Nutritional knowledge in European adolescents: results from the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study

Fruitful changes? Exploring household fruit purchase decisions following comprehensive food policy regulations in Chile

Changes in unprocessed healthy food purchases associated with the implementation of comprehensive food policy remain understudied. This study analyzes whether, following the announcement, modification, and implementation of Chile's Food Labeling and Advertising law targeting highly processed food (occurring in 2012, 2015, and 2016, respectively), households improved their fruit purchase decisions: purchase participation (i.e., buying likelihood) and purchase quantity. Expenditure data from a representative sample of Chilean households were employed, covering two consecutive survey waves conducted in 2011/2012 and 2016/2017. After controlling for socioeconomic factors (e.g., prices and income), results indicate that only purchase participation increased, providing weak support for positive spillover effects of a comprehensive food policy on fruit purchases. Subsample analyses reveal that this increase was driven by college-educated, childless, and low-income households and was stronger for sweeter and more convenient fruits. Considering that households in Chile do not meet health recommendations for daily fruit intake, additional policy efforts targeting healthy, unprocessed food consumption could be considered.

Nutritional and physical fitness parameters in adolescence impact cardiovascular health in adulthood

BACKGROUND & AIMS

Cardiovascular diseases are the leading cause of mortality worldwide, originating in the first decades of life. A better understanding of their early determinants would allow for better prevention. This study aimed to evaluate the impact of nutritional and activity-related characteristics during adolescence on young adult cardiovascular risk factors.

METHODS

The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study included adolescents (aged 12.5-17.5 years) in 10 European centres. Four centres designed a nested cohort including 236 participants who were reassessed as young adults (21-32 years). Food consumption was evaluated by dietary recalls, physical activity by accelerometers, physical fitness using physical tests and nutritional knowledge by questionnaires. Cardiovascular health was assessed by Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Study risk scores and its components. Factors associated with cardiovascular risk were identified using a multivariable regression model.

RESULTS

Higher Diet Quality Index (DQI, P = 0.012) and nutritional knowledge (P = 0.015) were significantly associated with lower modified PDAY risk scores. Ultra-processed foods were associated with a lower non-high-density lipoprotein (non-HDL) cholesterol (P = 0.003), whereas DQI (P = 0.014) and Planetary Health Diet Index (P = 0.016) were associated with a higher HDL cholesterol. Higher DQI was also related to a lower body mass index (BMI, P = 0.006). In addition, cardiorespiratory fitness was related to a lower BMI (P = 0.004).

CONCLUSIONS

Nutritional knowledge, diet quality and adherence to a sustainable diet in adolescence decrease cardiovascular risk in adulthood, whereas ultra-processed food consumption increases risk. These factors appear as targeted prevention tools for promoting a healthier adolescent lifestyle to decrease long-term cardiovascular risk.

CLINICAL TRIAL REGISTRY NUMBER

Clinicaltrials.gov NCT02899416.

Determinants of Diet Quality in Adolescents: Results from the Prospective Population-Based EVA-Tyrol and EVA4YOU Cohorts

(1) Background: Unhealthy dietary behaviors are estimated to be one of the leading causes of death globally and are often shaped at a young age. Here, we investigated adolescent diet quality and its predictors, including nutrition knowledge, in two large Central European cohorts. (2) Methods: In 3056 participants of the EVA-Tyrol and EVA4YOU prospective population-based cohort studies aged 14 to 19 years, diet quality was assessed using the AHEI-2010 and DASH scores, and nutrition knowledge was assessed using the questionnaire from Turconi et al. Associations were examined utilizing multivariable linear regression. (3) Results: The mean overall AHEI-2010 score was 42%, and the DASH score was 45%. Female participants (60.6%) had a significantly higher diet quality according to the AHEI-2010 and DASH score. AHEI-2010 and DASH scores were significantly associated (p < 0.001) with sex, school type, smoking, and total daily energy intake. The DASH score was additionally significantly associated (p < 0.001) with age, socioeconomic status, and physical activity. Participants with better nutrition knowledge were more likely to be older, to attend a general high school, to live in a high-income household, to be non-smokers, and to have a higher diet quality according to the AHEI-2010 and DASH score. (4) Conclusions: Predictors of better diet quality included female sex, physical activity, educational level, and nutrition knowledge. These results may aid focused interventions to improve diet quality in adolescents.

Nutrition knowledge, attitudes, and dietary practices among parents of children and adolescents in Weifang, China: A cross-sectional study

Parent's nutrition knowledge, attitudes, and dietary practices (KAP) play imperative roles in preventing malnutrition for themselves and their children. Our study aimed to determine the status and contributing factors of nutrition KAP among parents of children and adolescents. A total of 1746 parents (mean age 39.67 ± 5.38 years, females accounting for 69.82%) of primary and junior high school students in Weifang, China, completed a self-reported KAP questionnaire in August 2021. An analysis of Pearson product-moment correlation was conducted to determine the relationship between knowledge, attitudes, and practices. Chi-square test, followed by a multivariable robust Poisson regression analysis, was performed to identify the contributing factors to parents' KAP. A 65.94% awareness rate of nutritional knowledge was observed. The correlations between nutrition knowledge and attitudes (r = 0.03, P = 0.23), knowledge and practices (r = 0.02, P = 0.34), and attitudes and practices (r = 0.16, P < 0.01) were relatively weak. After adjusting for other contributing factors, females [prevalence ratio (PR) = 1.28, 95% confidence interval (CI) = 1.13-1.45], participants with secondary education (PR = 4.64, 95% CI = 1.60-13.50), junior college education (PR = 5.87, 95% CI = 2.01-17.13) and college degree or above education (PR = 6.58, 95% CI = 2.25-19.23) acquired higher nutrition knowledge scores. Moreover, healthy diet behaviors were more commonly implemented by females than males (PR = 1.42, 95% CI = 1.14-1.76), and which needed to be improved in those with abnormal body mass indexes (BMIs) [overweight (PR = 0.86, 95% CI = 0.74-0.99) and obese (PR = 0.76, 95% CI = 0.56-0.99)]. It was necessary for nutrition KAP promotion to be emphasized in nutritional knowledge and dietary practices, as well as health behavior guidance, especially for parents with low education and elevated BMIs.

The effect of nutritional and lifestyle education intervention program on nutrition knowledge, diet quality, lifestyle, and nutritional status of Croatian school children

Introduction

Nutrition education during adolescence has proven effective in increasing knowledge, attitudes, and practices in the diet. The Mediterranean diet has proven health benefits and is proposed as a model of a sustainable diet that is beneficial for health and the environment. Its promotion with the educational program can have a significant effect on improvements in nutrition knowledge, diet quality, and nutritive status of adolescents for their healthy adulthood.

Objective

This study aimed to investigate the effect of the educational program on the nutrition knowledge, diet quality, lifestyle, and nutritional status of school children from the littoral part of Croatia.

