % of total energy from fruit & vegetable juices & drinks 24-hour intake of snack foods (g) % of total energy from snack foods 3 24-hour intake of confectionery (g) % of total energy from confectionery 24-hour intake of sugar-sweetened non-alcoholic 4 beverages (g) % of total energy from sugar-sweetened non-alcoholic beverages 24-hour intake of fruit and vegetable juices & drinks (g) % of total energy from fruit & vegetable juices & drinks 24-hour intake of snack foods (g) % of total energy from snack foods 3 24-hour intake of confectionery (g) % of total energy from confectionery 24-hour intake of sugar-sweetened non-alcoholic 4 beverages (g) % of total energy from sugar-sweetened non-alcoholic beverages 24-hour intake of fruit and vegetable juices & drinks (g) % of total energy from fruit & vegetable juices & drinks 24-hour intake of snack foods (g) % of total energy from snack foods
3
1 quartile (highest SES) 10.5 2.7 42.0 1.7 83.9 2.1 1.4 0.4 26.0 5.5 113.1 3.5 94.2 1.8 14.6 3.2 34.2 5.6 185.8 4.3 134.5 2.3 11.6 2.9 16.7 2.8 232.6 4.1 126.1 2.0 15.4 2.8
st
nd
quartile 7.4 2.2 42.9 2.4 77.4 2.0 4.0 1.3 14.5 4.0 127.1 3.6 161.5 3.3 7.1 2.0 13.5 2.9 194.3 4.3 133.2 2.3 9.5 2.4 21.8 4.3 281.3 5.2 114.2 1.5 15.9 3.3
3 quartile 8.4 2.5 42.9 3.8 92.6 2.6 6.4 2.3 21.4 5.6 106.1 3.2 152.8 3.1 11.2 3.0 19.2 3.2 253.5 5.0 187.2 3.0 14.0 3.7 16.7 3.0 264.0 5.8 189.5 2.6 14.2 2.6
rd
4 quartile (lowest SES) 3.9 0.9 37.6 2.8 110.8 2.8 5.7 1.4 17.3 4.4 75.2 3.2 69.0 1.5 15.3 4.5 24.0 4.3 329.5 6.5 165.2 2.8 9.5 2.3 19.0 3.2 336.4 6.3 217.9 3.1 13.4 2.9
th
4-8
9-13
14-16
One-day food intake data collected at personal interview, population weights applied, n=874. SES as indicated by SEIFA 3 Excluded cereal, fruit, nut and seed bars 4 Included cordial; soft drinks & flavoured mineral water; electrolyte, energy &fortified drinks; other beverage flavourings and prepared beverages but excluded fruit and vegetable juices & drinks
2
64
The consumption of total sugars, saturated fat, calcium and sodium in children across all four SES bands is presented in Table 40. Key Findings: > The proportion of children meeting guidelines for total sugars was low (between 18.3-51.9%) across all children, regardless of SES
> The proportion of children meeting guidelines for saturated fat was low (between 9.6-25.4%) across
all children, older children from the highest SES were more likely to reach guidelines but the proportion was still quite low
> For all children (except those aged 12-16 years), the proportion of children meeting guidelines for
calcium was higher for those from families of higher SES

> All children consumed excessive amounts of sodium, the pattern of intake seemingly independent
of SES.
65

1 2
Table 40: Consumption of selected nutrients in South Australian children by age group and SES
Socio-Economic Status (SES) Age Group (years) 2-3 Food Group / Nutrient 1st quartile (Highest SES) 2nd quartile 3rd quartile 4th quartile (Lowest SES)
4-8
9-13
% of total energy from total sugars % of children meeting guidelines for total sugars (<20% of total energy) Proportion of total energy from saturated fat (%) Proportion of children meeting guideline for saturated fat (<10% of total energy) 24-hour intake of calcium (mg) Proportion of children with intakes estimated average requirement (EAR) for calcium (%)3 24-hour intake of sodium (mg) Proportion of children with intakes exceeding upper limit for sodium (%)3 Proportion of total energy from total sugars (%) Proportion of children meeting guidelines for total sugars (<20% of total energy) Proportion of total energy from saturated fat (%) Proportion of children meeting guideline for saturated fat (<10% of total energy) 24-hour intake of calcium (mg) Proportion of children with intakes estimated average requirement (EAR) for calcium (%)3 24-hour intake of sodium (mg) Proportion of children with intakes exceeding upper limit for sodium (%)3 Proportion of total energy from total sugars (%) Proportion of children meeting guidelines for total sugars (<20% of total energy) Proportion of total energy from saturated fat (%) Proportion of children meeting guideline for saturated fat (<10% of total energy) 24-hour intake of calcium (mg) Proportion of children with intakes estimated average requirement (EAR) for calcium (%)3 24-hour intake of sodium (mg) Proportion of children with intakes exceeding upper limit for sodium (%)3 Proportion of total energy from total sugars (%) Proportion of children meeting guidelines for total sugars (<20% of total energy) Proportion of total energy from saturated fat (%) Proportion of children meeting guideline for saturated fat (<10% of total energy) 24-hour intake of calcium (mg) Proportion of children with intakes estimated average requirement (EAR) for calcium (%)3 24-hour intake of sodium (mg) Proportion of children with intakes exceeding upper limit for sodium (%)3
26.2 24.2 13.8 17.8 893.3 96.8 1633.2 87.7 25.4 22.2 14.3 13.9 925.2 96.0 2383.7 92.0 24.6 25.5 14.2 15.3 1008.2 965.4b 62.9a 33.6b 2828.1 76.2 21.4 44.4 13.5 25.4 1094.3 36.7 3487.3 76.0
a
25.9 20.6 14.2 14.2 748.5 98.5 1424.7 86.1 25.4 19.1 14.0 15.0 770.6 92.9 2313.5 85.0 22.9 36.0 14.3 14.6 829.6 837.6 b 42.2 a 25.7 b 2889.2 78.6 20.9 51.9 13.7 20.5 984.7 32.1 3582.9 82.9
a
25.9 25.3 14.0 12.9 837.4 96.1 1745.2 89.9 24.2 29.5 13.4 21.7 693.6 81.1 2165.8 84.7 24.7 29.8 13.9 9.6 741.0 1043.1 b 32.9 a 37.1 b 2820.8 83.5 23.1 36.4 13.5 20.5 1041.0 38.4 3432.1 75.7
a
26.9 18.3 14.5 20.0 860.8 90.9 1670.9 92.6 23.4 39.2 14.3 14.9 801.0 76.1 2408.8 91.7 24.6 30.6 13.7 14.5 876.4 a 675.6 b 37.4 a 21.4 b 2857.6 87.3 22.7 34.5 14.5 13.2 928.8 32.2 3145.9 66.5
14-16
One-day food intake data collected at personal interview. For estimation of proportion of children meeting EAR for calcium and not exceeding upper level of sodium intake, 2-day intake data were used, population weights applied, n=874.
66
SES as indicated by SEIFA denotes figures for age group 9-11 years and 12-13 years respectively as different EARs exist within this main group of 9-13 year olds 3 C-SIDE programme was unable to produce a valid finding, which is likely to have been a result of small numbers in some categories, hence an alternative method of calculation (average of CAPI and CATI data) was used in obtaining proportion of children meeting recommendations in this table.
a, b
Figure 6 shows the contribution of energy from core and non-core foods as well as the number of serves of non-core food consumed in children across the four SES bands in the 24 hours prior to the interview. Key Findings:
> There was no identifiable pattern of consumption of core and non-core foods according to SES Figure 6: Contribution of energy from core and non-core foods (including mean intake of non-core food) in South Australian children by age and socio-economic status
80 74% 70 72% 68% 64% 60% 60 62% 59%
7.1
1,2,3
9 73%
7.9 7.7 7.4
64% 55% 56%

