Food group consumption pattern of school-aged children and adolescents inside and outside the school setting
: a cross-sectional study of a community in north-eastern Iran
Objectives: The objective of this study is to describe the food group consumption pattern of school-aged children and adolescents inside and outside the school setting.
Methods: This was a cross-sectional, descriptive study of 384 primary and secondary school students, and enrolled in 1th to 12th grade in schools of the province of North Khorasan, Iran. Food intake and dietary pattern were assessed using a validated Food Frequency Questionnaire (FFQ) and 24-hour diet recalls (24HRs), through a self-reported three-day dietary record. The 24HRs were collected by trained interviewers between March and May 2019. The frequency of consumption of foods or food groups was summarized by a single value for each school student, according to the recommendations provided by the Department of Community Nutrition in Iranian Ministry of the Health and Medical Education.
Results: Most of the primary and secondary school students were eating fewer than the optimum recommended servings of milk and milk products (39.8%), fruits and natural juices (63.8%) and vegetables and tubers (47.1%), the optimum recommended servings of meats and eggs (49.0%), and more than the optimum recommended servings of bread and cereals (47.1%) and legumes and nuts (46.4%). According to the mean of 24-hour recalls, there were significant differences in the consumption of food groups between the tertiles of the dietary pattern (p<0.05).
Conclusions: There is evidence that school-aged children and adolescents are in food insecurity. The study reinforces the importance of nutrition education actions and more effective public policies for promoting healthier food choices in childhood and adolescence.
2. Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas. 2013;76:296–302. doi: 10.1016/j.maturitas.2013.07.013.
3. Popkin BM. Does global obesity represent a global public health challenge? Am J Clin Nutr. 2011;93(2):232-3.
4. Duma-Kocan P, Barud B, Głodek E, Gil M. Assessment of nutritional habits and preferences among secondary school students. Rocz Panstw Zakl Hig. 2017;68(1):91-97.
5. Vieira DA, Castro MA, Fisberg M, Fisberg RM. Nutritional quality of dietary patterns of children: are there differences inside and outside school? J Pediatr (Rio J). 2017;93:47–57. doi: 10.1016/j.jped.2016.03.008.
6. Kaikkonen JE, Mikkilä V, Magnussen CG, Juonala M, Viikari JS, Raitakari OT. Does childhood nutrition influence adult cardiovascular disease risk?--insights from the Young Finns Study. Ann Med. 2013;45(2):120-8. doi: 10.3109/07853890.2012.671537.
7. Teblick A, De Deken S, Vanderbruggen W, Vermeersch M, Teblick S, Ruymaekers M, et al. Anthropometry and nutritional status of primary school children in a sub-urban region in Tanzania. Int J School Health. 2017;4(3):e46079. doi: 10.5812/intjsh.46079.
8. Psaki S, Bhutta ZA, Ahmed T, Ahmed S, Bessong P, Islam M, et al. Household food access and child malnutrition: results from the eight-country MAL-ED study. Popul Health Metr. 2012;10(1):24. doi: 10.1186/1478-7954-10-24.
9. Afolabi OT, Bello B, Ijadunola MY, Alabi CO, Akabueze CE, Alabi OA. Media exposure in primary school pupils in South Western Nigeria: a weight concern? Int J Child Adolesc Health. 2015;8(3):315-320.
10. UNICEF. The state of the world’s children 2012: Children in an urban world. 2012. Available from: https://www.unicef.org/sowc2012/pdfs/SOWC-2012-Main-Report_EN_21Dec2011.pdf.
11. Moghames P, Hammami N, Hwalla N, Yazbeck N, Shoaib H, Nasreddine L, Naja F. Validity and reliability of a food frequency questionnaire to estimate dietary intake among Lebanese children. Nutrition Journal. 2016;15:4. doi: 10.1186/s12937-015-0121-1.
12. Tette EM, Sifah EK, Nartey ET. Factors affecting malnutrition in children and the uptake of interventions to prevent the condition. BMC Pediatr. 2015;15:189. doi: 10.1186/s12887-015-0496-3.
