Socio-demographic differences in food habits and preferences of school adolescents in Jiangsu Province, China

Serum binding folate receptor autoantibodies lower in autistic boys and positively-correlated with folate

Folate receptor autoantibody (FRAA) has caught increasing attention since its discovery in biological fluids of patients with autism spectrum disorder (ASD), but quantification and understanding of its function are still in their infancy. In this study, we aimed to quantify serum binding-FRAA and explore its relation with serum folate, vitamin B12 (VB12) and ferritin. We quantitated serum binding-FRAA in 132 ASD children and 132 typically-developing (TD) children, as well as serum levels of folate, VB12 and ferritin. The results showed that serum binding-FRAA in the ASD group was significantly lower than that in the TD group (p < 0.0001). Further analysis showed that the difference between these two groups was attributed to boys in each group, not girls. There was no statistically significant difference in folate levels between the ASD and TD groups (p > 0.05). However, there was significant difference in boys between these two groups, not girls. Additionally, the combination of nitrite and binding-FRAA showed potential diagnostic value in patients with ASD (AUC > 0.7). Moreover, in the ASD group, the level of folate was consistent with that of binding-FRAA, whereas in the TD group, the binding-FRAA level was high when the folate level was low. Altogether, these differences revealed that the low serum FRAA in autistic children was mediated by multiple factors, which deserves more comprehensive investigation with larger population and mechanistic studies.

Barriers to consumption of fruits and vegetables and strategies to overcome them in low- and middle-income countries: a narrative review

This review provides an overview of the barriers to the consumption of fruits and vegetables (FVs) as well as strategies to improve the intake of FVs in low- and middle-income countries (LMICs). The importance of the consumption of FVs and its role in disease prevention are discussed briefly. Trends in the consumption of FVs in LMICs are also summarised. The WHO recommends that every individual should consume at least five servings or 400 grams of FVs per day. Epidemiological and clinical investigations have demonstrated that FVs contain numerous bioactive compounds with health-protecting activities. Despite their health benefits, the intake of FVs in LMICs remains low. Major barriers identified were socio-demographic factors, environmental conditions, individual and cultural factors, and macrosystem influences. These barriers may be lowered at the household, school, community, and national level through multi-component interventions including behaviour change communication (BCC) initiatives, nutrition education (NE), gardening initiatives, farm to institution programs (FIPs), food baskets, cash transfers, nutrition-agriculture policy and program linkages, and food-market environment-based strategies. This review has research implications due to the positive outcomes of strategies that lower such barriers and boost consumption of FVs in LMICs.

Evaluation and Comparison of Nutritional Status According to Area of Residence and Type of Institute, its Effect on Plaque and Gingival Status: A Comparative Longitudinal Study

Need of the study

Schoolchildren constitute about 113.8 million (2000-2001 census) population of India and around 11,413,000 comprises schoolchildren in Rajasthan (2000-2001 census), with overall 2.4% children suffering from dietary inadequacies. In the causation of nutritional deficiency diseases, dietary inadequacies have been considered a predominant etiological factor. To overcome such dietary problems and initiate any programs for improvement in general and oral health status, the present study was undertaken in the form of a dietary record of five consecutive days among schoolchildren belonging to different geographical areas.

Aim

To evaluate and compare nutritional status according to area of residence and type of institution and its possible effect on plaque and gingival status among 12-15-year-old schoolchildren of Jaipur.

Materials and methods

The list of schools was collected using simple random technique in both rural and urban areas of Jaipur city. Overall, four schools were drawn randomly from the selected area (two from government and two from private).

Results

In the urban area, nutrient scores (NS) were higher compared to rural areas, irrespective of the season. In contrast to this, plaque and gingival scores were higher in private schools of rural areas.

Conclusion

There is a need for awareness regarding applied nutrition among schoolchildren, irrespective of the area.

How to cite this article

Gaur AG, Sharma M, Sharma R, et al. Evaluation and Comparison of Nutritional Status According to Area of Residence and Type of Institute, its Effect on Plaque and Gingival Status: A Comparative Longitudinal Study. Int J Clin Pediatr Dent 2023;16(S-3):S233-S239.

Unhealthy lifestyles and clusters status among 3637 adolescents aged 11-23 years: a school-based cross-sectional study in China

BACKGROUND

Unhealthy lifestyles are risk factors for non-communicable diseases (NCDs) and tend to be clustered, with a trajectory that extends from adolescence to adulthood. This study investigated the association of diets, tobacco, alcohol, physical activity (PA), screen time (ST) and sleep duration (SD) in a total of six lifestyles, separately and as cumulative lifestyle scores, with sociodemographic characteristics among school-aged adolescents in the Chinese city of Zhengzhou.

METHODS

In the aggregate, 3,637 adolescents aged 11-23 years were included in the study. The questionnaire collected data on socio-demographic characteristics and lifestyles. Healthy and unhealthy lifestyles were identified and scored, depending on the individual score (0 and 1 for healthy and unhealthy lifestyles respectively), with a total score between 0 and 6. Based on the sum of the dichotomous scores, the number of unhealthy lifestyles was calculated and divided into three clusters (0-1, 2-3, 4-6). Chi-square test was used to analyze the group difference of lifestyles and demographic characteristics, and multivariate logistic regression was used to explore the associations between demographic characteristics and the clustering status of unhealthy lifestyles.

RESULTS

Among all participants, the prevalence of unhealthy lifestyles was: 86.4% for diet, 14.5% for alcohol, 6.0% for tobacco, 72.2% for PA, 42.3% for ST and 63.9% for SD. Students who were in university, female, lived in country (OR = 1.725, 95% CI: 1.241-2.398), had low number of close friends (1-2: OR = 2.110, 95% CI: 1.428-3.117; 3-5: OR = 1.601, 95% CI: 1.168-2.195), and had moderate family income (OR = 1.771, 95% CI: 1.208-2.596) were more likely to develop unhealthy lifestyles. In total, unhealthy lifestyles remain highly prevalent among Chinese adolescents.

CONCLUSION

In the future, the establishment of an effective public health policy may improve the lifestyle profile of adolescents. Based on the lifestyle characteristics of different populations reported in our findings, lifestyle optimization can be more efficiently integrated into the daily lives of adolescents. Moreover, it is essential to conduct well-designed prospective studies on adolescents.

TFOS Lifestyle: Impact of nutrition on the ocular surface

Nutrients, required by human bodies to perform life-sustaining functions, are obtained from the diet. They are broadly classified into macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals) and water. All nutrients serve as a source of energy, provide structural support to the body and/or regulate the chemical processes of the body. Food and drinks also consist of non-nutrients that may be beneficial (e.g., antioxidants) or harmful (e.g., dyes or preservatives added to processed foods) to the body and the ocular surface. There is also a complex interplay between systemic disorders and an individual's nutritional status. Changes in the gut microbiome may lead to alterations at the ocular surface. Poor nutrition may exacerbate select systemic conditions. Similarly, certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body. These disorders may lead to deficiencies in micro- and macro-nutrients that are important in maintaining ocular surface health. Medications used to treat these conditions may also cause ocular surface changes. The prevalence of nutrition-related chronic diseases is climbing worldwide. This report sought to review the evidence supporting the impact of nutrition on the ocular surface, either directly or as a consequence of the chronic diseases that result. To address a key question, a systematic review investigated the effects of intentional food restriction on ocular surface health; of the 25 included studies, most investigated Ramadan fasting (56%), followed by bariatric surgery (16%), anorexia nervosa (16%), but none were judged to be of high quality, with no randomized-controlled trials.

