Nutrition in school-age children: a rationale for revisiting priorities

Putting food at the centre of learning: an evidence-based and practice-informed model of holistic food education in schools

Food education in schools is increasingly being adopted as one of the key policy levers to support the shift towards healthier and more sustainable food practices worldwide. However, the way in which food education is designed and implemented is not often conducive to such goals. We propose a food learning model and process for designing holistic food education that fosters food competent children and adolescents as catalysts for change. The model applies evidence-based core principles required for effective food education, such as action-oriented goals that align with a student's contexts, co-ownership of the learning process, prioritising experiential learning, ensuring purposeful interactions, complementarity with the school food environment and beyond, and meaningful involvement of actors that influence children's food practices and perspectives. The process for designing food education programmes is anchored in the food learning model and highlights the importance of selecting the right entry points in the formal school system, assessment of learning needs, co-formulating competences, and the need for continuous and purposeful assessments of students' learning. We highlight the key challenges beyond programme design that must be addressed to enhance the success of food education, including the need to strengthen systemic capacity and improve the wider policy environment.

A Scoping Review of School-Based Nutrition Education Interventions in the Islamic Republic of Iran

This scoping review aims to identify evidence-based school nutrition interventions for implementation in Iran's dynamic economic, cultural, and socio-political environment. A review of published studies (2004-August 2024) using the PRISMA-ScR guidelines across 14 databases was conducted. The efficacy of various interventions reported significant positive changes at multiple levels: anthropometric, biological, and knowledge, attitudes, and behaviors related to healthy eating and lifestyle. Investigators carrying out research on "what works" in school-based nutrition education and general healthy lifestyle programs and services in the Islamic Republic of Iran have a host of challenges; however, much more research needs to be done. While there are few studies in this area of inquiry, outcomes on the nutrition interventions to date are impressive. The major challenges in improving school-based nutrition programs include the education of young women, establishing national standards for school food programs and education, and strategic advocacy by stakeholders to improve nutrition education in schools in Iran.

Do physical fitness and motor skill performances in underweight children differ from normal weight peers? A meta-analysis

BACKGROUND

Undernourished children are at risk of mortality and infection and tend to present with impaired cognitive and physical development with potentially lower physical fitness and motor skill competence. This meta-analysis aimed to compare the physical fitness and motor skill competence of underweight (UW) 3-12-year-old children to that of normal-weight (NW) peers of the same age.

METHODS

PubMed, Web of Science, and Scopus were systematically searched (last update: April 4th, 2024). The methodological quality of the studies was assessed with the Scottish Intercollegiate Guideline Network checklist. Pooled standardized mean differences (SMD; Hedges' g) were calculated using random-effects meta-analyses. Heterogeneity was considered too high if the I-squared value exceeded 50%. Then, subgroup analysis was considered. The level of evidence was estimated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method.

RESULTS

Seventeen studies were included in the meta-analysis on physical fitness, while six focused on motor skills, with one study contributing to both. Overall, children with UW have slightly lower physical fitness (SMD = -0.10) and motor skill competence (SMD = -0.12) compared to their NW peers, but the evidence to support this is very low. In North America and Europe, there was no significant difference in physical fitness between the groups. Asian and African children with UW have slightly but significantly weaker strength than NW peers (Asia: SMD = -0.21 Africa: SMD = -0.27). Asian UW children present with weaker anaerobic capacity (SMD = -0.25), whereas African UW children have less flexibility (SMD = -0.16) than NW peers.

CONCLUSION

UW children are less fit and have weaker motor skills than NW peers. Specifically in developing regions, UW children exhibited slightly but significantly poorer performance in specific fitness domains. Therefore, not all UW children will experience these problems. The heterogeneity across the studies may have masked the true differences. Future research on these children is needed to help us understand their profiles better.

PROSPERO REGISTRATION NUMBER

CRD42023446239.

Development and Validation of Nutrition Literacy Questionnaire for Chinese Pre-School Children

Background: This study aims to develop and validate the Nutrition Literacy Questionnaire for Chinese Pre-school Children (NLQ-PSC). Methods: The reliability of the questionnaire was determined by internal consistency, the construct validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and the content validity was assessed by the Pearson correlation coefficient. In order to analyze the application of NLQ-PSC, we conducted a cross-sectional study among 790 pre-school children. Results: From the literature review and qualitative methods, NLQ-PSC was developed, including two dimensions of knowledge and four practice dimensions. The NLQ-PSC questionnaire had good reliability and validity. The average NLQ-PSC score of all participants was 64.1 ± 11.0, and we found that older children, girls, and children who had well-educated parents presented higher nutrition literacy. Conclusions: NLQ-PSC has been validated and has shown good reliability and validity, and it could be considered a reliable tool to assess Chinese pre-school children.

Adolescent Nutritional Patterns and Health Behaviors in Romania: A Cross-Sectional Analysis

Background: Adolescence is a pivotal developmental stage marked by physiological and behavioral changes that significantly influence dietary habits and long-term health outcomes. Objectives: This study aimed to examine the associations between socio-demographic characteristics, psychological factors, and dietary behaviors among school-aged children and adolescents in Romania. Methods: A cross-sectional study was conducted using a structured, self-administered questionnaire completed by 662 children and adolescents aged 6 to 18 years, enrolled in primary, middle, and high schools across urban and rural areas. The questionnaire evaluated nutritional intake, meal patterns, hydration habits, physical activity, screen time, and psychological factors such as fatigue, stress, and mood fluctuations. Body mass index (BMI) was calculated based on self-reported height and weight. Results: The analysis reveals significant gender differences in body mass index (BMI), weight-loss behaviors, and family structure. Female adolescents were more likely to be underweight (18.27%) compared to male adolescents (10.82%), while overweight prevalence was higher among male adolescents (18.66%) than female adolescents (11.68%) (χ2 = 11.457, p = 0.009). Dietary patterns varied significantly across age groups, with high-school-aged children demonstrating lower vegetable consumption and increased autonomy over food choices. Primary school children exhibited higher intake of carbonated beverages (OR = 0.185, p = 0.002 for high school; OR = 0.116, p < 0.001 for middle school), whereas teenagers showed a preference for structured meals and lower fast-food intake. Meat consumption frequency correlated with greater diversity in protein sources (χ2 = 48.77, p < 0.001), while chaotic eating behaviors were more prevalent among middle and high-school-aged children (OR = 2.291, p = 0.032 for middle school; OR = 2.225, p = 0.030 for high school). Hydration habits played an essential role in dietary quality, with school-age children consuming ≥ 3 L of water daily exhibiting healthier eating patterns (OR = 7.146, p = 0.001). Additionally, psychological factors such as fatigue and stress were significantly associated with unhealthy dietary choice. Conclusions: These findings highlight the need for targeted nutritional education, school-based interventions, and family-focused strategies to improve adolescent health behaviors.