Methods

An education-based intervention study was carried out on 2,709 schoolchildren aged 10–12 years (educated/control group: 2617/92). The questionnaire about sociodemographic, anthropometric, dietary, physical activity, screen time, sleep habits, and nutrition knowledge was assessed at the baseline and after a 6- to 9-month follow-up for the medium-term effect of education. Nutrition knowledge was provided after 3 weeks for the short-term education effect assessment.

Results

Educated schoolchildren achieved a significant increase in nutrition knowledge (+75.5%), expressed as a short-term effect of the education and maintained at the 6- to 9-month follow-up (+66.8%, p &lt; 0.001). Follow-up of children significantly improved their nutritional status (underweight −56.6%, normal weight 24.8%, overweight −22.1%, and obesity −57.5%) and physical activity engagement (+13.2%). The proportion of children with a diet highly adhering to the Mediterranean diet significantly doubled (+105.0). Those children with the highest nutrition knowledge at the follow-up significantly improved their nutritional status (+218.9%), participated in organized sports (+204.7%), and had a diet that highly adhered to the MD (+291.8%).

Conclusion

A significantly good medium-term effect of education-based nutrition and lifestyle intervention program on nutrition knowledge, diet quality, lifestyle, and nutritional status of schoolchildren aged 10–12 years was shown. The educational program promoted a Mediterranean diet and lifestyle as a healthy and sustainable way of living, important for children's future health and wellbeing. New research-based approaches are needed for making children more aware and capable of handling the complexity of sustainable living.

Chrononutrition behavior during the COVID-19 pandemic and its relationship with body weight among college students

Introduction

Students in colleges are exposed to unhealthy lifestyles and poor dietary choices. They are at risk of being overweight, skipping meals, and developing eating disorders. However, there is a paucity of information on their chrononutrition behavior, which is very important, especially concerning the timing of food consumption across the day. Therefore, the present study aimed to investigate chrononutrition behavior and its potential association with body weight status among college students in Malaysia.

Methods

This cross-sectional study was conducted on 409 college students aged above 18 in Malaysia. The chrononutrition behavior was assessed using the validated Chrononutrition Profile Questionnaire (CP-Q). The questionnaire was distributed using an online platform. Participants self-reported their body weight and height, and the Body Mass Index (BMI) was computed. Data were analyzed using the SPSS software.

Results

A total of 409 participants were recruited, with a mean age of 21.5 ± 2.2 years. The prevalence of underweight, normal, and overweight was 24.7, 49.4, and 25.9%, respectively. The chrononutrition behavior revealed that participants ate breakfast about four times/week (mean 4.27 ± 2.43 days), and only 135 (33.0%) consumed breakfast daily. The largest meal consumed was during lunch (75.8%), and the mean of snacking after the last meal was 3.23 ± 2.01 days. The prevalence of night eating was low, and most participants (70.9) did not wake up at night to eat. The frequency, however, was significantly higher in the underweight group compared to the normal weight group (p < 0.05). We observed a significant association between BMI and eating window, evening latency, evening eating, and night eating. It was found that the underweight had a poor eating window (p < 0.01), poor evening latency (p < 0.01), poor evening eating (p < 0.01), and poor night eating (p < 0.05) compared to those with normal and overweight BMI groups. In contrast to predictions, poor chrononutrition behavior was more likely to predict being underweight compared to normal (p < 0.05).

Conclusion

Underweight young adults are more likely to have poor chrononutrition behavior. The results of the present study suggest that future nutrition education should also focus on the chrononutrition behavior of college students.

Nutritional Behaviour of Adolescents and the Impact of Covid-19 on A Diet in Saudi Arabia

Background In recent decades, changes in food consumption among adolescents in Arabic speaking countries, including The Kingdom of Saudi Arabia (KSA), has resulted in increased burden of overweight and obesity. COVID-19 related restrictions have further impacted lifestyle and diet among adolescents in KSA. Aim The present study aimed to assess the knowledge, attitude, behaviour and dietary patterns of adolescents and the impact of the COVID-19 pandemic related restrictions on these behaviours. Methods A cross-sectional study was conducted in six intermediate schools among 1500 adolescents (11-15 years) via an anonymous online survey. The Chi Square test was used to compare gender stratified nutritional knowledge, attitude and behaviour of adolescents and the impact of COVID-19 related restrictions. To determine the factors associated with nutritional change during COVID-19 lockdown, logistic regression was employed using the categorisation of nutritional change during COVID-19 restrictions versus no change in univariate and multivariate analyses. Results A good level of nutrition-related knowledge and attitude was demonstrated both by female and male students, with 66% and 57% of participants scoring above the median of the total possible knowledge and attitude score, respectively. After adjusting for all variables, higher nutrition knowledge score predicted students to be less likely to report increased food consumption during COVID-19 restrictions, whereas students with higher nutrition attitude scores and with a higher risk of increased food consumption were more likely to increase food consumption during COVID-19 restrictions. Conclusions Unhealthy dietary habits among Saudi adolescents are of paramount public health concern and the COVID-19 restriction period exacerbated the pre-pandemic nutrition-related unhealthy behaviours. Therefore, school-based interventions aiming to promote healthy lifestyles and the wellbeing of Saudi adolescents and use of qualitative recall dietary diary is also crucial to develop programs that prevent unhealthy lifestyles in adolescents in Saudi Arabia.

Nutritional and Oral Hygiene Knowledge versus Reported Behavior of Children and Adolescents-A Cross-Sectional Interview-Based Study

Despite the fact that healthy, sugar-reduced nutrition has been propagated by the media and in schools for years, dental caries in children remains a major health problem worldwide, caused primarily by an unhealthy diet. The objective of this study is to compare statements on nutrition and hygienic knowledge with those on children's actual dietary and hygienic behavior. A random sample of 554 children and adolescents aged 3-19 years was enrolled. Designed as a cross-sectional interview-based community survey, this study was conducted consecutively during three one-day public science-promoting events at the Saarland University's Medical Faculty. Participants' oral hygiene and nutritional knowledge was profound; however, the reported translation into practice showed deficiencies. Boys and younger children (3-10 years) often showed better oral hygiene knowledge than girls and older children (over 11 years) but had problems implementing it into their daily life practice. In contrast, girls and older children often showed less oral hygiene knowledge but reported more favorable behavior. Finally, children up to the mixed dentition phase preferred drinking sweets more often than older children, posing a risk to the developing permanent dentition. Intensifying well-known controlled motivation training approaches to encourage children and adolescents is recommended to put their knowledge into practice.