Analysis of Determinants of Food Preferences in a Polish Population-Based Sample of Primary School Adolescents: Diet and Activity of Youth during COVID-19 (DAY-19) Study

For the choices of food products, food preferences are crucial, as they influence the intake of nutrients and the resultant quality of diet, but in Poland, no studies of food preferences were conducted during the COVID-19 pandemic on a population of young adolescents. The aim of this study was to analyze the determinants of food preferences in a Polish population-based sample of primary school adolescents as part of the Diet and Activity of Youth during COVID-19 (DAY-19) Study. The DAY-19 Study focused on a national sample of a population of primary school adolescents who were recruited based on cluster sampling of participants from counties and schools, yielding a sample of 5039 individuals. Their food preferences were assessed using the Food Preference Questionnaire (FPQ), and they were compared in subgroups stratified by (1) gender: male and female; (2) age: younger (10-13 years) and older (14-16 years); (3) place of residence: urban and rural; (4) Body Mass Index (BMI): underweight, normal body weight, and overweight/obese (assessed based on Polish growth reference values); and (5) physical activity level: low and moderate (assessed using the International Physical Activity Questionnaire for children aged 10-13 (IPAQ-C) and adolescents aged 14-16 (IPAQ-A)). In the population of adolescents, no statistically significant differences in food preferences between subgroups stratified by gender were observed (p > 0.05). For boys, none of the studied factors (age, place of residence, BMI, physical activity level) was statistically significant determinant of food preferences (p < 0.05), while for girls, all of them were statistically significant determinants (p > 0.05). All the assessed factors (age, place of residence, BMI, physical activity level) in girls were associated with preferences for snacks, and older girls, those from a rural environment, those who were underweight and overweight/obese, as well as those having a low physical activity level declared a higher preference for snacks than younger ones (p = 0.0429), those from an urban environment (p = 0.0484), those of a normal body weight (p = 0.0091), and those having a moderate physical activity level (p = 0.0083). Similarly, girls from rural environments declared a higher preference for starches than those from urban environments (p = 0.0103), and girls having a low physical activity level declared a higher preference for fruit than those having a moderate physical activity level (p = 0.0376). Taking this into account, the population of girls, in particular, needs dedicated educational actions to support proper nutritional habits. Additionally, older age, living in a rural environment, being underweight and overweight/obese, and having a low physical activity level may be indicated as factors predisposing one to food preferences potentially promoting unhealthy dietary habits.

The nutrition transition, food retail transformations, and policy responses to overnutrition in the East Asia region: A descriptive review

BACKGROUND

The East Asia region is facing an increasing burden of overweight, obesity and related noncommunicable diseases, resulting from an ongoing nutrition transition. This study aimed to document the growing burden of overweight and obesity, and the accompanying dietary shifts, in the East Asia region and describe the policy responses to this.

METHODS

We present noncommunicable disease risk factor collaboration data on trends in the burden of malnutrition, and Euromonitor International data on trends in dietary purchases, in the East Asia region. We searched the NOURISHING and GINA databases to identify food and nutrition policies implemented in these countries.

RESULTS

There is an ongoing nutrition transition in the East Asia region, notably in upper-middle and lower-middle income countries. The prevalence of overweight, obesity, and accompanying health conditions, purchases of ultra-processed foods and beverages, and purchasing from supermarkets, fast-food and takeaway outlets, and other convenience retailers, are increasing. The policy response to this nutrition transition is limited, with the majority of policies implemented in higher-income countries.

CONCLUSIONS

East Asian countries are facing a growing burden of malnutrition, due in part to the dietary shifts occurring here. An ecological approach to policy intervention is needed to drive transformative food systems change.

Breakfast Consumption and Academic Achievement Among Chinese Adolescents: A Moderated Mediation Model

The studies have shown that a healthy lifestyle has a significant impact on the academic achievement of adolescents. Behavior of breakfast eating is considered a hallmark of dietary patterns and an important component of a healthy lifestyle. The prior study explained that students had a lower level of achievement motivation at school because they were exposed to some militating factors in their families such as absenteeism, ill health, malnutrition, and hunger. This study examined the mediating role of achievement motivation and moderating role of socioeconomic status (SES) in the association between breakfast consumption and academic achievement. This study used a sample of 15-year-old Chinese students who participated in Program for International Student Assessment (PISA) 2015. In terms of gender, female students accounted for 47.2% and male students accounted for 52.8%. The results showed that (1) breakfast consumption had a positive predictive effect on academic achievement; (2) achievement motivation played a partial mediating role in the relationship between breakfast consumption and academic achievement; and (3) the direct and indirect effects were moderated by the SES of students, which meant that the effect of breakfast consumption on achievement motivation can differ depending on the SES of students. Besides, both the effects were stronger for individuals with higher SES. The conclusion of this study has an important theoretical value and reference value to guide the Chinese parents and Chinese adolescents to pay more attention to breakfast consumption and healthy lifestyles.

Screening of central obesity among normal-weight children and adolescents in Shandong, China

The prevalence of central obesity in the total population has been reported in numerous studies. However, information on the prevalence of central obesity within normal-category BMI is scant. In the present study, we examined the profiles of central obesity among normal-weight children and adolescents. A total of 29 516 (14 226 boys and 15 290 girls) normal-weight children and adolescents (excluding underweight, overweight and obesity) aged 7-18 years were included in the final analysis. Central obesity was defined by the international age- and sex-specific cut-offs of waist circumference (WC) and threshold of waist:height ratio (WHtR ≥ 0·5). All subjects were classified into four groups (Q1-Q4) according to the age- and sex-specific quartiles of BMI, those in the upper fourth (Q4) were defined as 'high-normal BMI' and those in the lower fourth (Q1) were defined as 'low-normal BMI'. The prevalence of central obesity as measured by WC was 9·90 (95 % CI 9·41, 10·39) % for boys and 8·11 (95 % CI 7·68, 8·54) % for girls; by WHtR was 2·97 (95 % CI 2·69, 3·25) % for boys and 2·44 (95 % CI 2·20, 2·68) % for girls. Subjects in the Q4 group had a much higher prevalence of central obesity than their counterparts in the Q1 group (P < 0·01). Our findings suggest that the health risks of children with normal-weight central obesity may be missed when BMI is used alone as a measure; it is meaningful to include WC in clinical practice and to include the simple message 'Keep your waist to less than half your height'.

Profiles of anemia among school-aged children categorized by body mass index and waist circumference in Shandong, China

BACKGROUND

The prevalence of childhood obesity has been increasing worldwide. The connection between iron deficiency and obesity has received much research interest. The present study examined the profiles of anemia among school-aged children categorized by obesity-related index in Shandong, China.

METHODS

A total of 20,172 children aged 7, 9, 12, and 14 years participated in the study, whose hemoglobin (Hb) concentration was measured by laboratory technicians. The prevalence rates of anemia among children within each subgroup categorized by body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) were determined.

RESULTS

On the whole, 3.99% of boys and 6.68% of girls suffer from anemia. Disparities in the prevalence of anemia were observed between different subgroups categorized by BMI, WC and WHtR. For both boys and girls, the prevalence of anemia increased with the severity of thinness and obesity, suggesting that both severe thinness and severe obesity are associated with an elevated prevalence of anemia.

CONCLUSION

In the era of the obesity pandemic, obesity could potentially add to the burden of anemia, suggesting that obese children should not be ignored when establishing strategies targeted at preventing anemia.

Trends in abdominal obesity among Chinese children and adolescents, 1993-2015

OBJECTIVES

The prevalence of general overweight and obesity defined by body mass index criteria has greatly increased in Chinese children and adolescents in recent decades. However, few studies have considered the trend in abdominal obesity in Chinese children and adolescents. This study aimed to examine the secular trends in waist circumference (WC), waist-to-height ratio (WHtR) and the prevalence of abdominal obesity among Chinese children and adolescents aged 6-17 years from 1993 to 2015.

METHODS

A total of 11,985 children and adolescents aged 6-17 years participated in the China Health and Nutrition Survey, a continuous cross-sectional survey, conducted from 1993 to 2015. Abdominal obesity was defined as WC≥age- and sex-specific 90th percentile based on the reference from Chinese children and adolescents or WHtR≥0.50.