Maternal nutrition literacy and childhood obesity in food-insecure and secure households

This study examined whether maternal nutrition knowledge could help reduce the risk of obesity in children from food-insecure households compared to those from food-secure households. This cross-sectional study was performed on 327 mothers and their children. The children, aged 6-12 years, were recruited from primary schools throughout Shiraz, Iran. Food-insecurity and nutrition literacy were assessed using the Household Food-insecurity Access Scale (HFIAS) and a 60-item Food and Nutrition Literacy Assessment Tool (FNLAT), respectively. Logistic regression models were used to examine the association between children's overweight/obesity and maternal food and nutritional literacy (FNL) across food-secure households and those facing varying degrees of food-insecurity. One hundred thirty-three participants were classified as mild, 28 as moderate, and 7 as severely food-insecure. The results showed that maternal FNL was significantly associated with a reduced risk of overweight/obesity in children (odds ratio (OR) 0.29, 95% confidence intervals (CI) 0.17-0.51). Only moderate/severe food-insecurity was associated with overweight/obesity (OR 4.64, 95% CI 1.75-12.29). Both in food-secure and food-insecure households, good FNL was associated with a significant reduction in overweight/obesity risk compared to poor FNL. The findings suggest that nutrition education programs may be particularly beneficial for children living in food-insecure households, and that these programs should be tailored to address the specific needs of this population.

Evaluating socio-demographic, behavioral, and maternal factors in the dual burden of malnutrition among school-aged children in Batam, Indonesia

Malnutrition among school-aged children in urban-industrial settings presents a dual burden of undernutrition and overnutrition. The aim of this study was to examine factors influencing the nutritional status of elementary school children in Batam, Indonesia. A case-control study was conducted in Batam, focusing on children aged 6-12 years, with malnourished cases (undernutrition and overnutrition) and well-nourished controls, along with their mothers. Respondents were selected through stratified random sampling from public elementary schools. Inclusion criteria encompassed children enrolled in these schools, while exclusion criteria involved children with chronic health conditions. Data were collected via structured interviews utilizing validated questionnaires, anthropometric assessments (weight-for-age and height-for-age), and parent-reported socioeconomic, behavioral and family characteristics. Statistical analysis involved binary logistic regression to identify significant risk factors associated with malnutrition. A total of 188 children, including 94 malnourished cases (40 undernutrition and 54 overnutrition) and 94 well-nourished controls. The findings revealed significant differences between cases and controls in socioeconomic factors (pocket money (p = 0.027), family income (p = 0.042)), behavioral factors (sedentary activity (p = 0.019), dietary habits (p = 0.037)) and family factors (maternal BMI, p = 0.011; maternal nutritional knowledge, p = 0.004; parenting style, p = 0.035). Dominant risk factors for malnutrition (undernutrition or overnutrition) included poor dietary habits (adjusted odds ratio (aOR): 0.451; 95%CI: 0.225-0.901; p = 0.024), maternal obesity class II (aOR: 0.126; 95%CI: 0.030-0.535; p = 0.005), and low maternal nutritional knowledge (aOR: 0.294; 95%CI: 0.124-0.696; p = 0.005). Targeted family-centered interventions focusing on dietary practices and maternal education are therefore recommended to address this issue.

Multi-faceted nutritional science demonstrated through the prism of sugar: a scoping review on sugar intake and association with quality of life in children and adolescents

BACKGROUND

To strengthen the scientific evidence linking dietary sugar consumption with health outcomes, it's essential to look beyond the usual focus on non-communicable diseases (NCDs) and tooth decay. We thus hypothesize that considering other dimensions of health beyond physical health will meaningfully complement the evidence and expand our understanding of the relationship between nutrition and health.

PURPOSE

The aim of this scoping review was to explore the scientific evidence of an association between dietary sugar intake and quality of life (QoL) among healthy children and adolescents.

METHODS

We performed a literature search in three databases (i.e., PubMed, Scopus, and Web of Science). The search included all types of studies assessing dietary sugar intake in association with QoL, in children and adolescents published in English between January 2001 and January 2023.

RESULTS

Twenty-one full-text eligible papers were included in this review: one intervention, two prospective cohort studies, and 18 cross-sectional studies. The number of participants ranged from 25 to 65,000 and age of the participants ranged from 4 to 19 years. The studies differed considerably in exposure and outcome measures. For further qualitative analyses, the studies were categorized into studies related to different dimensions of QoL: food security (n = 4), sleep-related outcomes (n = 5), oral (n = 3) and (mental) health-related QoL (n = 9). Altogether, one study reported a null while the remaining 20 studies found adverse associations between intake of sugar, sugar-sweetened beverages (SSB), or sweets and outcome measures of QoL.

CONCLUSION

Through this scoping review, a number of scientific studies have revealed an association between sugar intake among children and adolescents and health-related QoL. The findings underscore a negative association. Our review emphasizes the crucial imperative of embracing a broader spectrum of health dimensions to gain a more wholistic understanding of nutrition, especially in collecting science-based evidence for the development of health policies, including dietary guidelines.

Adequate Food and Nutrition in School: Acceptability and Consumption by Students of a Brazilian Municipality

OBJECTIVE

This study aimed to evaluate the acceptability of a specific menu preparation based on minimally processed foods and the factors associated with the consumption of school meals by students in Brazilian public schools.

