Metabolic diseases

We may have at least 11 patron saints devoted to food, but what we really need is a patron saint of public health diplomacy.

Stephen Leeder

To the Editor: We agree with Selvey and Carey1 that minimising the environmental impact of the food supply chain is vital. However, we disagree with recommendations that target some food categories. Variation in environmental footprint within a food category can be more important than the variation between categories.2 Research on environmental modelling systems needs to address complex trade-offs between factors such as carbon emissions, water, land ...

Manny Noakes · Bradley G Ridoutt · Gilly Hendrie · Brian A Keating

To the Editor: We agree that nutritious food choices should also be sustainable, but Selvey and Carey’s portrayal of seafood production1 is incorrect. The 2012 assessment of Australia’s fisheries found that only two of the 111 fish stocks classified (1.8%) were overfished, rather than the 40% claimed by Selvey and Carey, and one of these (bluefin tuna) is rebuilding rapidly.2 Assuming 15 million Australians eat two 100 g portions of seafood every week, our annual seafood requirements are 156 000 tonnes from the 241 100 tonnes of current sustainable fishing and aquaculture production. Globally, current fishing pressure is sustainable in 70% of world fish stocks.3 Demonising seafood based on discredited science claiming the world will run out of fish by 20484 does not help in making nutritious food choices. All food production has an environmental impact. We and others have applied the life-cycle analysis methods advocated by Selvey and Carey to several seafood industries. The amount of carbon dioxide produced by fisheries is lower than that from chicken, pork or beef production.5 Wild fisheries use little water and no fertilisers, pesticides or antibiotics,5,6 which makes seafood a healthy and sustainable choice for people and the environment.

Bridget S Green · Anna K Farmery · Colin D Buxton

To the Editor: We agree that nutritious food choices should also be sustainable, but Selvey and Carey’s portrayal of seafood production1 is incorrect. The 2012 assessment of Australia’s fisheries found that only two of the 111 fish stocks classified (1.8%) were overfished, rather than the 40% claimed by Selvey and Carey, and one of these (bluefin tuna) is rebuilding rapidly.2 Assuming 15 million Australians eat two 100 g portions ...

Caleb Gardner

To the Editor: Selvey and Carey infer that the consumption of imported seafood by Australian consumers is evidence that Australian seafood production is unsustainable.1 However, trade in canned and frozen seafood is extensive because these products are stable and because of the comparative advantage of production between countries. The same process results in Australia’s reliance on imported electronics, clothes and cars — it does not ...

Alexandra McManus

To the Editor: The two contributions by Gray and colleagues1 and Loblay and colleagues2 on the topic of salicylate intolerance illustrate that absence of evidence does not equate to evidence of absence.3 Neither paper quotes the admittedly sparse European peer-reviewed literature on the topic, including an understanding of the basic biochemistry,4,5 a diagnostic test, and clinical prevalence studies of intolerance to dietary salicylate.5-7 A wealth ...

Richard F Heller · C Ann Heller · Jane Heller

To the Editor: I am concerned that the recent articles on salicylate diets in the Journal1,2 may be seen as a current position statement on the usefulness of a low-chemical elimination diet. An elderly psychiatrist colleague said in 1976, “In 20 years time many parents will not be giving their children red cordial but scientists will still be discussing the issue!” The discussion continues, not because ...

Joan C Breakey

In reply: We are pleased that our publication has generated discussion regarding the benefits of low salicylate diets. However, the correspondence and references from Heller and colleagues and Breakey do not provide any further evidence for the use of such diets and simply reaffirm the lack of good-quality data in this area. Until such data are available, the use of salicylate elimination diets remains an ...

Paul E A Gray*

It is very unlikely that there is any substance to the suggestion that calcium supplementation increases the risk of cardiovascular disease.

B E Christopher Nordin

This study adds overweight and obesity to the list of chronic disease risk factors highly prevalent among incarcerated youth. Changes to the food environment and the approach to physical activity in custody are needed.

Leigh Haysom PhD, MMed(ClinEpi), MB BS · Devon Indig PhD, MPH, BSc · Elizabeth Moore PhD · Louise L Hardy PhD, MPH(Hons) · Paul A van den Dolder PhD, MSc MPhysio

Industry self-regulation initiatives, introduced in 2009, have not reduced the overall number of unhealthy food ads that children see on television

Lisa G Smithers PhD, GradCertPublicHealth, GradDipHumNutr · Tracy L Merlin BA(Hons), AdvDipPM, MPH · John W Lynch PhD, MPH, MEd

In the face of crippling rates of chronic disease linked to unhealthy lifestyles, our governments may need to intervene more to ensure food and alcohol industry self-regulation maintains credibility

Roger S Magnusson BA/LLB(Hons), PhD, GradDipManagDevelop · Belinda H Reeve BA(Hons), LLB

This before-and-after study aimed to measure the short-term health value of promoting healthy eating by regularly supplying fresh produce to disadvantaged families. Episodes of illness and common clinical conditions, prescription of antibiotics and the prevalence of anaemia and iron deficiency were measured as indicators of the short-term health effects of having healthy food provided.

Andrew P Black MB BS(Hons), PhD, FAFPHM · Hassan Vally BSc(Hons), PhD, MAppEpi · Peter S Morris MB BS, PhD, FRACP · Mark Daniel BSc, MSc, PhD · Adrian J Esterman BSc(Hons), MSc, PhD · Fiona E Smith BSc, MNutrDiet, APD · Kerin O’Dea BSc, PhD

Clinicians need to consider analytical issues when requesting and interpreting these testsVitamin B12 and folate tests are useful for identifying patients with a deficiency. In this issue of the Journal, Willis and colleagues highlight some of the limitations of serum vitamin B12 assays.1 They also emphasise the uncertainty regarding whether red-cell or serum folate should be the preferred first-line test for folate status. The issues underlying ...

Christopher-John L Farrell MB BS, FAACB, FRCPA

A review of case notes from our Sydney-based paediatric allergy services, between 1 January 2003 and 31 December 2011, identified 74 children who had been prescribed diets that eliminated foods containing natural salicylates before attending our clinics. The most common indications for starting the diets were eczema (34/74) and behavioural disturbances (17/74) including attention deficit hyperactivity disorder (ADHD). We could find no peer-reviewed evidence to support the efficacy of salicylate elimination diets in managing these diseases. We do not prescribe these diets, and in a survey of European and North American food allergy experts, only 1/23 respondents used a similar diet for eczema, with none of the respondents using salicylate elimination to treat ADHD. A high proportion (31/66) of children suffered adverse outcomes, including nutritional deficiencies and food aversion, with four children developing eating disorders. We could find no published evidence to support the safety of these diets in children. While this uncontrolled study does not prove a causal relationship between salicylate elimination diets and harm, the frequency of adverse events appears high, and in the absence of evidence of safety or efficacy, we cannot recommend the use of these diets in children.

Paul E A Gray Mb Chb, FRACP, FRCPA · Sam Mehr MB BS, FRACP, FRCPA · Constance H Katelaris MB BS, PhD, FRACP · Brynn K Wainstein MB ChB, FRACP, PhD · Anita Star BHlthSc, PhD, APD · Dianne Campbell MB BS, FRACP, PhD · Preeti Joshi MB BS, FRACP, PhD · Melanie Wong PhD, FRACP, FRCPA · Brad Frankum BMed(Hons), FRACP · Karuna Keat MB BS, FRACP, FRCPA · Geraldine Dunne BSc(Hons), RN · Barbara Dennison DipCommNut, ANAPD · Alyson Kakakios MB BS, FRACP · John B Ziegler FRACP, MD, FAAAAI