A UK report has found most Brits gain adequate levels of iron, but warned that the elderly, small children, girls, some women and the poor may be susceptible to deficiencies and should consider iron supplementation among other measures. “While most people in the UK are iron replete, health professionals need to be alert to increased risk of iron deficiency anaemia in toddlers, girls and women of reproductive age (particularly those from low income groups) and some adults aged over 65 years,” wrote the Scientific Advisory Committee on Nutrition’s Committee on Medical Aspects of Food and Nutrition Policy (COMA).
“Those with symptoms suggesting iron deficiency anaemia should receive appropriate clinical assessment and advice, including dietary advice on how to increase their iron intakes and to consider use of iron supplements if required.” The report updated COMA’s 1998 finding that high levels of red meat consumption were linked to colorectal cancer and also investigated the effects of reduced iron-rich red meat consumption. COMA concluded that a, “healthy balanced diet, which includes a variety of foods containing iron” is the best way to attain, “adequate iron status”.
“Such an approach is more important than consuming iron-rich foods at the same time as foods/drinks that enhance iron absorption (e.g., fruit juice, meat) or not consuming iron rich foods with those that inhibit iron absorption (e.g., tea, coffee, milk),” the committee said.
On the issue or red meat consumption COMA found that reduced red meat consumption levels would not cause widespread iron deficiencies. “Adults with relatively high intakes of red and processed meat (around 90 g/day or more) should consider reducing their intakes. A reduction to the UK population average for adult consumers (70 g/day cooked weight) would have little impact on the proportion of the adult population with low iron intakes.”
Current UK guidelines state that 3.2 oz (90g) is a healthy daily portion of red meat, and that only those who eat more than 5oz (140g) need to cut back. However some research has challenged these levels. A 2005 European study found those who regularly eat more than 5.6oz (160g) of red meat daily increase their risk of contracting bowel cancer by a third. In 2007, the World Cancer Research Fund report in 2007 concluded that there was a link between red meat consumption and an increased risk of bowel cancer.
The COMA report follows research from the British Nutrition Foundation (BNF) which contradicts these recommendations
Eating a diet rich in omega-3 fatty acids appears to protect seniors against the onset of a serious eye disease known as age-related macular degeneration (AMD). Researchers did a fresh analysis of a one-year dietary survey conducted in the early 1990s. The poll involved nearly 2,400 seniors between the ages of 65 and 84 living in Maryland’s Eastern Shore region, where fish and shellfish are eaten routinely.
While participants in all groups, including controls, averaged at least one serving of fish or shellfish per week, those who had advanced AMD had consumed less fish and seafood containing omega-3 fatty acids. After their food intake was assessed, participants underwent eye examinations. About 450 had AMD, including 68 who had an advanced stage of the disease, which can lead to severe vision impairment or blindness. Prior evidence suggested that dietary zinc is similarly protective against AMD, so the researchers looked to see if zinc consumption from a diet of oysters and crabs reduced risk of AMD, but no such association was seen.
The researchers believe that the low dietary zinc levels relative to zinc supplements could account for the absence of such a link. However, they cautioned against people to start taking omega-3 supplements to protect against AMD based on this study because they are not sure that the above results have sufficient power to draw any conclusions. The correlation is important but larger studies with longer term follow-up are needed before being able to properly assess the impact.
Excessive intake of sugar-sweetened beverages like soft drinks and fruit juices that offer no nutritional value other than calories to the diet of teenagers can elevate their risk of heart disease in later life, claims a new study. According to health experts, there is growing evidence of the link between excess sugar consumption among youngsters and a number of health conditions such as obesity, hypertension, elevated triglycerides that are considered markers for heart disease. Lead author of the study, Jean Welsh, post-doctoral fellow at Emory University School of Medicine in Atlanta stated, “We need to be aware of sugar consumption. “It’s a significant contributor of calories to our diet and there are these associations that may prove to be very negative. “Sugar-sweetened soft drinks and sodas are the major contributor of added sugar and are a major source of calories without other important nutrients. “Parents and adolescents need to become aware of the amount of added sugar they are consuming and be aware that there may be some negative health implications if not now, then down the line.”
According to the American Heart Association (AHA) recommendations, a teenager who requires 2,200 calories may have an upper limit of 150 calories from added sugar while someone with an energy requirement of 1,800 calories per day should limit added sugar to 100 calories. However, the National Health and Nutrition Survey (NHANES) of 2,157 teenagers aged 12 to 18 years found that the average teenager consumes close to 500 calories added sugars each day. “Adolescents are eating 20 per cent of their daily calories in sugars that provide few if any other nutrients,” said Jean Welsh.