6.4
60% 57% 53%
55%
% of total energy
50
4.9 4.9 4.6 3.1 5.0
5.7
6.7
61%
6.9
% energy from core food % energy from non-core food Number of serves of non-core food
40
4
2.9
30
2.8
20
2.6
10 0 0
SE S
Age group
1 2
2-3 years
4-8 years
9-13 years
One-day food intake data collected at personal interview, population weights applied, n=874. Foods classified as core and non-core according to the AGHE. Caution is required when interpreting these data as the classification of core and non-core food is not always clear cut. Non healthy option are not counted as core food where possible, 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 or flavoured; mixed dishes where cereal is major component (not hamburgers); all fish and seafood products and dishes; all fruit products and dishes; egg products and dishes; all meat, poultry and game products and dishes (not organ meat/offal products and dishes, not sausage/frankfurts/saveloys); all milk, yoghurt and cheese (dairy or non-dairy); all soups; seeds and seeds products; nuts and nut products; potato (not chips, wedges or gems); all other vegetables and dishes; legumes and pulses products 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
67
1s tq u 2n art il d qu e 3r art d i qu le 4t art i h l qu e ar til e

14-16 years
1s tq u 2n art il d qu e 3r art d i qu le 4t art ile h qu ar til e
qu 1s art t q iles u 2n art il d qu e 3r art i d qu le 4t art il h qu e ar til e
1s tq u 2n art il d qu e 3r art i d qu le 4t art il h qu e ar til e
Table 41 below shows the proportion of children consuming breakfast on a school day by age and socio-economic status. Key Findings:
> Fewer 14-16 years olds from families of lower SES consumed breakfast compared to other children
from the same age group but of a higher SES background

1
Table 41: Proportion (%) of South Australian children eating breakfast on a school day by age group and 2 SES
Socio-Economic Status2 (SES) Age Group (years) 5-8 9-13 14-16 All age groups
1
1st quartile (highest SES)
2nd quartile
3rd quartile
4th quartile (lowest SES)
100.0 86.5 87.0 90.2
100.0 92.0 91.5 94.3
95.9 100.0 75.7 92.4
100.0 93.0 78.0 92.7
One-day food intake data collected at personal interview from children 5 years, on a school day. Participants were considered to have consumed breakfast if food or beverages providing energy were consumed between 05.01 to 09.00 hours, population weights applied, n=326 2 SES as indicated by SEIFA.
68
Table 42 below shows the number of eating occasions per day in children by age and socio-economic status. Key Findings:
> No identifiable pattern for number of eating occasions was observed across SES quartiles. Table 42: Estimated number of eating occasions per day in South Australian children by age and SES
Age Group (years)
2-3
1 2
Socio-Economic Status (Quartiles)

1st (highest SES) 2nd 3rd 4th
Number of eating occasions per day (Consumption of energy providing food only)
Number of eating occasions per day (Consumption of energy providing food and beverages)
7.9 6.8 7.2 7.2 7.4 6.1 6.6 6.7 6.6 5.9 6.4 6.0 5.9 5.8 6.0 5.5 6.8 6.1 6.5 6.3
8.1 7.0 7.5 7.3 7.6 6.4 6.9 6.9 6.9 6.3 6.9 6.6 6.5 6.2 6.5 6.0 7.2 6.4 6.9 6.7
4-8
1st 2nd 3rd 4th
9-13
1st 2nd 3rd 4th
14-16
1st 2nd 3rd 4th
All age groups
1st 2nd 3rd 4th (lowest SES)
One-day food intake data collected at personal interview, energy consumed within 30-minute time intervals across the day is
considered as one eating occasion, e.g. 12:01 to 12:30, 12:31 to 13:00 etc, population weights applied, n=874.
SES as indicated by SEIFA.
69
Physical Activity
There were few differences in self-reported or objectively measured physical activity across the SES bands (Table 43). Children from high SES households tended to spend somewhat more time playing sport, but the overall number of minutes spent in MVPA, and the number of daily steps, were not different. Children from both the highest and lowest SES quartiles spent less time in free play than children from the middle two quartiles (p = 0.02).
Table 43: Physical activity patterns of South Australian children across the four SES bands
Highest SES 1 quartile MVPA (minutes/day) Pedometer steps/day Sport (minutes/day) Play (minutes/day)1 Active transport (minutes/day)
1
Lowest SES 2
nd
st
quartile
3 quartile
rd
4th quartile
112 11391 49 49 44
116 11764 43 61 40
123 10880 46 64 40
106 11385 40 48 41
= p < 0.05
Screen Time
Unlike physical activity, there were significant differences in screen time across the SES bands (Table 44). Children from low SES households had higher amounts of screen time (p = 0.03). Children in the lowest SES quartile accumulated 30-50 minutes more screen time each day than children in the other quartiles. The differences were mainly found in television time (children from the lowest SES households watched 28-33 minutes more television each day) and videogame time (children from the lowest SES households spent 8-22 more minutes each day playing videogames). Although PAL across SES bands were similar, while screen times were higher in low SES households, overall energy expenditure (PAL) declined by about 4% across the SES bands, although this is not statistically significant.
Table 44: Screen time patterns of South Australian children across the four SES bands
Highest SES 1 quartile Screen time (minutes/day)1 Television time (minutes/day) Videogame time (minutes/day) Computer time (minutes/day)
2 st
Lowest SES 2
nd
quartile
3 quartile
rd
4th quartile
255 162 49 44 1.67
246 157 35 53 1.64
236 162 39 35 1.63
286 190 57 40 1.61
PAL (METs)
1 2
= p < 0.05 PAL = Physical Activity Level
70
The Role of the Family in How Children Use Their Time

Families are important influences on how children use their time. A number of studies have identified
the critical roles of siblings and caregivers as role models and social supports for children in relation
to physical activity. More siblings, and particularly siblings closer in age, represent a greater reservoir
of potential playmates. Larger families may also offer economies of scale for parents engaging their
children in physical activity. A family with two or more caregivers has a greater potential pool of adults
to engage children in active recreation than a single-parent family. A second parent may make it less
likely that the television or videogame console will serve as a surrogate babysitter. In this section we
will look at the influence of family structure on fatness, physical activity and sedentary behaviours in
children and adolescents.
Family structure often intersects with socio-economic position. For example, it is more common to find
single-parent families in the lower SES quartiles, as these families have only one wage earner.
Similarly, families with only one child often have younger parents who are not as advanced in their
careers, and hence are in lower income bands. Nevertheless, elements of family structure appear to
be important determinants of how active children are, even when differences in SES are allowed for.
This section considers the following aspects of family structure:
> The presence of siblings of the same gender (yes/no = no sibling or different gender sibling)
> The presence of siblings close in age to the target child [singleton child/small age gap ( 3
years)/large age gap (>3 years)]

> The number of children in the household > The number of adults in the household > The relationship of the primary caregivers (married/de facto/single parent).
The relationships between these characteristics and various measures of fatness (standardised BMI score, waist:height ratio), physical activity (daily pedometer steps, minutes of MVPA per day, minutes of sport per day), sedentary behaviour (minutes of screen time per day, minutes of videogame playing per day), and overall daily energy expenditure (PAL, in METs) are shown in Table 45. All values have been adjusted for age, gender and reported household income. The broad pattern is quite clear. Lower weight status is associated with households where there are more children, and children are closer in age. Physical activity is greater in households where there are more children, where there are siblings close in age and of the same gender, and where there are more adults. This probably reflects both greater opportunities for play, and greater social support from parents. Screen time is also lower in households where there are more children, particularly of the same gender. Given these relationships with physical activity and screen time, it is not surprising to find that overall energy expenditure is greater in household where there are same gender siblings and a greater number of adults. The marriage status of the caregivers does not impact on any of the outcomes, so that single-parent effects appear to be mediated by the number of adults and number of children in the household. To make these differences more concrete, compare a South Australian family with a single parent and singleton child to a family with two parents and two or more children. The singleton child from the single parent family has a 3% greater waist girth, takes 1270 fewer steps each day (11% of the average value), plays 20 minutes (45%) less sport each day, gets 27 minutes (11%) more screen time, and uses 4% less energy each day.
71
Table 45: Relationship between aspects of family structure and weight status, physical activity and sedentary behaviour variables in South Australia
Same gender sibling Sibling age difference Number of children Number of adults Marriage status
BMI z-score
ns
ns
ns
ns
ns
Waist: height
ns
singleton > large > small difference = 0.014 p = 0.036 small > large > singleton difference = 1331 steps/day p = 0.017
decreases by 0.008 for every extra child p = 0.012
ns
ns
Pedometer
yes > no
difference =
1213 steps/day
p = 0.005
yes > no difference = 18 min/day p = 0.001
ns
ns
ns
MVPA
ns
ns
ns
ns
Sport
ns
ns
ns
increases by 7 min/day for each extra adult p = 0.022
ns
Screen time
no > yes difference = 27 min/day p = 0.03 no > yes

