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1 From the School of Public Health, Curtin University, Perth, Australia, and the Office of Aboriginal Health, Health Department of Western Australia, Perth, Australia.
2 Presented at the symposium Fat Intake During Childhood, held in Houston, June 8–9, 1998. 3 The views expressed in this article are the author's own and do not necessarily reflect the official policies of the Health Department of Western Australia. 4 Address reprint requests to M Gracey, Health Department of Western Australia, 189 Royal Street, Perth, WA 6004, Australia. E-mail: michael.gracey{at}health.wa.gov.au.
ABSTRACT
Before permanent European colonization 2 centuries ago, Australian Aborigines were preagriculturalist hunter-gatherers who had adapted extraordinarily well to life in a variety of habitats ranging from tropical forests, coastal and riverine environments, savannah woodlands, and grasslands to harsh, hot, and very arid deserts. Colonization had serious negative effects on Aboriginal society, well-being, and health, so much so that Aborigines are now the unhealthiest subgroup in Australian society. The change from active and lean hunter-gatherers to a more sedentary group of people whose diet is now predominantly Westernized has had, and continues to have, serious effects on their health, particularly in relation to cardiovascular disease and type 2 diabetes mellitus, which are highly prevalent among Aborigines. The contemporary diets of Australian Aborigines are energy rich and contain high amounts of fat, refined carbohydrates, and salt; they are also poor in fiber and certain nutrients, including folate, retinol, and vitamin E and other vitamins. Risks of development of cardiovascular disease and type 2 diabetes in this population probably develop during late childhood and adolescence. This indicates a need for greater emphasis on health promotion and disease prevention than at present and a need to plan these in culturally sensitive, secure, and appropriate ways. Most information about Aboriginal diets is anecdotal or semiquantitative. More effort needs to be invested in studies that more clearly and precisely define dietary patterns in Aboriginal people, especially children, and how these patterns influence their growth, nutritional status, and health, prospectively.
Key Words: Australian Aborigines • nutrition • obesity • malnutrition • diet • infections
INTRODUCTION
The Aboriginal people of Australia are unique ecologically, historically, culturally and, in some ways, biologically (1, 2). Although there are many other "indigenous" or "aboriginal" populations throughout the world, this article refers to the aboriginal people of Australia as Aborigines or Aboriginals, which is a widely accepted convention.
These people have lived in Australia for tens of thousands of years (1, 2), perhaps for 100000 y (3). In prehistoric times, remote northwest Australia was separated from the outer eastern islands of Indonesia, and the northern tip of Queensland in eastern Australia (now Cape York) was separated by land bridges and relatively short sea voyages (50–100 km) from island to island, then on to the undiscovered "Great South Land" or "Terra Australis." The Aborigines may have come and settled in this vast land mass (7.4 million km2) from the north, then were separated from the rest of humanity when the end of the last Ice Age caused an elevation of the seas and isolated them from outside contact; Australia was then a huge island separated by water from countries to the north, and its mainland was cut off by sea from today's southern state of Tasmania.
Exceptions to this remarkable isolation were regular visits over centuries by traditional Asian fishermen who came to the northwest coast and reefs for their rich fishing grounds and regular contact across the Torres Strait, between its islands and northern Queensland and Papua New Guinea. Dutch and French explorers and seafarers then made irregular and temporary contact with the west coast of Australia during the 17th and 18th centuries, then permanent European colonization was established by the British in 1788 on the east coast by means of a penal colony in what is now the city of Sydney.