Diet Quality, Dieting, Attitudes and Nutrition Knowledge: Their Relationship in Polish Young Adults-A Cross-Sectional Study

The purpose of this study was to examine the relationships between diet quality, dieting, nutrition knowledge and attitudes in a group of Polish young adults. A cross-sectional survey was conducted in 2018 amongst 638 students of food and nutrition-related majors. Based on the frequency of consumption of 24 food groups, the “Pro-Healthy Diet Index” (pHDI) and “Non-Healthy Diet Index” (nHDI) were calculated. To assess the nutrition knowledge, the “GAROTA” test was used. The k-means clustering method was used to identify clusters-attitudes towards food and nutrition. The relationships between pHDI and nHDI indices, dieting, nutrition knowledge (NK), and attitudes towards food and nutrition were verified, using multiple linear regression analysis. The results confirmed some relationships between the variables. Higher nHDI characterized males (p < 0.0001) and people with more unfavorable attitudes towards food and nutrition (p < 0.0001), and those not using a diet (p < 0.0001). Higher nutrition knowledge (p < 0.0001) and higher BMI (p = 0.0370) were correlated with lower nHDI. Higher pHDI characterized people with more favorable attitudes (p < 0.0001) and those using a diet (p = 0.0002). Nutrition knowledge showed an adverse association with nHDI (r = −0.172, p < 0.05) and no association with pHDI. Thus, declarative nutrition knowledge does not seem to be a good indicator of healthy dietary behavior. Nutrition education programs that concentrate only on knowledge of facts, and neglect the development of favorable attitudes towards food and nutrition, may not be efficient enough to develop adequate dietary behavior of students.

Nutrition Knowledge as a Driver of Adherence to the Mediterranean Diet in Italy

Background

An optimal Nutrition knowledge (NK) among the population could result in greater Adherence to the Mediterranean Diet (AMD), a recognized dietary pattern capable of preventing chronic food-related diseases. This study aimed to evaluate the association between NK and AMD in Italy.

Methods

A national representative sample of 2,869 adults took part in an assessment that was carried out through a self-administrated questionnaire including sections relating to NK and AMD. AMD was evaluated following the PREDIMED PLUS methodology. Descriptive statistics were provided, and ordinal measures of NK score and AMD were calculated based on quartiles of the quantitative scores. A contingency analysis was performed to check associations between variables.

Results

In Italy, the average NK score was 50 ± 13.3, equivalent to 56.8% of correct answers. The average value of AMD was 6.8, corresponding to 40% of the maximum score with 31.4% of the population demonstrating low AMD, 31.3% in the lower-middle range, 24% in the medium-high range, and only 13.3% reporting a high AMD. A significant association between NK and AMD was found; respondents who reported the lowest AMD corresponded to those with the lowest NK (36.7%; p < 0.05) and similarly, those with the highest level of adherence to MD also achieved the highest NK scores (41.7%; p < 0.05).

Conclusion

This study showed that AMD in Italy is generally low, and the strong association between NK and AMD demonstrated that there is a clear connection between a healthy dietary pattern and the nutrition literacy of the population. Those with the highest AMD corresponded to the highest NK and, conversely, those with the lowest AMD displayed the lowest NK. The study also highlighted that socioeconomic aspects were strong determinants of both AMD and NK.

Nutrition Literacy of Middle School Students and Its Influencing Factors: A Cross-Sectional Study in Chongqing, China

Nutrition literacy plays an important role in children's dietary habits and nutrition. This study aimed to analyse the status of nutrition literacy and its influencing factors amongst middle school students in Chongqing, China. “Nutrition literacy scale for middle school students in Chongqing” was used in 29 districts of Chongqing in September 2020. The scores of nutrition literacy and its' three sub-domains (functional, interactive and critical nutrition literacy) were divided into low and high groups based on their median scores. Binary logistic regression was used to measure the influencing factors of nutrition literacy. A total of 18,660 middle school students were included in this study. The median of nutrition literacy of middle school students was 61.68 (IQR = 14.37). Interactive nutrition literacy had the highest score (median = 70.00, IQR = 20.00), followed by functional nutrition literacy (median = 68.69, IQR = 14.14) and critical nutrition literacy (median = 45.83, IQR = 25.00). Students who were the minority (OR = 0.71, 95% CI = 0.637–0.785), in senior high school (OR = 0.51, 95% CI = 0.477–0.548), in rural areas (OR = 0.85, 95% CI = 0.790–0.911), receiving school meal support from the government (OR = 0.63, 95% CI = 0.591–0.664), with other caregivers' parenting (OR = 0.86, 95% CI = 0.805–0.914), with parents having a low level of education and with an abnormal BMI [thin (OR = 0.91, 95% CI = 0.837–0.990), overweight (OR = 0.87, 95% CI = 0.785–0.968), and obese (OR = 0.83, 95% CI = 0.767–0.902)] presented less probability of being a high level of nutrition literacy. Our results could assist public health authorities in developing strategies of nutrition literacy promotion for references and theoretical foundations.

The relationship between nutrition and physical activity knowledge and body mass index-for-age of school-aged children in selected schools in Ghana

BACKGROUND

Nutrition knowledge contributes significantly to the nutritional status and habits of individuals as it influences their food consumption. And body mass index (BMI) of individuals. Recent data suggests a relationship between nutrition and physical activity knowledge, attitude, practices, and anthropometric indices of Ghanaian children.

OBJECTIVE

To determine the relationship between nutrition and physical activity knowledge and using BMI-for-age of school-aged children.

METHODS

A cross-sectional study involving 591 school-aged children (8-13 years) chosen at random from schools in Ghana's Ho Municipality. Socio-demographic information was gathered. Data on nutrition and physical activity knowledge, attitude, and practice were also collected using structured questionnaires. BMI was calculated after weight and height were measured.

RESULTS

Majority of the participants had poor knowledge on nutrition (46.6%) and physical activity (49.8%) even though more children in private schools (63.3%) had better (good and excellent) knowledge in nutrition than children from public schools (48.2%). Older children (11-13 years) had 'good' knowledge of physical activity (54.7%) as opposed to younger children. Males (59.5%) and children in private schools (66.3%) also had better overall scores in combined nutrition and physical activity knowledge than their female and public-school counterparts, respectively. Physical activity knowledge was significantly (p < 0.05) associated with the BMI-for-age categories. Nutrition knowledge (p < 0.05) and total nutrition and physical activity knowledge scores (p < 0.001) were weakly but positively associated with BMI-for-age.

CONCLUSION

The results suggest that BMI-for-age of the participants was positively correlated to the nutrition knowledge and the total nutrition and physical activity knowledge (NutPA).