difference = 19
min/day
p = 0.001
yes > no difference = 0.06 METs p = 0.04
ns
decreases by 20 for each extra child p = 0.0005 decreases by 7 min/day for each extra child p = 0.026
ns
ns
Videogames
ns
ns
ns
PAL
ns
ns
increases by 0.04 METs with every extra adult p = 0.005
ns
ns = not significant, MVPA = moderate to vigorous physical activity, PAL = physical activity level All values have been adjusted for age, gender and household income.
72
10 Health Regions
In South Australia, there are two metropolitan health regions (Central Northern Adelaide and Southern Adelaide) and seven non-metropolitan health regions (Hills Mallee Southern, Wakefield, South East, Northern and Far Western, Eyre, Mid North and Riverland). The Central Northern Adelaide region covers the central, western, eastern and northern suburbs of the Metropolitan Adelaide (excluding Gawler) incorporating the Local Government Areas (LGAs) of Adelaide, Prospect, Walkerville, Burnside, Campelltown, Charles Sturt, Norwood Payneham St Peters, Playford, Port Adelaide-Enfield, Salisbury, Tea Tree Gully, Unley, West Torrens and part of the Adelaide Hills. The Central Northern Adelaide region has just over half of the States population and the characteristics of this region are very heterogeneous. For example, this region contains areas of both highest and lowest Index of Relative Socio-Economic Disadvantage scores within the metropolitan area (Glover et al. 2006). The Southern Adelaide region contains the remainder of the population of the metropolitan regions and includes the Statistical Local Areas (SLAs) of Holdfast Bay, Marion, Mitcham and Onkaparinga. Like the Central Northern Adelaide region, the Southern Adelaide region is also a very heterogeneous area with significant variation in socio-economic status. There are however, fewer low income, poor groups in this region than in the northern region (Glover et al. 2006). The seven non-metropolitan health regions are very diverse in their geography, history and demography and have varied profiles of disadvantage (Glover et al. 2006). These seven nonmetropolitan health regions comprised the SA Country health regions. Data presented here are averages only and therefore do not reflect the potential large variances one would expect from regions with such diversity. The number of children sampled from the Central Northern Adelaide, Southern Adelaide and Country health regions were 282, 288 and 304 respectively. The survey population is not necessarily representative of the population profile of the whole region (see Table 8). For example in SAHS more than half of the survey population falls into the most advantaged SES quartile.
Figure 7: South Australian health regions
Metropolitanhealthregions
1. CentralNorthernAdelaideHealth Serviceregion(CNAHS) (excluding Gawler) SouthernAdelaideHealthService region(SAHS)
NonmetropolitanHealthregions
2.
Nonmetropolitanhealthregions
3. CountryHealthSouthAustralia(CHSA) comprisingofhealthregions: HillsMallee Southern; SouthEast; Wakefield; MidNorth; Riverland; Eyre; NorthernandFarWestern
NorthernandFarWestern
MidNorth Eyre Riverland Wakefield
Metropolitan 1 Healthregions 2
HillsMallee Southern
South East
73
Fruit and Vegetable Consumption

