School dinners and markers of cardiovascular health and type 2 diabetes in 13-16 year olds: cross sectional studyBMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38618.540729.AE (Published 03 November 2005) Cite this as: BMJ 2005;331:1060
All rapid responses
I wonder what is the relevance of this kind of study to the entire
population.? This could, of course, be a pointer, nothing more!
Has anyone looked at the composition of what children eat either at
school or at home? The milk they drink could be loaded with bovine growth
hormone and antibiotics given to cows! The chicken they eat is similarly
loaded with growth hormone and antibiotics used to shorten the egg to
table time of the bird. What is the end product of the sugar equivalents
in the present soft drinks that children are fond of, thanks to the ads,
and its effect on the human system? Human greed to make more money and his
proclivity for comfort will certainly rob all of us of our health in the
not too distant future!
The fruits and vegetables that children consume must be having enough
fertilisers and insecticides sprayed to protect the crop. Why are we
having this myopia of looking at things in a reductionist style while what
happens to humans as time evolves depends on the whole and not on the bits
and pieces? It is, of course fashionable to do this kind of reductionist
research for publication.
I wonder when are we going to have a change in the paradigm of
medical research sans statistics that we make up and then look up? I know
I am airing unwelcome comments, but would someone THINK deeply about all
these? The risk factor hypothesis seems to be very fashionable while no
one would want to know why the majority, having similar risks, escapes the
tragedy? Are there asset factors that we are missing?
Competing interests: No competing interests
Thanks Whincup and his colleagues  for the conducting research on
an important and burning issue. The incidence of type 2 diabetes reported
in children and adolescents has increased alarmingly worldwide [2,3] and
the UK is not an exception. Globally, an estimated 10% of school-aged
children, between 5 and 17 years old, are overweight or obese, and the
situation is getting worse. Studies suggest that there are twice as may
obese children (1 in 10) in the UK as there were 10-12 years ago, and that
this is a trend seen elsewhere in the developed world.  According to
WHO, each of these children is at increased risk of developing type 2
diabetes. In the UK, the risk of type 2 diabetes is 13.5 times greater
among Asian than white children. [5,6] A recent multi-centred study
conducted in the UK reported increased numbers of overweight and obese
children are developing type 2 diabetes and warned that if the condition
continues to grow at the current rate, it is estimated that the disease
will make up as much as 45% of all new cases of diabetes in children over
the next 10-15 years. 
Traditionally, type 2 diabetes has been believed to be an adult
disease entity with known risk factors of obesity, sedentary lifestyle,
and positive family history. However, in the last 2 decades, type 2
diabetes has been reported among children and adolescents with increasing
frequency. [7-9] This increase in frequency of type 2 diabetes seems to
parallel the increase in prevalence and severity of obesity in children
and adolescents. [3,10] Genetic and familial factors, foetal environmental
factors, particularly maternal gestational diabetes and intrauterine
growth retardation, poor dietary habits and lack of physical activity
during childhood and adolescence lead to increasing levels of insulin
resistance that appear to be crucial in the pathogenesis of type 2
diabetes in the young. The disorder is associated with microvascular
disease, with a suggestion of greater risk of nephropathy than of
retinopathy, and also leads to the development of early macrovascular
diseases.  This new phenomenon of obesity and type 2 diabetes in
children and adolescents poses significant problems for treatment because
the safety of therapies used in treating obesity and type 2 diabetes
(apart from insulin) have not been tested in this age group. 
There is a growing realisation that diseases normally associated with
adult life such as cardiovascular disease, diabetes, stroke, cancers and
respiratory diseases may have their roots in poor eating habits during
childhood. Poor dietary choices and lifestyle preferences acquired during
childhood are likely to be carried on into adult life. For this reason, we
should have to be careful about the children’s diets both home and school
to prevent an epidemic among children and adolescents.
1. Whincup,PH, Owen CG, Sattar N, Cook DG. School dinners and
markers of cardiovascular health and type 2 diabetes in 13-16 year olds:
cross sectional study. BMJ, doi:10.1136/bmj.38618.540729.AE (published 6
2. Ehtisham S, Barrett TG. The emergence of type 2 diabetes in childhood.
Ann Clin Biochem 2004;41:10-6.
3. Steinberger J, Daniels SR. Obesity, Insulin Resistance, Diabetes, and
Cardiovascular Risk in Children: An American Heart Association Scientific
Statement From the Atherosclerosis, Hypertension, and Obesity in the Young
Committee (Council on Cardiovascular Disease in the Young) and the
Diabetes Committee (Council on Nutrition, Physical Activity, and
Metabolism). Circulation 2003;107:1448-53.
4. National Audit Office. Tackling Obesity in England. London: The
Stationery Office, 2001.
5. Ehtisham S, Barrett TG, Shaw NJ. Type 2 diabetes mellitus in UK
children: an emerging problem. Diabet Med 2000;17:867-71.
6. Drake AJ, Smith A, Betts PR, Crowne EC, Shield JP. Type 2 diabetes in
obese white children. Arch Dis Child 2002;86:207-8.
7. Pinhas-Hamiel O, Dolan LM, Daniels SR, et al. Increased incidence of
non-insulin-dependent diabetes mellitus among adolescents. J Pediatr
8. Fagot-Campagna A, Narayan KM, Imperatore G. Type 2 diabetes in
children. BMJ 2001;322:377-8.
9. Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among
North American children and adolescents: an epidemiologic review and a
public health perspective. J Pediatr 2000;136:664-72.
10. Troiano RP, Flegal KM, Kuczmarski RJ, et al. Overweight prevalence and
trends for children and adolescents: the National Health and Nutrition
Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med. 1995:149:
11. Bloomgarden, ZT. Type 2 Diabetes in the Young. Diabetes Care.
12. IDF. Diabetes Atlas. Brussels, Belgium: International Diabetes
Competing interests: No competing interests