In order to get an insight into the impact of high sugar consumption in adolescence on the risk of cardiovascular disease in later life the researchers studied 646 teenagers. For the purpose of the study, they analyzed the 24-hour dietary recall by teens with data from the US Department of Agriculture on sugar content in foods. It was noted that the teens’ average daily consumption of added sugars was three to five times higher that the limit acceptable by the AHA.
The study found, that teens who consumed 30 percent or more of total calories from added sugars exhibited lower levels of HDL, or “good” cholesterol and higher levels of triglycerides and LDL or “bad” cholesterol, compared to those who ate less than 10 percent of added sugar. In addition, it was observed that obese and overweight teenagers who consumed more sugar also had the most insulin resistance.
Although the study hints at a possible association between added sugar intake and poor cholesterol profiles as well as other heart disease risk factors, researchers feel there is need for more research to substantiate the findings. Welsh stated, “We need controlled studies to really understand the role of added sugars in cardiovascular disease. But it is important to be aware of the added sugar in the foods we all eat.”
The study is published in the American Heart Association (AHA) journal ‘Circulation.’
About a third of some of the most common forms of cancer could be prevented through healthy diet, physical fitness, and limiting alcohol intake, the American Institute for Cancer Research and the World Cancer Research Fund say in a new report. About 7.6 million people die from cancer every year worldwide, and 12.7 million new cases are diagnosed. According to the Union for International Cancer Control, a third of cancer cases could be cured through early diagnosis and treatment and 30% to 40% could be prevented. About 340,000 cases of cancer could be prevented annually in the U.S. if more people started eating a varied and healthy diet, started a regimen of physical activity, limited alcohol intake, and maintained a healthy weight, the new report says.
“Physical activity is recommended for people of all ages as a means to reduce risks for certain types of cancers and other non-communicable diseases,” says Tim Armstrong, MD, of the World Health Organization, says in a news release. “In order to improve their health and prevent several diseases, adults should do at least 150 minutes moderate physical activity throughout the week. This can be achieved by simply walking 30 minutes five times per week or by cycling to work daily.”
To reduce cancer risk, people also should quit smoking, avoid excessive sun exposure, and protect themselves against cancer-causing infections.
Tim Byers, MD, MPH, of the Colorado School of Public Health, says scientists urge Americans “to make the simple lifestyle changes of eating healthy food, getting regular physical activity, and maintaining a healthy weight to reduce cancer risk.” The World Cancer Declaration outlines 11 targets it says could be achieved by 2020 to fight cancer. These goals include: significant drops in global tobacco use, obesity, and alcohol intake; universal vaccination programs for hepatitis B and human papilloma virus (HPV); universal availability of effective pain medication; and efforts to dispel misconceptions about cancer. The health organizations say in a detailed report that the most common cancers in the U.S. and Britain are of the breast, colon/rectum, lung, and prostate.
The American Institute for Cancer Research recommends the following cancer-prevention steps.
- Limit consumption of calorie-dense foods, particularly processed foods high in added sugar, low in fiber, or high in fat.
- Avoid sugary drinks.
- Eat more of a variety of vegetables, fruits, whole grains, and beans.
- Limit consumption of red meats such as beef, pork, and lamb, and avoid processed meats.
- Limit consumption of salty foods and foods processed with sodium.
- Dietary supplements for lowering cancer risk are not recommended.
- Be as lean as possible without becoming underweight.
- Be physically active for 30 minutes or more every day.
The study was carried out by researchers from University of Otago Medical School, New Zealand. Funding was provided by Genesis Oncology Trust, the Dean’s Bequest Funds of the Dunedin School of Medicine, the Gisborne East Coast Cancer Research Trust and the Director’s Cancer Research Trust. The research was published in the peer-reviewed American Journal of Epidemiology. This was a case-control study in New Zealand that compared a group of adults with bowel cancer, and a group without bowel cancer, and looked at whether they drank milk at school. School milk was freely available in most schools in New Zealand until 1967 when the government programme was stopped. Many schools in the Southland region stopped free milk as long ago as 1950.