RESULTS

After adjustment for age, sex and region, mean WC increased from 60.27 cm in 1993 to 64.31 cm in 2015 (p for trend <0.001), and mean WHtR increased from 0.430 to 0.434 (p for trend <0.05). The prevalence of abdominal obesity defined by WC reference increased from 5.0% in 1993 to 19.3% in 2015 and defined by WHtR reference increased from 6.4% in 1993 to 14.5% in 2015 (p for trend <0.001).

CONCLUSIONS

The prevalence of abdominal obesity among Chinese children and adolescents aged 6-17 years has increased between 1993 and 2015.

Study of the Influence of Sociodemographic and Lifestyle Factors on Consumption of Dairy Products: Preliminary Study in Portugal and Brazil

Sociodemographic characteristics, including regional variations, have been associated with different food consumption patterns. Behavioral factors and lifestyle variables may also contribute to different food dietary trends. In this way, the present study intended to investigate the consumption habits of the most relevant types of dairy products around the world and relate them to sociodemographic factors, for example, age, sex, education and country as well as with some anthropometric and behavioral aspects, for example, body mass index, satisfaction with body weight and exercise or sedentary lifestyles. One other objective of the study was to categorize the lifestyles of the participants, according to measured variables linked with hours of inactivity or exercise, in order to use these as possible differentiating variables for the consumption of dairy products. The study involved a questionnaire survey undertaken on a non-probabilistic convenience sample of participants from Portugal (PT) and Brazil (BR), and participation was voluntary and anonymous. The data analysis involved different statistical techniques: basic statistics, chi-square tests, factor analysis, cluster analysis and tree classification analysis. The results showed that semi skimmed milk is never consumed by about half of the participants (47.4% for PT and 46.7 for BR), and those numbers increase for skimmed (64.8% for PT and 50.9% for BR), chocolate flavored milk (82.6% for PT and 65.6% for BR) and enriched milks (94.8% for PT and 85.3% for BR). Cheeses are also consumed in the two countries by small numbers of people. The number of participants consuming imported cheeses in both countries was particularly low (only 4.0% consume these more than once a week in both countries), suggesting national products may be preferred. It was further observed that those who consume cheese do it seldom (once a week) or sometimes (2–3 times per week). Butter is also consumed by only about half of the adult population (43.8% for PT and 49.5% for BR), but the percentage of those who never consume butter increases for skimmed butter (66.0% for PT and 82.6% for BR) and unsalted butter (70.2% for PT and 69.1% for BR). The consumption of yogurts also follows similar low consumption patterns. The most frequently consumed yogurt types in Portugal are liquid (30.5% consume regularly) and natural yogurts (34.8% consume regularly), while in Brazil the most frequent are creamy fruit pulp yogurt (14.4% consume regularly), liquid (13.7% consume regularly) and Greek type yogurt (10.2% consume regularly). A factor analysis and a cluster analysis established groups according to lifestyles, as follows: 1—Screeners, 2—Exercisers, 3—Travelers and 4—Others. These lifestyles were found to be influential in the consumption of dairy products for all classes of dairy tested: milk, cheese, yogurt and butter. For example, the screeners were found to consume more milk, more butter, more cheese and more yogurt. Additionally, other influential factors were age, sex, education, BMI and satisfaction with body weight. Nevertheless, country was not a meaningfully discriminant variable in relation to the other variables included in the classification analysis. The results concluded that, despite some small differences in the patterns of consumption of dairy products in both countries, the levels of consumption of dairy products are extremely low, for all classes studied (milk, cheese, yogurt or butter). Additionally, it was concluded that some factors are influential on the level of consumption of dairy products, and therefore decision makers can plan their interventions according to the characteristics of the targeted segments of the population, according to lifestyle, age, sex, education, BMI and satisfaction with body weight.

The Association of Demographic Characteristics and Food Choice Motives with the Consumption of Functional Foods in Emerging Adults

The functional food market is one of the fastest growing segments of the global food industry. The aims of this study were to understand the association of demographic characteristics and food choice motives (FCMs) with (a) attitudes toward functional foods and (b) consumption of functional foods in Australian emerging adults. Data were collected through a paper-based and online questionnaire completed by 370 young adults aged between 17 and 29 years. A binomial logistic regression was used to determine the association between demographic characteristics and FCMs with attitudes towards functional foods. The logistic regression model was statistically significant at χ2(11) = 48.310 (p < 0.001) and explained 18.1% of the variance in attitude towards functional food. Of the several predictors, only the FCMs natural content and weight control were statistically significant. A binomial logistic regression was also used to determine the association between demographic characteristics and FCMs with the consumption of functional foods. The logistic regression model was statistically significant at χ2(9) = 37.499 (p < 0.001) and explained 14.1% of the variance in functional food consumption. Of the eight predictors, three were statistically significant: living situation, natural content and health. Findings highlight that when targeting emerging adults, functional food companies could benefit from promoting the natural and health properties of their products. Furthermore, consumption can be increased by targeting the parents of emerging adults and by designing functional foods that attract emerging adults interested in controlling weight.

Prevalence and correlates of fruit and vegetable consumption among adolescents in Laos

The study aimed to estimate the prevalence and correlates of fruit and vegetable (FV) intake among adolescents in the "2015 Laos Global School-Based Student Health Survey (GSHS)". The study sample consisted of 3,683 school adolescents with a median age of 16 years from Laos that responded to the 2015 cross-sectional GSHS. The prevalence of inadequate fruit consumption (<2/day) was 74.0%, inadequate vegetable consumption (<3/day) 78.5%, and inadequate FV consumption (<5/day) 83.7%. In adjusted logistic regression analysis, physical inactivity (adjusted odds ratio = AOR: 1.43, 95% confidence interval=CI, 1.061.93) was positively, and being overweight or obese (AOR: 0.65; 95% CI, 0.450.95), soft drink consumption (AOR: 0.55; 95% CI, 0.440.69), fast food consumption (AOR: 0.59; 95% CI, 0.470.74), and peer support (AOR: 0.69; 95% CI, 0.540.88) were negatively associated with inadequate FV consumption. A high proportion of inadequate FV consumption was found and strategies to increase FV consumption in this population may take into account sociodemographic, lifestyle, peer and parental factors.

Consumption of foods containing prohibited artificial colors among middle-school children in Nay Pyi Taw union territory, Myanmar

Background

Food safety control in Myanmar is regulated by the Department of Food and Drug Administration (FDA). FDA conducts food safety education programs in schools and regular market surveys of foods containing prohibited artificial colors. However, the consumption of foods containing FDA-prohibited artificial colors among school children is understudied. This study aimed to assess the consumption of foods containing FDA-prohibited artificial colors among middle-school children in Nay Pyi Taw Union Territory, Myanmar.

Methods

A cross-sectional study was conducted at eight public schools in Nay Pyi Taw Union Territory in 2017. The schools were selected using simple random sampling with a drawing method. In total, 776 students (359 boys and 417 girls) participated in face-to-face interviews using a structured questionnaire and photos of foods containing artificial color published by FDA. A multiple logistic regression was performed to estimate adjusted odds ratio (AOR) for consumption of such foods.

Results

In total, 519 (66.9%) children consumed foods with the FDA-prohibited colors. It was revealed that students at suburban schools were nearly five times more likely to consume foods containing FDA-prohibited artificial colors (AOR = 4.84; 95% confidence interval (CI) 2.99–7.82) compared to those at urban schools. In addition, being in the seventh grade (AOR = 3.38; 95% CI 2.30–4.98), availability of prohibited food in school canteen (AOR = 6.16; 95% CI 2.67–14.22), and having a less educated father (AOR = 1.76; 95% CI 1.06–2.92) were positively associated with consumption of the foods with the prohibited colors.

Conclusion

More than half of the students consumed foods with the prohibited colors. Consumption was more frequent among students from suburban schools, those with unsafe foods accessible at their school canteen, seventh graders, and students with a less educated father. The findings highlighted that school food safety programs, which focus on preventing consumption of foods containing FDA-prohibited artificial colors, are urgently required. Food safety regulation is also required to ban the sale of unsafe food, especially in school canteens.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6669-5) contains supplementary material, which is available to authorized users.