Aboriginal life before European colonization
There may have been 250000–300000 Aborigines in Australia before European colonization just over 200 y ago (4); obviously, little is known about their health before European contact (1). A study of 200 mostly nomadic Aboriginal men, widely distributed in remote parts of Australia in the late 1960s to early 1970s, showed that their average height was 168.4 cm and that their average weight was 57.8 kg (5). A group of Aboriginal people newly emerged from the Great Sandy Desert in Western Australia 30 y ago were described as "slimly built, sinewy feather-weights" whose average height was 167.1 cm; only 3 of the 22 men examined weighed >56 kg (6). Over their long isolation from the outside, Aborigines adapted well to their various living environments (eg, coastal areas, riverine areas, tropical forests, savannah woodlands, temperate timbered and grassed areas in the south and on the east cost, and harsh, hot, and extremely dry deserts in central Australia). These people became the world's largest and most successful group of hunter-gatherers. They were preagriculturalists, had no domesticated animals (except dingoes, or native dogs), and, although they were able to make fire for cooking and used fires to flush out animals for hunting and to clear grasslands, did not have metal or ceramic cooking or carrying utensils. They did, however, use fish traps and simple dams to farm eels and fish (2).
It is important to appreciate the vast diversity of Aborigines before European contact. They lived mostly in widely dispersed, small groups that gathered regularly by the hundreds for games, fights, corroborees (ceremonial dances), initiations, and exchange of news. They also developed finer things of life, including storytelling (no written languages were developed), painting, carving, and body painting that became part of their ceremonial dancing (2). The diversity of Australia's Aborigines is exemplified by the vast number of phila of complex Aboriginal languages, which are not simply dialects. Many of these languages are still alive, and for many older Aborigines English is a second or third language, or is not comprehended at all.
Aboriginal food and diets before European settlement
The Aborigines' food supplies before contact depended on the locality and season; in the interior of the country, food supplies were often scarce and the unpredictable water supplies affected survival. Animal foods that were hunted included mammals (eg, kangaroos, wallabies, possums, bandicoots, and bats), reptiles (eg, crocodiles, snakes, turtles, goannas, and other lizards), birds (eg, emus, parrots, bush turkeys, and ducks), and fish in rivers and along the coast. The eggs of many of these creatures were important. The men hunted large animals like kangaroos and emus. Insects such as honey ants and wild bees provided honey that was and still is popular in remote areas—this was an important carbohydrate source. Witchetty grubs are high in fat and have a composition similar to that of olive oil—these grubs are eaten raw or are lightly cooked in the ashes of a small open fire. The fatty parts of animals such as goannas were traditionally very popular after being cooked whole on red hot coals on the ground and turned occasionally so that the skin could be cooked; in northern Australia, food may be steamed while wrapped in leaves (or, today, in metal foil).
The seashore and river estuaries provided not only fish, sharks, stingrays, and dugongs, but also crabs, oysters, mussels, other shellfish, and snails. Inland waters were very important for fish, crustaceans, turtles, snakes, and birds and for plants such as water lilies.
The rich supply of plants the Aborigines ate included wild plums, apples, peaches, berries, figs, grapes, oranges, and desert bananas; the wild plum, Terminalia fernandiana, is the richest known natural source of vitamin C. There are also bush tomatoes and native vegetables such as carrots, onions, and bush potatoes. A variety of yams exists in different environments from the coast to the deserts. There is also a large range of nuts indigenous to Australia, including the macadamia nut and local chestnuts, walnuts, and almonds; these are most plentiful in Queensland (7). Seeds from bushes, such as mulga and acacia, and from grasses were painstakingly prepared and ground into a paste from which damper (a type of bread) was prepared by slow cooking or baking by using the coals of an open fire and eaten with other foods (8). Damper, prepared these days with highly refined flour, is still used widely by Aboriginal people and is sometimes spread with butter, margarine, jams, and other sweet spreads.
In traditional times, hunting for animals that were available irregularly and that had mostly lean meats was time-consuming and was hard work; gathering plants that were rich in vitamins, potassium, magnesium, and calcium but low in sodium, as well as harvesting, gathering, and hunting other low-energy foods and small animals, was also time- and effort-intensive and was done mainly by women and children. This subsistence hunter-gatherer lifestyle was very tough, and we can only speculate as to the health and fitness of Aborigines before colonization.