The consumption of fruit and vegetable in children across the three SA health regions is presented in Table 46. Key Findings:
> Overall, estimated fruit and vegetable intakes were well below recommendations > Older children (9 years) from Southern Adelaide were consuming more fruit products and dishes
than children from the Central Northern or Country health regions. This was particularly noticeable amongst 14-16 year olds where intake of fruit products and dishes was close to double for children in Southern Adelaide
> Children from Southern Adelaide consumed greater amounts of vegetable products and dishes
than children from the Central Northern or Country health regions. This trend was evident across all age groups, although intakes were very similar to children aged 14-16 years from the Central Northern health region
> With the exception of children aged 2-3 years, fewer children from the Central Northern health
region achieved recommendations for fruit intake (with or without juice)
> Conversely, again with the exception of children aged 2-3 years, fewer children from the Country
health region achieved recommendations for vegetable intake (with or without potato).
Table 46: Fruit and vegetable consumption by age group and South Australian health regions
SA Health Regions Age Group (years) 2-3 Food Group 24-hour intake of fruit products and dishes2 (g) Proportion meeting recommendation3,4 for fruit, includes juices5(%) excludes juices5 (%) 24-hour intake of vegetable products and dishes6 (g) Proportion meeting recommendation3,4 for vegetable, includes potato (%) excludes potato (%) 4-8 24-hour intake of fruit products and dishes2 (g) Proportion meeting recommendation3,4 for fruit, includes juices5 (%) excludes juices5 (%) 24-hour intake of vegetable products and dishes6 (g) Proportion meeting recommendation3,4 for vegetable, includes potato (%) excludes potato (%) 9-13 24-hour intake of fruit products and dishes2 (g) Proportion meeting recommendation3,4 for fruit, includes juices5 (%) excludes juices5 (%) 24-hour intake of vegetable products and dishes6 (g) Proportion meeting recommendation3,4 for vegetable, includes potato (%) excludes potato (%) 14-16 24-hour intake of fruit products and dishes2 (g) Proportion meeting recommendation3,4 for fruit, includes juices5 (%) excludes juices5 (%) 24-hour intake of vegetable products and dishes6 (g) Proportion meeting recommendation3,4 for vegetable, includes potato (%) excludes potato (%) Central Northern Southern Adelaide Country
1
171.1 94.2 71.9 97.2 10.2 0.3 162.4 78.4* 54.1* 100.1 24.3* 10.9* 132.3 80.9 46.2 177.8 27.6 3.1 83.8 19.6* 1.6* 236.9 19.1* 6.6*
166.5 76.5 57.4 114.0 22.8 8.9 170.3 81.8* 55.9* 118.4 31.2* 11.7* 163.1 90.9 57.0 208.9 31.1 9.2 168.0 26.8* 10.2* 235.4 19.7* 5.8*
158.9 93.7 57.3 89.4 17.7 9.4 183.5 82.7* 57.1* 89.9 29.3* 8.1* 148.6 97.4 57.0 164.6 26.8 4.3 88.1 22.5* 4.2* 198.5 16.5* 3.8*
74
Mean daily intake estimated by using one-day food intake data collected at personal interview, two-day food intake data (more indicative of usual intake) were used to estimate proportion of children meeting requirements, population weights applied, n=874. 2 Included fresh fruit, dried and preserved fruit, mixed dishes where fruit is the major component but excluded fruit juices and drinks 3 Recommendation as per the AGHE. When calculating percentage meeting recommendation for vegetable, intakes from vegetables and legumes were combined 4 C-SIDE programme (which allows for both within and between individual intake variances) was used in the first instance to estimate usual intake. An alternative method of calculation (average of CAPI and CATI data) had to be used when C-SIDE was unable to produce a valid finding, which is likely to have been a result of small numbers in some categories. Results obtained by the alternate method are marked with an asterisk (*). 5 Juice included fruit and vegetables juices and drinks 6 Included potatoes, cabbage/cauliflower and similar brassica vegetables, carrot and similar root vegetables, leaf and stalk vegetables, peas and beans, tomato and tomato products, other fruiting vegetables, other vegetables and vegetable combinations and dishes where vegetable is the major component
Consumption of Other Selected Major and Sub-Major Food Groups, Nutrients, Core and Non-Core Foods
> The intake of confectionery (excluding cereal, fruit, nut and seed bars), sugar-sweetened non
alcoholic beverages, fruit and vegetable juices and drinks, snack foods and their contribution to total energy intake are presented in Table 47. Key Findings:
> Older children (9 years) from the Central Northern health region consumed a greater proportion of
total energy from sugar-sweetened, non-alcoholic beverages compared to children from the Southern Adelaide or Country health regions
> Children of all age groups (exception 2-3 year olds) from the Country health region consumed a
greater proportion of total energy from fruit and vegetable juices compared to either the Southern Adelaide or Central Northern health regions
> There was no identifiable trend in intake of snack foods according to health regions.
75
Table 47: Consumption of selected major and sub-major food groups by age group and SA health regions
SA Health Regions Age Group (years) 2-3 Food Group 24-hour intake of confectionery2 (g) Proportion of total energy from confectionery (%) 24-hour intake of sugar-sweetened non-alcoholic beverages3(g) Proportion of total energy from sugar-sweetened non-alcoholic beverages (%) 24-hour intake of fruit and vegetable juices and drinks (g) Proportion of total energy from fruit and vegetable juices and drinks (%) 24-hour intake of snack foods (g) Proportion of total energy from snack foods (%) 24-hour intake of confectionery2 (g) Proportion of total energy from confectionery (%) 24-hour intake of sugar-sweetened non-alcoholic beverages3(g) Proportion of total energy from sugar-sweetened non-alcoholic beverages (%) 24-hour intake of fruit and vegetable juices and drinks (g) Proportion of total energy from fruit and vegetable juices and drinks (%) 24-hour intake of snack foods (g) Proportion of total energy from snack foods (%) 24-hour intake of confectionery2(g) Proportion of total energy from confectionery (%) 24-hour intake of sugar-sweetened non-alcoholic beverages3(g) Proportion of total energy from sugar-sweetened non-alcoholic beverages (%) 24-hour intake of fruit and vegetable juices and drinks (g) Proportion of total energy from fruit and vegetable juices and drinks (%) 24-hour intake of snack foods (g) Proportion of total energy from snack foods (%) 24-hour intake of confectionery2 (g) Proportion of total energy from confectionery (%) 24-hour intake of sugar-sweetened non-alcoholic beverages3 (g) Proportion of total energy from sugar-sweetened non-alcoholic beverages (%) 24-hour intake of fruit and vegetable juices and drinks (g) Proportion of total energy from fruit and vegetable juices and drinks (%) 24-hour intake of snack foods (g) Proportion of total energy from snack foods (%) Central Northern Southern Adelaide Country
9.8 2.4 34.0 2.5 122.2 3.0 3.9 1.0 15.4 3.9 105.2 3.3 89.3 1.9 14.0 4.1 16.8 2.9 299.1 5.3 162.6 2.6 10.7 2.9 22.0 3.5 423.1 7.1 174.2 2.3 17.5 2.9
7.5 2.2 52.5 2.4 57.2 1.5 4.6 1.7 21.1 4.6 115.5 3.9 112.3 2.0 13.5 3.0 36.3 6.1 210.4 5.0 123.6 2.1 11.1 2.6 18.8 3.5 160.0 3.6 134.0 1.9 12.5 2.7
4.9 1.5 38.6 2.9 87.5 2.3 4.4 1.3 21.6 5.8 93.7 3.0 154.7 3.3 8.5 2.4 16.5 3.1 217.3 4.8 177.6 3.1 11.5 3.0 15.1 3.0 283.5 5.7 181.6 2.7 14.8 3.0
4-8
9-13
14-16
1 2 3
One-day food intake data collected at personal interview, population weights applied, n=874. Excluded cereal, fruit, nut and seed bars Included cordial; soft drinks and mineral flavoured water; electrolyte, energy and fortified drinks; other beverage flavourings and prepared beverages but excluded fruit and vegetable juices and drinks
The consumption of total sugars, saturated fat, calcium and sodium in children across the three SA health regions is presented in Table 48. Key Findings:
> Proportion of total energy from saturated fat was higher among children from the Country health
region compared to either metropolitan health region and for most age groups there were fewer children from the Country health region able to meet the guideline for saturated fat intake
> For most age groups there were fewer children from the Central Northern health region able to
meet the guideline for calcium intake.
76
Table 48: Consumption of selected nutrients by age group and SA health regions
SA Health Regions Age Group (years) 2-3 Food Group Proportion of total energy from total sugars (%) Proportion of children meeting guidelines for total sugars (<20% of total energy) Proportion of total energy from saturated fat (%) Proportion of children meeting guideline for saturated fat (<10% of total energy) 24-hour intake of calcium (mg) Proportion of children with intakes estimated average requirement (EAR) for calcium (%)2 24-hour intake of sodium (mg) Proportion of children with intakes exceeding upper limit for sodium (%)2 Proportion of total energy from total sugars (%) Proportion of children meeting guidelines for total sugars (<20% of total energy) Proportion of total energy from saturated fat (%) Proportion of children meeting guideline for saturated fat (<10% of total energy) 24-hour intake of calcium (mg) Proportion of children with intakes estimated average requirement (EAR) for calcium (%)2 24-hour intake of sodium (mg) Proportion of children with intakes exceeding upper limit for sodium (%)2 Proportion of total energy from total sugars (%) Proportion of children meeting guidelines for total sugars (<20% of total energy) Proportion of total energy from saturated fat (%) Proportion of children meeting guideline for saturated fat (<10% of total energy) 24-hour intake of calcium (mg) Proportion of children with intakes estimated average requirement (EAR) for calcium (%)2 24-hour intake of sodium (mg) Proportion of children with intakes exceeding upper limit for sodium (%)2 Proportion of total energy from total sugars (%) Proportion of children meeting guidelines for total sugars (<20% of total energy) Proportion of total energy from saturated fat (%) Proportion of children meeting guideline for saturated fat (<10% of total energy) 24-hour intake of calcium (mg) Proportion of children with intakes estimated average requirement (EAR) for calcium (%)2 24-hour intake of sodium (mg) Proportion of children with intakes exceeding upper limit for sodium (%)2
1
Central Northern
Southern Adelaide
Country
26.8 18.3 13.2 21.0 823.1 94.8* 1555.6 99.8 24.0 29.9 13.7 16.2 758.3 75.8* 2408.1 86.5* 24.0 32.3 13.8 13.2 828.5 , 930.8b 54.6a, 28.7b 2934.2 99.4 22.3 37.3 13.5 24.0 948.7 27.1* 3619.8 74.5*
a
26.4 25.3 14.4 15.4 813.5 96.1* 1604.3 93.4 24.8 24.7 13.8 18.1 858.4 94.9* 2332.5 89.7* 25.2 27.8 14.0 13.9 910.5 , 926.1b 64.1a, 32.1b 2717.3 100 21.2 46.6 13.9 21.6 1071.5 40.8* 3474.2 78.1*
a
25.4 23.3 15.1 11.4 872.0 96.2* 1697.9 98.1 24.8 28.9 14.5 14.8 763.4 87.2* 2220.6 88.7* 23.3 30.8 14.2 13.7 883.8a, 829.7b 59.7a, 14.3b 2896.8 93.5 22.6 40.6 13.9 14.1 1000.7 35.0* 3145.9 72.7*
4-8
9-13
14-16
One-day food intake data collected at personal interview. For estimation of proportion of children meeting EAR for calcium and not exceeding upper level of sodium intake, two-day intake data were used, population weights applied, n=874. C-SIDE programme (which allows for both within and between individual intake variances) was used in the first instance to estimate usual intake. Aan alternative method of calculation (average of CAPI and CATI data) had to be used when C-SIDE was unable to produce a valid finding, which is likely to have been a result of small numbers in some categories. Results obtained by the alternate method are marked with an asterisk (*). a, b denotes figures for age group 9-11 years and 12-13 years respectively as different EARs exist within this main group of 9-13 year olds.
2
77
Figure 8 shows the contribution of energy from core and non-core foods as well as the number of serves of non-core food consumed in children across the three SA health regions in the 24 hours prior to the interview. Key Findings:
> With the exception of children aged 14-16 years, all children from the Central Northern health
region consumed a greater proportion of energy from core foods and a lower proportion from noncore foods compared to children from either the Southern Adelaide or Country health regions
> Across all health regions the number of serves of non-core foods consumed increased with
increasing age.
Figure 8: Contribution of energy from core and non-core foods food) by age group and SA health regions
1,2,3
80 70
75% 71% 70% 63% 61% 60% 6.8 58% 7.0 55% 5.3 4.5 4.9 6.7 56% 57% 8.1 60% 6.9 60%6.6
9 8 7 6 5 4 2.9 3 2 1
% energy from core food
60
% of total energy
% energy from noncore food
50 40
3.0
Number of serves of noncore food
30
2.7 20 10 0 0 0
0
e n id try er la th un de Co or A N l rn tra he en ut C o S e n id try er la th un de Co or A N l rn tra he en ut C o S e n id try er la th un de Co or A N l rn tra he en ut C o S
e n ns id try er io la th un eg de Co or R A N l lth rn tra ea he en H ut C o A S S
Age group
2-3 years
4-8 years
9-13 years
14-16 years
1 2
One-day food intake data collected at personal interview, population weights applied, n=874. Foods classified as core and non-core according to the AGHE. Caution is required when interpreting these data as the classification of core and non-core food is not always clear cut. Non healthy option are not counted as core food where possible, 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 or flavoured; mixed dishes where cereal is major component (not hamburgers); all fish and seafood products and dishes; all fruit products and dishes; egg products and dishes; all meat, poultry and game products and dishes (not organ meat/offal products and dishes, not sausage/frankfurts/saveloys); all milk, yoghurt and cheese (dairy or non-dairy); all soups; seeds and seeds products; nuts and nut products; potato (not chips, wedges or gems); all other vegetables and dishes; legumes and pulses products and dishes; formula dietary food; infant formula, human breast milk, infant cereal products/custards/fruit juices; water 3 One serve of non-core food = 600kJ
78
Table 49 below shows the proportion of children consuming breakfast on a school day by age and health regions.
Key Findings:
> Fewer 14-16 year olds from the Country health region were consuming breakfast compared to the
Central Northern and Southern Adelaide health regions.