Mapping and Predicting Patterns of Chinese Adolescents' Food Preferences

This study aimed to examine the patterns of, as well as the predictors for, Chinese adolescents’ food preferences. Using the national data of the China Health and Nutrition Survey (CHNS), we analyzed the data of 697 adolescents in the age range of 12 to 17 years. Latent class analysis revealed four types of food preferences: varied diet (37.09%, n = 254), avoiding vegetables (19.69%, n = 131), low appetite (7.56%, n = 50), and healthy diet (35.66%, n = 222). Major predictors for food preferences included demographic variables (e.g., gender, urban versus rural residence), nutrition knowledge, preference for activities, and social attitudes. Results did not show any significant differences in BMI z-scores among the four latent classes. However, there were significant differences in the number of sleeping hours among the classes.

Food neophobia and pickiness among children and associations with socioenvironmental and cognitive factors

Food neophobia and picky eating are common behaviors exhibited among children that may impact their nutritional health. Due to the limited data available regarding food neophobia and pickiness in Saudi Arabia, this study aimed to estimate the prevalence of picky eating and food neophobia among Saudi children and to examine the association of socioenvironmental and cognitive factors with food neophobia and pickiness. The study included 216 healthy children with no known allergy, aged 3-7 years old, recruited from six schools in Jeddah, Saudi Arabia. A questionnaire was utilized to collect sociodemographic information from parents. Food neophobia and pickiness were evaluated using 2 separate scales. Socioenvironmental factors that may contribute to the development of food neophobia and pickiness were evaluated, such as breastfeeding duration and weaning practices, parental strategies, peer modeling, and social facilitation. Sensory sensitivity and disgust were also evaluated to assess the association with cognitive factors. Linear regression analysis with 95% confidence intervals was used to test the associations with the selected socioenvironmental and cognitive factors. The majority of children showed moderate to severe food neophobia and pickiness (98.6% and 89.8%, respectively). The socioenvironmental factors of peer modeling and selected parental strategies were found to have a significant association with food neophobia and pickiness. Assessed cognitive factors were found to be associated with food neophobia and pickiness. Future studies investigating causes of food neophobia and food pickiness among children are warranted.

Breakfast habits, nutritional status and their relationship with academic performance in elementary school students of Tehran, Iran

Background

The aim of this study was to examine the breakfast habits, nutritional status and their relationship with academic performance in primary school students in Tehran, Iran.

Method

In this cross-sectional study 829 primary school children were included. Child Body Mass Index (BMI) was calculated based on the objective measures of height and weight as well as adjusted for age and gender. Data on Breakfast habits and academic performance were collected by a valid checklist. For data analysis we used Chi-squared and Fisher’s exact test using SPSS software, version 11.5; statistical significance was assumed if p-value is below the 0.05

Results

The average breakfast consumption per week was 5.5 times (days) with a standard deviation of 2.9. Based on the results, 30.9% of participants did not consume full breakfast (six times or less) and 69.1% had a complete one. In terms of academic grade level, 88.4% of the participants were in a high level, 10.3% in appropriate conditions and only 1.3% of the respondents required more effort (inappropriate). There was no significant correlation between breakfast consumption and academic status (p=0.73), nutritional status of the participants according to the academic performance status Individuals showed no statistically significant relationship (P=0.9).

Conclusion

Unlike previous studies, this study revealed no correlation between the academic grade level of elementary students with nutritional status and breakfast habits. It is suggested that according to the qualitative school scoring method, future studies are needed to assessing the students’ academic performance. Other parameters will be considered in addition to the average in order to provide a better perspective of students’ academic performance.

Analysis of dietary trends in Chinese adolescents from 1991 to 2011

BACKGROUND AND OBJECTIVES

To examine temporal trends in dietary energy, fat, carbohydrate, protein, sodium and potassium intake of Chinese adolescents aged 12 - 17 years by sex and urbanicity, using data from the China Health and Nutrition Survey.

METHODS AND STUDY DESIGN

Individual level, consecutive 3 - day 24-hour recalls were analyzed from survey years 1991 (n=504), 2000 (n=665), and 2011 (n=267) from nine provinces representing a range of geography, economic development, and health indicators in China. Linear multivariable regression models were conducted to predict mean intakes of energy, macronutrients, sodium, and potassium. Models were adjusted for age, per capita income, parental education, region, and family size.

RESULTS

From 1991 to 2011, total energy consumption decreased among both sexes and all urbanicity groups (p<0.05). Sodium intake decreased in all sex and urbanicity groups except the high urbanicity group, which was the only group to show significant change in potassium intake (p<0.05). Sodium-potassium ratios decreased overall and across both sexes (p<0.05). However, the major observed shift was a structural change from carbohydrates to fat and protein. Both sexes showed decrease in carbohydrate-derived energy (p<0.05). Proportion of fat-derived energy increased in female adolescents. Proportion of protein-derived energy increased in male adolescents, as well as in the low and high urbanicity groups (p<0.01).

CONCLUSIONS

This suggests Chinese adolescents are transitioning to a low carbohydrate diet. Urbanicity appears to play a role in sodium, potassium and protein intake. Improvements of sodiumpotassium ratios are primarily due to decreased sodium intake and require further reduction efforts.

A comparative study of fruit and vegetable consumption and physical activity among adolescents in 49 Low-and-Middle-Income Countries

Physical inactivity and low consumption of fruits and vegetables (FV) during adolescence may persist through adulthood, putting adolescents at risk of developing chronic diseases. Although studies from high-income countries have reported differences in FV consumption and physical activity (PA) between adolescent boys and girls, few exist from low-and-middle-income countries (LMICs). In this study, we examined patterns of FV consumption and PA among adolescent boys and girls in LMICs. Country selection was based on availability of Global School-Based Student Health Survey (GSHS) data from 2004 to 2013. The total analytic sample was 164,771 adolescents from 49 LMICs. Descriptive statistics were generated to determine adolescents meeting the World Health Organization (WHO) recommendations for FV and PA. A Rao-Scott adjusted chi-square statistic was computed to assess gender differences. Less than 30% of adolescents across all countries met the WHO guidelines for FV consumption or PA. Morocco (29.5%) and India (29.5%) however had the highest percentage of adolescents meeting recommendations for FV and PA, respectively. Adolescent boys were more active than girls, and this difference was more notable in the Middle East and North African region. Adolescents achieving the WHO recommendations for daily consumption of FV and PA were consistently low in all countries.

Determinants of takeaway and fast food consumption: a narrative review

Out-of-home foods (takeaway, take-out and fast foods) have become increasingly popular in recent decades and are thought to be a key driver in increasing levels of overweight and obesity due to their unfavourable nutritional content. Individual food choices and eating behaviours are influenced by many interrelated factors which affect the results of nutrition-related public health interventions. While the majority of research based on out-of-home foods comes from Australia, the UK and USA, the same issues (poor dietary habits and increased prevalence of non-communicable disease) are of equal concern for urban centres in developing economies undergoing ‘nutrition transition’ at a global scale. The present narrative review documents key facets, which may influence out-of-home food consumption, drawn from biological, societal, environmental, demographic and psychological spheres. Literature searches were performed and references from relevant papers were used to find supplementary studies. Findings suggest that the strongest determinants of out-of-home food availability are density of food outlets and deprivation within the built environment; however, the association between socio-economic status and out-of-home food consumption has been challenged. In addition, the biological and psychological drives combined with a culture where overweight and obesity are becoming the norm makes it ‘fashionable’ to consume out-of-home food. Other factors, including age group, ethnicity and gender demonstrate contrasting effects and a lack of consensus. It is concluded that further consideration of the determinants of out-of-home food consumption within specific populations is crucial to inform the development of targeted interventions to reduce the impact of out-of-home foods on public health.

Trends in Fast-Food and Sugar-Sweetened Beverage Consumption and Their Association with Social Environmental Status in South Korea

BACKGROUND

As South Korea has enjoyed rapid economic development, Koreans' diet, particularly consumption of fast food (FF) and sugar-sweetened beverages (SSBs), has changed.