Case-control studies are appropriate for looking at whether people with and without a disease have had a particular exposure (milk in this case). The difficulty is in accounting for all potential confounding factors, particularly other health and lifestyle factors, which could be related to both diet and bowel cancer risk, for example regular childhood milk consumption could be a reflection of a ‘healthy’ diet and other healthy lifestyle behaviours that may reduce risk of cancer. In addition, when examining such a specific dietary factor – ie milk consumed in school – it is difficult to account for all possible milk or other dairy products consumed outside of school.
In this case-control study, 562 adults (aged 30 to 69) with newly diagnosed bowel cancer were identified from the New Zealand Cancer Registry in 2007. For a control group, 571 age-matched adults without cancer were randomly selected from the electoral register. All participants were mailed a questionnaire that asked about any previous illness, use of aspirin or dietary supplements in childhood, participation in school milk programmes, other childhood milk consumption, childhood diet (including other milk and dairy), smoking, alcohol consumption prior to 25 years of age, screening tests for bowel cancer, family history of cancer, education and sociodemographic characteristics. Childhood weight and height were not questioned. For school milk consumption they were specifically asked:
- Whether they drank school milk
- How many half-pint bottles they drank a week
- What age they first drank school milk
- When they stopped drinking school milk
Statistical risk associations between school milk participation and cancer were calculated. The calculations took into account several risk factors for bowel cancer risk including age, sex, ethnicity and family history.
What were the basic results?
Data on school milk consumption was available for 552 cases and 569 controls. As expected, people who started school before 1967 were more likely to have had free school milk than those who began school after 1968. Seventy-eight percent of cases participated in the school milk programme compared with 82% of controls. School milk consumption was associated with a 30% reduced risk of developing bowel cancer (odds ratio 0.70, 95% confidence interval 0.51 to 0.96).
When looking at the effect of number of bottles consumed per week they found that compared with no bottles, five bottles per week was associated with 32% significantly decreased risk, and 10 or more bottles with 61% significantly decreased risk. However, there was no significant association with one to four bottles or six to nine bottles. The researchers found a similar trend when the total school consumption of milk was compared with no consumption: 1,200-1,599 bottles was associated with 38% significantly decreased risk; 1,600-1,799 with 43% decreased risk; and 1,800 or more bottles associated with 38% significantly decreased risk. There was no significant association with fewer than 1,200 bottles. The researchers calculated that for every 100 half-pint bottles consumed at school there was a 2.1% reduction in the risk of bowel cancer. Outside of school, there was a significantly reduced risk of bowel cancer with more than 20 dairy products a week compared with none to nine dairy products a week.
The researchers conclude that their national case-control study ‘provides evidence that school milk consumption was associated with a reduction in the risk of adult colorectal cancer in New Zealand. Furthermore, a dose-dependent relation was evident’. This study has strengths in its relatively large size, its reliable and nationally representative identification of cases and controls, and its thorough data collection. However, the conclusion that school milk consumption is associated with a reduced risk of bowel cancer in adulthood must be interpreted in light of a number of considerations:
The analysis took into account established risk factors for bowel cancer including age, sex, ethnicity and family history. However, many other potential confounders were not considered, including diet, physical activity, overweight and obesity, smoking or alcohol consumption. Diet in particular has been implicated in bowel cancer risk, with diets high in saturated fat, red meat and processed foods and low in fibre, fruit and vegetables thought to increase risk. Potentially, any of these lifestyle behaviours could be confounding the relationship between school milk consumption and bowel cancer and regular childhood milk consumption could be a reflection of a ‘healthy’ diet and other healthy lifestyle behaviours that reduce risk of cancer. When looking at the effect of number of bottles consumed per week, the researchers found that, compared with no bottles, five bottles were associated with 32% significantly decreased risk and 10 or more bottles with 61% significantly decreased risk. However, there was no significant association with one to four bottles or six to nine bottles. Therefore, the trend here is not very clear. Particularly as only 16 cases and 31 controls drank 10 or more bottles a week, statistical comparison between such small numbers should be viewed with caution. With many food questionnaires there is the potential for recall bias. For example, adults may have difficulty remembering how many bottles of school milk they drank many years before. When estimating their average weekly amount, it is highly possible that this could be inaccurate or that their consumption varied slightly from week to week and year to year. Particularly when researchers were using this response and combining it with the number of weeks in the school year and their total years at school to give a total number of bottles consumed at school (figures in 100s or 1,000s), there is the possibility of being incorrectly categorised. Hence, there may be less reliability when calculating risk according to the category of total milk bottles consumed. Cancer prevalence, and particularly environmental and lifestyle risk factors for cancer, can vary between countries. These findings in New Zealand may not be represented elsewhere. Of note, the researchers acknowledge that a cohort study in the UK found the opposite: increased childhood dairy consumption was associated with increased risk of bowel cancer. Case-control studies are most appropriate for looking at rare diseases, where you would expect there to be only a small number of cases developing among a large number of people. In the case of bowel cancer, which is common, the slightly more reliable cohort design could have also been used, where children who drank milk at school and those who didn’t were followed over time to see if they developed cancer. However, such a cohort would consequently need extensive long-term follow-up.
