Children from Ethnic Groups and those following Cultural Diets

Chapter 27
Children from Ethnic Groups and those following Cultural Diets


Eulalee Green


Introduction


The UK is the home to a multicultural and multi-ethnic society. Immigration during the late 1950s and early 1960s was in response to labour shortages. Since the 1980s conflict in Africa and Europe has led to further immigration and, together with movement of people from newly joined European Union countries, the diversity of the UK has increased. As with the early migrations, ethnic communities have remained near large industrialised cities. These ethnic groups have introduced a wide variety of cultures, including dietary beliefs and practices, which have had to fit into their new lifestyles. Achieving nutritionally adequate diets became a challenge with people finding themselves in an environment very different from their homeland.


The top 15 countries of last residence of migrants to the UK in 2005–2006 are shown in Fig. 27.1 and Table 27.1. Table 27.2 shows the percentage of ethnic groups in England and Wales in 2011.

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Figure 27.1 Immigrants to the UK in 2005–2006: top 15 countries of last residence.


Source: Office of National Statistics [1].


Table 27.1 Top 15 countries of last residence of all migrants 2005–2006 combined



































































Ranking Country of last residence Thousands of immigrants
1 Poland 109
2 India 98
3 Australia 76
4 Pakistan 54
5 Germany 48
6 South Africa 47
7 USA 46
8 China 44
9 France 34
10 New Zealand 26
11 Spain 26
12 Bangladesh 20
13 Philippines 19
14 Nigeria 17
15 Japan 16

Source: Office of National Statistics [1].


Table 27.2 Percentage of ethnic groups in England and Wales, 2011
























































































Percentages


Total population Ethnic population
White White British 80.5

Irish 0.9 4.6

Gypsy or Irish traveller 0.1 0.5

Other White 4.4 22.5
Mixed/multiple ethnic groups White and Black Caribbean 0.8 4.1

White and Asian 0.6 3.1

White and Black African 0.3 1.5

Other mixed 0.5 2.6
Asian/Asian British Indian 2.5 12.8

Pakistani 2.0 10.3

Bangladeshi 0.8 4.1

Chinese 0.7 3.6

Other Asian 1.5 7.7
Black/African/Caribbean/Black African 1.8 9.2
British Caribbean 1.1 5.6

Other Black 0.5 2.6
Other ethnic group Arab 0.4 2.1

Any other ethnic group 0.6 3.1

Source: Office of National Statistics [2].


Infants and children of any age have special dietary requirements. It is therefore essential that healthcare professionals understand religious and cultural attitudes towards diet when they are initiating any dietary intervention, in order to achieve optimal growth and development in these children. Assessment of intake must be accurate and any advice given must be relevant to dietary custom so that it is both realistic and achievable.


Children are subject to many outside influences and often start to develop westernised dietary ideas. With time, these ideas are taken home and adopted by other members of the family. The extent of adoption of dietary practices which differ from traditional customs is variable; therefore all diets must be individually assessed.


Table 27.3 shows the religions practised in the UK and Table 27.4 gives a guide to religious and cultural influences on the diet.


Table 27.3 Percentage of the UK population belonging to a religion, April 2011–March 2012



































Religion Population percentage Number (thousands)
Christian 62.0 37 191
Islam/Muslim 4.6 2755
Hindu 1.4 860
Sikh 0.6 350
Jewish 0.5 287
Buddhist 0.4 246
None or undeclared 29.9 17 927

Source: Office of National Statistics [2].


Table 27.4 A guide to religious and cultural influences on diet































































































































































Food Buddhist Christian Hindu Jewish Muslim Rastafarian Seventh Day Adventist Sikh
Eggs Acceptable to some Acceptable Acceptable to some No blood spots Acceptable Acceptable to some Acceptable to most Acceptable
Milk, yoghurt Acceptable Acceptable Acceptable to some Acceptable Acceptable to some Acceptable to some Acceptable to most Acceptable
Cheese Acceptable Acceptable Not with rennet Not with rennet Not with rennet Acceptable to some Acceptable to most Acceptable to some
Pork Acceptable to some Acceptable to most Rarely acceptable Not acceptable Not acceptable Not acceptable Not acceptable Rarely acceptable
Beef Acceptable to some Acceptable Not acceptable Kosher Halal Acceptable to some Acceptable to some Not acceptable
Lamb Acceptable to some Acceptable Acceptable to some Kosher Halal Acceptable to some Acceptable to some Acceptable
Chicken Acceptable to some Acceptable Acceptable to some Kosher Halal Acceptable to some Acceptable to some Acceptable to some
Fish Acceptable to some Acceptable— some only fish with fins and scales Acceptable— with fins and scales Acceptable— with fins, scales and backbone Acceptable— with fins and scales Acceptable— with fins and scales Acceptable— with fins and scales Acceptable to some
Shellfish Not acceptable Acceptable to most Acceptable to some Not acceptable Acceptable to some Not acceptable Not acceptable Acceptable to some
Animal fats Acceptable to some Acceptable Acceptable to some Kosher Halal Acceptable to some Not acceptable Acceptable to some
Alcohol Not acceptable Acceptable to most Not acceptable Acceptable Not acceptable Not usually wine Not acceptable Acceptable
Cocoa, coffee, tea Acceptable Acceptable Acceptable Acceptable Acceptable Not acceptable Decaffeinated are suitable Acceptable
Fasting
Good Friday and Ash Wednesday 3 days a year or 1–2 days every week Yom Kippur 1 day of atonement (no food or liquid for 25 hours) Ramadan 1 month fasting (no food or liquid during daylight)