METHODS

A hedonic scale was employed to assess the acceptability of a milk preparation with 100% cocoa and sugar. A structured questionnaire was used to evaluate school food consumption, addressing consumption frequency, dietary habits, environmental conditions, and consumption of competing foods. A binomial logistic regression model was conducted to verify the association between individual variables and conditions of meal supply and consumption. Data analyses were performed using the Jamovi 2022 software.

RESULTS

A total of 1080 students participated, with 630 taking part in the acceptability test, and 450 completing the consumption questionnaire. The study highlighted acceptance below the minimum PNAE standards (79.68%) for the tested preparation, indicating a need for further investigation into student preferences. Pleasant taste was the most frequently cited reason (53.2%) for consumption. Disliking the served lunch increased the likelihood of not consuming school meals by 2.73% (p = 0.03). Bringing snacks from home showed no significant impact on consumption (p = 0.677). Using inadequate cutlery increased the likelihood of not consuming school meals by 6.44% (p = 0.009).

CONCLUSIONS

The study underscored the low acceptance of milk prepared with 100% cocoa and sugar, along with irregular school meal consumption, emphasizing the need for strategies to align students' taste preferences with healthier menu options. While PNAE ensures nutrient-rich meals, improving flavor, variety, and dining conditions, alongside permanent food and nutrition education, is essential to enhance adherence and support students' health. Although snacks do not affect the consumption of school meals, controlling snack intake is important from a health perspective.

Does the healthy plate model workshop improve nutrition knowledge, behaviors, and habits in school-age children? The impact of workshop on dietary habits : Original article

BACKGROUND

This study was conducted to identify the impacts of the healthy plate model workshop on 4th-graders nutrition knowledge, behaviors, and habits.

METHODS

The study was conducted from March to June 2023 in the Uskudar district of Istanbul, involving 102 children (50% girls) with a mean age of 10.2 ± 0.45 years. A pretest-intervention-posttest design was used for the research. Before and after the training, a questionnaire was administered to measure students' demographic characteristics, physical activity status, adherence to the Mediterranean Diet, frequencies of food group consumption, and nutritional knowledge.

RESULTS

The number of students consuming eggs, legumes, vegetables, fruits, and oilseeds daily increased after the training (p > 0.05). Increases were observed in daily consumption of meat group and water (p < 0.05). While the proportion of students who consumed whole fruit with skin was 35.3% before the training, this rate increased to 47.1% after the training (p < 0.05). The mean nutritional knowledge score (before: 71.37 ± 11.8; after: 80.45 ± 1.6, p < 0.05) and the Mediterranean Diet Quality Index (KIDMED) score (before: 4.77 ± 2.41; after: 5.50 ± 2.45, p < 0.05) increased significantly after the training. A weak positive correlation was identified between pre-training nutritional knowledge scores and KIDMED index scores (r = 0.19; p = 0.045). Furthermore, a negative weak relationship was observed between post-training nutritional knowledge scores and meal-skipping status (r=-0.231; p = 0.019).

CONCLUSIONS

Structured nutrition education for school-age children can positively impact their nutritional knowledge and dietary habits.

Vegetable consumption and promotion among school-age children and adolescents in West Africa: a systematic review and narrative synthesis

Low vegetable consumption among school-age children and adolescents puts them at risk of micronutrient malnutrition and non-communicable diseases. There is a dearth of synthesised literature on vegetable intake and interventions to promote increased consumption among this age group in West Africa. This study pooled evidence on vegetable consumption and interventions to promote vegetable consumption among school-age children and adolescents (6-19 years) in West Africa. Quantitative and qualitative studies from 2002 to 2023 were electronically searched in PubMed, African Journals Online (AJOL) and Google Scholar databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system was adhered to in reporting this review (PROSPERO ID: CRD42023444444). The Joanna Briggs Institute critical evaluation tool was used to appraise the quality of studies. Forty (40) studies met the search criteria out of n 5080 non-duplicated records. Meta-analysis was not possible due to high heterogeneity. Low vegetable consumption expressed in frequency or amounts was recorded among school-age children and adolescents in the reviewed studies. Intervention studies were mostly among adolescents; the most common type of intervention was the use of nutrition education. Insufficient evidence and high heterogeneity of studies reflect the need for more high-quality interventions using globally identified standards but applied contextually. School-age children appear to be an under-served population in West Africa with regard to nutrition interventions to promote vegetable consumption. There is a need for multi-component intervention studies that encourage vegetable consumption as a food group. Gardening, parental involvement, gamification and goal setting are promising components that could improve the availability, accessibility and consumption of vegetables.

Effects of High-Intensity Motor Learning and Dietary Supplementation on Motor Skill-Related Physical Fitness in Thin Ethiopian Children Aged 5 to 7 Years: An Exploratory Pilot Cluster-Randomized Trial

BACKGROUND

Malnutrition has extensive consequences, affecting multiple levels of functioning, including motor skill impairments. However, current interventions have mainly focused on dietary treatment, often neglecting motor impairments and relying solely on clinical and anthropometric indicators to assess treatment response. This study aims to bridge this gap by examining the combined effect of ready-to-use supplementary food (RUSF) and high-intensity motor learning (HiML) on motor skill-related physical fitness in children with moderate thinness (MT).

METHODS

A cluster randomized controlled trial was conducted among children 5-7 years old with MT in Jimma Town. Three schools were randomized to three intervention arms, including a total of 69 children: RUSF (n = 23), RUSF + HiML (n = 25), and no intervention (n = 21). The HiML training was applied for 12 weeks, and RUSF was distributed daily for 12 weeks. HiML was given daily (1 h/day, 5 days/week). The primary outcome was motor skill-related physical fitness assessed at baseline and endline using the performance and fitness test battery (PERF-FIT). The changes from baseline to endline measurements were calculated as differences, and the mean difference in these changes/differences (DID) was then computed as the outcome measure. AN(C)OVA was used to directly investigate differences between groups. Statistical significance was declared at p-value ≤ 0.05.