OBJECTIVE

To examine time trends in FF and SSB consumption and their associations with social environmental status (SEnS) in South Korea.

DESIGN

Korean National Health and Nutrition Examination Surveys (KNHANES) were a series of population-based cross-sectional surveys.

PARTICIPANTS

Data from the KNHANES conducted in 1998, 2001, 2005, and 2007-2009 for 49,826 Koreans aged ≥1 year were used.

MAIN OUTCOME MEASURES

Consumption of FF and SSBs were assessed by a 24-hour recall. We defined two FF categories (Western-style and Korean-style) and one SSB category. Sex, age, household income, and residence regions were investigated.

STATISTICAL ANALYSES PERFORMED

The primary sampling units, strata, and sampling weights were taken into account using SAS survey-related procedures. Logistic regression models were used to test associations between SEnS and FF consumption.

RESULTS

Over an 11-year period, the proportion of participants' who consumed Western FF and SSBs on the surveyed day doubled (P<0.05). Per capita energy contribution from Western FF also increased in adults, men, and low-income groups. SSB consumption doubled (per capita: 32 to 82 kcal/day, only consumers: 123 to 166 kcal/day), but consumption of Korean-style FF decreased (P<0.05). Compared with the low-income rural resident group, the high-income urban resident group was much more likely to consume Western FF (OR=26.7[3.7, 193.4]) and SSBs (odds ratio [OR]=3.1 [2.4, 4.1]) in 1998. However, in recent years, the patterns changed; the high-income urban resident group was more likely to consume Korean-style FF (OR=2.0[1.3, 2.9]) and SSBs (OR=1.7[1.3, 2.1]).

CONCLUSIONS

In South Korea, people who reported consuming Western FF and SSBs on the surveyed day almost doubled during 1998-2009, whereas those who consumed Korean FF decreased. SEnS was related to FF and SSB consumption.

A Web-Based Lifestyle Medicine Curriculum: Facilitating Education About Lifestyle Medicine, Behavioral Change, and Health Care Outcomes

BACKGROUND

Lifestyle medicine is the science and application of healthy lifestyles as interventions for the prevention and treatment of disease, and has gained significant momentum as a specialty in recent years. College is a critical time for maintenance and acquisition of healthy habits. Longer-term, more intensive web-based and in-person lifestyle medicine interventions can have a positive effect. Students who are exposed to components of lifestyle medicine in their education have improvements in their health behaviors. A semester-long undergraduate course focused on lifestyle medicine can be a useful intervention to help adopt and sustain healthy habits.

OBJECTIVE

To describe a novel, evidence based curriculum for a course teaching the concepts of Lifestyle Medicine based on a web-based course offered at the Harvard Extension School.

METHODS

The course was delivered in a web-based format. The Lifestyle Medicine course used evidence based principles to guide students toward a "coach approach" to behavior change, increasing their self-efficacy regarding various lifestyle-related preventive behaviors. Students are made to understand the cultural trends and national guidelines that have shaped lifestyle medicine recommendations relating to behaviors. They are encouraged to engage in behavior change. Course topics include physical activity, nutrition, addiction, sleep, stress, and lifestyle coaching and counseling. The course addressed all of the American College of Preventive Medicine/American College of Lifestyle Medicine competencies save for the competency of office systems and technologies to support lifestyle medicine counseling.

RESULTS

The course was well-received, earning a ranking of 4.9/5 at the school.

CONCLUSIONS

A novel, semester-long course on Lifestyle Medicine at the Harvard Extension School is described. Student evaluations suggest the course was well-received. Further research is needed to evaluate whether such a course empowers students to adopt behavior changes.

Associations between perceived friends' support of healthy eating and meal skipping in adolescence

OBJECTIVE

Meal skipping is a relatively common behaviour during adolescence. As peer influence increases during adolescence, friendship groups may play a role in determining eating patterns such as meal skipping. The current study examined cross-sectional and longitudinal associations between perceived friends' support of healthy eating and breakfast and lunch skipping among adolescents.

DESIGN

Survey of intrapersonal, social and environmental factors that may influence eating patterns at baseline (2004/05) and follow-up (2006/07).

SETTING

Thirty-seven secondary schools in Victoria, Australia.

SUBJECTS

Sample of 1785 students aged 12-15 years at baseline.

RESULTS

Adolescents who reported that their friends sometimes or often ate healthy foods with them were less likely (adjusted OR; 95 % CI) to skip breakfast (sometimes: 0·71; 0·57, 0·90; often: 0·54; 0·38, 0·76) or lunch (sometimes: 0·61; 0·41, 0·89; often: 0·59; 0·37, 0·94) at baseline than those who reported their friends never or rarely displayed this behaviour. Although this variable was associated with lunch skipping at follow-up, there was no evidence of an association with breakfast skipping at follow-up. There was no evidence of an association between perceived encouragement of healthy eating, and an inconsistent relationship between perceived discouragement of junk food consumption, and meal skipping.

CONCLUSIONS

Friends eating healthy foods together may serve to reduce meal skipping during early adolescence, possibly due to the influence of directly observable behaviour and shared beliefs held by those in the same friendship group. Verbal encouragement or discouragement from friends may be less impactful an influence on meal skipping (than directly observable behaviours) in adolescents.

Factors Associated With Unhealthy Snacks Consumption Among Adolescents in Iran's Schools

Background: Well-informed interventions are needed if school-based health promotion is to be effective. Among other aims, the Iranian Health Promoting School (IHPS) program that was launched in 2011, has an important aim of promoting dietary behaviors of adolescents. The present study, therefore, aimed to investigate the factors affecting unhealthy snacking of adolescents and provide evidence for a more effective IHPS program.

Methods: In a cross-sectional study design, 1320 students from 40 schools in Kerman city were selected using a proportional stratified random sampling method. A modified qualitative Food Frequency Questionnaire (FFQ) was used to gather data about unhealthy snacking behavior. Data about intrapersonal and environmental factors were obtained using a validated and reliable questionnaire. A mixed-effects negative-binomial regression model was used to analyze the data.

Results: Taste and sensory perception (prevalence rate ratio [PRR]=1.18; 95% CI: 1.09-1.27), being a male (PRR=1.20; 95% CI: 1.05-1.38) and lower nutritional knowledge (PRR=0.96; 95% CI: 0.91-0.99) were associated with higher weekly unhealthy snaking. Perceived self-efficacy (PRR=0.95; 95% CI: 0.91-1.00) negatively influenced the frequency of unhealthy snaking, with this approaching significance (P<.06). In case of environmental factors, high socio-economic status (SES) level (PRR=1.45; 95% CI: 1.26-1.67), single-parent family (PRR=1.14; 95% CI: 1.01-1.30), more social norms pressure (PRR=1.08; 95% CI: 1.01-1.17), pocket money allowance (PRR=1.21; 95% CI: 1.09-1.34), easy accessibility (PRR=1.06; 95% CI:1.01-1.11), and less perceived parental control (PRR=0.96; 95% CI: 0.92-0.99) all had a role in higher consumption of unhealthy snacks. Interestingly, larger school size was associated with less unhealthy snacking (PRR=0.79; 95% CI: 0.68-0.92).

Conclusion: Unhealthy snacking behavior is influenced by individual, socio-cultural and physical-environmental influences, namely by factors relating to poor parenting practices, high SES level, family characteristics, improper social norms pressure, and less knowledge and self-efficacy of students. This evidence can be used to inform a more evidencebased IHPS program through focusing on supportive strategies at the home, school, and local community levels.

Breakfast and fast food eating behavior in relation to socio-demographic differences among school adolescents in Sanandaj Province, Iran

INTRODUCTION

Fast food consumption and skipping breakfast has been increasingly prevalent among high school adolescents in recent years. These unhealthy food habits are considered as risk factors of chronic diseases among adolescents and adults.