The possible association between milk/dairy consumption, or calcium intake, in childhood, or in later years, is worthy of further study. However, from this study alone, it cannot be concluded that school milk prevents bowel cancer later in life.
Women who eat more than three servings of fish per week are less likely to experience a stroke, a new study suggests. Specifically, fish-lovers in Sweden were 16 percent less likely to experience a stroke over a 10-year-period, relative to women who ate fish less than once a week. “Fish consumption in many countries, including the U.S., is far too low, and increased fish consumption would likely result in substantial benefits in the population,” said Dr. Dariush Mozaffarian of the Harvard School of Public Health. When choosing fish to eat, it’s best to opt for fish that are rich in omega-3 fatty acids, found most abundantly in fatty fish like salmon, mackerel and albacore tuna. “But any fish is better than none,” Mozaffarian noted.
“Indeed, these fatty acids likely underlie the benefits of fish on stroke risk”, said study author Dr. Susanna Larsson of the Karolinska Institute in Stockholm. “These fatty acids may reduce the risk of stroke by reducing blood pressure and blood (fat) concentrations.”
This is not the first study to suggest that people who eat more fish have a lower risk of stroke, and experts already recommend a fishy diet to reduce the risk of cardiovascular problems, Mozaffarian added. “This study supports current recommendations.” Earlier this year, for instance, a study showed that middle-aged and older men who eat fish every day are less likely than infrequent fish eaters to develop a suite of risk factors for heart disease, diabetes and stroke.
In the current study, published in the American Journal of Clinical Nutrition, Larsson and her colleagues looked at 34,670 women 49 to 83 years old. All were free of cardiovascular disease and cancer at the beginning of the study, in 1997. During 10 years of follow-up, 1,680 of the women (4 percent) had a stroke. Stroke caused by blockage of an artery that supplies blood to the brain — also known as a “cerebral infarction” or “ischemic stroke” — was the most common event, representing 78 percent of all strokes in the study. Other types of strokes were due to bleeding in the brain, or unspecified causes.
Women who ate more than three servings of fish per week had a 16 percent lower risk of stroke than women who ate less than one serving a week. “Not a small effect,” Mozaffarian said, noting that it was roughly equivalent to the effect of statin drugs on stroke risk. Furthermore, the researchers asked women about their diets only once, using a questionnaire, which might have caused errors that would underestimate the link between a fishy diet and stroke risk, he explained. “So, the true risk reduction may be larger.”
Interestingly, women appeared to benefit most from eating lean fish, when other research shows fatty fish is better for health. This finding may stem from the fact that most fatty fish, such as herring and salmon, is eaten salted in Sweden, Larsson explained. “A high intake of salt increases blood pressure and thus may increase the risk of stroke,” she said. “So the protective effects of fatty acids in fatty fish may be attenuated because of the salt.”
Indeed, when it comes to fish, not all have equal benefits, Mozaffarian noted – for instance, he said, research has not shown any cardiovascular benefits from eating fast food fish burgers or fish sticks. In addition, women of childbearing age should avoid certain types of fish known to carry relatively high levels of pollutants, such as shark and swordfish, Mozaffarian cautioned. “This is a very, very short list of fish to avoid or minimize — there are many, many other types of fish to consume,” he said. “Women at risk of stroke are generally beyond their child-bearing years, and so for these women, all types of fish can be consumed.”
Larsson and her team speculate that certain nutrients in fish, such as fatty acids and vitamin D, might explain its apparent benefits. The Swedish study cannot prove cause and effect for high fish consumption and lowered stroke risk, however. For instance, fish consumption could be a sign of a generally healthier lifestyle or some other mechanism at work. Last December, Larsson and colleagues published data from the same group of women in the journal Stroke showing that those who eat a lot of red meat may also be putting themselves at increased risk of stroke.