Other comments Most Buddhists are vegetarians or vegans, although some may not be
Certain foods are taken during prayers. Some Hindus may be vegetarians or vegans (Jains) Kosher (food fit to eat), i.e. meat from animals slaughtered by a Kosher butcher
Meat and dairy products are not consumed within 3 hours of each other
Halal, i.e. the meat must be from animals that have been bled to death and the phrase ‘in the name of God’ is said Processed, preserved or tinned foods may be avoided. Most only eat Ital foods, i.e. in a whole and natural state
No fruits of the vine, e.g. sultanas, grapes, currants
Some are vegetarians Some are vegetarians
Black and minority ethnic groups Chinese, Vietnamese Afro-Caribbean, Chinese, Greek, Greek Cypriot, Ugandan, Vietnamese, West African (e.g. Nigerian and Ghanaian), Indian Gujarati, Punjabi, Indian Jews of all nationalities Arab, Bangladeshi, Pakistani, Gujarati, Somali, Turkish, Turkish Cypriot, Ugandan, West African (e.g. Nigerian and Ghanaian), Indian Afro-Caribbean Afro-Caribbean Indian

Source: Adapted from British Dietetic Association Community Nutrition Group [3].


Vegetarian and vegan diets


Vegetarianism and veganism are common dietary practices among many religious and ethnic groups. In addition, increasing numbers of the indigenous population are restricting their intake of meat and animal products for either humanitarian, ethical or health reasons. Table 27.5 gives a classification of vegetarian and vegan diets. Providing careful attention is given to ensuring nutritional adequacy, these diets will support normal growth and development [4–6]. In general the greater the degree of dietary restriction, the greater is the risk of nutritional deficiency [7]. The vegan diet is most restricted; Table 27.6 gives dietary sources of the nutrients most at risk.


Table 27.5 Classification of vegetarian and vegan diet











































































































Foods excluded Animal protein source Non animal protein source Nutrients at risk of deficiency
Partial vegetarian Red meat Poultry Beans Iron

Offal Fish Pulses


Milk Nuts


Cheese Seeds


Yoghurt


Eggs
Lacto-ovo vegetarian Red meat Milk Beans Iron

Offal Cheese Lentils

Poultry Yoghurt Nuts

Fish Eggs Seeds
Lacto vegetarian Red meat Milk Beans Iron

Offal Cheese Lentils Vitamin D

Poultry Yoghurt Nuts

Fish
Seeds

Eggs

Vegan Red meat
Beans Protein

Offal
Lentils Energy

Fish
Nuts Iron

Poultry
Seeds Fat soluble vitamins

Eggs

Vitamin B2

Milk

Vitamin B12

Cheese

Calcium

Yoghurt

Zinc

Table 27.6 Sources of nutrients at risk of deficiency in a vegan diet




































Nutrient at risk of deficiency Suitable dietary alternative sources
Protein Pulses (soya, tofu, tempeh, beans and lentils), grains (wheat, rice, rye, millet), seeds, groundnuts*, nuts* and nut spreads*. Meals should have a combination of grains with seeds or grains with pulses to get the right balance of essential amino acids
Energy Vegetable oils/margarines, ground nuts*, nut spreads*
Iron Iron fortified breakfast cereals, wholegrain cereals, wholemeal bread, pulses, dried fruit, nuts*. Dark leafy green vegetables are not a good source of iron for infants and young children as the portion size is so large (120 g for 2 mg iron). Foods rich in vitamin C, such as fruits and vegetables, aid the absorption of non animal sources of iron
Fat soluble vitamins In England, white Caucasians will make enough vitamin D for the year from 30 minutes/day of moderate sunlight exposure from April to October. Black and Asian people living in England will not make enough and must rely on dietary sources or supplements: vegetable oils/margarines, fortified soya milk and fortified breakfast cereals
Essential fatty acids Whole grains, nuts, seeds and seed oils
Vitamin B2 Wheat germ, almonds, green leafy vegetables, yeast extract (e.g. Marmite, Tastex), avocado, soya beans, fortified soya milk
Vitamin B12 Fortified yeast extract (e.g. Marmite, Tastex), fortified cereals, fortified soya milk, tofu
Calcium Fortified soya products (milk and yoghurt), seaweed products (kombu, wakame, nori), nuts* and seeds. Other sources (bread, leafy green vegetables, pulses) are not good sources of calcium for infants and young children as the portion size is so large (>120 g for 100 mg calcium)
Zinc Some soya products (flour, miso, cheese and tempeh), nuts*, seeds, wheat germ, wholemeal bread, fortified breakfast cereals, seaweed and hard cheeses
Iodine Whole grains, seaweeds and vegetables

* Nuts should be introduced with care if there is history/evidence of nut allergy and nuts should not be given to children under 2 years of age unless finely ground due to choking risk.