Effects of European colonization
Permanent European colonization of Australia was followed by a traumatic 2 centuries for Aborigines who are now seriously disadvantaged both socioeconomically and in terms of their health and well-being (9). These areas of disadvantage cover such measures as educational attainments, unemployment, income, housing and hygiene standards, hospitalization rates, prevalence of infectious and degenerative diseases, and shortened life expectancy at birth (10).
It is generally recognized that these disadvantages stem from being a so-called fourth-world community, ie, being colonized or being a minority in relation to the dominant encompassing state. It was not until the late 1960s that Aborigines were granted citizenship rights; this was followed by a very rapid change in living circumstances and food sources for Aboriginal people. At that time, Aborigines in remote areas tended to live in makeshift camps and were provided by religious missions or government agencies with bread, tea, milk or full-cream dried milk, refined flour, and refined white sugar. Their diets in these camps and in government "feeding stations" were lacking in fresh fruit and vegetables and were likely to be deficient in vitamin A, vitamin C, folate, and calcium (11).
Aboriginal child health since the late 1960s
In the late 1960s and early 1970s it was reported that malnutrition was prevalent in Aboriginal infants and young children, often in association with gastroenteritis, respiratory tract infections, and other infections, and that the infant and young child mortality rates for Aborigines were much higher than for other Australians (12, 13).
Undoubtedly, much of this was due to poor housing, inadequate hygiene, and environmental contamination (14) but it was probably compounded by the synergistic interactions of infection and malnutrition (15). Unsatisfactory weaning practices are likely to have played an important role in this.
In keeping with data from other industrialized countries, breast-feeding in Australia is less common in lower socioeconomic groups in which child health may already be compromised by poverty and educational disadvantage (16). This is certainly the case for Aboriginal people who, generally, are seriously socioeconomically disadvantaged in relation to the rest of the Australian population. A joint survey of infant feeding practices in Western Australia and Tasmania found that in Western Australia 100% of women in social class A (professional and academic) breast-fed their infants at hospital discharge, whereas 81% of those in social class D (unskilled) did so; the corresponding figures for Tasmania were 100% and 64%, respectively (17). At age 12 mo, 35% of infants of mothers in social class A were still being breast-fed compared with only 9% of those in social class D in Western Australia. The figures for Tasmania were 50% and 10%, respectively (17). Similar findings were made in the state of Victoria in the early 1990s (18).
There is a lack of hard data about breast-feeding practices among Australian Aborigines. The maintenance of a traditional lifestyle appears to be related to the prevalence of breast-feeding, but the determination of recent breast-feeding ranges is hampered by inadequate information. A study in Western Australia in the early 1980s found that the prevalence of breast-feeding before the age of 9 mo in remote tribal areas was 100%. Among Aboriginals living near big country towns the prevalence was 66% at 6 mo of age, but <50% at 6 mo of age for those in the urbanized southwestern area of Western Australia (19).
Traditionally, Aboriginal mothers breast-fed their babies frequently and exclusively for 6 mo and continued to breast-feed for up to 4 y (20). Traditionally oriented Aboriginal mothers I have worked with in remote areas often breast-feed for 2 y, but weaning is often well established by then. Most of Australia's Aboriginal population now live in cities, regional centers, or country towns and have rapidly become very urbanized. Among 127 Aboriginal mothers studied in Perth in the early 1980s, 82% initiated breast-feeding but only 50% were still breast-feeding at 12 wk, although 19% were still breast-feeding at 12 mo, but only 6% were giving breast milk as the sole milk feed (21). Many of the mothers used unmodified cow milk or soy milks. In Melbourne recently, 84.5% of mothers commenced breast-feeding but 8.6% stopped within a week and 6% more stopped within the first month; only 50% of the babies were being breast-fed at age 3 mo (20). This earlier cessation of breast-feeding may have important long-term health implications as it does in Pima Indians (22). Pima subjects studied at ages 10–39 y were relatively heavier if they were exclusively bottle-fed in the first 2 mo of life whereas exclusively breast-fed subjects had significantly higher rates of type 2 diabetes mellitus.