SOURCE: bit.ly/dKunk8 American Journal of Clinical Nutrition, online December 29, 2010.
A new study shows following a Mediterranean style diet rich in vegetables, olive oil, and fish may keep the mind sharp and slow age-related cognitive decline.The diet typified by the Italians, Greeks, and other Mediterranean cultures has already been shown to reduce the risk of heart disease, diabetes, and some types of cancer. But this and other studies are now suggesting that the diet may also have healthy benefits for the mind.
The Mediterranean diet emphasizes fruits and vegetables, fish, legumes, non-refined cereals, olive oil, and moderate wine consumption, usually at meals. Researchers found older adults who followed the diet more closely had slower rates of age-related cognitive decline than those who didn't, even after adjusting for other factors such as educational level. “The more we can incorporate vegetables, olive oil, and fish into our diets and moderate wine consumption, the better for our aging brains and bodies,” says Christy Tangney, PhD, associate professor of clinical nutrition at Rush University, in a news release.
In the study, published in the American Journal of Clinical Nutrition, researchers analyzed information gathered by the ongoing Chicago Health and Aging Project, which follows 3,759 adults over the age of 65 living on the South Side of Chicago. Every three years, the participants took tests of memory and basic math skills and filled out a questionnaire on how often they eat 139 different foods. The study follow-up time was 7.6 years on average.
Researchers looked at how closely the participants followed a Mediterranean diet and then compared it to their scores on age-related cognitive decline. Out of a maximum score of 55 for total adherence to a Mediterranean diet, the average score was 28. The results showed those with higher than average scores had a slower rate of age-related mental decline than those with lower scores. Researchers also looked at how closely the participants followed the Healthy Eating Index-2005, which is based on the 2005 Dietary Guidelines for Americans. They found no relationship between adherence to this type of diet and the rate of age-related cognitive decline.
What did the research involve?
The researchers needed to obtain several sets of data to fill their model. Data for UK deaths from coronary heart disease, stroke and cancer were obtained from the Office for National Statistics, the General Register Office for Scotland and the Northern Ireland Statistics and Research Agency. Information on the population's intake of foods and nutrients was obtained from two sources: the average intake of fatty acids, fibre, and fruit and vegetables for 2005–7 was derived from the Expenditure and Food Survey, while estimates of salt intake came from the National Diet and Nutrition Survey, 2006.
The modelling also incorporated several meta-analyses of individual studies looking at diet and disease risk factors. The researchers looked at reviews that had pooled data from randomised trials, cohort studies or case-control studies, giving priority to meta-analyses of randomised trials. These different studies were combined in the model to calculate the change in risk of disease for an individual who changes his or her diet. To estimate the change in health outcomes with a change in diet at a population level, the model used the difference between current average consumption levels and recommended levels of different foods in the UK.
What were the basic results?
In a general summary of the main findings, the researchers calculated that:
About 33,000 deaths a year would be avoided if UK dietary recommendations were met. There would be a reduction in deaths from coronary heart disease of 20,800 (95% credible interval 17,845 to 24,069), a reduction of 5,876 for deaths from stroke (3,856 to 7,364) and a reduction of 6,481 for deaths from cancer (4,487 to 8,353). About 12,500 of these avoided deaths would be in people aged 75 or under. About 18,000 of the avoided deaths would be men and 15,000 would be women. More than 15,000 of the avoided deaths (nearly half the total figure) would be due to increased consumption of fruit and vegetables. Reducing average salt intake to 6g a day would avoid 7,500 deaths annually. The greatest number of deaths avoided would be in Northern Ireland and Scotland, whose populations are furthest from achieving dietary recommendations.
How did the researchers interpret the results?
The researchers say their study suggests that increasing average consumption of fruits and vegetables to five portions a day is the target likely to offer most benefit in terms of deaths avoided. They also say that reducing recommended salt levels to 3g daily and saturated fat to 3% of total energy would achieve a similar reduction in mortality.
They conclude that their calculations based on the Dietron model are robust, pointing out that their estimate of deaths avoided is lower than a previous government survey which calculated that 70,000 deaths a year could be avoided if government dietary recommendations were met. The estimates could be used in calculating the allocation of resources for interventions aimed at reducing chronic disease.