Table 49: Proportion (%) of South Australian children eating breakfast on a school day by age group and SA health regions
SA Health Regions Age Group (years) 5-8 9-13 14-16 All age groups
1
Central Northern
Southern Adelaide
Country
97.4 90.5 84.6 91.3
100.0 88.4 83.4 90.7
100.0 100.0 81.6 95.9
One-day food intake data collected at personal interview from children 5 years, on a school day. Participants were considered to have consumed breakfast if food or beverages providing energy were consumed between 05.01 to 09.00 hours, population weights applied, n=326
Table 50 below shows the number of eating occasions per day in children by age and health regions. Key Findings:
> The number of eating occasions for children from the Southern Adelaide health region was
consistently higher (across age and for food, food and beverages) than children from with the
Central Northern or Country health regions.
Table 50: Estimated number of eating occasions per day by age group and SA health regions
Number of eating occasions per day (Consumption of energy providing food only) Number of eating occasions per day (Consumption of energy providing food and beverages)
1
Age Group (years)
SA Health Regions
2-3
Central Northern Southern Adelaide Country
7.4 7.5 6.9

6.5 7.1 6.3 6.1 6.5 6.1 5.5 6.0 5.8 6.3 6.7 6.2
7.6 7.9 7.0

6.7 7.4 6.6 6.6 7.0 6.5 6.2 6.4 6.2 6.7 7.1 6.5
4-8
Central Northern
Southern Adelaide
Country 9-13 Central Northern Southern Adelaide Country 14-16 Central Northern Southern Adelaide Country All age groups Central Northern Southern Adelaide Country
79
One-day food intake data collected at personal interview, energy consumed within 30-minute time intervals across the day is considered as one eating occasion, e.g. 12:01 to 12:30, 12:31 to 13:00 etc, population weights applied, n=874.
Levels of Fatness by Health Region

Adolescents from the Central Northern Health Area tended to be fatter than their peers from the Southern Adelaide and Country Health Areas (Table 51). The differences were statistically significant (p = 0.004) for waist: height ratio, but not for the percentage of adolescents overweight or obese, or BMI z-scores.
Table 51: Means for selected physical activity variables by health region
Central Northern % overweight or obese BMI z-score waist: height ratio (%)1 Southern Adelaide Country
27.0 +0.61 57.6
21.2 +0.46 47.7
25.7 +0.62 47.3
Adjusted for age and gender.

Significantly different across health areas, p < 0.05
Levels of Physical Activity by Health Region

Adolescents from the SA Country Health Areas tended to be more active than their peers from the Central Northern and Southern Health Regions (Table 52), although the differences only reached statistical significance for daily minutes of MVPA (p = 0.0007).
Central Northern PAL (METs) MVPA (minutes/day)1 Pedometer steps/day Southern Adelaide Country
1.60 106 10,945
1.62 97 11,359
1.66 126 11,235

1 Significantly different across health areas, p < 0.05
Levels of Screen Time by Health Region

There were few differences across the health regions for screen time among adolescents. The time spent playing videogames was somewhat higher (p = 0.04) among adolescents from the Central Northern Health Region (Table 53).
Central Northern Screen time (minutes/day) Television (minutes/day) Videogames (minutes/day)1
1
Southern Adelaide
Country
287 173 60
274 168 50
260 178 43

Significantly different across health areas, p < 0.05
80
11 School Days, Weekends and Holidays

Childrens use of time and dietary patterns vary according to the type of day. For example, adolescents sleep more on weekend days than on school days. School days also result in more even activity patterns. Although all children are subject to the homogenising regimen of the school, there is less variability among children in MVPA, sport and screen time. These differences are important when comparing data from different surveys, and when deciding how and where to target interventions. Here we will look at how activity patterns vary across different types of days: school days, weekends, and holidays (school holidays and public holidays). The data are based on 1740 recalled days from 435 South Australian adolescents aged from 9 - 16. All data have been adjusted for age and gender. Of these 1740 recalls, 819 were school days, 375 weekend days and 546 holidays.
Physical Activity
Table 54 shows differences in physical activity patterns. There are no differences in daily minutes of MVPA or sport across the three day types.
Table 54: Mean time (minutes/day) South Australian children spent in MVPA and sport on school days, weekend days, and holidays
School days MVPA (minutes/day) Sport (minutes/day) Weekend days Holidays
114 42
122 47
110 47
Screen Time and Overall Energy Expenditure

Unlike physical activity, there were significant differences in screen time and overall energy expenditure on the different day types. Adolescents spent about 100 minutes more each day in front of small screens on weekends and holidays, and 20-30 minutes more playing videogames. As a result, PALs were 3-6% lower on weekends and holidays than on school days (Table 55).
Table 55: Mean time (minutes/day) South Australian children spent in screen time and videogame playing, and mean PAL on school days, weekend days, and holidays
School days Screen time (minutes/day)1 Videogame time (minutes/day)1 PAL (METs)1
1
Weekend days
Holidays
197 33 1.67
295 60 1.63
305 54 1.57
= p < 0.05
The broad pattern is that while there are few differences in physical activity across the different types of day, screen time is much higher on weekends and holidays, and hence PAL is lower. This suggests that one way of increasing overall energy expenditure would be to reduce levels of screen time on non-school days.
81
School Versus Outside School: Energy

Table 56, Table 57 and Table 58 show the proportion of total energy consumed during and outside school hours by gender, SES and the health regions respectively. Key Findings:
> Approximately one third of total energy intake was consumed during school hours for all children,
regardless of age, SES or health region

> The percent of energy consumed during school hours decreased with increasing age for both girls
and boys
> For 9-13 and 14-16 year olds, the total energy intake consumed during school hours tended to
increase with increasing SES