'We know what we should eat but we don't …': a qualitative study in Irish secondary schools

Healthy eating opportunities for young people need to be provided in the school setting. Links between formal education and local policies and practices, and active involvement of students are emphasized in whole school approaches to health promotion. In many jurisdictions, schools struggle to provide nutritious food that is acceptable to students. The aim of this study was to conduct an in-depth exploration of school food and students' food choice with students, teachers and principals in six Irish secondary schools. Students conducted their own focus groups with peers, and a researcher conducted focus groups with teachers and one-to-one interviews with principals. Students, teachers and principals expressed dissatisfaction with food provision within their respective schools and reported unhealthy dietary behaviours among the student body as the norm. Divergent views, however, emerged regarding education, knowledge and the primary drivers of food choice. Teachers and principals saw a role for more education modules and students believed environmental infrastructures, practices and policies needed to be addressed to improve behaviours. This consultation with students, teachers and principals highlight that, in addition to education, the social and environmental aspects of food choice and eating at school deserve attention in future research and policy.

Evaluation of Eating Habits and Their Impact on Health among Adolescents and Young Adults: A Cross-Sectional Study

According to the health field concept, the most important factor affecting health is a lifestyle. The current upward trend in overweight and obesity among younger populations is a consequence of inadequate lifestyle habits. The study aimed to characterise youth nutrition behaviour and knowledge in the context of the risk of developing overweight or obesity. The study group consisted of 307 high school students, 59% females and 41% males, aged between 15 and 19. Nutrition behaviours were studied using the standardised Questionnaire of Eating Behaviour. Body weight and body height were measured with a body composition analyser and a body height meter, respectively. It was observed that the average body mass index was 21.7 ± 3.4 kg/m² for the females and 22.3 ± 3.1 kg/m² for the males (p = 0.036). Disturbed weight-to-height ratios (i.e., overweight and obesity) were found in 15.6% of the females and 16.5% of the males. The diets of approximately 90% of these youth were characterised by excessively low pro-health product content. The males showed a significantly higher intensity of adverse health traits compared to the females (8.1% vs. 0.7%, p = 0.002). More than half of the males presented insufficient knowledge about food and nutrition (53.5% vs. 30.8%, p < 0.001). Regardless of gender, the study showed a positive correlation between adolescents’ level of knowledge and the pro-health diet index (gamma coefficient: 0.42, p < 0.001) and a negative correlation between their level of knowledge and the unhealthy diet index (gamma coefficient: −0.66, p < 0.001). The level of knowledge was closely related to the indicators of the intensities and adverse health characteristics of their diets. These results indicate the need for educational programs to raise awareness among youth in civilisation backgrounds.

Nutrition Literacy among Adolescents and Its Association with Eating Habits and BMI in Tripoli, Lebanon

(1) Background: Adolescence is a period of increased autonomy and independent decision making; it determines health behaviors that can persist into the future. Individual factors like food choices and unhealthy lifestyle have an essential role in the development and prevention of obesity among adolescents and are associated with the nutrition literacy of parents and other adults. While the association of parents' nutrition literacy with adolescent BMI has been addressed, there is still a scarcity of studies that examine the effect of adolescents' nutrition literacy on their eating habits and body mass index (BMI) status. (2) Methods: A cross-sectional study was conducted that included 189 adolescents (68 with overweight and obesity and 121 with normal weight) aged between 14-19 years from four private schools in Tripoli, Lebanon. A self-administered questionnaire that included the Nutrition Literacy Assessment Instrument (NLAI) and the Adolescent Food Habits Checklist (AFHC) was used. Anthropometrics were measured using standardized procedures. The association between nutrition literacy, food habits and BMI was assessed using a chi squared test for independence and Poisson regression analysis where suitable. (3) Results: Results indicated no association between all five components of nutrition literacy and body mass index categories. Furthermore, there was no association between the Adolescent Food Habits Checklist and overweight or obese BMI status (RR = 0.947, 95%CI: 0.629-1.426) (p = 0.796). No association was observed between nutrition literacy and food habits, except for an inverse association with macronutrients literacy. (4) Conclusions: In conclusion, the study indicated that there was no association between the components of nutrition literacy with body mass index or with food habits, except for macronutrient literacy.

Patterns of Avoiding Nutrition Mistakes in Metropolitan Adolescents Are Associated with Sex, Nutrition Knowledge, Physical Activity, and Family Environment

A comprehensive approach to the identification of the relationship between behaviors limiting nutrition mistakes, nutrition knowledge, and physical activity in the context of the family environment has not yet been widely explored. We aim to identify patterns of avoiding nutrition mistakes in high school students from Warsaw, Poland, and to assess their associations with nutrition knowledge (NK), physical activity (PA), body mass index (BMI), demographic, and family environment characteristics. A cross-sectional study involving 616 high school students, aged 16–19, was conducted. The data were collected by distributing questionnaires. The k-means method was used for cluster analysis, and logistic regression was used to assess the adherence to identified patterns. We identified three patterns: Prudent Ones (45%), Inconsequent (39%), and Rebels (16%). About 70% of adolescents had insufficient NK. The adherence to the Rebels pattern was lower by 85 % in girls, by 68% in students with younger siblings, and was about 4.0-times higher in children of mothers with primary education, 2.4 times higher in students with insufficient NK, and 1.9-times higher in students living in a family with more than 4 persons. The groups of adolescents with feature characteristics of the Rebels and Inconsequent are possible targets for intervention and require further in-depth research to explain their lack of attempts to avoid nutrition mistakes. The results clearly indicate the necessity of including metropolitan teenage boys in effective nutritional education for the rationalization of their dietary behavior.

Aligning nutrition knowledge and dietary habits of generation Z: Is there a room for improvement?

The potential association between determinants such as nutrition knowledge and dietary habits with obesity development among adolescents of generation Z (Zoomers) was investigated in the presented study. Data regarding meals consumption frequency, snack choice and familiarity with amounts of basic food nutrients in diet were gathered throughout a self-designed questionnaire from 854 adolescents (11-18 years) attending elementary and secondary schools in the Autonomous Province of Vojvodina, Serbia. The corresponding data was analysed and discussed primarily concerning BMI-forage , and subsequently, gender and educational stage. The association between BMI categories and examined determinants was tested using chi-square and multinomial logistic regression statistics. Although most of the surveyed adolescents had normal weight (72.1%), a notable share of overweight adolescents was also detected (17.9%). Additionally, observed irregularities in breakfast and dinner consumption frequencies and participants' modest nutrition knowledge can contribute to further diet deterioration. Statistically significant but weak associations between BMI-forage and choice of snack, dinner consumption frequency, as well as the frequency of salty snack and fast food consumption, were noted. Furthermore, an increase in nutrition knowledge was inversely associated with obesity prevalence (OR 6.56, 95% CI 1.388-31.037). As an outcome, the need for improvement regarding studied determinants especially nutrition knowledge is established and represents a task to achieve through health promotion strategies among generation Z.