AIM

To determine the consumption amount of fast food, breakfast, and some associated factors in adolescents.

METHODS

In this cross-sectional study in 2015, 553 adolescent students aged 14-18 years were randomly selected among high schools of Sanandaj, Iran. Demographic data and also consumption amount of fast food and breakfast in adolescents in addition to the related factors were studied. Data were collected using a researcher-made questionnaire which its reliability and validity were measured by five experts and analyzed with SPSS-16 by Chi-square test and ANOVA.

RESULTS

The results show that 69.8 % of subjects consume fast food at least once a week. Fast food and breakfast consumption is related significantly to subjects' fathers' occupation respectively (p=0.005), (p=0.006). Eating breakfast is significantly higher among boys than girls (p<0.001). There is also a significant relationship between adolescents' age and parents' education level, and adolescents' breakfast consumption respectively (p=0.003), (p<0.001). The studied factors affecting adolescents' fast food consumption are: their own and their families and friends' interest and accompaniment, advertisement, close proximity of school and home to fast food stores.

CONCLUSION

The consumption of fast food is high among Iranian adolescents. It correlates significantly with variables including father's occupation and all of the associated factors. Breakfast consumption correlates significantly with adolescents' age and gender, as well as parents' occupation and educational level.

Development of food lists as a first step to develop a food frequency questionnaire for toddlers in a multi-ethnic population

AIM

Toddlerhood is an important stage of growth, thus understanding the food intake of children in this age group is important. In Singapore, there is currently no simple tool, such as Food Frequency Questionnaire (FFQ), to collect dietary information from this ethnically diverse age group. Generating an appropriate food list is a crucial step in the development of a FFQ and this step is not clearly documented in the literature. The purpose of this study is to generate food lists and portion sizes for toddlers from three major ethnic groups in Singapore and document the processes involved in this first stage.

METHODS

A total of 30 mothers (equal number of Malays, Indians and Chinese) of 11-24-month-old children completed three-day food records and participated in the focus group discussion. The reported food items were then categorised into food groups.

RESULTS

The food lists varied by ethnic groups with the longest list obtained from Chinese toddlers. There were also other foods that were then classified as common foods for all ethnicities. Commonly used utensils among the three ethnic groups were small-sized bowls, plates, cups and spoons. For portion sizes, these utensils were typically half-filled for the toddlers.

CONCLUSIONS

As all Singaporeans have access to the same foods, the ethnic-specific food lists generated in this study could be combined into one list. Together with portion sizes, this information can be used for developing a semi-quantitative FFQ.

Health Benefits of Urban Allotment Gardening: Improved Physical and Psychological Well-Being and Social Integration

With an ever-increasing urban population, promoting public health and well-being in towns and cities is a major challenge. Previous research has suggested that participating in allotment gardening delivers a wide range of health benefits. However, evidence from quantitative analyses is still scarce. Here, we quantify the effects, if any, of participating in allotment gardening on physical, psychological and social health. A questionnaire survey of 332 people was performed in Tokyo, Japan. We compared five self-reported health outcomes between allotment gardeners and non-gardener controls: perceived general health, subjective health complaints, body mass index (BMI), mental health and social cohesion. Accounting for socio-demographic and lifestyle variables, regression models revealed that allotment gardeners, compared to non-gardeners, reported better perceived general health, subjective health complaints, mental health and social cohesion. BMI did not differ between gardeners and non-gardeners. Neither frequency nor duration of gardening significantly influenced reported health outcomes. Our results highlight that regular gardening on allotment sites is associated with improved physical, psychological and social health. With the recent escalation in the prevalence of chronic diseases, and associated healthcare costs, this study has a major implication for policy, as it suggests that urban allotments have great potential for preventative healthcare.

Eating attitudes and its relationship with nutritional status: a micro level study on a group of adolescent girls in the city of Howrah, West Bengal

BACKGROUND

To assess the relationship between eating attitudes and nutritional status.

METHODS

This cross-sectional study was conducted among 400 adolescent girls (258 aged 14-17 years and 142 aged 18-21 years) from the city of Howrah, West Bengal. Eating attitude was measured using eating distress syndrome (EDS) questionnaire. Nutritional status was assessed using body mass index, waist-hip ratio (WHR) and body fat percentage (BF%).

RESULTS

Participants with disordered eating attitudes revealed significantly higher values for body mass index (BMI), WHR and BF% than those with normal eating attitudes (p≤0.01). Hierarchical linear regression analyses show that eating attitudes and socio-demographic characteristics (like mothers' education and occupation, age and birth order of the participants) significantly predict nutritional status.

CONCLUSION

The nutritional status of adolescents depends on their eating attitudes and socio-demographic characteristics.

Elevated transaminase levels among overweight adolescents in eastern China

AIM

We aim to investigate the prevalence and correlates of suspected nonalcoholic fatty liver disease (NAFLD) among adolescents in eastern China.

METHODS

The study uses data from the annual health examination among all students finishing high school who applied for university entrance in Changzhou City between 2012 and 2014 (n = 19 162). Suspected NAFLD was defined as overweight plus elevated alanine aminotransferase levels (males >25.8 U/L; females >22.1 U/L).

RESULTS

The prevalence of suspected NAFLD was 6.9% (11.1% in males and 2.6% in females). Students from medium and high socio-economic status (SES) schools had a higher prevalence of suspected NAFLD than those from low SES schools. Prehypertension had similar odds ratios (ORs, above four) for suspected NAFLD in both genders. The positive association between impaired fasting glucose/diabetes and suspected NAFLD was stronger in females than males. Compared with those born in autumn, these born in spring (OR 1.39; 95% CI, 1.16-1.67) and winter (OR 1.24; 95% CI, 1.04-1.49) had increased odds to have suspected NAFLD in males but not in females.

CONCLUSION

Suspected NAFLD was prevalent among urban university applicants especially in males and those of high SES. Prehypertension was positively related to suspected NAFLD. Season of birth was related to suspected NAFLD in males but not in females.

Socio-economic disparities in the diet of French children and adolescents: a multidimensional issue

OBJECTIVE

The present research aimed to study the multidimensionality of the link between dietary intake and socio-economic position (SEP) in a representative sample of French children and adolescents, using a variety of SEP indicators.

DESIGN

Data from the second French national food consumption survey (INCA2) were used. Information on food consumption was collected using a 7d food record and SEP data (occupation, education, income, household wealth indices) using questionnaires. Multivariable linear regression analyses were performed separately in children and adolescents to assess the relationships between dietary components (food groups and macronutrients) and each dimension of SEP.

SETTING

The INCA2 survey, France.

SUBJECTS

A representative sample of French children (3-10 years of age; n 574) and adolescents (11-17 years of age; n 881).

RESULTS

Compared with children from a higher SEP, those from a lower SEP had lower intakes of fruit and vegetables, yoghurts and confectionery and higher intakes of starchy foods, meat, milk, sugar-sweetened beverages and pizzas/sandwiches. Similar results were observed in adolescents for fruit and vegetables, yoghurts and sugar-sweetened beverages. Adolescents also had lower intakes of cakes/pastries and higher intakes of processed meat and dairy desserts. Neither energy nor protein intake was associated with SEP. Adolescents from a lower SEP had higher carbohydrate and lower lipid intakes. Overall, these findings were consistent across the various dimensions of SEP, but the gradient was steeper depending on the caregiver's educational level.

CONCLUSIONS

This research highlights the need for specific messages to help poorly educated families adopt good eating habits.