RESULTS

There was a significantly greater and comparable improvement in both the RUSF and RUSF + HiML groups compared to the control group for the 'stepping' item (p < 0.001), the 'side jump' item (p < 0.001), the 'standing long jump' (p < 0.001) and the 'jumping and hopping' total (p = 0.005). The RUSF + HiML group showed significantly greater improvements in the 'bounce and catch' (p = 0.001) and 'throw and catch' (p < 0.001) items compared to the RUSF group, which, in turn, demonstrated greater improvement than the control group in both items (p < 0.01).

CONCLUSIONS

A 12-week combination of RUSF + HiML was proven to be safe in children with MT and caused clear improvements in motor skill-related physical fitness. When the children received RUSF with HiML training, similar gains in stepping, side jump, standing long jump, and jumping and hopping were observed, except for the ball skills where the HiML training group performed better.

Height-Age as An Alternative to Height-For-Age z-Scores to Assess the Effect of Interventions on Child Linear Growth in Low- and Middle-Income Countries

Background

Assessments of the efficacy of interventions to improve child growth are often based on differences in mean height-for-age z-scores (HAZ) and stunting (HAZ<-2) in randomized controlled trials (RCTs). However, this approach does not account for children's starting skeletal age and does not enable assessment of the extent to which interventions optimized linear growth.

Objectives

The objectives of this study were to develop and apply a new method using height-age to express linear growth effects in RCTs.

Methods

Longitudinal individual participant data (IPD) from a Bangladeshi trial cohort were used to compare height-age estimates derived from individual-level heights, mean raw height, or mean HAZ. Then, using mean height-age as a proxy for skeletal age, we developed the "proportion of maximal benefit" (PMB) metric to quantify intervention effects relative to optimal growth for children's starting skeletal age. Optimal growth occurs when height-age increases in parallel with chronologic age (i.e., PMB = 100%), whereas no effect (compared with control) corresponds to a PMB of 0%. Linear growth outcomes in 4 published RCTs of nutrition-specific interventions were re-expressed as mean height-age and PMB and compared with effects conventionally expressed as intervention-compared with-control mean differences (MD) in HAZ.

Results

Mean height-age could be derived from any published estimate of mean raw height or mean HAZ; however, to calculate the PMB, height or HAZ data were required at both the beginning and end of the observation period. Interpretations of intervention effects were consistent when expressed as either the height-age MD or HAZ MD. In contrast, the PMB does not have a corresponding metric on the HAZ scale and, therefore, provided a new way to quantify intervention efficacy.

Conclusions

Height-age can be used as an alternative to HAZ to express intervention effects. The PMB has the advantage of conveying the extent to which an intervention improved average linear growth in relation to a biologically-defined benchmark.

Fasting: A Complex, Double-Edged Blade in the Battle Against Doxorubicin-Induced Cardiotoxicity

In recent years, there has been a surge in the popularity of fasting as a method to enhance one's health and overall well-being. Fasting is a customary practice characterized by voluntary refraining from consuming food and beverages for a specified duration, ranging from a few hours to several days. The potential advantages of fasting, including enhanced insulin sensitivity, decreased inflammation, and better cellular repair mechanisms, have been well documented. However, the effects of fasting on cancer therapy have been the focus of recent scholarly investigations. Doxorubicin (Dox) is one of the most widely used chemotherapy medications for cancer treatment. Unfortunately, cardiotoxicity, which may lead to heart failure and other cardiovascular issues, has been linked to Dox usage. This study aims to comprehensively examine the possible advantages and disadvantages of fasting concerning Dox-induced cardiotoxicity. Researchers have investigated the potential benefits of fasting in lowering the risk of Dox-induced cardiac damage to solve this problem. Nevertheless, new studies indicate that prolonged alternate-day fasting may adversely affect the heart's capacity to manage the cardiotoxic properties of Dox. Though fasting may benefit overall health, it is essential to proceed cautiously and consider the potential risks in certain circumstances.

Editorial on Nutrition Education, Food Literacy, and Healthy Diets in Childhood and Adolescence

Childhood and adolescence are critical developmental stages, where adequate nutrition plays a pivotal role in ensuring proper growth and long-term health [...].

How Do School Salad Bars Impact Elementary School Students' Dietary Quality and Energy Intake at Lunch? A Randomized Controlled Plate Waste Investigation

Background: Children's dietary quality is suboptimal, increasing the risk of numerous chronic illnesses. Salad bars (SBs) have potential to enhance children's nutritional intake within the National School Lunch Program (NSLP); yet, empirical support is lacking. To address this gap, we evaluated the impact of school salad bars on dietary quality and energy intake at lunch. Methods: Seven matched elementary school pairs were randomly selected. All schools served pre-portioned fruit and vegetables (F&V) at baseline. Within each pair, one school received an SB. Digital imagery plate waste methods were applied at baseline and 4-6 weeks post salad bar installation to determine intake (20% increments for food, ounces for beverages). Dietary quality (Healthy Eating Index (HEI-2015)) and energy intake (kcal) were evaluated in NDSR. Multilevel modeling evaluated group (SB vs. control) and time (baseline vs. post) differences and group-by-time interactions for: (1) HEI-2015 (total and component scores) and (2) kcal intake (overall, F&V, non-F&V, and beverage kcals). Results: Data from 5674 trays are reported. Significant group-by-time interactions were observed for HEI-2015 total scores and Greens and Beans, Total Fruit, Whole Fruit, Refined Grains, and Added Sugar component scores (p < 0.0001), supporting improved dietary quality in SB schools. SB HEI-2015 scores were 60.1 ± 9.8 at post (+5.3 from baseline; p < 0.0001) compared with 57.2 ± 9.5 in controls (+1.0 from baseline; p = 0.065). Total energy intake significantly increased in SB schools (376 ± 151 kcal (baseline) → 434 ± 176 kcal (post)), driven by F&V energy (+59 kcal), with no change for controls. Discussion: Within the NSLP, SBs improved dietary quality and increased energy intake due to increased F&V intake without replacing other foods. Results can inform school nutrition policies designed to reduce chronic illness risk.