Dietary Patterns and Their Association with Body Composition and Cardiometabolic Markers in Children and Adolescents: Genobox Cohort

Diet is a key factor for obesity development; however, limited data are available on dietary cluster analysis in children with obesity. We aimed to assess the associations between dietary patterns and obesity and several cardiometabolic markers. Anthropometry, bioelectrical impedance, blood pressure and plasma biomarkers of oxidative stress, inflammation and endothelial damage were determined in 674 Caucasian children, aged 5-16, with normal or excess weight. Using a food frequency questionnaire and cluster analysis, two consistent dietary patterns were shown, labeled as health conscious (HC) and sweet and processed (SP). The HC pattern included a greater proportion of participants with overweight/obesity than the SP cluster (80.1% vs. 63.8%). However, children with obesity within the HC cluster, showed less abdominal fat, through waist to hip (0.93 vs. 0.94) and waist to height (0.61 vs. 0.63) indexes (p < 0.01). Univariate general models showed several additional differences in cardiometabolic risk biomarkers in the global and stratified analyses, with a healthier profile being observed mainly in the HC cluster. However, multivariate models questioned these findings and pointed out the need for further studies in this field. Anyhow, our findings support the benefits of a healthy diet and highlight the importance of dietary patterns in the cardiometabolic risk assessment of children with overweight/obesity, beyond weight control.

Gym Members Show Lower Nutrition Knowledge than Youth Engaged in Competitive Sports

OBJECTIVE

Adolescents may be vulnerable to misleading nutritional information and adopt unhealthy food habits. In addition, specific features related to physical training, either aimed to improve fitness or to comply with sport demands, may influence food habits of the youth. This cross-sectional study was aimed to compare nutrition knowledge, food habits and adherence to Mediterranean diet in youth engaged in fitness training, competitive sports or inactive.

METHODS

Three questionnaires, the General and Sport Nutrition Knowledge (GeSNK) questionnaire, a food habit questionnaire and the KIDMED were administered to gym members, athletes engaged in volleyball, long-distance swimming, and gymnastics, and inactive adolescents.

RESULTS

The total sample included 211 youth (age 16.8 ± 1.7 years). Gym members, like the inactive youth, had lower general and sport-related nutrition knowledge compared to athletes (p = 0.001). In the whole sample, general nutrition knowledge was positively associated with healthy food habits (p < 0.01) and adherence to the Mediterranean diet pattern (p < 0.02).

CONCLUSIONS

Gym members had a level of nutrition knowledge lower than young athletes and similar to inactive youth. Healthy food habits were related with nutrition knowledge among adolescents. Specific nutritional education programs are needed to address food habits in fitness settings.

Income Segregation and Access to Healthy Food

INTRODUCTION

Differences in diet quality across socioeconomic groups are a key contributor to health gradient. An agent-based model was developed to explore how income segregation affects food access for poor households under idealized circumstances where the poor have the same knowledge of and preferences for healthy food as the nonpoor.

METHODS

The agent-based model featured households with heterogeneous incomes and automobile ownership characteristics on the basis of 2016 U.S. Census Bureau data. Households had identical preferences and were perfectly informed about the prices and availability of food products in different grocery stores. The model featured 2 fully informed competing grocery stores that chose their locations, product lines, and prices to maximize profits. The model was simulated for different levels of income segregation. The model in this article was created and analyzed in 2019.

RESULTS

With no segregation, the rich and the poor households had comparatively equal access to grocery stores (in terms of travel distance) and healthy food (in terms of availability). With high segregation, poor households were forced to travel farther for groceries and may find healthy food unavailable at the grocery stores closest to their homes. Incentivizing grocery stores to locate equitably would require offering them substantial subsidies.

CONCLUSIONS

The model demonstrates that even under idealized conditions of perfect information and fully rational consumers, income segregation leads to adverse consequences for healthy food access by the poor. Agent-based modeling is useful to explore important hypothetical scenarios and should be considered as one of many worthwhile complementary frameworks to study complex topics.

Relationship between nutrition knowledge, education and other determinants of food intake and lifestyle habits among adolescents from urban and rural secondary schools in Tyrol, Western Austria

Objective:

The aim of this study was to investigate the association of the number of hours of nutrition education and teachers’ qualifications with nutrition knowledge and dietary behaviour in students.

Design:

In this representative cross-sectional study, socio-demographic data, anthropometric measurements, socio-economic status (SES), physical fitness, nutrition knowledge and eating habits were assessed. Differences between groups were tested by χ² and t tests. Multiple linear and logistic regression modelling was used to examine the relationship between demographic characteristics, lifestyle and dietary behaviours, nutrition knowledge, nutrition-trained teachers and number of nutrition lessons.

Setting:

Sixteen secondary schools in urban (n 6) and rural regions (n 10) of Tyrol, Western Austria.

Participants:

Students (n 513) aged 14·2 (sd 0·7) years.

Results:

Higher nutrition knowledge was significantly associated with attending rural school (P = 0·001), having no migration background (P < 0·001), (very) good physical activity behaviour (P = 0·040), non-trained teacher (P = 0·006) but higher number of hours of nutrition education (P = 0·013). Regression models showed that higher nutrition knowledge was independently associated with lower intake of meat and iced tea and higher intake of vegetables and plant-based oils. A higher amount of nutrition education (h/week) was significantly associated with higher intake of dark (wholegrain) bread, lower intake of meat and of energy drinks sweetened with sweeteners.

Conclusions:

Our results suggest that more hours in nutrition education result in higher nutrition knowledge and greater nutrition literacy, which may lead to health-promoting dietary habits. School-based nutrition education can be seen as preventive measure to increase nutritional competences in adolescents independent of their SES.

Socioeconomic Differences and the Potential Role of Tribes in Young People's Food and Drink Purchasing Outside School at Lunchtime

Socioeconomic deprivation has been linked to food consumption practices, but studies investigating the food environment around schools provide mixed findings. Peer influence and marketing cues are considered important influencers of young people's behaviors. This study used a tribal theory lens to investigate the factors affecting pupils' purchasing and consumption of food/drinks outside schools at lunchtime. A survey was conducted with 243 pupils from seven UK secondary schools of differing socioeconomic status (SES). A purchasing recall questionnaire (PRQ) was developed and administered online at the participating schools to capture food and drink purchasing, intake, and expenditure. No significant differences were found in terms of energy and nutrients consumed or food/drink expenditure between pupils from schools of lower and higher SES. Enjoyment of food shopping with friends was linked with higher food energy intake and spend. Higher susceptibility to peer influence was associated with greater influence from food advertising and endorsements. Without ignoring the impact that SES can have on young people's food choices, we suggest that tribal theory can be additionally used to understand pupils' eating behaviors and we present implications for social marketers and policy makers.

Measuring nutritional knowledge using Item Response Theory and its validity in European adolescents

OBJECTIVE

To analyse the Nutritional Knowledge Test (NKT) using Item Response Theory (ITR) analysis and to assess the construct validity of the Nutritional Knowledge Scale (NKTS) and its associations with adolescent food group consumption and nutritional biomarkers.