Dietary Patterns in Relation to General and Central Obesity among Adults in Southwest China

Dietary patterns represent a broader picture of food consumption, and are better correlated with a variety of health outcomes. However, few studies have been conducted to explore the associations between dietary patterns and obesity in Southwest China. Data from the 2010-2012 National Nutrition Survey in the province of Yunnan, Southwest China, were analyzed (n = 1604, aged 18-80 years). Dietary data were collected using the 24 h dietary recall over three consecutive days. Height, weight, and waist circumference were measured following standard methods. Exploratory factor analysis was used to identify dietary patterns. Logistic regression was used to explore the association between dietary patterns and obesity. Three distinct dietary patterns were identified, which were labeled as traditional, modern, and tuber according to their key components. With potential confounders adjusted, adults in the highest quartile of the modern pattern were at higher risk of general and central obesity (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.15-3.48; OR 2.01, 95% CI 1.37-2.93). In contrast, adults in the highest quartile of the tuber pattern were at lower risk of general and central obesity (OR 0.34, 95% CI 0.15-0.61; OR 0.64, 95% CI 0.43-0.95) but at higher risk of underweight (OR 2.57, 95% CI 1.20-6.45). No significant association was found between the traditional pattern and obesity. Moreover, dietary pattern differences occurred due to the differences in socio-demographic characteristics. In conclusion, the modern dietary pattern was positively, and the tuber pattern negatively, associated with general and central obesity among adults in Southwest China.

The Influence of U.S. Chain Restaurant Food Consumption and Obesity in China and South Korea: An Ecological Perspective of Food Consumption, Self-Efficacy in Weight Management, Willingness to Communicate About Weight/Diet, and Depression

This study examined the impact of U.S. chain restaurant food consumption in China and South Korea from an ecological perspective. Specifically, it explored the relationships among several environmental and individual variables that have been found to affect obesity/weight management in previous research, including the prevalence/popularity of U.S. chain restaurants in these countries, frequency of U.S. chain restaurant food consumption, self-efficacy in weight management, willingness to communicate about weight/diet, self-perceptions of weight/obesity stigma, body mass index (BMI), and depression. The results indicated that willingness to communicate about weight/diet predicted increased self-efficacy in weight management. Higher BMI scores were found to predict increased weight/obesity stigma, and increased frequency of U.S. restaurant food consumption, weight/obesity stigma, and reduced self-efficacy in weight management were found to predict increased levels of depression. The theoretical and practical implications of the findings are discussed, along with limitations and directions for future research.

Dietary sugar intake and dietary behaviors in Korea: a pooled study of 2,599 children and adolescents aged 9-14 years

BACKGROUND/OBJECTIVES

Dietary sugar intake, particularly added sugar and sugar-sweetened beverages, has received worldwide attention recently. Investigation of dietary behaviors may facilitate understanding of dietary sugar intakes of children and adolescents. However, the relationship between dietary sugar intake and dietary behaviors in the Korean population has not been investigated. Thus, this study aimed to estimate dietary sugar intake and food sources according to sex as well as examine the relationship of dietary sugar intake with frequent snacking and dietary patterns among Korean children and adolescents.

SUBJECTS/METHODS

We pooled data from five studies involving Korean children and adolescents conducted from 2002 to 2011. A total of 2,599 subjects aged 9-14 years were included in this study. Each subject completed more than 3 days of dietary records.

RESULTS

Mean daily total sugar intake was 46.6 g for boys and 54.3 g for girls. Compared with boys, girls showed higher sugar intakes from fruits (7.5 g for boys and 8.8 g for girls; P = 0.0081) and processed foods (27.9 g for boys and 34.9 g for girls; P < 0.0001). On average, 95.4% of boys and 98.8% of girls consumed snacks during the study period, and total sugar intake showed a significantly increasing trend with increasing energy intake from snacks (P < 0.0001 for both sexes). Two dietary patterns were identified by cluster analysis: Traditional and Westernized patterns. Total sugar intake was higher in the Westernized pattern (56.2 g for boys and 57.2 g for girls) than in the Traditional pattern (46.5 g for boys and 46.3 g for girls).

CONCLUSIONS

These results suggest that multilateral and practical development of a nutrition education and intervention program that considers dietary behaviors as well as absolute sugar intake is required to prevent excessive sugar intake in Korean children and adolescents.

Ethnic Differences in the Food Intake Patterns and Its Associated Factors of Adolescents in Kelantan, Malaysia

Objective: The aim of the study was to identify the ethnic differences in dietary patterns and its association with socio-economic, dietary and lifestyle practices among adolescents in Kelantan, Malaysia. Methods: A population-based study of 454 adolescents aged 12 to 19 years was included. A validated food frequency questionnaire was used to assess dietary patterns and three dietary patterns were identified based on the principal component analysis method. Results: Malay adolescents had significantly higher scores for the Western-based food pattern and local-based food pattern, whereas Chinese adolescents showed higher scores for the healthy-based food pattern. Multivariate analyses show that age and physical activity (PA) levels were positively associated with healthy-based food pattern in Malay (All, p < 0.001), whereas higher consumption of eating-out from home (EatOut) (p = 0.014) and fast food (p = 0.041) were negatively associated. High weekly breakfast skipping (p < 0.001) and EatOut (p = 0.003) were positively associated with a Western-based pattern, whereas age (p < 0.001) and household income (p = 0.005) were negatively associated. Higher frequency of daily snacking (p = 0.013) was positively associated with local-based food pattern. For Chinese adolescents, age (p < 0.001), PA levels (p < 0.001) and maternal education level (p = 0.035) showed positive associations with the healthy-based pattern, whereas high EatOut (p = 0.001) and fast food intakes (p = 0.001) were negatively associated. Higher weekly consumption of EatOut (p = 0.007), fast food (p = 0.023) and carbonated beverages (p = 0.023), and daily snacking practice (p = 0.004) were positively associated with higher Western-based food pattern, whereas age (p = 0.004) was inversely associated. Conclusion: This study showed that there were significant differences in dietary patterns and its association factors between Malay and Chinese adolescents. More importantly, these findings suggest that unhealthy dietary and lifestyle practices could increase the risk of adherence to unhealthy Western-based food pattern that is high in fat, sugar and salt contents, and, consequently, increase the risk of developing obesity and metabolic-related disorders during these critical years of growth.

Consumption of sugar-rich food products among Brazilian students:National School Health Survey (PeNSE 2012)

This study aimed to analyze the consumption of high-sugar foods by Brazilian schoolchildren and to identify associated factors, based on data from the National School Health Survey (PeNSE 2012). Consumption of these foods was classified as: do not consume sweets and soft drinks regularly; consume sweets or soft drinks regularly; and consume sweets and soft drinks regularly. Its association with sociodemographic information, eating habits, and family contexts were investigated via multiple ordinal regressions. Regular consumption of sweets and/or soft drinks was reported by 19.2% and 36.1% of adolescents, respectively, and higher prevalence was associated with female gender, age 14-15 years, higher maternal education, not living with the mother and father, not eating meals with the parents, eating while watching TV, and longer TV time. Nearly one-fifth of adolescents regularly consumed sweets and soft drinks, which was associated with socio-demographic and behavioral factors that should be targeted in order to improve their food consumption.

Eating Habits of Malaysian Children: Findings of the South East Asian Nutrition Surveys (SEANUTS)

This article aims to describe the eating habits of Malaysian children using a nationally representative data set from the South East Asian Nutrition Surveys (SEANUTS) in Malaysia. A total of 2797 children aged 2 to 12 years were included in this analysis. Eating habits and dietary intakes of children were assessed using questionnaires. Overall, 56.1% of children consumed 3 main meals every day. Approximately 20% of children snacked 3 times per day, whereas 9.7% ate fast food on a weekly basis. Irregular meal patterns were significantly associated with lower micronutrient intakes, and the groups with higher odds for this pattern were older children, Malays, and those living in rural areas. Considering the relatively high rate of irregular meal consumption and its potential influence on dietary nutrient intake, persistent efforts must be continued to promote and inculcate healthy eating habits among children from an early age.

Food-choice motives of adolescents in Jakarta, Indonesia: the roles of gender and family income

Objective

The aims of the present study were to assess the reliability and validity of the Food Choice Questionnaire (FCQ) and to determine the factors associated with food-choice motives in public junior-high-school students in Jakarta, Indonesia.

Design

Cross-sectional study with self-administered questionnaires. Trained research assistants measured height and weight of the participants on the day of the data collection.

