Perspective: Interventions to improve the diets of children and adolescents

Research priorities for nutrition of school-aged children and adolescents in low- and middle-income countries

PURPOSE

A lack of data, intervention studies, policies, and targets for nutrition in school-age children (SAC) and adolescents (5-19 years) is hampering progress towards tackling malnutrition. To stimulate and guide further research, this study generated a list of research priorities.

METHODS

Using the Child Health and Nutrition Research Initiative (CHNRI) method, a list of 48 research questions was compiled and questions were scored against defined criteria using a stakeholder survey. Questions covered all forms of malnutrition, including micronutrient deficiencies, thinness, stunting, overweight/obesity, and suboptimal dietary quality. The context was defined as research focused on SAC and adolescents, 5 to 19 years old, in low-and middle-income countries, that could achieve measurable results in reducing the prevalence of malnutrition in the next 10 years.

RESULTS

Between 85 and 101 stakeholders responded per question. Respondents covered a broad geographical distribution across 38 countries, with the largest proportion focusing on work in East and Southern Africa. Of the research questions ranked in the top ten, half focused on delivery strategies for reaching adolescents and half on improving existing interventions. There were few differences in the ranked order of questions between age groups but those related to in-school children and adolescents had higher expert agreement than those for out-of-school adolescents. The top ranked research question focused on tailoring antenatal and postnatal care for pregnant adolescent girls.

CONCLUSION

Nutrition programmes should incorporate implementation research to inform delivery of effective interventions to this age group, starting in schools. Academic research on the development and tailoring of existing nutrition interventions is also needed; specifically, on how to package multisectoral programmes and how to better reach vulnerable and underserved sub- groups, including those out of school.

Effects of Online Nutrition Training Program About Mediterranean Diet on Anthropometric Measurements and Diet Quality in Overweight and Obese Adolescent Girls

Objective: This study was conducted to evaluate the effect of an online nutrition training program about the Mediterranean diet for 8 weeks in overweight and obese female high school students on anthropometric measurements and diet quality. Methods: A total of 86 students between the ages of 14-18 years were included in the study, and they were divided into two groups as nutrition training (n=44) and control groups (n=42). The Mediterranean Diet Quality Index (KIDMED) scores were calculated and anthropometric measurements of groups were taken by the dietician at the beginning and at the end of the study. Results: The KIDMED score of the nutrition training group was 4.59±2.40 at the beginning, later on it increased to 7.43±2.57 after the program (p= .001). After the program, it was determined that the difference between the KIDMED scores of the nutrition training and control groups were statistically significant (p= .034), however the decrease in body weight (p= .09), BMI (p= .64), and waist circumference (p= .06) were similar between groups. Conclusion: As a result of the study, it can be said that online nutrition training program about the Mediterranean diet for 8 weeks may affect the diet quality positively of overweight and obese female adolescents, but long-term programs should be planned to determine the effects on anthropometric measurements.

The infectious disease trap of animal agriculture

Infectious diseases originating from animals (zoonotic diseases) have emerged following deforestation from agriculture. Agriculture can reduce its land use through intensification, i.e., improving resource use efficiency. However, intensive management often confines animals and their wastes, which also fosters disease emergence. Therefore, rising demand for animal-sourced foods creates a "trap" of zoonotic disease risks: extensive land use on one hand or intensive animal management on the other. Not all intensification poses disease risks; some methods avoid confinement and improve animal health. However, these "win-win" improvements alone cannot satisfy rising meat demand, particularly for chicken and pork. Intensive poultry and pig production entails greater antibiotic use, confinement, and animal populations than beef production. Shifting from beef to chicken consumption mitigates climate emissions, but this common strategy neglects zoonotic disease risks. Preventing zoonotic diseases requires international coordination to reduce the high demand for animal-sourced foods, improve forest conservation governance, and selectively intensify the lowest-producing ruminant animal systems without confinement.

Trend of Ultraprocessed Product Intake Is Associated with the Double Burden of Malnutrition in Mexican Children and Adolescents

BACKGROUND

Ultraprocessed products (UPPs) have been associated with unfavorable health outcomes; however, until now, they have not been associated with the coexistence of undernutrition and overnutrition, known as the double burden of malnutrition (DBM) at the individual level.

METHODS

Cross-sectional analyses were performed on data collected from children and adolescents participating in the 2006 and 2016 Mexican National Health and Nutrition Surveys. The food and beverages reported in the food frequency questionnaire (SFFQ) were classified as UPPs as defined by the NOVA classification system. Associations of UPPs with anemia, excess weight, and the DBM were estimated with logistic regression models. A pseudo-panel was generated using the cohorts of children born from 1997 to 2001 to estimate the effect of the UPPs on anemia, excess weight, and the DBM.

RESULTS

The consumption of UPPs (% energy) was higher in 2016 (children 30.1% and adolescents 28.3%) than in 2006 (children 27.3% and adolescents 23.0%) in both age-groups. The higher contribution of UPPs was positively associated with excess weight and the DBM in children's lower tertile of socioeconomic status (SES) and the DBM in higher tertile of SES in adolescents. The pseudo-panel analysis shows the positive association between UPPs and DBM in lower SES.

CONCLUSIONS

These results provide evidence of the association between the consumption of UPPs and the DBM and excess weight in children and adolescents.

School Feeding Programs: What Happens Globally?

School feeding programs (SFPs) are an important effort to address food insecurity, improve nutritional education, and ultimately improve health outcomes. The objective of this research was to describe the nutritional, cultural, food safety, and agro-family participation of SFPs in different countries and observe the SFP in low-middle and high-income countries to establish disparities. The study followed documentary research of SFP official online resources complemented by a literature review. The programs were assessed in four criteria: (1) nutritional aspects, (2) cultural aspects, (3) food safety, and (4) agro-family participation. Out of 192 countries registered, 117 countries (60.93%) have an SFP, and only 8 (4.16%) do not have SFPs. A total of 67 countries (34.89%) did not have an official online resource and did not respond to follow-up emails. Out of the 117 countries with SFP, all of them had a detailed description of their nutritional aspects, cultural aspects (11.96%), food safety (16.23%), and agro-family participation (23.93%). Europe and Central Asia were the continents with the most comprehensive SFP. While most countries incorporate nutritional aspects and healthy food, cultural, food safety, and agro-family participation must be incorporated in their SPF to optimize children and adolescent development. Moreover, the study identified disparities across countries where the SFPs were identified in low-middle countries compared to middle- and high-income countries.