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Confectionery consumption in childhood and adult violence

  • Simon C. Moore (a1), Lisa M. Carter (a2) and Stephanie H. M. van Goozen (a3)
Summary

Diet has been associated with behavioural problems, including aggression, but the long-term effects of childhood diet on adult violence have not been studied. We tested the hypothesis that excessive consumption of confectionery at age 10 years predicts convictions for violence in adulthood (age 34 years). Data from age 5, 10 and 34 years were used. Children who ate confectionery daily at age 10 years were significantly more likely to have been convicted for violence at age 34 years, a relationship that was robust when controlling for ecological and individual factors.

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Corresponding author
Simon C. Moore, Violence and Society Research Group, Applied Clinical Research and Public Health, School of Dentistry, University of Cardiff, Cardiff CF14 4XY, UK. Email: mooresc2@cardiff.ac.uk
Footnotes
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The research was supported by a grant from the Economic and Social Research Council (ES/D000483/1).

Declaration of interest

None.

Footnotes
References
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1 Farrington, DP. Early predictors of adolescent aggression and adult violence. Violence Vict 1989; 4: 79100.
2 Gesch, CB, Hammond, SM, Hampson, SE, Eves, A, Crowder, MJ. Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomized placebo-controlled trial. Br J Psychiatry 2002; 181: 22–8.
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4 Hibbeln, JR, Nieminen, LRG, Lands, WEM. Increasing homicide rates and linoleic acid consumption among five western countries, 1961–2000. Lipids 2004; 39: 1207–13.
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6 Fairchild, G, Goozen, SH, Stollery, SJ, Aitken, MR, Savage, J, Moore, SC, et al. Decision-making and executive function in male adolescents with early-onset or adolescence-onset conduct disorder and control subjects. Biol Psychiatry 2009; 66: 162–8.
7 Benton, D. The impact of diet on anti-social, violent and criminal behaviour. Neurosci Biobehav Rev 2007; 31: 752–74.
8 Turner, CF, Ku, L, Rogers, SM, Lindberg, LD, Pleck, JH, Sonenstein, FL. Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science 1998; 280: 867–73.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
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Confectionery consumption in childhood and adult violence

  • Simon C. Moore (a1), Lisa M. Carter (a2) and Stephanie H. M. van Goozen (a3)
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eLetters

Re: Confectionary consumption and violence: a weak methodological basis for a great impact claim

Simon C Moore, Senior Lecturer
06 January 2010

We are pleased that our paper [1], a paper suggesting an association between childhood confectionery consumption and adult violence, continues to provoke interest. In Dario Gregori's correspondence he makes the strongstatement "most of the conclusions drawn by the authors are flawed by serious methodological concerns, which make the overall findings, as proposed by the authors, seriously questionable". As will be demonstrated,this is an unfortunately naive position. Gregori correctly observes that "the number of violent people in their cohort is very low" and continues to suggest that reporting results on such small samples should be discouraged. We are interested in life course factors that predict adult violence in the hope that such research might inform early life-course interventions. We therefore have two options. Either recruit violent offenders and enquire of their childhoods, or follow a cohort of individuals recording information on their circumstances to assess associations with later problem behaviour. Unfortunately, Gregori appears unaware of the vagaries of human memory and the particular difficulties many offenders have with recalling what they did the previous day, let alone several decades ago. It is thus methodologically unfeasible to conduct retrospective studies thus leaving cohort studies as the only realistic and robust methodology. We are fortunate in the UK to have one of the most highly regarded cohort studies in the world, but despite its large initial sample size the rarity of violence means only a small numberof respondents demonstrate the behaviour of interest. Should we, as Gregori counsels, simply not consider using the British Cohort Study to look into childhood factors predicting adult violence because violence is rare? We suggest that this would be a valuable and informative resource squandered if that advice were followed. Gregori also suggests that modelson rare data should not involve too many covariates. In our short paper wedid report that we considered various configurations including the unadjusted association between confectionery and violence and that the strength of association was consistent across models - analytically we didas much as we could to test this association. We chose not to report simpler models and hardly mentioned the extensive analyses assessing the impact of attrition simply because we felt this paper suited a short-report and including this additional information would only detract from what was a perfectly well articulated finding. We therefore maintain that we analysed some of the best cohort data available to assess childhood predictors of an important outcome and found a robust association. We werehonest with regards the sample size, concluding in the paper that this is one area that should be addressed before firm conclusions could be drawn. At best we would regard Gregori's statement as naively opportunistic. Gregori also makes the rather unusual statement "it is still difficult to understand for the reader why deciding to focus on confectionery instead of on other factors, resulting in a heavier association with violence (gender has an OR almost three times higher than confectionery, and late birth almost the same) or perhaps in a smoother aetiological interpretation (child-oriented parenting)." It is unusual for two reasons.First, anyone with any interest in ongoing research into life-course trajectories and offending behaviours would know that the literature on these "other" factors is reasonably mature and restating what is known would be of little interest to readers. Second, there are at least severallarge on-going studies examining the long-term relationship between diet and behaviour and there is growing and considerable interest in the relationship between diet, health and behaviour. We can only conclude thatGregori is opportunistically commenting on areas of research that he has little or no expertise in.