Settings

Fourteen randomly selected public junior-high schools in East Jakarta, Indonesia.

Subjects

Public junior-high-school students (n681) in grades 7 and 8, aged 13–14 years (377 girls and 304 boys).

Results

Three food-choice motives (subscales) were obtained from factor analysis and reliability testing: (i) comfort; (ii) convenience and price; and (iii) health. The subscale with the greatest mean value was health. Family affluence was inversely associated with the convenience and price subscale (β=−0·05,P=0·01) and with the health subscale (β=−0·04;P=0·02). Females were less likely than males to consider health when choosing foods (β=−0·16;P=0·03).

Conclusions

While its factor structure differed from those found in previous studies of adults, the FCQ can provide reliable measures of food-choice motives among these adolescents. Students from less affluent families placed more importance on food’s convenience and price, but more affluent students did not necessarily make healthier choices. Compared with females, males were more likely to choose healthy foods. Future interventions should be tailored based on the socio-economic status of the target group.

Nutrient Intake in Vietnamese Preschool and School-Aged Children is Not Adequate: The Role of Dairy

BACKGROUND

The traditional Vietnamese diet carries the risk of micronutrient deficiencies, and a substantial part of children <11 years do not meet the Vietnamese recommended dietary allowance (RDA) for a range of nutrients. Dairy products are known for their high nutrient density and milk in particular for its provision of high-quality protein and relevant concentrations of calcium, magnesium, vitamin B2, vitamin B12, and pantothenic acid.

OBJECTIVE

The present study aimed to evaluate the contribution of dairy to the overall nutrient intakes in the diets of Vietnamese children and to gain insight into factors affecting dairy consumption.

METHODS

Food intake, including dairy, was assessed by a 24-hour recall in 2811 Vietnamese children clustered into 4 age-groups: 1.0 to 2.9, 3.0 to 5.9, 6.0 to 8.9, and 9.0 to 11.9 years, and dairy was categorized into 6 product groups based on available information in the Vietnamese food composition table.

RESULTS

Higher dairy intake was associated with significantly higher intakes (in % estimated average requirement and %RDA) of all assessed nutrients, and largest effects and strongest associations were found for vitamin B2, calcium, vitamin D, fat, vitamin B1, protein, vitamin A, and zinc. Age, area of residence, and wealth status influenced the consumption of dairy products. Furthermore, age also influenced nutrient intake adequacy, which was generally lower at older age, especially after the age of 6 years.

CONCLUSION

The nutrient composition of the diet in especially Vietnamese school-aged children requires attention, and (fortified) dairy can play an important role in this.

City Level of Income and Urbanization and Availability of Food Stores and Food Service Places in China

Objective

The contribution of unhealthy dietary patterns to the epidemic of obesity has been well recognized. Differences in availability of foods may have an important influence on individual eating behaviors and health disparities. This study examined the availability of food stores and food service places by city characteristics on city level of income and urbanization.

Methods

The cross-sectional survey was comprised of two parts: (1) an on-site observation to measure availability of food stores and food service places in 12 cities of China; (2) an in-store survey to determine the presence of fresh/frozen vegetables or fruits in all food stores. Trained investigators walked all the streets/roads within study tracts to identify all the food outlets. An observational survey questionnaire was used in all food stores to determine the presence of fresh/frozen vegetables or fruits. Urbanization index was determined for each city using a principal components factor analysis. City level of income and urbanization and numbers of each type of food stores and food service places were examined using negative binomial regression models.

Results

Large-sized supermarkets and specialty retailers had higher number of fresh/frozen vegetables or fruits sold compared to small/medium-sized markets. High-income versus low-income, high urbanized versus low urbanized areas had significantly more large-sized supermarkets and fewer small/medium-sized markets. In terms of restaurants, high urbanized cities had more western fast food restaurants and no statistically significant difference in the relative availability of any type of restaurants was found between high- and low-income areas.

Conclusions

The findings suggested food environment disparities did exist in different cities of China.

Association of Dietary Sugars and Sugar-Sweetened Beverage Intake with Obesity in Korean Children and Adolescents

Few studies have examined the association between dietary sugar intake and obesity in Asian children and adolescents. We evaluated the association of dietary sugar intake and its food source with obesity in Korean children and adolescents. In this cross-sectional analysis, data were obtained from five studies conducted between 2002 and 2011. The study included 2599 children and adolescents who had completed more than three days of dietary records and had anthropometric data. Total sugar intake was higher in girls than in boys (54.3 g for girls and 46.6 g for boys, p < 0.0001). Sugar intake from milk and fruits was inversely associated with overweight or obesity in girls only (OR for overweight, 0.52; 95% CI, 0.32–0.84; p for trend = 0.0246 and OR for obesity, 0.42; 95% CI, 0.23–0.79; p for trend = 0.0113). Sugar-sweetened beverage (SSB) consumption was not associated with obesity in girls, while boys had lower odds ratios for obesity (OR for obesity, 0.52; 95% CI, 0.26–1.05; p for trend = 0.0310). These results suggest that total sugars and SSB intake in Asian children and adolescents remains relatively low and sugar intake from milk and fruits is associated with a decreased risk of overweight or obesity, especially in girls.

Weight concerns and food habits of adolescent girls in two contrasting ecological regions: A comparative study in India

OBJECTIVE

To compare the incidence of weight concerns and food habits between two ethnically different groups of adolescent girls residing in two distinct ecological settings: the plains of Kolkata and the mountains of Sikkim.

METHODS

Two separate cross-sectional studies were conducted within a period of five years in urban hilly areas of Sikkim and the city of Kolkata, India. A total of 506 girls aged 14-19 years were selected from the study areas of Sikkim (n=224) and Kolkata (n=282). Girls were interviewed for weight concerns and food habits along with socio-demographic characteristics. Weight concerns were assessed with four variables such as, perceptions about own body weight, felt dissatisfied with own body weight, urge for dieting and use of weight reduction diet. Food habits included consumption of major foods during the past one week.

RESULTS

Bivariate analyses showed that Kolkata girls perceived themselves as overweight, remained dissatisfied with body weight, expressed perceived need for dieting and followed weight reduction diet more compared to the girls of Sikkim. Food habits indicated that all Sikkimese girls preferred to consume cereals regularly, while Kolkata girls consumed vegetables, pulses, fish, fruits, bread and butter and fried foods more than Sikkimese girls. Multivariate analyses showed that place of residence was significantly (p<0.05) associated with both weight concerns and food habits of girls.

CONCLUSION

Diversity in culture, ethnicity and socio-economic standard perhaps develop the disparity in food habits and weight concerns between girls of urban hilly areas of Sikkim and the city of Kolkata.

Frequency of consumption of fruits, vegetables and soft drinks: a comparative study among adolescents in urban and rural areas

OBJECTIVE

To compare the frequency of consumption of fruits, vegetables and soft drinks among adolescents living in urban and rural areas of Pernambuco State.

METHODS

A cross-sectional study based on secondary analysis of data from a representative sample of high school students in Pernambuco (n = 4,207, 14 - 19 years) was conducted. Data were collected through a previously validated questionnaire. Adolescents who reported a daily consumption of soft drinks and occasional consumption of fruits, juices and vegetables were classified as exposed to inadequate standard of consumption of these foods. The independent variable was the place of residence (urban/rural). Data were analyzed by frequency distribution, χ2 test and binary logistic regression.

RESULTS

It was observed that students residing in rural areas had a higher prevalence of occasional consumption of natural fruit juices (37.6%; 95%CI 36.1 - 39.0) than those living in urban areas (32.1%; 95%CI 30.7 - 33.6). The proportion of students exposed to daily consumption of soft drinks was higher among those who reported they lived in urban areas (65.0%; 95%CI 63.5 - 66.4) compared to those who reported living in rural areas (55.3%; 95%CI 53.8 - 56.9).

CONCLUSION

Adolescent students living in rural areas had a higher prevalence of low consumption of natural fruit juices while those residing in urban areas had a higher prevalence of daily consumption of soda drinks.