There is little documented quantitative information about current dietary habits in Australian Aboriginal children and adolescents. The estimated dietary energy intakes of 169 Aboriginal children aged 7.8–13.1 y and living in the far northwest of Australia, measured by a 24-h dietary recall method, was 5308 kJ, compared with 6795 kJ in 70 non-Aboriginal children of the same ages living in Adelaide, South Australia (23). In the same study, intakes of fat (37.0 compared with 69.5 g), protein (42.9 compared with 50.6 g), carbohydrate (189 compared with 203 g), and fiber (7.63 compared with 13.8 g) were substantially lower than in non-Aboriginal children. Another 24-h dietary recall study in remote parts of the Kimberley region in the tropical north of Western Australia used a very experienced nutritionist and community health nurse working with local Aboriginal health workers to estimate dietary patterns and some nutrient intakes in Aboriginal infants and young children in the first 2 y of life (24). Mean fat intakes were 11.6 g at age 0–6 mo, 12.4 g at age 6–12 mo, 38.8 g at age 12–18 mo, and 51.9 g at age 18–24 mo; intakes of energy and fat and other nutrients were consistently lower at times when social security support was very limited or unavailable.
Aboriginal child nutrition and later health consequences?
The nutritional status of Aboriginal infants is characterized by prevalent low birth weight, followed by "catch-up" growth for a few months, which is then followed by a retardation of weight gain and linear growth for at least the first 2 or 3 y (25) (Figure 1). Little systematic, longitudinal information is available about growth of Aboriginal children after 5 y through to adolescence. However, it is now well known that obesity, cardiovascular disease (CVD), and diabetes mellitus are very prevalent in Aboriginal adults (26). CVD, particularly ischemic heart disease, is now the principal cause of death among Aboriginal people and at 40 y of age Aborigines are 10 times more likely than other Australians to die from these conditions (27, 28). Hypertension is common and appears to be related to alcohol consumption patterns and obesity (29), which has a characteristically central distribution in males and females (30) and is often well established by teenage years in Aboriginal girls who have adopted a Westernized lifestyle. This may be an important feature of acculturation. A study of adiposity and fat distribution in 425 Yolngu, a group of Aboriginal people living in several communities representing a wide range of lifestyles in northeast Arnhem Land (in the "top end" of the Northern Territory), compared the body mass index (BMI; in kg/m2) measurements of these people with BMI standards developed for people of European descent. Most of the Yolngu were lean and the prevalence of obesity was considerably lower than in other Australian groups, including Aboriginal and non-Aboriginal people (31). The relation between aging and obesity among the Yolngu resembled that for other tradition-orientated Aborigines, as well as for other groups of indigenous people. Namely, the males maintained their weight into old age whereas the females tended to lose body fat with age. Both males and females had a significantly more central distribution of subcutaneous fat than did their non-Aboriginal counterparts.
FIGURE 1. . Weight-for-age z scores from birth to 5 y of Aboriginal children from far northwest Australia from the late 1960s to the early 1990s (25).
A cross-sectional survey of 353 Aborigines aged >15 y in a community in central Australia with a long history of acculturation showed that dyslipoproteinemia, impaired glucose tolerance, hyperinsulinemia, and diabetes mellitus were prevalent (32). More than 5% of subjects aged <35 y and 29.6% of those aged >35 y had diabetes. Impaired glucose tolerance was also common in the older subjects (14.8% compared with 4.7%). A large insulin response, with wide individual variation, occurred after oral glucose loading. Hyperinsulinemia was strongly associated with impaired glucose tolerance, being overweight or obese, and having high waist-to-hip ratios, plasma cholesterol concentrations, and triacylglycerol concentrations. The authors commented on the need for earlier intervention programs (eg, during adolescence) to reduce the prevalence of diabetes, which is now endemic in many Aboriginal communities and epidemic in some. Hyperinsulinemia and obesity have been shown to be more common in Aboriginal people living in contact with Europeans for 150 y in southeastern Australia; comparisons with national data suggest a gradient in the prevalence of obesity, which is lowest in urban areas, higher in the country, and higher still among Aborigines, ie, inversely related to socioeconomic status (33).