DESIGN

Cross-sectional study.

SETTING

Multicentre investigation conducted in ten European cities.ParticipantsAdolescents aged 12·5-17·5 years (n 3215) who completed over 75 % of the NKT.

RESULTS

Factor analysis indicated that the NKT can be analysed with a one-dimensional model. Eleven out of twenty-three items from the NKT presented adequate parameters and were selected to be included in the NKTS. Nutrition knowledge was positively associated with consumption of fruits, cereals, dairy products, pulses, meat and eggs, and fish, as well as with blood concentrations of vitamin C, β-carotene, n-3 fatty acids, holo-transcobalamin, cobalamin and folate; nutrition knowledge was negatively associated with intake of olives and avocado, alcohol and savoury snacks.

CONCLUSIONS

The NKTS assessed nutritional knowledge adequately and it is proposed as a new tool to investigate this subject in future studies.

The mix of good nutritional attitude and poor nutritional knowledge is associated with adequate intake of vitamin A and iron from wild fruits and vegetables among rural households in Acholi subregion of Northern Uganda

Nutritional knowledge and attitude of a population greatly affect intake of essential micronutrients. Much of the understanding on the impact of nutritional knowledge and attitude on nutrient intake has been derived from studies conducted among affluent societies using commercial food products. However, information on the link between status of nutritional knowledge and attitude on intake of essential nutrients from wild fruits and vegetables among rural communities is largely lacking. This study examined the status of nutritional knowledge and attitude associated with intake of vitamin A and iron from wild fruits and vegetables among rural households in Acholi subregion of northern Uganda. A cross-sectional study design making use of individual household questionnaire and proximate dietary recall of a calendar year consumption period involving 248 randomly selected rural households was applied. Results showed that households had good nutritional attitude but poor nutritional knowledge. Status of knowledge was dependent on nutrition training (p = 0.028; coefficient, β = 0.710) and age of the respondent (p = 0.044; β = -0.023), whereas status of attitude was predicted by age of the respondent (p = 0.014; β = 0.048). Consumption of wild fruits and vegetables contributed adequately to the dietary vitamin A and iron requirements of the households. The results have demonstrated that intake of vitamin A and iron from wild fruits and vegetables among rural households is associated with good nutritional attitude but poor nutritional knowledge. A concerted effort is necessary to improve household nutritional knowledge for better utilization of wild fruits and vegetables.

Adolescents' diet quality in relation to their relatives' and peers' diet engagement and encouragement: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

OBJECTIVE

To examine the associations between adolescents' diet quality and their perceived relatives' and peers' diet engagement and encouragement.

DESIGN

Cross-sectional study performed in European countries. Diet quality was scored using the Diet Quality Index for Adolescents (DQI-A) based on four components: quality, diversity, balance and meal frequency. Perceived diet quality engagement and perceived encouragement of the relatives/peers were assessed using the questions 'How healthy is each of the following persons' diet?' and 'How often does each of the following persons encourage you to eat a healthy diet?'

SETTING

Vienna, Ghent, Lille, Athens, Heraklion, Pecs, Rome, Dortmund, Zaragoza and Stockholm.

SUBJECTS

Healthy adolescents (n 2943).

RESULTS

The perceived engagement level of the mother, father and sister was each positively associated with the DQI-A (P<0·05). A positive association was found for the perceived engagement level of siblings, father and mother with all specific components (P<0·05). DQI-A was negatively associated with the perceived encouragement level from a best friend and positively associated with the encouragement level of the mother and father (P<0·05). Diversity, balance and quality components were positively associated with the perceived encouragement level from the mother and father (P<0·05), whereas the best friend's perceived encouragement was negatively associated with the meal frequency component (P<0·01).

CONCLUSIONS

These findings highlight the role of social engagement and encouragement of relatives and peers in adolescents' diet quality. Intervention or promotion programmes aimed at enhancing diet quality in adolescents should target both family and peers.

Relationship between nutrition knowledge and dietary intake among primary school children in Japan: Combined effect of children's and their guardians' knowledge

Background

Improving the dietary habits of children is important to decrease the future burden of noncommunicable diseases. While various food education programs have been implemented worldwide, evaluation of nutrition knowledge is difficult, even at baseline. Further, the relationship between nutrition knowledge and dietary intake has not been clarified in non-western countries.

Methods

After developing nutrition knowledge questionnaires for Japanese primary school children and adults, we examined whether higher nutrition knowledge of children and their guardians was associated with better dietary intake in children. A total of 1210 children in four public primary schools and 319 guardians were included in this cross-sectional study.

Results

Nutrition knowledge questionnaires were developed for children in lower and higher grades and adults. Higher nutrition knowledge of the children was significantly associated with higher vegetable intake (p for trend = 0.024 for boys and <0.0001 for girls in lower grades, <0.0001 for boys and 0.020 for girls in higher grades). Higher nutrition knowledge of the guardians was also associated with higher vegetable intake, except for boys in higher grades. The relationship between guardians' nutrition knowledge and intake of staple foods and fruits in children differed by children's sex.

Conclusions

We developed nutrition knowledge questionnaires for Japanese children and adults and identified a relationship between higher nutrition knowledge and healthier dietary habits. The child's own nutrition knowledge of dietary intake might be as important as that of the guardian for some foods. Sex differences in the effect of nutrition knowledge should receive greater attention in food education.

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Nutrition knowledge questionnaires were developed for Japanese children and adults.

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Higher nutrition knowledge was associated with healthier dietary habits in children.

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Both children's and guardians' nutrition knowledge affected food intakes in children.

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Sex differences in the effect of nutrition knowledge were suggested.

Perceived barriers to achieving a healthy weight: a qualitative study using focus groups at public and private schools in Guatemala City

BACKGROUND

Overweight prevalence among Guatemalan girls is higher in public than in private schools. Little is known about adolescent girls' perceptions of the right ways to achieve a healthy weight. This study examines public and private school adolescent girls' perceptions of a "healthy weight," and barriers and facilitators to achieving it.

METHODS

We conducted 4 focus groups in public and private schools in Guatemala City with girls from 13 to 15 years old. The discussion guide included open-ended questions and activities aimed at examining perceptions of "healthy weight" and barriers and motivators to achieving it within the school environment. Focus groups were audio-recorded and transcribed. Data analyses followed established methods of content analysis.

RESULTS

Twenty-eight girls (private school, n = 12; public school, n = 16) of ages ranging from 13.1 to 15.9 years (median, 14, IQR, 13.6-14.9) participated in the study. Girls identified images of thin and fit women as healthy. They cited healthy eating and physical activity as ways to achieve a healthy weight. Within the school environment, barriers to maintaining a healthy weight included a lack of healthy food options and the prioritization of sports for boys over girls. In public schools, facilities were less than optimal; in private schools, girls' access to facilities was limited. Public school girls stated that their uniforms were inappropriate for exercising.