1.Moore, S.C., L. Carter, and S. Van Goozen, Confectionery consumption in childhood and adult violence. British Journal of Psychiatry, 2009. 195: p. 366-367.
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Confectionary consumption and violence: a weak methodological basis for a great impact claim

Dario Gregori, Associate Professor of Biostatistic
04 January 2010

Moore et al. [1] found in a recent paper a “novel and robust” relationship between confectionary consumption during childhood and conviction for violence at older ages. Unfortunately, most of the conclusions drawn by the authors are flawed by serious methodological concerns, which make the overall findings, as proposed by the authors, seriously questionable.As recognized by the authors, the number of violent people in their cohortis very low. The lack of descriptive information in the paper, contrarily on the reasonable recommendations of the guidelines in reporting observational studies [2], forces the reader to an exercise of reconstruction. However, what is eventually emerging is that only about 33subjects where violent (0.47% of 6942), and of these, only 23 (69% of the 33 violent subjects) where eating confectionery. With such numbers in hand, it is highly discouraged in the biostatistical literature to model the probability of being violent using so many parameters (8) as the authors did, since the fit is essentially driven by the number of cases and not by the entire sample size [3]. The deficiencies of this approach are well known and numerous, affecting any part of the modelling process, from the variable selection to the effect size estimation [4] and are not,generally, accommodated by the adoption of rare-events logistic models, which only provide a fix for bias in estimating regression parameters, leaving the above considerations unchanged. With such small number of cases, obviously no interactions have been considered, even though some of them could result as very intuitive, like,for instance confectionery consumption and child-oriented parenting. In absence of a serious attempt of considering interactions in the model, therisk of finding spurious associations is great and well documented under the concept of “Simpson’s paradox” [5]. Unfortunately, no details are provided in the paper among distribution of the other 7 factors included in the multivariable model (gender, late birth ...) between violent and non-violent people, so that it is almost impossible to understand how low the cell frequency in some of such combinations is. But even in absence ofsuch data, it is still difficult to understand for the reader why decidingto focus on confectionery instead of on other factors, resulting in a heavier association with violence (gender has an OR almost three times higher than confectionery, and late birth almost the same) or perhaps in asmoother aetiological interpretation (child-oriented parenting). Having the above considerations in mind, conclusions drawn by the authors on suggesting a relationship between confectionery and violence seem more theeffect of an over-interpretation of the fitted model, being in any case everything but robust.

References

1.Moore SC, Carter LM, van Goozen S. Confectionery consumption in childhood and adult violence. Br J Psychiatry 2009; 195: 366-367.2.Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 2007; 18: 805-835.3.Harrell FE, Jr., Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996; 15: 361-387.4.Harrell FE, Jr., Lee KL, Califf RM, Pryor DB, Rosati RA. Regression modelling strategies for improved prognostic prediction. Stat Med 1984; 3:143-152.5.Agresti A. Categorical Data Analysis. (2nd edn). Wiley & Sons: New York, 2002.
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Re: From sweet to sour

Simon Moore
11 December 2009

Our publication [1], a paper suggesting an association between childhood confectionery consumption and adult violence, provoked considerable media interest and therefore discussion both in print and online. Brunskill and Hill have taken the opportunity to further this discussion and have highlighted the form of the hypothesis, possibly omitted confounders, risk and odds ratios, the strength of the reported relationship and the potential negative effects of the paper through promoting punitive parenting style. The far ranging media interest stimulated by this paper ranged from deriding the work as a waste of moneyto one that could bring peace and harmony to a North American city, and possibly further afield. Brunskill is therefore quite correct in remindingus that as good Popperians [2] behavioural scientists test null hypotheses: science progresses through the falsification of beliefs, and accordingly we reported the acceptability of the null probabilistically inthe regression statistics. But the point remains that at least in the media such results are too often reported as facts when they are statements of belief looking to be challenged. Stating “what works”, inferring causality, and demonstrating “proof” are further examples of naivety that contributes to the disparity between academic and lay reporting. We therefore welcome Brunskill’s discussion of other possible covariates that might explain the stated relationship. It is only through such insights that science can move forward productively and are pleased to have the opportunity to reaffirm that Moore et al. was not a statement of fact. Turning to Hill’s comments on the strength of the reported relationship: any good public health strategy will seek to minimize harm. Some interventions might reduce the chance of an individual engaging in anharmful act by a miniscule degree [3] but when multiplied up across many thousands of individuals, the difference between individual and public health, we may begin to see considerable advantages. Although the relationship between confectionery and violence is small, if it was substantiated and informed an effective intervention, it might represent aconsiderable number of victims and therefore targeting resources at reducing confectionery use might provide a cost effective means of addressing a particularly costly behaviour. While educational interventions would be expected to have a greater impact, the cost of schools is considerably more than policies restricting exposure to confectionery advertising, for example. We fully accept Hill’s comments onrisk and odds ratios but, as any author who has published across disciplines will attest, it is often easier to stick with metrics that match readers’ expectations. Perhaps the most important issue raised by Smith and Brunskill concerns the effect of this research on parents themselves; specifically, that the paper might engender a shift to a more punitive parenting style. Smith is likely correct in stating that rewards are an important component of good parenting. However, rewards need not besurrogates, such as confectionery, and the absence of which might encourage more honest forms of reward.