> For 9-13 and 14-16 year olds from the Central Northern health region, total energy intake
consumed at school was lower compared to children of the same age for either the Southern
Adelaide or Country health region.
Table 56: Proportion (%) of total energy (including energy from fermentable fibre) consumed by South 1 Australian children during and outside school hours by age and gender groups
Gender Boys Age Group (years) 5-8 9-13 14-16 Girls 5-8 9-13
14-16 Total Children 5-8 9-13 14-16
1
% of total energy consumed during school hours 32.6
% of total energy consumed outside school hours 67.4
30.3
69.7
28.3
33.6
71.7
66.4
33.2
32.6 33.1 31.7 30.4
66.8
67.4 66.9 68.3 69.6
One-day food intake data collected at personal interview from children 5 years, on a school day. School hours defined as between 09:01 to 15:00 hours, population weights applied, n=329.
82
Table 57: Proportion (%) of total energy (including energy from fermentable fibre) consumed by South 1 Australian children during and outside school hours by age and SES
Age Group (years) 5-8 Socio-Economic Status (SES) (quartiles) 1st (highest SES) 2nd 3rd 4th 9-13 1st 2nd 3rd 4th 14-16 1st 2nd 3rd 4th Total Children 1st 2nd 3rd 4th (lowest SES)
1
32.4 31.4 34.0 34.4 31.7 31.3 28.4 34.3 31.4 26.7 28.7 34.1 31.9 30.2 30.7
67.6 68.6 66.0 65.6 68.3 68.7 71.6 65.7 68.6 73.3 71.3 65.9 68.1 69.8 69.3
One-day food intake data collected at personal interview from children 5 years, on a school day. School hours defined as between 09:01 to 15:00 hours, population weights applied, n=326. 2 SES as indicated by SEIFA
Table 58: Proportion (%) of total energy (including energy from fermentable fibre) consumed during and 1 outside school hours by age and SA health regions
Age Group (years) 5-8 SA Health Regions Central Northern Southern Adelaide Country 9-13 Central Northern Southern Adelaide Country 14-16 Central Northern Southern Adelaide Country Total Children Central Northern Southern Adelaide Country
1
32.7 30.8 27.1 34.4 34.0 27.6 33.0 30.5 29.7 33.5 32.1
67.3 69.2 72.9 65.6 66.0 72.4 67.0 69.5 70.3 66.5 67.9
One-day food intake data collected at personal interview from children 5 years, on a school day. School hours defined as between 09:01 to 15:00 hours, population weights applied, n=326.
School Versus Outside School: Fruit and Vegetable

Table 59, Table 60 and Table 61 show the proportion of fruit and vegetable consumed during and outside school hours by gender, SES and the health regions respectively. Key Findings: > Approximately two thirds of total fruit intake was consumed during school hours for all age groups, although overall fruit intake was well below recommendations
> There was no identifiable pattern according to SES or health region > For total vegetable intake, the proportion consumed was greatest (>75%) outside of school hours.
83
This was true for both girls and boys and across all age groups
> Children of higher SES tended to consume a greater proportion of their total vegetable intake
during school hours compared to children of lower SES

> Children from the Southern Adelaide health region consumed a greater proportion of vegetable
intake during school hours compared to children from the Central Northern and Country health regions.
Table 59: Proportion (%) of total fruit and vegetables (including legumes) consumed by South Australian 1 children during and outside school hours by age and gender groups
% of total fruit2 consumed during school hours % of total fruit2 consumed outside school hours % of vegetable3 (including legume) consumed during school hours 4.6 % of vegetable3 (including legume) consumed outside school hours 95.4
Gender
Age Group (years)
Boys
5-8 9-13 14-16
64.2 75.5 68.8 76.6 65.3 63.8 70.0 70.0 66.4
35.8 24.5 31.2 23.4 34.7 36.2 30.0 30.0 33.6
13.6 12.1 6.7 12.8 24.8 5.6 13.2 18.3
86.4 87.9 93.3 87.2 75.2 94.4 86.8 81.7
Girls
5-8 9-13 14-16
Total Children
5-8 9-13 14-16
One-day food intake data collected at personal interview from children 5 years, on a school day. School hours defined as between 09:01 to 15:00 hours, population weights applied, n=224 for fruit and n=260 for vegetable, consumers only Included fresh fruit, dried and preserved fruit, mixed dishes where fruit is the major component but excluded fruit juices and drinks; mean fruit intake for children aged 5-8, 9-13, 14-16 and consuming fruit was 232.7g, 242.6g and 239.0g respectively Included potatoes, cabbage/cauliflower and similar brassica vegetables, carrot and similar root vegetables, leaf and stalk vegetables, peas & beans, tomato and tomato products, other fruiting vegetables, other vegetables and vegetable combinations, dishes where vegetable is the major component, mature legumes and pulses, mature legume and pulses products and dishes; mean vegetable and legume intake for children aged 5-8, 9-13, 14-16 and consuming vegetable or legume was 134.8g, 246.2g and 272.3g respectively
84
Table 60: Proportion (%) of total fruit and vegetables (including legumes) consumed by South Australian 1 children during and outside school hours by age and SES
% of total fruit3 consumed during school hours % of total fruit3 consumed outside school hours % of vegetable4 and legume consumed during school hours 7.9 % of vegetable4 and legume consumed outside school hours 92.1
Age Group (years)
Socio-Economic Status (SES) (quartiles)
5-8
1st (highest SES) 2nd 3rd 4th
65.2 75.7 75.0 66.3 76.2 65.4 70.6 64.8 61.6 78.1 49.8 74.7 69.3 72.0 68.2 67.4
34.8 24.3 25.0 33.7 23.8 34.6 29.4 35.2 38.4 21.9 50.2 25.3 30.7 28.0 31.8 32.6
8.5 3.4 3.7 16.6 11.4 12.5 10.5 23.6 27.1 9.4 12.2 16.2 15.4 8.5 8.3
91.5 96.6 96.3 83.4 88.6 87.5 89.5 76.4 72.9 90.6 87.8 83.8 84.6 91.5 91.7
9-13
1st 2nd 3rd 4th
14-16
1st 2nd 3rd 4th
Total Children
1st 2nd 3rd 4th (lowest SES)
One-day food intake data collected at personal interview from children 5 years, on a school day. School hours defined as between 09:01 to 15:00 hours, population weights applied, n=222 for fruit and n=258 for vegetable, consumers only. SES as indicated by SEIFA 3 Included fresh fruit, dried and preserved fruit, mixed dishes where fruit is the major component but excluded fruit juices and drinks; mean fruit intake for children aged 5-8, 9-13, 14-16 and consuming fruit was 232.7g, 242.6g and 239.0g respectively 4 Included potatoes, cabbage/cauliflower and similar brassica vegetables, carrot and similar root vegetables, leaf & stalk
vegetables, peas and beans, tomato and tomato products, other fruiting vegetables, other vegetables and vegetable
combinations, dishes where vegetable is the major component, mature legumes and pulses, mature legume and pulses
products and dishes; mean vegetable and legume intake for children aged 5-8, 9-13, 14-16 and consuming vegetable or
legume was 134.8g, 246.2g and 272.3g respectively
Table 61: Proportion (%) of total fruit and vegetables (including legumes) consumed by South Australian 1 children during and outside school hours by age and SA health regions
% of total fruit2 consumed during school hours % of total fruit2 consumed outside school hours % of vegetable3 and legume consumed during school hours 5.5 % of vegetable3 and legume consumed outside school hours 94.5
Age Group (years)
SA Health Regions
5-8
68.7 77.4 61.0 57.0 77.4 75.4 83.5 60.7 48.7 67.3 73.6 65.3
31.3 22.6 39.0 43.0 22.6 24.6 16.5 39.3 51.3 32.7 26.4 34.7
6.3 4.9 8.7 16.6 13.7 17.5 23.1 10.5 9.9 15.6 9.6
93.7 95.1 91.3 83.4 86.3 82.5 76.9 89.5 90.1 84.4 90.4
9-13
14-16
Total Children
One-day food intake data collected at personal interview from children 5 years, on a school day. School hours defined as between 09:01 to 15:00 hours, population weights applied, n=222 for fruit and n=258 for vegetable, consumers only.
85
Included fresh fruit, dried and preserved fruit, mixed dishes where fruit is the major component but excluded fruit juices and drinks; mean fruit intake for children aged 5-8, 9-13, 14-16 and consuming fruit was 232.7g, 242.6g and 239.0g respectively 3 Included potatoes, cabbage/cauliflower and similar brassica vegetables, carrot and similar root vegetables, leaf and stalk vegetables, peas and beans, tomato and tomato products, other fruiting vegetables, other vegetables and vegetable combinations, dishes where vegetable is the major component, mature legumes and pulses, mature legume and pulses products and dishes; mean vegetable and legume intake for children aged 5-8, 9-13, 14-16 and consuming vegetable or legume was 134.8g, 246.2g and 272.3g respectively
Weekdays and Weekend Days

