Vulnerable age groups need specific advice
What can you say to parents of fussy eaters?
There is obviously behavioural advice on offering food, mealtime rituals and avoiding conflict being acted out around food. There is a place for child multivitamin tablets which are probably better than single calcium and iron supplements alone.
Vitamins A, D and C are available on prescription and are suggested for children up to the age of five, and should be promoted to children from low-income families and Asian children who may be at increased risk of rickets.
There is some concern that weaning diets are often low in iron and mothers may need advice on this. Rusks, fortified cereals and green vegetables are an easy way to add iron-rich foods to the diet.
Teenagers are another at-risk group aren't they?
Many girls are on a diet of some kind, usually weight-reducing, and eating disorders are widely prevalent. This coincides with the most important years for bone health. It is important to ask the right questions and be pro-active in promoting a calcium and vitamin D rich diet.
What about the elderly who are often neglected when it comes to dietary advice?
The elderly are at most risk of osteoporosis and osteoarthritis. With respect to osteoporosis, there is some debate about calcium supplements to over-50s. Some studies do show a benefit, but the best advice centres on increasing exercise and overall diet improvement to increase the amount of vitamin K and D.
There is some work to show antioxidants help in cataracts although by the time they are evident it is probably too late. But we should promote fruit and vegetables to younger people because they may have a role here as well as preventing atherosclerosis and cancer.
Although some studies have linked these substances to disease prevention, the evidence for these supplements is from food not supplements. It may well be the unique way they occur in combination with other substances in food that matters. Many arthritis sufferers believe in glucosamine and there is recent work supporting them in comparison with NSAIDs.