13. Degarege D, Degarege A, Animut A. Undernutrition and associated risk factors among school age children in Addis Ababa, Ethiopia. BMC Public Health. 2015;15:375. doi: 10.1186/s12889-015-1714-5.
14. Welker E, Lott M, Story M. The school food environment and obesity prevention: progress over the last decade. Curr Obes Rep. 2016;5:145-155. doi: 10.1007/s13679-016-0204-0PMID: 27066793.
15. Ranjani H, Pradeepa R, Mehreen TS, Mohan Anjana R, Anand K, Garg R, et al. Determinants, consequences and prevention of childhood overweight and obesity: An Indian context. Indian J Endocrinol Metab. 2014;18 Suppl 1:S17-25.
16. Karnik S, Kanekar A. Childhood obesity: a global public health crisis. Int J Prev Med. 2012;3(1):1-7.
17. Karnopp EV, Vaz JS, Schafer AA, Muniz LC, Souza RL, Santos I, et al. Food consumption of children younger than 6 years according to the degree of food processing. J Pediatr (Rio J). 2017;93:70-78. doi: 10.1016/j.jped.2016.04.007 0021-7557.
18. Fatihah F, Ng BK, Hazwanie H, Norimah AK, Shanita SN, Ruzita AT, et al. Development and validation of a food frequency questionnaire for dietary intake assessment among multi-ethnic primary school-aged children. Singapore Med J. 2015;56(12):687-94. doi: 10.11622/smedj.2015190.
19. Schwartz C, Scholtens PA, Lalanne A, Weenen H, Nicklaus S. Development of healthy eating habits early in life. Review of recent evidence and selected guidelines. Appetite. 2011;57(3):796-807. doi: 10.1016/j.appet.2011.05.316.
20. Tugault-Lafleur CN, Black JL, Barr SI. A systematic review of methods to assess children's diets in the school context. Adv Nutr. 2017;8(1):63-79. doi:10.3945/an.116.013144.
21. Best C, Neufingerl N, van Geel L, van den Briel T, Osendarp S. The nutritional status of school-aged children: why should we care? Food and Nutrition Bulletin. 2010;31(3),400-417. doi: 10.1177/156482651003100303.
22. Meher S, Nimonkar R. Assessment of dietary pattern of school-going adolescents in a metro city: a cross-sectional study. Int J Community Med Public Health. 2018;5:4043-8. doi: http://dx.doi.org/10.18203/2394-6040.ijcmph20183593.
23. Oellingrath IM, Svendsen MV, Hestetun I. Eating patterns and mental health problems in early adolescence - a cross-sectional study of 12-13-year-old Norwegian schoolchildren. Public Health Nutr. 2013;17(11):2554-62.
24. Zahe K, Méité A, Ouattara H, Dally T, Kouame KG, Aké-Tano O, Kati-Coulibaly S. Diet, nutritional status and school performance of schoolchildren in the district of Abidjan: case of Yopougon and Bingerville. Nutr Health Sci. 2017;4(1):102. doi: 10.15744/2393-9060.4.102.
25. Rathnayaka R, Wang Z. Influence of family status on the dietary patterns and nutritional levels of children. Food and Nutrition Sciences. 2012;3(8):1055-1059. doi: 10.4236/fns.2012.38140.
26. Dernini S, Berry EM. Mediterranean diet: from a healthy diet to a sustainable dietary pattern. Front Nutr. 2015;2:15. doi: 10.3389/fnut.2015.00015.
27. Iranian Ministry of Health and Medical Education. Perspective of children’ nutrition in provinces. Tehran: UNICEF; 2001.
28. Kelishadi R, Ardalan G, Qorbani M, et al. Methodology and early findings of the fourth survey of childhood and adolescence surveillance and prevention of adult non-communicable disease in Iran: The CASPIAN-IV Study. Int J Prev Med. 2013;4(12):1451-60.