This well-conducted modelling study used various data sources to link consumption of different dietary components with disease risk factors (for example blood pressure, cholesterol and obesity) and subsequent mortality from coronary heart disease, stroke and cancer. The study supports previous research showing that diet plays a crucial role in health and that a diet with plenty of fruit and vegetables, fibre and low fat and salt levels can reduce the risk of chronic disease, in particular coronary heart disease. However, its predictions are made at the population level. A model such as this cannot predict individual risk, which will depend on many factors, including family history, smoking and other lifestyle habits.
It is important to note that the figures are based on the estimates and assumptions made when using a mathematical model, and not on reality. As the authors themselves note, the modelling technique they used may have led to “some degree of double counting” and that, therefore, their estimate of reduced mortalities if dietary recommendations were met is likely to be an overestimate. Also, the accuracy of the model depends to some extent on the quality of the meta-analyses that were included, and the quality of the individual studies that were pooled within these reviews in order to establish associations between diet and particular disease risk factors.
Overall, this study supports current dietary recommendations and even though it cannot predict how diet influences risk for individuals, it does indicate that keeping to dietary recommendations reduces the risk of disease.
Dietary recommendations include eating five portions of fruit and vegetables a day (about 440g) and 18g of fibre (provided by wholegrain foods and some fruit and vegetables). It is recommended that salt intake is limited to a maximum of 6g a day and that a third of total energy is provided by fats, with saturated fat comprising 10%. The researchers point out that in 2007, according to the estimated average intakes in the sources they used, none of the UK countries met these recommendations.
Even young children appear to be consuming more caffeine, so much so that caffeine could be contributing to sleep problems in primary school children, researchers found. Three-quarters of children ages 5 to 12 consumed caffeine on an average day in a survey of parents at routine clinic visits by William J. Warzak, PhD, of the University of Nebraska Medical Center in Omaha, and colleagues. The more caffeine children consumed, the fewer hours they slept on average (P=0.02), the researchers reported online in the Journal of Pediatrics, although not drawing a causal link. The average intake was two or three times higher than the 22- to 23-mg daily average reported nearly a decade ago, they noted.
Eight- to 12-year-olds in Warzak's study averaged 109 mg of caffeine — the equivalent of nearly three 12-oz cans of soda each day. But even the 52 mg of caffeine consumed by 5- to 7-year-olds on an typical day was well above the level known to have a physiologic effect on adults, the researchers noted. “There's really no role for caffeine in kids,” Marcie Schneider, MD, of the Albert Einstein College of Medicine in New York City, emphasized in commenting on the study. “We know that caffeine raises your blood pressure, raises your heart rate, and can be addictive.” Unlike older teens who are likely drinking coffee to wake up in the mornings for school, the assumption is that younger kids are getting most of their caffeine from soda, noted Schneider, who serves as a member of the American Academy of Pediatrics Committee on Nutrition.
She urged pediatricians to raise parents' awareness of the issue, perhaps as part of the yearly checkup. “We routinely ask kids what they're eating and drinking,” “It may be something that is worth pediatricians pointing out to parents that this kid does not need caffeine in their life partially because it does some things that are negative.”
Warzak's group surveyed parents of 228 children seen at an urban outpatient pediatric clinic during routine visits about the children's average daily consumption of drinks and snacks with an emphasis on caffeine-containing items. None of the children had a known sleep disorder or medical condition that might cause bedwetting. Illustrated depictions were provided to help parents accurately estimate serving sizes.
Nearly all of the caffeine intake was consumed through beverages. Few children got a meaningful amount of caffeine from food. “Caffeine's diuretic properties have encouraged behavioral health practitioners to eliminate caffeine from the diet of children with enuresis,” the researchers noted. However, they found that intake didn't correlate with the number of nights a child wet the bed (P=0.49). Overall, enuresis was actually less likely in children who consumed caffeine.
The researchers cautioned that interpretation of these results may be complicated by cultural differences in reporting children's behavioral health concerns and that their study could not draw any causal conclusions. Schneider also noted the use of parental reports and the relatively small sample as limitations. Although the findings offered no support for removing caffeine from children's diets on the basis of bedwetting, Warzak's group concluded in the paper that “given the potential effects of caffeine on childhood behavior, a screen of caffeine consumption might be beneficial when evaluating childhood behavioral health concerns.”
Source: Warzak WJ, et al “Caffeine consumption in young children” J Pediatr 2011; DOI: 10.1016/j.jpeds.2010.11.022.