The intakes of energy, total fat, saturated fat and sodium on weekdays and on weekend days were compared and the results are presented in Table 62 (by age group), Table 63 (by SES) and Table 64 (by SA health regions). Key Findings:
> 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, consumption of energy, fat (including saturated fat), and sodium increased with
increasing SES
> While those children from families of higher SES tended to consume greater amounts of energy,
total fat (including saturated fat) and sodium on weekend days compared to weekdays, this pattern was reversed for children from families of lowest SES
> Children from the Central Northern and Southern Adelaide health regions were consuming greater
amounts of energy, total fat (including saturated fat) and sodium on weekend days compared to weekdays
> There were no clear differences observed for intake of energy, total fat (including saturated fat) and
sodium on week days across all health regions while on weekend days, children from the Country health region consumed less energy, total fat (including saturated fat) and sodium than either of the metropolitan health regions.
Table 62: Comparison of weekday and weekend day intakes of energy, total fat, saturated fat and sodium in South Australian children by age group
Age Group (years) Type of Day Nutrient Energy including fermentable fibre (kJ) Week day (Monday to Friday) Total fat (g) Saturated fat (g) Sodium (mg) Energy including fermentable fibre (kJ) Total fat (g) Saturated fat (g) Sodium (mg)
1
2-3
4-8
9-13
14-16
Total
6006.4 48.3 23.0 1600.6 6073.2 53.3 25.4 1659.9
7411.2 61.3 28.0 2331.5 7390.2 65.4 30.0 2275.2
9248.5 77.6 35.0 2869.7 9066.3 80.3 37.9 2782.4
10624.1 91.7 39.7 3397.6 11026.7 96.5 43.2 3537.1
8527.5 71.5 32.2 2645.3 8684.2 76.6 35.4 2679.4
Weekend day (Saturday & Sunday)
One-day food intake data collected at personal interview, population weights applied, n=877.
86
Table 63: Comparison of weekday and weekend day intakes of energy, total fat, saturated fat and sodium 2 in South Australian children by SES
Socio-Economic Status (SES) 1st quartile (highest SES) 4th quartile (lowest SES)
Type of Day
Nutrient Energy including fermentable fibre (kJ) Total fat (g) Saturated fat (g) Sodium (mg)
2nd quartile
3rd quartile
Total
8863.5 73.4 33.8 2672.1 9791.5 88.4 41.0 2778.8
8054.5 66.7 29.9 2622.7 8641.6 77.6 36.0 2736.7
8676.9 72.4 32.1 2548.9 8592.2 74.2 33.4 2734.4
8400.8 72.3 32.5 2681.9 7412.4 62.8 30.1 2326.5
8502.9 71.3 32.1 2636.9 8684.2 76.6 35.4 2679.4
Week day (Monday to Friday)
Energy including fermentable fibre (kJ) Total fat (g) Saturated fat (g) Sodium (mg)
1 2
One-day food intake data collected at personal interview, population weights applied, n=874. SES as indicated by SEIFA
Table 64: Comparison of weekday and weekend day intakes of energy, total fat, saturated fat and sodium in South Australian children by SA health regions
SA Health Regions Central Northern Southern Adelaide
Type of Day
Nutrient Energy including fermentable fibre (kJ) Total fat (g) Saturated fat (g) Sodium (mg) Energy including fermentable fibre (kJ)
Country
Total
8525.6 71.8 31.9 2671.6 8652.8 73.9 34.4 2836.4
8616.0 71.2 32.2 2630.4 9262.2 82.1 38.2 2698.5
8359.1 71.0 32.3 2606.8 8161.1 73.3 33.3 2549.6
8502.9 71.3 32.1 2636.9 8684.2 76.6 35.4 2679.4
Weekday (Monday to Friday)
Total fat (g) Saturated fat (g) Sodium (mg)
One-day food intake data collected at personal interview, population weights applied, n=874.
87
12 Weight Status, Physical Activity and Screen Time

Weight status whether children are classified as obese, overweight, normal or underweight would be expected to impact on how they use their time, however, data gathered from simpler questionnaire methods have proved inconsistent. Some studies suggest that overweight and obese children are less active than normal weight children, others find no differences. There are similar contradictory findings in relation to screen time. In this section, we look at the relationship between weight status, using the criteria of Cole, et al. (2007), and various aspects of use of time. All values have been adjusted for age and gender.
Physical Activity
There were significant differences in the number of steps children of different weight categories took each day, with obese children taking significantly fewer steps. There are similar trends in other aspects of physical activity (MVPA, sport, free play), although these do not reach statistical significance. Table 65 shows differences in physical activity patterns.
Table 65: Mean number of steps per day and mean time (minutes/day) spent in MVPA, sport and free play for South Australian children of different weight categories
Obese Pedometer steps/day1 MVPA (minutes/day) Sport (minutes/day) Play (minutes/day)
1
Overweight
Normal
Underweight
10,058 89 29 44
11,169 112 48 56
11,379 107 47 58
10,477 126 51 76
= p < 0.05
Screen Time
There were significant differences in screen time across weight status categories. Obese children watched more television and accumulated more screen time than non-obese children and their overall energy expenditure was much lower. Table 66 shows differences in screen time patterns.
Table 66: Mean time (minutes/day) spent in screen time, television and videogames, and mean PAL for South Australian children of different weight categories
Obese Screen time (minutes/day)1 TV (minutes/day) 1 Videogames (minutes/day) PAL (METs)**
1
Overweight
Normal
Underweight
329 216 56 1.51
251 164 61 1.65
247 171 48 1.63
216 118 45 1.66
p < 0.10
88
13 Conclusion and Recommendations