29. Motlagh ME, Ziaodini H, Qorbani M, Qorbani M, Taheri M, Goodarzi A, et al. Methodology and early findings of the fifth survey of childhood and adolescence surveillance and prevention of adult noncommunicable disease: the CASPIAN-V study. Int J Prev Med. 2017;8:4. doi: 10.4103/2008-7802.198915.
30. García-Padilla FM, Gonzalez-Rodriguez A, Martos-Cerezuela I, Liébana Fernández JL, Melo Salor JA. Dietary habits of secondary school students in Andalusia during school time in relation to food stores in the environment. Eglobal. 2017;16(2):94-19. doi: 10.6018/eglobal.16.2.239881.
31. Verstraeten R, Leroy JL, Pieniak Z, Ochoa-Aviles A, Holdsworth M, Verbeke W, et al. Individual and environmental factors influencing adolescents' dietary behavior in low- and middle-income settings. PLOS One. 2016;11(7):e0157744. doi: 10.1371/journal.pone.0157744.
32. Micha R, Karageorgou D, Bakogianni I, Trichia E, Whitsel LP, Story M, et al. Effectiveness of school food environment policies on children's dietary behaviors: a systematic review and meta-analysis. PLOS ONE. 2018;13(3):e0194555. doi: 10.1371/journal.pone.0194555. eCollection 2018.
33. Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, Franch HA, et al. Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation. 2012;126(12):1514-63.
34. Villa JK, Silva AR, Santos TS, Ribeiro AQ, Pessoa MC, Sant'Ana LF. Dietary patterns of children and socioeconomical, behavioral and maternal determinants. Rev Paul Pediatr. 2015;33(3):303-10. doi: 10.1016/j.rpped.2015.05.001.
35. Lee, Y, Manan WWA. Nutritional status, academic performance and parental feeding practices of primary school children in a rural district in Kelantan, Malaysia. Progress in Health Sciences. 2014;4(1):144.
36. Iranian Ministry of Health and Medical Education. Food-based dietary guidelines for Iran. 2015. Available from: http://nut.behdasht.gov.ir.
37. Prentice AM. Dairy products in global public health. Am J Clin Nutr. 2014;99(5):1212S-6S. doi: 10.3945/ajcn.113.073437.
38. Clemens R, van Klinken BJ. Oats, more than just a whole grain: an introduction. Br J Nutr. 2014;112(2):S1-3.
39. Borneo R, León AE. Whole grain cereals: functional components and health benefits. Food Funct. 2012;3(2):110-9. doi: 10.1039/c1fo10165j.
40. United Nations Committee on Economic, Social, and Cultural Rights. The right to adequate food. Geneva: United Nations; 1999.
41. Food and Agriculture Organization. Rome Declaration on Food Security and World Food Summit Plan of Action. 1996. Available from: http://www.fao.org/3/w3613e/w3613e00.htm.
42. Melnik TA1, Rhoades SJ, Wales KR, Cowell C, Wolfe WS. Food consumption patterns of elementary schoolchildren in New York City. J Am Diet Assoc. 1998;98(2):159-64. doi: 10.1016/S0002-8223(98)00040-6.
43. Blanchette L, Brug J. Determinants of fruit and vegetable consumption among 6-12 year-old children and effective interventions to increase consumption. J Hum Nutr Diet. 2005;18(6):431-43. doi: 10.1111/j.1365-277X.2005.00648.x.
44. Keita AD, Casazza K, Thomas O, Fernandez JR. Neighborhood-level disadvantage is associated with reduced dietary quality in children. J Am Diet Assoc. 2009;109(9):1612-6. doi: 10.1016/j.jada.2009.06.373.
45. Kubik MY, Lytle LA, Hannan PJ, Perry CL, Story M. The association of the school food environment with dietary behaviors of young adolescents. Am J Public Health. 2003;93(7):1168–1173.
46. World Health Organization, Regional Office for Europe. Food and nutrition policy for schools: a tool for the development of school nutrition programmes in the European Region. 2006. Available from: http://www.who.int/iris/handle/10665/107797.