It seems that the development of impaired glucose tolerance, hyperlipidemia, and hyperinsulinemia can be rapid in previously traditional Aboriginal people. In a very remote community living on the Timor Sea coast in far northwest Australia, the change from a traditional diet (including plentiful seafood), supplemented by a mission fruit and vegetable garden up until the 1970s, then followed by the introduction of store-bought foods led to an increased prevalence of these health problems (26, 34). Between 1979 and 1990 the prevalence of hypercholesterolemia increased in 15–35-y-old males (n = 29) from 0 to 17.2% and in females of the same age (n = 46) from 5% to 10.9%; prevalence rates of elevated plasma triacylglycerol in the whole community aged 15 y (n = 120) increased from 13.6% to 24.2%. Foods available in Aboriginal community food stores are usually limited and the diets are monotonous; they often lack fresh fruit and vegetables and include large amounts of refined flour, sugar, sliced white bread, sweetened soft drinks, confectionery, fried take-out food, and fatty cuts of meats, and cigarettes are popular purchases (34). Our survey of remote Aboriginal food stores in Western Australia and their nutritional implications (34) showed a substantial difference in BMIs between the ages of 5–9 y and 10–17 y, which was more evident among girls (Table 1).
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TABLE 1. Mean BMIs in Aboriginal children and adolescents in remote communities in Western Australia1
Dietary and lifestyle changes to prevent CVD and diabetes
From the perspectives of health promotion and disease prevention, it is vitally important to know when changes in lifestyle from active hunter-gatherers to a less-energetic, sedentary way of life, combined with a shift from traditional to modern, Westernized diets, might be having their health effects on Aboriginal children and adolescents. This may be occurring much earlier than is generally recognized. In Aboriginal children and adolescents living in the Great Sandy Desert in Western Australia, hyperinsulinemia was evident in apparently healthy subjects as young as 11 y. The proportion of these 100 children and adolescents who were overweight increased from 2.7% in 1989 to 17.6% 5 y later (35). At a mean age of 18.5 y, 8.1% of the population had impaired glucose tolerance, 2.7% had diabetes, and 21.6% had elevated plasma cholesterol concentrations. Previous work had shown that temporary reversion to a traditional diet and more active patterns of energy expenditure in Aborigines with diabetes leads to a marked improvement in carbohydrate and lipid metabolism and in weight loss (36). Earlier interventions to prevent type 2 diabetes and CVD in Aboriginal children and adolescents should therefore take higher priority than previously.
There are relatively few published quantitative data about what Aborigines are eating and drinking today. This is partly because of the major problems in the reliability of standard dietary assessment methods when studying these people (37). Techniques such as weighed-food records, 24-h dietary recall, "usual" dietary histories, and food-frequency records or questionnaires all have serious limitations. For these reasons, Lee et al (38) developed a food store–turnover method that gives a reasonable assessment of apparent per capita consumption in discrete, isolated communities that rely heavily on their own food stores for their food supplies. Limitations include the lack of information about waste, consumption of food by animals (eg, dogs), bulk storage, very slow changes of store stock, dietary intakes from sources other than the store, and lack of information about food consumption by individuals and in different age groups (38).
Studies from the Northern Territory that used this method showed that intakes of energy, sugars, and fat were excessive, whereas the apparent intakes of dietary fiber and several nutrients including folate, calcium, retinol, carotene, riboflavin, and vitamin E were low. White sugar, flour, bread, and meat provided >50% of apparent dietary energy (38). Fried and heavily salted snack foods and take-out food like fried chicken (normally with the skin), French fries, meat pies, and crumbed sausages were very popular. Rates of consumption of sweetened carbonated beverages were very high and confectionery, chocolate, and ice pops or ice cream are usually consumed by children, often in large amounts and at a rapid rate because of high ambient temperatures, lack of refrigeration, and the common cultural practice of immediate consumption.