Systemic biological mechanisms underpin poor post-discharge growth among severely wasted children with HIV

In sub-Saharan Africa, children with severe malnutrition (SM) and HIV have substantially worse outcomes than children with SM alone, facing higher mortality risk and impaired nutritional recovery post-hospitalisation. Biological mechanisms underpinning this risk remain incompletely understood. This case-control study nested within the CHAIN cohort in Kenya, Uganda, Malawi, and Burkina Faso examined effect of HIV on six months post-discharge growth among children with SM and those at risk of malnutrition, assessed proteomic signatures associated with HIV in these children, and investigated how these systemic processes impact post-discharge growth in children with SM. Using SomaScanTM assay, 7335 human plasma proteins were quantified. Linear mixed models identified HIV-associated biological processes and their associations with post-discharge growth. Using structural equation modelling, we examined directed paths explaining how HIV influences post-discharge growth. Here, we show that at baseline, HIV is associated with lower anthropometry. Additionally, HIV is associated with protein profiles indicating increased complement activation and decreased insulin-like growth factor signalling and bone mineralisation. HIV indirectly affects post-discharge growth by influencing baseline anthropometry and modulating proteins involved in bone mineralisation and humoral immune responses. These findings suggest specific biological pathways linking HIV to poor growth, offering insights for targeted interventions in this vulnerable population.

Trends in Nutritional Status and Dietary Behavior in School-Aged Children with Congenital Heart Defects

Background: Malnutrition and poor weight gain has been reported in infants with congenital heart defects (CHDs); however data in older children with CHDs are limited. In order to obtain representative data on the nutritional status, dietary behavior, and potential influencing factors in school-aged children with CHDs, we performed a nationwide online survey. Methods: Patients aged 6 to 17 years registered in the German National Register for CHDs were asked to participate in this study by completing the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) eating study questionnaire in order to assess their self-reported dietary habits. The use of the same questionnaire enabled a comparison with a representative subset of 4569 participants of the KiGGS study. Results: A total of 894 patients (mean age 12.5 ± 3.0 years; 47.2% female) were enrolled. Patients were allocated according to anatomic complexity into simple (23.8%), moderate (37.8%), and complex CHDs (38.4%). The consumption of sugar-containing food (p < 0.001) and fast food (p < 0.05) was significantly lower among the CHD patients than in the healthy children. Children with CHDs showed significantly lower body mass index (BMI) percentiles (p < 0.001) compared with their healthy peers, while children with complex and moderate CHDs had the lowest BMI. While in CHD patients, the BMI percentiles were not related to unhealthy food, there was a strong correlation with the CHD severity and number of previous interventions (p < 0.01). Conclusions: According to this nationwide survey, school-aged children with complex CHD are at risk of undernutrition, which is not due to dietary habits but to CHD severity and repeated surgery.

Papadopoulou S. Association of Competitive Adolescent Athletes from Lean and Non-Lean Sports Physical, Social and Psychological Characteristics with Adherence to Mediterranean Diet

Mediterranean diet (MD) is regarded as one of the healthier dietary patterns which is recommended for athletes. This study aims to investigate the adherence to the Mediterranean diet (AMD) and associated beliefs in a large, diverse sample of competitive adolescent athletes from various sports, including both lean and non-lean sports. Additionally, the study examines factors important regarding intention to AMD within the Theory of Planned Behavior (TPB). In the study took part 711 adolescents (357 male, aged = 14.93 ± 1.38, and 354 female, aged = 14.85 ± 1.35) athletes. The level of AMD was not a significant different between lean (mean = 4.98, SD = ±3.90) and non-lean (mean = 4.77, SD = ±3.68) sport. According to the sport type the 35% of lean sport athletes demonstrated low AMD, 34.1% moderate adherence and 30.9% a high degree. The non lean athletes demonstrated low AMD in 36.3%, moderate adherence 33% and high degree in 30.7%. The results of the mediation analysis indicated a significant mediation effect of intention in the relationship between TPB variables and MD. Based on the results of the study the type of sport does not play a role in the AMD, which, as in the general population, is low. Also validate the TPB and underscore the significance of targeting individuals' intentions to promote positive dietary behaviors.

Nutritional quality and diversity in Ghana's school feeding programme: a mixed-methods exploration through caterer interviews in the Greater Accra Region

BACKGROUND

The Ghana School Feeding Programme (GSFP) provides public primary school pupils with a free daily meal. Each meal is expected to follow set menus, providing 30% of children's' (6-12 years) energy requirements. This study assessed the nutritional quality and diversity of planned and provided GSFP meals, engaging school caterers to identify how meal quality in the Greater Accra Region could be enhanced.

METHODS

A cross-sectional mixed methods study design was used. Multistage sampling was used to select 129 schools implementing the GSFP in six districts of the Greater Accra Region. GSFP district menus were collected as well as a one-week school caterer recall of provided school meals. The meal served on the day of data collection was recorded and photographed. Nutritional quality was evaluated based on nutrient profiling methods: energy density (low<125kcal/100g; medium 125-225kcal/100g; high>225kcal/100g) and nutrient density (low<5%; medium 5-10%; high>10%). Meal diversity was assessed by a simple count composed of 5 food groups: cereals, pulses/nuts/seeds, animal-source, vegetables and fruits. Caterers' views on programme facilitators and barriers were also explored.

RESULTS

Planned menus included 14-20 weekly options, composed of eight minimally processed traditional dishes. All meals, except white rice, had a high nutrient density/100g. Energy density was varied (low, n=2; medium, n=2; high, n=4). Meals included only 2/5 or 3/5 food groups, mainly starchy staples, pulses/nuts/seeds, and sometimes vegetables. Fruit was never reported. About half of caterers (51.1%) reported deviating from the planned menus: 11.7% served alternative meals, with some including animal-sourced food (17.0%), and 39.4% repeated meals provided during the week, often based on starchy staples, influencing overall nutritional quality. Most caterers reported food item cost and lack of food purchase guidelines as barriers to providing school meals, while food safety training and guidelines for food preparation were facilitators.

CONCLUSIONS

While school meals are composed of minimally processed, nutrient dense, local foods, there are notable gaps in meal diversity and compliance, as reflected in provided meals. Caterer compliance to planned menus varied greatly, reflecting recent food price inflation. Upwardly adjusting the current meal allocation of 1.2 cedis (0.22USD) per child per day could enhance access to more affordable, nutritious and diverse foods in school meals.