CONCLUSION

Our findings support the need to provide more healthy food options in Guatemalan schools. In addition, physical activity for girls should be promoted and facilities made available for their use.

A systematic review of factors affecting energy intake of adolescent girls

BACKGROUND

Adolescence is considered a critical period marked by an increase in energy intake to meet the body's physiological needs especially during puberty. This study reviews existing literature and critically analyses factors associated with eating habits and energy intake of adolescent girls.

METHODS

A comprehensive search was conducted to identify at least 200 peer reviewed articles which dealt with the factors affecting energy intake (EI) and eating habits of adolescent girls. Studies were identified using a reference period between 1994 and 2016, based primarily on the PubMed/ CINL/ Science Direct/Google Scholar databases using keywords adolescent/ teenagers, factors/determinants and energy intake.

RESULTS

No studies investigated all factors affecting energy intake among adolescents. Some studies found mixed association among the determinants of EI in adolescent girls. However, a number of reviews confirm that many factors namely physical activity level, socio-economic status, diet, individual and social factors do contribute to either a higher or a lower EI of adolescents.

CONCLUSION

There is a dire need to consider factors associated with EI when designing nutritional intervention programs to prevent health problems in adulthood. The goal is not to change behavior of all but to increase the percentage of people adopting healthier lifestyle.

The Prevalence of Tooth Wear in the Dutch Adult Population

This study aimed to assess the prevalence of tooth wear in different age groups of the Dutch adult population and to determine this tooth wear distribution by gender, socioeconomic class, and type of teeth. Results were compared with the outcomes of a previous study in a comparable population. As part of a comprehensive investigation of the oral health of the general Dutch adult population in 2013, tooth wear was assessed among 1,125 subjects in the city of 's-Hertogenbosch. The data collected were subjected to stratified analysis by 5 age groups (25-34, 35-44, 45-54, 55-64, and 65-74 years), gender, socioeconomic class, and type of teeth. Tooth wear was assessed using a 5-point ordinal occlusal/incisal grading scale. The number of teeth affected was higher in older age groups. Men showed more tooth wear than women, and subjects with low socioeconomic status (low SES) showed on average higher scores than those with high SES. Tooth wear prevalence found in this study was higher in all age groups than in the previous study. The present study found prevalences of 13% for mild tooth wear and 80% for moderate tooth wear, leading to the conclusion that these are common conditions in the Dutch adult population. Severe tooth wear (prevalence 6%) may however be characterized as rare. A tendency was found for there to be more tooth wear in older age groups, in men as compared with women, in persons with lower SES, and in the present survey as compared with the previous one.

Reliability and validity of a revised version of the General Nutrition Knowledge Questionnaire

BACKGROUND/OBJECTIVES

The General Nutrition Knowledge Questionnaire (GNKQ) was developed in the 1990s and has been widely used. Since then advances in understanding of associations between diet and disease have led to changes in dietary recommendations. This study reports the validity and reliability of an updated version of the GNKQ, bringing it into line with current nutritional advice.

METHODS/SUBJECTS

Following a review of current recommendations, the revised version of the GNKQ (GNKQ-R) was created, consisting of 88 items and four sections. Reliability and validity of the GNKQ-R were determined in four validation studies: (1) reliability was examined using an online sample (n=266), (2) construct validity was assessed with 96 Dietetics students and 89 english students using the 'known-groups' method, (3) associations between nutrition knowledge and socio-demographic characteristics were examined using the previously described samples and (4) sensitivity to change was tested by measuring GNKQ-R scores pre- and post-exposure to online nutrition information in written (n=65) and video (n=41) formats.

RESULTS

The reliability was >0.7 in all sections. Dietetics students scored significantly higher than english students. As predicted, GNKQ-R scores were significantly higher among females vs males, people with a degree vs without, and people with very good vs poor or good health status. They were lower in those older than 50 years vs younger adults. GNKQ-R scores were significantly greater after the nutrition interventions in both written and video formats.

CONCLUSIONS

The GNKQ-R is a valid measure of nutrition knowledge that is consistent, reliable and sensitive to change.

Investigation of Nutritional Behaviors in the First and Second Trimesters in Pregnant Women Referring to Clinics in Hamadan, Iran, in 2013

Background:

Pregnancy is a particular period in women’s life that is accompanied by an increase in nutritional needs. Having a normal pregnancy period and successful pregnancy outcomes depends on the intake of sufficient amount of food. The present study aimed to determine nutritional behaviors in pregnant women in the first and second trimesters referring to clinics in Hamadan, Iran.

Methods:

This cross-sectional study was conducted on 170 women referred to health and treatment centers of Hamadan in 2013. Among Hamadan’s health and treatment centers, 10 were selected as the research setting through cluster sampling. Then, the pregnant women at 8-24 weeks of gestation were randomly entered into the study. The data were collected using nutritional behaviors questionnaire in three months. Accordingly, mean scores below 50, between 50 and 75, and above 75 were considered as weak, moderate, and perfect nutritional behaviors, respectively. The data were analyzed using the SPSS statistical software, version 21 and P<0.05 was considered as statistically significant.

Results:

The results showed that more than three fourths of the study participants had moderate nutritional behaviors. Insufficient intake of fruit, vegetables, and cereals was detected in 80.6%, 54.1%, and 47.1% of the participants, respectively. Besides, 30% of the women had not used folic acid supplement during their pregnancy period or were not aware of its necessity. The results of multivariate analysis indicated that age was only significantly associated with pregnant women’s score of nutritional behaviors (P=0.010). Additionally, no significant relationship was found between the women’s nutritional behaviors and their strategies for elimination of common pregnancy complications, such as constipation, heartburn, urinary tract infection, and anemia.

Discussion and Conclusion:

Considering the participants’ moderate nutritional behaviors, health and treatment centers are recommended to provide the necessary training for improving pregnant women’s nutritional behaviors and supervise and follow their execution and evaluation.

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.

Healthy Hunger-Free Kids Act Increases Phytochemicals in Menus and Curriculum Furthers Identification of Phytochemical-Rich Foods

Objective

This study evaluated whether providing the Fruits and Vegetables (F/V) required by the Healthy Hunger-Free Kids Act (HHFKA) increased phytochemical/antioxidant content of school lunches. Additionally, the ability of adolescents to apply their nutritional knowledge following participation in a nutrition-focused science-based curriculum was assessed.

Methods

Changes in antioxidant/phytochemical content from F/V offered in school lunch menus were analyzed Pre-and Post-HHFKA. Food logs completed by 717 youth aged 10-18 were analyzed for correctly identifying "fighting foods".