Some information about dietary fat intakes in other Australian children
The 1985 National Dietary Survey of Schoolchildren (aged 10–15 y) showed that the following were the major sources of dietary fats for Australian boys and girls (39; Table 2): milk and milk products (26.2 g for boys, 23.8 g for girls), meat and meat products (23.7 and 22.2 g), fats (16.4 and 17.0 g), cereals and cereal products (14.2 and 15.2 g), vegetables (6.4 and 6.3 g), snack foods (3.8 and 4.9 g), confectionery (2.6 and 3.3 g), eggs (2.2 g and 2.3 g), nuts and seeds (1.8 and 2.0 g), condiments and soups (1.4 and 1.6 g), and all other foods (1.3 and 1.4 g).
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TABLE 2. Top 10 sources of fat in the diets of 12-y-old Australian children1
The top 10 sources of fat for 12-y-old boys and girls are shown in Table 2; more-detailed dietary sources of fat in 10–15-y-olds is given in Table 3. Fat intakes (in grams) of boys and girls from 10 through 15 y are shown in Table 4.
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TABLE 3. Contribution of food sources to fat intakes by 10–15-y-old Australian children
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TABLE 4. Fat intake of Australian children1
The mean daily fat intake by Australian boys aged 15 (115 g) was 47% greater than that of boys aged 10 y (78 g), whereas that of 15-y-old girls (75 g) was only 10% greater than that of 10-y-old girls (68 g). The range of fat intakes in the Australian Schoolchildren's National Dietary Survey was 36% (for girls aged 10 y) to 37% of dietary energy (for boys aged 11 y and girls aged 11 and 12 y). About 35% of dietary energy intake was provided from fat in a group of 8-y-old children studied in Adelaide, South Australia (40); the mean fat intakes expressed as proportions of dietary energy intakes in 11- and 12-y-old children in Western Australia were 36–37% for boys and 37–38% for girls (41). The mean percentage contributions of total fat to dietary intake in children in the 1995 National Nutrition Survey are shown in Table 5 (42).
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TABLE 5. Mean contribution of total fat to energy intakes in Australian children
Fatty acids
Children in the Australian National Dietary Survey of Schoolchildren consumed a higher proportion of their fat as saturated fat (range: 42–44%) compared with the 1983 National Dietary Survey of Adults (range: 39–41%); values for polyunsaturated fat ranged from 13% to 14% for children, compared with 14–16% in the national adult survey (43).
There are some more recent data about dietary fat intakes from 2-d diet records of schoolchildren in Perth, Western Australia, that give a more detailed picture of these patterns in the general Australian population. In 1990, 16% of 12-y-olds were deriving <33% of energy from fat (the national dietary guideline at that time); by 1992 this percentage had risen to 50%. In 1015 children aged 10–12 y who were studied in 1991, mean proportions of dietary energy from total fat were 33.2% in boys and 33.1% in girls; the national guideline was 30% of energy intake from fat but 15% of boys and 10% of girls were deriving >40% of dietary energy from fat (44). Mean saturated fat intakes were 13.7% in boys and 13.9% in girls (the national guideline of 10% was exceeded by 90% of boys and girls). Mean intakes of polyunsaturated fat (national guideline, 10%) were 5.1% in boys and 4.9% in girls; these intakes were <5% in 58% of boys and girls. Average monounsaturated fat intakes (national guideline, 10%) were 11.9% in boys and 11.8% in girls; >78% of boys and girls were consuming more than was recommended by the guidelines. In the same study, 32% of boys and 34% of girls had total plasma cholesterol concentrations >4.5 mmol/L.