Investigating the Effects of Dietary Supplementation and High-Intensity Motor Learning on Nutritional Status, Body Composition, and Muscle Strength in Children with Moderate Thinness in Southwest Ethiopia: A Cluster-Randomized Controlled Trial

BACKGROUND

In Ethiopia, moderate thinness (MT) is a persistent issue among children. Yet, evidence on the effects of dietary supplementation and motor skills training in these children is limited.

OBJECTIVE

This study aimed to assess the effect of Ready-to-Use Supplementary Food (RUSF), whether or not combined with high-intensity motor learning (HiML), on weight, height, body composition, and muscle strength in children 5-7 years old with MT living in Jimma Town, Ethiopia.

METHODS

A cluster-randomized controlled trial was carried out among 69 children (aged 5-7) with MT assigned to receive RUSF (n = 23), RUSF + HiML (n = 25), or no intervention (control group, n = 21). A multivariable Generalized Estimating Equations model was used and the level of significance was set at alpha < 0.05.

RESULTS

At baseline, there were no significant differences in the outcome measurements between the RUSF, RUSF + HiML, and control groups. However, after 12 weeks of intervention, there were significant mean differences in differences (DIDs) between the RUSF group and the control arm, with DIDs of 1.50 kg for weight (p < 0.001), 20.63 newton (N) for elbow flexor (p < 0.001), 11.00 N for quadriceps (p = 0.023), 18.95 N for gastrocnemius sup flexor of the leg (p < 0.001), and 1.03 kg for fat-free mass (p = 0.022). Similarly, the mean difference in differences was higher in the RUSF + HiML group by 1.62 kg for weight (p < 0.001), 2.80 kg for grip strength (p < 0.001), 15.93 for elbow flexor (p < 0.001), 16.73 for quadriceps (p < 0.001), 9.75 for gastrocnemius sup flexor of the leg (p = 0.005), and 2.20 kg for fat-free mass (p < 0.001) compared the control arm.

CONCLUSION

RUSF alone was effective, but combining it with HiML had a synergistic effect. Compared to the control group, the RUSF and RUSF + HiML interventions improved the body composition, height, weight, and muscle strength of the studied moderately thin children. The findings of this study suggest the potential that treating moderately thin children with RUSF and combining it with HiML has for reducing the negative effects of malnutrition in Ethiopia. Future research should explore these interventions in a larger community-based study. This trial has been registered at the Pan African Clinical Trials Registry (PACTR) under trial number PACTR202305718679999.

Nutritional Deficiencies and Associated Oral Health in Adolescents: A Comprehensive Scoping Review

INTRODUCTION

The shift to processed foods in American diets has increased vitamin and mineral deficiencies among adolescents, impacting growth and health, often manifesting as oral lesions. This review study aimed to explore the link between nutritional deficiencies and adolescent oral health to improve guidance and prevent long-term issues.

METHODS

A systematic review of literature from 2013 to 2023 was conducted on adolescents aged 10-19 years, using PRISMA guidelines. Searches in PubMed, Web of Science, Dentistry & Oral Sciences Source-Ebscohost, and Scopus included peer-reviewed articles, excluding reviews and non-empirical studies. Data were screened and extracted with independent reviews for accuracy.

RESULTS

Malnutrition strongly correlates with poor oral health. Undernourished children have a 60% increase in dental caries, exacerbated by high sugar intake. Early malnutrition delays dental eruption, temporarily protecting against caries, while stunting and infections cause enamel defects. Chronic conditions like cerebral palsy and celiac disease worsen oral health, with risks persisting into adulthood.

CONCLUSIONS

Nutritional deficiencies and oral health are interconnected, requiring integrated healthcare. Early interventions and holistic strategies can improve outcomes and reduce long-term burdens. Comprehensive health education and routine dental evaluations are essential for prevention and treatment, enhancing health across all demographics.

A multi-sectoral community development intervention has a positive impact on diet quality and growth in school-age children in rural Nepal

Poor diet quality (diet diversity and animal-source food [ASF] consumption) during childhood negatively affects growth, development, behaviour and physiologic function in later life. Relatively less is known about the impact of poor diet on the growth of school-age children compared to children <5 years of age, especially in low/middle-income countries. A better understanding of delivery strategies for effective interventions to improve diet and hence growth in school-age children is needed. A 36-month longitudinal controlled impact evaluation in rural Nepal assessed the nutrition and growth of children <5 years of age in families assigned via community clusters to full package intervention (community development, training in nutrition [during pregnancy and for children <5 years] and livestock husbandry), partial package (training only) or control (no inputs). Concurrent data were collected prospectively (baseline plus additional four rounds) on school-age children (5-8 years at baseline) in these households; the present study analysed findings in the cohort of school-age children seen at all five study visits (n = 341). Diet quality improved more in the full package school-age children compared to those in partial package or control households. full package children consumed more ASF (β +0.40 [CI 0.07,0.73], p < 0.05), more diverse diets (β +0.93 [CI 0.55,1.31], p < 0.001) and had better head circumference z-scores (β +0.21 [CI 0.07,0.35], p < 0.01) than control children. In conclusion, a multi-sectoral community development intervention was associated with improvements in diet and growth of school-age children in rural Nepal even though the intervention focused on the diet of children <5 years of age. The diet and growth of school-age children can be favourably influenced by community-level interventions, even indirectly.

Nutrition and public health in Georgia: reviewing the current status and inspiring improvements: a joint event of the Georgian Nutrition Society, The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, October 2023

Georgia lies to the northeast of Türkiye, having a western border on the Black Sea. With a population of some 3·73 million, Georgia has a tradition of gastronomic excellence dating back millennia. However, changing lifestyles and external influences have, as elsewhere, led to problems of suboptimal nutrition, and lifestyle-related diseases and disorders prevail. There is considerable scope for improving the focus on public health (PH) and nutrition in Georgia. With this in mind, the Georgian Nutrition Society teamed up with The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, a PH charity based in Istanbul, Türkiye, to host a conference and workshops in Tbilisi, Georgia. The primary purpose was to review the current status of PH and nutrition in Georgia with reference to the situation elsewhere, to share examples of best practice and to identify opportunities for improvement. A particular highlight was the presentation of a programme of nutrition education for family physicians recently implemented in Türkiye. This summary of the proceedings is intended as a blueprint for action in Georgia and also to inspire others to consider how PH might be improved via a focus on balanced nutrition.