Weight Status
The proportion of children and adolescents classified as overweight or obese remains unacceptably high. Combining the results from this survey with those from other surveys since 1985, there has been no increase in the prevalence of childhood overweight and obesity over the last ten years. The highest prevalence rates were found in teenage girls, and in children from the lowest SES quartile. Recommendations
> Continue to monitor childrens weight status, given the surprising plateau in overweight and obesity. > Interventions specifically targeting teenage girls, low SES groups, and one-parent families with one
or two children should be encouraged.
Diet
Many South Australian children, especially those in the older age group, are not meeting estimated requirements for micronutrients known to be important for bone health. Likewise, fruit and vegetable consumption is well below recommendations, particularly when energy dense juices and potato (mostly prepared using high fat methods) are removed from the analyses. Intakes of saturated fat, sugars and sodium tended to be higher than recommendations in this sample of South Australian children. Recommendations
> Continue to support public health interventions for improvement of childrens diet > Some key areas of focus are justified by the findings of this report, including families of lower SES;
older children, especially girls 14-16 years; consumption and increase in intakes of fruit and vegetable and dietary sources of calcium.
Physical Activity
Overall, most children met the Commonwealths physical activity recommendation of at least 60 minutes MVPA each day. The group with the lowest levels of MVPA were girls aged 14-16. These girls also had the lowest daily energy expenditure of any group. The main difference between boys and girls was in the amount of sport each group experienced. Recommendations
> Continue to monitor childrens participation in physical activity. > Interventions specifically targeting teenage girls involvement in sport should be encouraged. > Consideration should be given to increasing the 60 minute threshold for MVPA.
89
Screen Time
Very few children met the Commonwealth screen time recommendation of no more than 120 minutes exposure for entertainment purposes each day. The group with the highest levels of screen time were 12-14 year old boys. Children from low SES households and obese children had much higher levels of screen time, and screen time was much higher on holidays as opposed to weekends and school days. Levels of screen time in South Australian children were a little higher than the national average. The high level of screen time in this survey was one of the most striking findings. Recommendations
> Reduction in screen time, replacement of screen time with physical activity, and perhaps modifying
screen time to make it more active should be research and policy priorities.
> Tips on how to replace screen time with activity, especially on holidays, should be developed.
Sleep
There was strong evidence of inadequate sleep in older adolescents. By the age of 16, the gap between school day and non-school day had increased to more than two hours per night. This suggests that young people are under-sleeping on school days and catching up on non-school days. Low sleep duration was associated with a greater risk of overweight and obesity. Recommendations
> >
Develop age-specific sleep guidelines Encourage programmes to foster good sleep habits.
90
14 References
Ashwell, M (2005), Waist to height ratio and the Ashwell shape chart could predict the health risks of obesity in adults and children in all ethnic groups, Nutrition & Food Science, vol.35, no.5, pp.359-364. Australian Bureau of Statistics (2003), Household Telephone Connections, Queensland, Catalogue No 8159.3, ABS, Canberra Australian Bureau of Statistics (1998), National Nutrition Survey Nutrient Intakes and Physical Measurements Australia 1995, Catalogue No 4805.0, ABS, Canberra Australian Bureau of Statistics (2006), Census of Population and Housing Australia (Australia), Catalogue No 2068.0 8 February 2006 Census Tables, viewed 11 June 2008, <http://abs.gov.au/websitedbs/D3310114.nsf/home/Census+data> Australian Communications and Media Authority (2008), Telecommunications Today, Report 5: Consumer choice and preference in adopting services, Commonwealth of Australia Cole, TJ, Flegal, KM, Nicholls, DF, et al. (2007), Body mass index cut-offs to define thinness in children and adolescents [published online ahead of print Jun 25, 2007]. British Medical Journal, 335:194. doi:10.1136/bmj.39238.39444.55. Department of Community Services and Health (1988), National dietary survey of schoolchildren (10 15 years): 1985 No. 1 Foods consumed, AGPS, Canberra Department of Community Services and Health (1989), National dietary survey of schoolchildren (10 15 years): 1985 No. 2 Nutrient Intakes, AGPS, Canberra Department of Health and Ageing (2004a), Australias Physical Activity Recommendations for 5-12 year olds, Commonwealth of Australia Department of Health and Ageing (2004b), Australias Physical Activity Recommendations for 12-18 year olds, Commonwealth of Australia Department of Health and Ageing (2008), National Childrens Nutrition and Physical Activity Survey Users Guide 2007, AGPS, Canberra. Dollman, J, Norton, K & Norton, L (2005), Evidence for secular trends in childrens physical activity behaviour, British Journal of Sports Medicine, vol. 39, pp. 892-897. Dollman, J & Olds, TS (2006), Secular changes in fatness and fat distribution in Australian children matched for body size, International Journal of Pediatric Obesity, vol.1, no.2, pp. 109-113. Glover, J, Hetzel, D, Glover, L, Tennant, S & Page, A (2006), A Social Health Atlas of South Australia (Third Edition), Adelaide, Public Health Information Development Unit, The University of Adelaide. Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, Prentice AM. Critical evaluation of energy intake data using fundamental principles of energy physiology. 1. Derivation of cut-off values to identify under-recording. European Journal of Clinical Nutrition 1991; 45: 569 581 Mackerras, D & Rutishauser, I (2005), 24-Hour national dietary survey data: how do we interpret them most effectively?, Public Health Nutrition, vol.8, no.6, pp. 657-665. Ministry of Health (MOH) (2003), NZ Food:NZ Children. Key results of the 2002 National Nutrition Survey. Wellington: Ministry of Health. National Health and Medical Research Council (2003), Food for Health. Dietary Guidelines for children and adolescents in Australia. Canberra: Commonwealth of Australia. National Health and Medical Research Council (2005), Nutrient Reference Values for Australia and New Zealand, AGPS Canberra:NHMRC.
91
Olds, T, Ridley, K, Wake, M, Hesketh, K, Waters, E, Patton, G. & Williams, J (2007), How should activity guidelines for young people be operationalised?, International Journal of Behavioral Nutrition and Physical Activity, 4: 43 doi:10.1186/1479-5868-4-4. Presidents Council on Physical Fitness and Sport (2002), The Presidential Active Lifestyle Award (PALA). Washington, DC: PCPFS. Ridley, K, & Olds, T (2008), Assigning energy costs to activities in children: a review and synthesis, Medicine and Science in Sports and Exercise (accepted for publication). Ridley, K, Olds, T, & Hill, A (2006), The Multimedia Activity Recall for Children and Adolescents: development and evaluation, International Journal of Behavioral Nutrition and Physical Activity, 3:10 doi:10.1186/1479-5868-3-10. Smith, A, Kellett, E, Schmerlaib, Y (1998), Australian Guide to Healthy Eating. Canberra: Department of Health and Family Services. Tudor-Locke, C, Pangrazi, RP, Corbin, CP, Rutherford, WJ, Vincent, SD, Raustorp, A, Tomson, LM, & Cuddihy, TF (2004), BMI-referenced standards for recommended pedometer-determined steps/day for children, Preventive Medicine, vol.38, no.6, pp. 857-864.
92
For more information

Health Promotion Branch SA Health Citi Centre Building 11 Hindmarsh Square Adelaide SA 5000 Telephone: 08 8226 6329 www.health.sa.gov.au
Non-English speaking: for information in languages other than
English, call the interpreting and Translating Centre and ask them
to call The Department of Health.
This service is available at no cost to you, contact (08) 8226 1990.
Department of Health, Government of South Australia.

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Printed December 2008.

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2007 National Australian

South Australian Findings

1,2,3 1,2,3 1 1,2,3

University of South Australia

Commonwealth Scientific and Industrial Research Organisation (CSIRO)

I-view Pty Ltd

The members of the Technical Reference Group were:

The Food Composition Team prepared the food composition database

The members of the Food Composition Team were:

Food Standards Australia and New Zealand (FSANZ)

Therapeutic Goods Administration (TGA)

Executive Summary Overview

children (2-3 years)

South Australian children.

for most nutrients, without the need to take additional supplements 10

multivitamin and or mineral supplements

little energy consumed between the hours of 22:00 and 06:00

Height and Weight

Linking Nutrition, Activity and Body Size

South Australian Data Versus National Data

accumulating 28 minutes more screen time than Australian children in general.

(g) than children from families of lower SES.

and age of siblings, marriage status)

expenditure was lower

children on a school day

for all age groups

with increasing SES.

2.1 Sample Design

2.2 Contacting households

2.3 Recruiting Participants

Table 2: Recruitment of South Australian participants through RDD Number of households

2,671 1,081 1,219 53 245 63 10 877

5.2 0.8 71.9

2.4 Survey Methodology

CATI Not Complet e 5 4 6 5 7 4 0 31

123 125 156 145 151 139 93 932

Food and Nutrients

Comparison with Food Guidelines and Dietary Recommendations

Food Habits and Other Questions

Comparison with Physical Activity Guidelines

2.5 Survey Methodology Issues

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

Caregiver 1 (n) 163 54 10 592 143

Caregiver 2 (n) 156 52 7 549 -

Caregivers in SA survey (%) 18.5 6.1 1.0 66.2 15.3

Includes up to Year 12 and Certificate III and IV

Children (n) 50 50 17 218

Children in SA survey (%) 5.7

5.7 1.9 24.9

3.4 Socio-Economic Status

quartile (%) 25.5 10.4 18.1

3 quartile (%) 35.1 30.9 73.0

4 quartile (%) 30.1 7.6 8.2

Food and Nutrients

4.1 Food and Drinks

other age group

children (2-3 years)

other age groups

664 136 72 8 7 162 7 67 426 21 23 1 17 100 4 6 17 12 0 4 3 20

998 185 115 9 10 173 8 88 327 3 15 2 22 93 11 16 15 28 0 2 4 0

1357 196 168 8 5 150 8 109 442 2 24 3 29 205 8 13 24 29 0 5 5 1

1827 286 219 9 15 117 10 198 435 0 33 5 51 240 12 16 17 25 0 5 5 0

668 140 47 6 7 170 2 63 427 18 12 2 10 101 14 3 10 10 0 0 4 10

870 139 98 7 12 170 6 77 291 22 13 1 16 112 4 8 20 26 0 3 3 2