A 1993 study of 850 10–12-y-olds showed mean total fat intakes, expressed as proportions of dietary energy, of 33.6% in boys and 33.5% in girls; 73.1% of boys and 69.9% of girls obtained >30% of their dietary energy from fat; 12% of boys and 14% of girls obtained >40% of their dietary energy from fat (45). In the same study, 31.5% of boys and 38.1% of girls had cholesterol concentrations >4.5 mmol/L. In 10–12-y-olds in the same study, increased fat intake was associated with tobacco smoking among parents: mean saturated fat intake in children was 14.9% if neither parent smoked and 16.7% if both parents smoked; total fat intake was 32.9% if neither parent smoked and 35.6% if both parents smoked. Fat intakes were also higher in parents who smoked than in those who did not smoke (46). A study of clustering of CVD risk factors in Australian adolescents in relation to dietary patterns showed that, in >600 adolescents aged 15 y, 65.7% of the boys and 66.9% of the girls consumed >33% of their dietary energy as fat; 95% of the boys and 94% of the girls had >10% saturated fat in the diet, 81% of the boys and 79.3% of the girls had >10% monounsaturated fat, and only 1.7% of the boys and 2.6% of the girls had >10% polyunsaturated fat (47). Increased fat intake was associated with an increased risk of CVD; fat intake was found to be associated with socioeconomic status in girls but not in boys; those of lower socioeconomic status consumed 37.8% of total dietary energy as fat, compared with 35.2% in the higher socioeconomic group. In >500 adolescents aged 18 y, total fat intakes were similarly related to socioeconomic status (47).
Convenience foods and meat were the greatest sources of dietary fat (59% in boys, 53% in girls). Total dietary fat intakes were <30% of energy in 20% of the study sample and >40% of energy in 25% of the study sample; the saturated fat intake was <10% in 10% of subjects. Polyunsaturated fat intakes of >10% were found in <2% of the subjects and a ratio of polyunsaturated to saturated fat of 1 was found in <1% of subjects. Fat intakes were greater in male smokers (36.1% compared with 34.4% in non-smokers) with higher consumption of cakes, cookies, nuts (mainly as peanut butter), processed meats, and desserts (47, 48).
Regrettably, such detailed reports on dietary patterns and fat intakes in Aboriginal children and adolescents do not exist. This is particularly unfortunate because Aborigines are now becoming increasingly prone to CVD, which are now the number one cause of death and does not infrequently occur in the third and fourth decades of life in this population (27–29). This serious gap in knowledge limits appropriate preventive and remedial action. This requires urgent attention, and nutrition and the seriousness of nutrition-related diseases must be recognized as a key priority in Aboriginal health.
Suggestions and targets for fat intakes in Australian children and adolescents
The Australian Department of Health has adopted the following suggestions directed at reducing fat intakes in all Australian children (49):
Targets
The suggested guidelines for use in Australia are as follows. From birth to age 2 y, fat should account for 50% of energy intake in breast-fed and formula-fed infants; in non-breast-fed infants, infant formula, not cow milk, is preferable. Between the ages of 6 and 24 mo, the target is 40% of energy as dietary fat. The fat content of milk becomes less important with age because other foods that contribute fats and oils are consumed. However, skim milk (<0.5% fat) and reduced-fat milk (1.5–2.5% fat) should not be used in infants and children aged <2 y. From 2 to 5 y, carbohydrate intakes should increase gradually and a gradual reduction of dietary fat intake to 35–40% of energy consumed is the target; reduced-fat and skim milks are not recommended. From 5 to 14 y, 35% of energy should be consumed as fat, with no more than 10% of energy from saturated fat; this goal is consistent with maintenance of normal growth (50). During adolescence, 30% of energy should be consumed as fat, with no more than 10% of energy coming from saturated fat.
These suggestions and targets are compatible with other recommended dietary guidelines for Australian children and adolescents (51). In particular, these include the suggestion that children need appropriate food and physical activity to grow and develop normally; growth should be checked regularly. Finally, children should enjoy a wide variety of nutritious foods.
ACKNOWLEDGMENTS
I am grateful to the Commissioner of Health for permission to publish this article.
REFERENCES