Improvement of Adherence to the Mediterranean Diet through a Nutrition Education Teaching Pack for Teachers within the "School Fruit Scheme" Program: An Italian Long-Term Trial in School Children

A previous short time span study related to the effectiveness of a teaching pack (TP) in improving the adherence to the Mediterranean Diet (MD) showed positive results. The present study was aimed at investigating and confirming those results, with a follow up data collection, in the same sample, a year after the baseline intervention. Pre- and post-intervention assessments were conducted. Weight and height were measured. Eating patterns/lifestyle were assessed by the KIDMED test and questionnaires. Thirteen schools in three areas with low, medium and high prevalence of overweight/obesity (North, Center and South respectively) were involved, with a representative baseline cluster sample of 494 fourth class children (8-10 years old) in 2015. An intervention group and a control group were recruited in each school; the intervention group (n = 395) got the intervention, the control group (n = 99) did not. The children's KIDMED score changes were the main outcome measures. Differences in percentages of adherence and in yes/no answers on the KIDMED test, at baseline and after one year, for both the intervention and the control groups, were assessed through contingency tables and statistical tests. Improvements in the high and low adherence rates to MD were observed (high adherence: 24.4% to 43.3%; low adherence: 15.0% to 3.9%, p < 0.0001). The percentages of subjects with optimal adherence improved in both sexes (females: 25.5% to 49.5%, p < 0.0001; males: 23.1% to 36.6%, p < 0.0001) in all the geographical areas and ponderal status classes. Accompanying free distribution of fruit and vegetables with a nutritional intervention led by trained teachers with a cross-curricular approach can be successful in promoting healthy eating in children.

8-Year Follow-up of a Maternal Education Trial in a Low-Resource Setting

OBJECTIVES

Nutrition and stimulation interventions promote early childhood development, but little is known about their long-term benefits in low- and middle-income countries. We conducted a follow-up study of a cluster-randomized maternal education trial performed in children aged 6 to 8 months to assess the sustainability of developmental benefits after 8 years.

METHODS

The education intervention lasted 6 months and consisted of nutrition, hygiene, sanitation, and child stimulation aspects. We assessed child processing and cognitive abilities using the Kaufman Assessment Battery for Children Second Edition (KABC-II) and attention and inhibitory control using the Test of Variables of Attention after 8 years. The original trial included 511 mother-child pairs (intervention, n = 263; control, n = 248), whereas in the current study, 361 (71%; intervention, n = 185; control, n = 176) pairs were available for analyses.

RESULTS

The intervention group scored higher than the controls (all P < .001) on all 5 KABC-II subscales and on the KABC-II global score (mean difference: 14; 95% confidence interval, 12-16; P < .001). For all 5 Test of Variables of Attention variables, the intervention group scored higher than the controls on both the visual and auditory tasks (all P < .05). Because the intervention was delivered as a package, a limitation is that we cannot pinpoint the individual contribution of each component (nutrition, hygiene, and stimulation) to the developmental benefits.

CONCLUSIONS

The intervention group consistently scored markedly higher on both neuropsychological tests. Thus, even 8 years after the original maternal education intervention, the developmental benefits that we observed at child age of 1, 2, and 3 years, were sustained.

Underweight in the first 2 years of life and nutrition risk in later childhood: a prospective cohort study

BACKGROUND

Children with underweight in the first 2 years have lower body mass index z-score (zBMI) and height-for-age z-score (HAZ) in later childhood. It is not known if underweight in the first 2 years is associated with nutrition risk in later childhood.

OBJECTIVE

(1) Determine the relationship between underweight (zBMI < -2) in the first 2 years and nutrition risk measured by the Nutrition Screening for Toddlers and Preschoolers (NutriSTEP) score from 18 months to 5 years. (2) Explore the relationship between underweight in the first 2 years and the NutriSTEP subscores for eating behaviours and dietary intake from 18 months to 5 years.

METHODS

This was a prospective study, including healthy full-term children in Canada aged 0-5 years. zBMI was calculated using measured heights and weights and the WHO growth standards. NutriSTEP score was measured using a parent-completed survey and ranged from 0 to 68. Nutrition risk was defined as a score ≥21. Linear mixed effects models were used.

RESULTS

Four thousand nine hundred twenty-nine children were included in this study. At enrolment, 51.9% of participants were male. The prevalence of underweight children was 8.8%. Underweight in the first 2 years was associated with higher NutriSTEP (0.79, 95% CI: 0.29,1.29), higher eating behaviour subscore (0.24, 95% CI: 0.03, 0.46) at 3 years and higher odds of nutrition risk (OR: 1.39, 95% CI: 1.07,1.82) at 5 years.

CONCLUSIONS

Children with underweight in the first 2 years had higher nutrition risk in later childhood. Further research is needed to understand the factors which influence these relationships.

Do Food and Meal Organization Systems in Polish Primary Schools Reflect Students' Preferences and Healthy and Sustainable Dietary Guidelines? The Results of Qualitative Research for the Junior-Edu-Żywienie (JEŻ) Project

The school environment, together with that of the family, shapes students' eating behaviors, and is an important element of formal and informal nutrition education. The informal and practical dimensions can be realized through the food and meals offered/sold in school canteens, shops, and vending machines. As children and adolescents spend 6-10 h/day in schools and consume at least two meals there, the school food environment is important from a public health perspective. The aim of this study is to assess food and meal organization in primary schools in Poland. The study was conducted using individual in-depth interviews (IDIs) involving 24 school headmasters and 24 representatives of people employed in school canteens or catering companies involved in meal organization in schools. The nutritional food on offer at schools is important for shaping students' food preferences and choices, consequently influencing the development, functioning, and health of this subpopulation. The school environment can be an ideal place for hands-on nutrition education. In addition to the knowledge provided, there must be a consistent message concerning the provision of nutrition information to students between the teachings of parents, teachers, and, indirectly, the food and meals available at school. Our qualitative study is confirmed by the results of quantitative research to better understand the organization of nutrition and the problems and needs of primary schools in this area.