1.Moore, S.C., L. Carter, and S. Van Goozen, Confectionery consumption in childhood and adult violence. British Journal of Psychiatry, 2009. 195: p. 366-367.

2.Popper, K.R., The Logic of Scientific Discovery. 1992, London: Routledge.

3.Slovic, P., B. Fischhoff, and S. Lichtenstein, Accident probabilities and seat belt usage: A psychological perspective. Accident Analysis and Prevention, 1978. 10: p. 281-285.

Declaration of Interest: the author of this paper attests that they receive no fees and grants from, employment by, consultancy for, shared ownership in, or any close relationship with, an organisation whose interests, financial or otherwise, may be affected by the publication of this response.
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From sweet to sour

David M Brunskill, specialty registrar in forensic psychiatry
02 December 2009

In summarising that children who ate confectionary daily at age 10 years were significantly more likely to have been convicted for violence at age 34 years, Moore et al’s short report [1] provided a media friendly sound-bite, as exemplified by the headline from the press release on the royal college website: “eating sweets every day in childhood increases adult aggression” [2].
/>Whilst this may effectively demonstrate an underlying tension associated with the College’s aims (of promoting public awareness/acceptance of mental health issues, and the related need to provide an accessible point of interest), it seems important that a scientific approach should not compromised in the longer-term.

Perhaps with this balancing act in mind, it has been considered that a short report should be a really excellent long paper that has been worked carefully to reveal the bare essentials [3]. However, by choosing to focus on the conclusion which most supported their hypothesis (conspicuously not posed in the null form), the authors run the risk of minimising the complexity associated with this important area of study (e.g. being a male child had a positive odd’s ratio nearly three times as large as that of daily confectionary consumption).

Although the scope of a short report is acknowledged, it does not appear clear that exogeneity has been satisfactorily ruled out (e.g. child poverty/over-crowding could potentially be associated with both childhood confectionary consumption and adult violence respectively). Additionally, by asserting that the association is significant where ecological, childhood and other controls were included, it is assumed that all the potential confounders were identified prior to the regression, which seems unlikely in such a complex social scenario.

Putting critical appraisal to one side, the authors have creatively highlighted a socially important issue, and their favoured explanation is neat and intriguing. By looking beyond the tooth-rotting effects of 1980’s confectionary and towards a psychological viewpoint, this short report can make a valid contribution to the debate by widening the consideration and understanding of the multiple factors which contribute to adult violence.

[1] Moore S, Carter L, van Goozen S Confectionary consumption in childhood and adult violence Br J Psychiatry 2009; 195:366-367

[2] Press release www.rcpsych.ac.uk Home page, October 2009

[3] Tyrer P Short reports are short reports Br J Psychiatry 2009; 195:378 ... More

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Confectionery and violence

Mike Smith, Psychiatric Registrar
02 December 2009

Moore et al have produced a quite thought provoking report on the possible relationship between excessive consumption of confectionary in childhood and subsequent violence in adulthood. (1)

Unfortunately, as the authors point out, violence is a rare event amongst the cohort. In order to consider further whether potential intervention in confectionary consumption amongst 10 year olds would be worthwhile, it would have been useful for the absolute risk of violence among the chocolate and non-chocolate eaters to be outlined. While it is hard to argue with their statement that“targeting resources at childhood diet may improve health”, the use of rewards to influence childhood behaviour is an important component of goodparenting, and one needs to be careful not to promote a more punitive parenting style, which could have the potential to lead to an increase in rates of violence. (2,3,4)

An association between educational qualifications at 16 and daily confectionary eating was noted by the authors. While it is not possible toextrapolate from this an association between educational qualifications and adult violence it would seem to be a critical relationship to investigate further. One would hypothesize that the association between these two variables would be significantly stronger than the association between confectionary and violence.

1. Moore SC, Carter LM, van Goozen S. Confectionery consumption in childhood and adult violence The British Journal of Psychiatry 2009; 195: 366-36

2. Woodward LJ, Fergusson DM, Chesney C, Horwood LJ. Punitive parenting practices of contemporary young parents. Journal of the New Zealand Medical Association 14-December-2007, Vol 120 No 1267 http://www.nzma.org.nz/journal/120-1267/2866/

3. Scholte EM. Factors predicting continued violence into young adulthood. Journal of Adolescence 1999. 22(1):3-20, Feb.

4. Widom, C. "The Intergenerational Transmission of Violence". In: Pathways to Criminal Violence. N. Weiner & M. Wolfgang (eds.) CA: Sage. 1989.
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