Healthy Start: the impact of a new food provision scheme

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Healthy Start the impact of a new food provision
scheme

• FA Ford, RB Fraser, SE Wademan, T Mouratidou
• Reproductive and Developmental Medicine
• Centre for Pregnancy Nutrition
• University of Sheffield

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Welfare Food Scheme
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Summary of Welfare Food Scheme (WFS)

• Expectant and nursing mothers, and infants and
  children lt5yrs receiving qualifying benefits
• Means tested application via benefits office
• Tokens for liquid and infant formula milk
• Free vitamin supplements

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Reasons for change

• Milk does not address dietary inequalities
• Role of calcium overstated
• Potential for vitamins unfulfilled
• folic acid
• vitamin D
• Under 18s and under 16s
• Health gains of breastfeeding lost

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Summary of Healthy Start (HS)

• Pregnant women and families with children lt4
  years receiving qualifying benefits
• All pregnant women lt18 years
• Means tested application via health
  professional (midwife, HV, GP)
• HS vouchers entitle
• -liquid and infant formula milk
• -fresh fruit and vegetables
• -free vitamin supplements

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Sheffield before and after study

• Sample
• Caucasian, English speaking pregnant and
  postnatal women and their infants
• Recipient of, or eligible for food-support
  benefit
• Information
• Dietary assessment, Food Frequency Questionnaire
  (FFQ)
• Anthropometric, socio-demographic and behavioural
  characteristics

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Timeline of Sheffield before and after study
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Results Demographic

• Samples were similar for
• Age
• Mean Body Mass Index
• Educational attainment
• Self-reported smoking status

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Uptake of WFS/HS benefits amongst those
considered eligible

• Pregnant Postnatal
• WFS HS WFS HS
• 57 56 71 84

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EAR Estimated Average Requirements P
Pregnant PnL Postnatal lactating PnNL Postnatal
non-lactating
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Follow up readings- postnatal HS and WFS women
energy (Kcal)
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Five a day pregnant HS and WFS women
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Five a day postnatal HS and WFS women
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Summary

• Nutrient intakes
• HS was associated with generally improved intakes
  in pregnancy and the postnatal period
• -milk (full fat)
• -fruit and vegetables
• -eating more of the foods in their usual diet
• Energy
• More HS pregnant and postnatal women reached the
  recommended level for energy
• Fewer HS pregnant and postnatal women had an
  energy deficit but more had an energy surplus
• Vitamin supplements
• HS vitamin supplements were not available at the
  time of this study

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Conclusions and discussion

• Overall positive significant results
• Both schemes only reached about 55 of the
  potential beneficiaries in pregnancy
• The quality of dietary advise offered by health
  professionals has not been evaluated
• Longer-term studies and local audits should be
  initiated to assess uptake and benefits of the HS
  scheme, including the impact of the HS vitamin
  supplement and local prices for formula milk

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Maternal and child nutrition
Implementing NICE guidance
2008
NICE public health guidance 11
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NICE Maternal and Child NutritionHealthy Start

• Encourage all those who may be eligible to apply
  ensure forms and vitamin supplements are
  available
• Offer Healthy Start vitamin supplements to all
  women and children who are eligible
• Offer eligible parents tailored support and
  advice on using Healthy Start vouchers, on
  breastfeeding and on how to introduce infants to
  solid foods
• Audit local uptake

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NICE Maternal and Child NutritionTraining

• Caring for women who may become (or who are)
  pregnant and children under 4 requires training
  in
• their nutritional needs
• the rationale for recommending supplements
• how to provide dietary advice
• breastfeeding management (BFI minimum standard)
• practical ways of changing eating behaviour

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Interpregnancy weight changes

• Vilamor et al Lancet 2006
• Mean pregnancy interval was 24m
• Mean BMI change 0.5 units
• 1 BMI unit increase between pregnancies (approx
  3Kg) resulted in 30 higher rate of GDM
• 2 BMI units increase between pregnancies (approx
  6Kg) resulted in 100 higher rate of GDM

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Do food-support programmes increase
obesity?

• A recent meta-analysis of food-support programmes
  in the USA showed that, food-support
  participation over a 1- or 2-year period
  increased the probability of a woman becoming
  obese by 2 to 5 percentage points and may lead to
  a 0.5-point increase in BMI, or about 1.4kg for a
  woman 165cm to 170cm tall
• Ver Ploeg US Dept. of Agriculture, Economic
  Research Service. March 2008.