Frequency of Gastrointestinal Parasites, Anemia, and Nutritional Status among Children from Different Geographical Regions of Bolivia

The study aimed to measure the frequency of occurrence of infections with helminths, protozoa, and risk factors of undernutrition and anemia among schoolchildren from the Bolivian highland (altiplano) and lowland (subtropical) rural regions, with a high frequency of gastrointestinal parasite infections. Cross-sectional data were collected from 790 children, 5-13 years old. Microscopic examination of stool using the Ritchie technique, hemoglobin testing using the HemoCue analyzer, and anthropometric measurements were performed. Over 60% and 20% of children were infected with protozoa and helminth parasites, respectively. Infections caused by pathogenic Hymenolepis nana (15.7-5.2%), Ascaris lumbricoides (41.9-28.5%), Giardia lamblia (30.1-11.2%), Entamoeba histolytica (5.7-0.7%), and nonpathogenic Entamoeba coli (48.9-16%), Blastocystis hominis (40.2-28.5%), Iodamoeba butschli (16.1-2.5%), Chilomastix mesnili (19.2-7.3%), and Entamoeba histolytica/dispar (7.4-5.5%) parasites, were more prevalent in the highlands than the lowlands. Single parasitic infections were more prevalent in the lowlands; polyparasitism of light or heavy intensity predominated in the highlands. A strongly increased risk of anemia and a low prevalence of wasting were determined in children in the highlands. A higher risk for stunting was associated with children of older age, and a low burden of intestinal helminths would prevent wasting in children of highlands. Infections with A. lumbricoides and G. lamblia pathogens in older children were not significant covariates for stunting. Environmental, nutritional, and parasitic factors may predispose to anemia in the highlands. A nutritional intervention and parasite control effort will substantially improve children´s health in the highlands.

Long-term effects of child nutritional status on the accumulation of health human capital

Research on the impact of childhood nutrition on adult health and human capital has been extensively studied in developed countries, but research in China on this topic is limited. Nowadays, for children's nutritional status, while significant progress has been made in addressing childhood undernutrition in China, regional disparities persist, conversely, the prevalence of childhood overweight continues to rise. For adults' health human capital, the burden of chronic non-communicable diseases among Chinese residents is gradually increasing, over 50% of Chinese residents are overweight or obese, with obesity being one of the risk factors for other chronic diseases. Therefore, this study uses national representative data from 1991 to 2015 China Health and Nutrition Survey (CHNS), matched with individual information from their childhood, to examine the relationship between childhood nutrition and adult health human capital. Based on the two-way fixed effects models and logit models, the study finds that childhood nutrition status measured by height-for-age z score (HAZ) significantly and continuously has been influencing adult health human capital measured by height, BMI, self-rated health (SRH), whether have been sick in last four weeks (SH). BMI-for-age z score (BMIZ) significantly and continuously influence adult health human capital measured by BMI, blood pressure, and perceived stress (PS). Among that, this study places special emphasis on the long-lasting effects of late childhood and adolescence (ages exceeding 6) on the progressive height accumulation and sustained presence of elevated blood pressure. In conclusion, reducing childhood overweight and promoting linear growth and development throughout the whole childhood can reduce the future burden of disease on the nation.

The Family Environment as a Source for Creating the Dietary Attitudes of Primary School Students-A Focus Group Interview: The Junior-Edu-Żywienie (JEŻ) Project

The family environment plays a crucial role in creating the health behaviours of children and youth. This study aimed to explore the attitudes of parents with children aged 7-12 who represent an influential environment for creating the eating behaviours of children. A qualitative study was conducted using focus-group interviews (FGI) involving 101 parents from various socioeconomic backgrounds. Three categories of parents were identified based on their level of involvement and awareness of nutrition: 'aware', 'determined', and 'relaxed'. Among parents of 10-12-year-old students, an additional category, 'distanced' parents, was identified. The study revealed that parents require support in terms of providing compelling arguments and practical recommendations related to meals and reducing or eliminating their children's consumption of sweets, snacks, fast food, and, in the case of older students, energy drinks. Parents reported that their children had a moderate understanding of the principles of proper nutrition. The majority of respondents viewed this knowledge as primarily theoretical and expressed a need for practical guidance and activities, which they believe should be offered by schools. To achieve positive outcomes in educational activities related to food and nutrition, it is essential to involve children, parents, guardians, teachers, and other school staff in these efforts.

School-Based Nutrition Programs in the Eastern Mediterranean Region: A Systematic Review

This systematic review aims at documenting government-led school nutrition programs/interventions in countries of the Eastern Mediterranean Region (EMR). A systematic review of the available literature on this topic was conducted between 25 October 2022 and 15 November 2022 using 15 electronic databases as well as grey literature. The search was limited to materials published post 2000 in English, Arabic, or French. Articles/Reports were included in the review if they provided information on school-based nutrition programs/interventions developed, adopted or implemented by a governmental entity in the EMR countries, irrespective of study design. In total, 158 documents were retained until 16 May 2023. School-based programs/interventions were categorized into 13 types. In total, 298 school-based nutrition programs/interventions were identified. The most common were school meals and school feeding programs (all EMR countries) followed by nutrition education within the curriculum (77% of countries), extracurricular nutrition education (64%), standards for school canteens or foods/beverages available in schools (64%), and training of school staff (59%). Approximately half reported the inclusion of fruit and vegetable schemes (54%) or the establishment of hygienic cooking facilities (50%), while less than half reported standards for the marketing of food/beverages (45%), bans/standards for vending machines, milk feeding schemes, or micronutrient supplementation programs (41%). The least common interventions were school gardens (32%) and take-home rations (14%). Countries with the lowest gross domestic product and lowest government effectiveness score had the lowest number of programs/interventions. Many of the programs have tackled both school-aged children as well as preschoolers. We were able to identify monitoring and process evaluation for 21 programs in 14 countries. Few programs have undergone impact assessment.