Yeast extracts should be used with care in children under 2 years of age due to the high salt content.


Infant feeding


The current recommendation is for infants to be exclusively breast fed until 6 months of age. Solids should be introduced at around 6 months of age; breast feeding should be continued during this time [8]. There is a higher proportion of women from minority ethnic groups who choose to breast feed their babies up to 6 months (Table 27.7).


Table 27.7 Prevalence of breast feeding at ages up to 6 months by mother’s ethnicity in Great Britain, 2010










































































































Total Great Britain White Mixed Asian or Asian British Black or Black British Chinese or other ethnic group

% % % % % %
Birth 82 79 87 96 95 96
2 days 77 75 81 88 90 94
3 days 75 73 80 86 90 93
4 days 73 71 80 85 90 93
5 days 72 69 79 84 90 93
6 days 71 68 79 83 90 93
1 week 70 67 79 83 90 92
2 weeks 66 63 79 81 89 87
6 weeks 56 52 75 73 85 82
4 months 43 39 60 58 73 76
6 months 35 32 49 49 61 66

Source: Data.Gov.UK [9].


All breast fed infants and infants having less than 500 mL of infant formula should be given a vitamin D supplement which should continue until 5 years of age [10]. Suitable vitamin drops include Healthy Start, Abidec and Dalivit (Table 1.22).


If the infant is not breast fed an infant formula must be given. Table 27.8 shows normal infant formulas and special therapeutic formulas which are suitable for vegetarian and vegan families and for those who require a Halal formula. Some families will accept ‘unsuitable’ formulas if there is a clinical need.


Table 27.8 Infant formulas suitable for Halal, vegetarian and vegan diets























































Cow’s milk based formulas Suitable for Halal Suitable for vegetarian
Abbott Similac X
Cow & Gate First Infant Milk X
Cow & Gate Infant Milk for Hungrier Babies X
Cow & Gate Follow-on Milk X
Milupa Aptamil First Infant Milk X
Milupa Aptamil Hungry Milk X
Milupa Aptamil Follow-on Milk X
Milupa Aptamil Growing-up (1+) X
Milupa Aptamil Growing-up (2+) X
SMA First Infant Milk X
SMA Extra Hungry Infant Milk
SMA Follow-on Milk

At the time of printing, there were no formulas suitable for vegan diets. In addition, there were no amino acid, peptide or soya based infant formulas that were suitable for Halal, vegetarian or vegan diets, based on their ingredients. However, some manufacturers have statements to the effect that their formula is acceptable for certain cultural and religious groups—check with the manufacturer.


Some vegetarian families choose to give their babies goat’s milk or ewe’s milk in the belief that these confer health benefits and are preferable to cow’s milk. These milks are contraindicated because of their nutritional inadequacy, high renal solute load and doubtful microbiological safety [11, 12]. The European Food Safety Authority considers that protein from goat milk can be suitable as a protein source for infant formula provided the formula complies with the compositional criteria laid down in Directive 2006/141/EC [13]; however, goat’s milk formula has no health benefits over normal infant formulas.


Providing the maternal diet is adequate, breast milk will be nutritionally adequate for the first 6 months of life for most infants. Specific attention must be paid to the mother’s vitamin D, calcium and iron intakes. Vegan mothers may require supplementation with additional vitamin B12 [11]. Vitamin B12 deficiency resulting in neurological damage [14], irritability, faltering growth, apathy, anorexia and developmental regression has been reported in breast fed infants of vegan mothers [12]. Some algae (e.g. spirulina) and seaweeds (e.g. nori) contain natural compounds that are similar to vitamin B12; however, the human body cannot use these nutrients. Furthermore, because they are so similar to B12 they compete with it and can be the cause of B12 deficiency in people who do not eat animal products. Vegetarian sources of iron and vitamin B12 are given in Table 27.9.


Table 27.9 Sources of iron and vitamin B12 suitable for vegetarians



























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Apr 1, 2017 | Posted by in NUTRITION | Comments Off on Children from Ethnic Groups and those following Cultural Diets
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Source Iron mg B12 µg
Infant formula, 200 mL 1.4 0.4
Milk (all types except UHT), 200 mL 0.06 1.8
Yoghurt full fat (1 medium pot), 150 g 0.15 0.3
Cheddar type cheese (1 slice), 40 g 0.12 1.0
Fromage frais (1 medium pot), 100 g 0.06 0.5