Results

Significant increases in antioxidant/phytochemical content resulted following implementation of HHFKA (P<0.05). Seventy-five percent [0, 100] of the time students accurately identified "fighting foods" in their one-day in-school food log (n=468).

Conclusions and Implications

Creatively incorporating nutrition education into core curriculum, when paired with a supportive built environment that increases F/V access (HHFKA), generates a multilevel intervention promoting F/V consumption among school-aged youth.

Maternal post-natal tobacco use and current parental tobacco use is associated with higher body mass index in children and adolescents: an international cross-sectional study

BACKGROUND

We investigated whether maternal smoking in the first year of life or any current parental smoking is associated with childhood or adolescent body mass index (BMI).

METHODS

Secondary analysis of data from a multi-centre, multi-country, cross-sectional study (ISAAC Phase Three). Parents/guardians of children aged 6-7 years completed questionnaires about their children's current height and weight, whether their mother smoked in the first year of the child's life and current smoking habits of both parents. Adolescents aged 13-14 years completed questionnaires about their height, weight and current parental smoking habits. A general linear mixed model was used to determine the association between BMI and parental smoking.

RESULTS

77,192 children (18 countries) and 194 727 adolescents (35 countries) were included. The BMI of children exposed to maternal smoking during their first year of life was 0.11 kg/m(2) greater than those who were not (P = 0.0033). The BMI of children of currently smoking parents was greater than those with non-smoking parents (maternal smoking: +0.08 kg/m(2) (P = 0.0131), paternal smoking: +0.10 kg/m(2) (P < 0.0001)). The BMI of female adolescents exposed to maternal or paternal smoking was 0.23 kg/m(2) and 0.09 kg/m(2) greater respectively than those who were not exposed (P < 0.0001). The BMI of male adolescents was greater with maternal smoking exposure, but not paternal smoking (0.19 kg/m(2), P < 0.0001 and 0.03 kg/m(2), P = 0.14 respectively).

CONCLUSION

Parental smoking is associated with higher BMI values in children and adolescents. Whether this is due to a direct effect of parental smoking or to confounding cannot be established from this observational study.

The role of curriculum dose for the promotion of fruit and vegetable intake among adolescents: results from the Boost intervention

Background

Multi-component interventions combining educational and environmental strategies have proved effective in increasing children and adolescents’ fruit and vegetable intake. However such interventions are complex and difficult to implement and several studies report poor implementation. There is a need for knowledge on the role of dose for behaviour change and for assessment of intervention dose to avoid conclusions that intervention components which are not implemented are ineffective. This study aimed to examine 1) the association between dose of a class curriculum and adolescents’ fruit and vegetable intake in a school-based multi-component intervention, 2) if gender and socioeconomic position modify this association.

Methods

We carried out secondary analysis of data from intervention schools in the cluster-randomized Boost study targeting 13-year-olds’ fruit and vegetable intake. Teacher- and student data on curriculum dose delivered and received were aggregated to the school-level and class-level (only possible for student data). We analysed the association between curriculum dose and students’ (n 995) self-reported fruit and vegetable intake (24-h recall questionnaire) after finalization of the intervention using multi-level analyses. Potential moderation was examined by analyses stratified by gender and socioeconomic position.

Results

Average dose received at class-level was significantly associated with students’ fruit and vegetable intake (10 g (CI: 0.06, 20.33) per curricular activity received). In stratified analyses the association remained significant among boys only (14 g (CI: 2.84, 26.76) per curricular activity received). The average dose delivered and received at the school-level was not significantly associated with students’ intake.

Conclusions

We found a dose—response relationship between number of curricular activities received and adolescents’ fruit and vegetable intake. The results indicate that curriculum dose received only mattered for promotion of fruit and vegetable intake among boys. Future studies should explore this gender difference in larger samples to guide the planning of school-based curricular interventions with regards to the optimal number of curricular activities required to promote behavioural change in subgroups with low fruit and vegetable intake at baseline.

Trial registration

Current Controlled Trials ISRCTN11666034.

Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood

Clinical manifestations of cardiometabolic risk (CMR) may be set early in childhood due to unfavorable behaviors or lifestyle patterns related to diet and physical activity. Several factors may determine the adoption of such lifestyle-related behaviors, which researchers have tried to cluster under certain frameworks or models. In this context, the framework developed and proposed by this review gathers all the present knowledge regarding these determining factors to date and groups them into three main categories related to personal characteristics and the social and physical environment. Based on the proposed framework, a large variety of personal, social and physical environmental factors can positively or negatively influence CMR-related behaviors (either directly or indirectly via their interrelations), thus leading to decreased or increased risk, respectively. This framework could be of great value to public health policy makers and legislators for designing and implementing interventional programs tailored to the needs of susceptible population groups who are most in need for such initiatives. Targeting the correlates as potential determinants of CMR-related behaviors, and not just on the behaviors themselves, has been shown previously to be the most effective approach for tackling health issues related to CMR starting from early life stages.

A qualitative study of independent fast food vendors near secondary schools in disadvantaged Scottish neighbourhoods

BACKGROUND

Preventing and reducing childhood and adolescent obesity is a growing priority in many countries. Recent UK data suggest that children in more deprived areas have higher rates of obesity and poorer diet quality than those in less deprived areas. As adolescents spend a large proportion of time in school, interventions to improve the food environment in and around schools are being considered. Nutrient standards for school meals are mandatory in the UK, but many secondary pupils purchase foods outside schools at break or lunchtime that may not meet these standards.

METHODS

Qualitative interviews were conducted with fast food shop managers to explore barriers to offering healthier menu options. Recruitment targeted independently-owned shops near secondary schools (pupils aged c.12-17) in low-income areas of three Scottish cities. Ten interviews were completed, recorded, and transcribed for analysis. An inductive qualitative approach was used to analyse the data in NVivo 10.

RESULTS

Five themes emerged from the data: pride in what is sold; individual autonomy and responsibility; customer demand; profit margin; and neighbourhood context. Interviewees consistently expressed pride in the foods they sold, most of which were homemade. They felt that healthy eating and general wellbeing are the responsibility of the individual and that offering what customers want to eat, not necessarily what they should eat, was the only way to stay in business. Most vendors felt they were struggling to maintain a profit, and that many aspects of the low-income neighbourhood context would make change difficult or impossible.

CONCLUSIONS

Independent food shops in low-income areas face barriers to offering healthy food choices, and interventions and policies that target the food environment around schools should take the neighbourhood context into consideration.

Relationship between Nutrition Knowledge and Physical Fitness in Semiprofessional Soccer Players

Whereas nutrition has a crucial role on sport performance, it is not clear to what extent nutrition knowledge is associated with physical fitness. The aim of this study was to examine the current level of nutrition knowledge of soccer players and whether this level is associated with physical fitness. Soccer players (n = 185, aged 21.3 ± 4.9 yr, weight 72.3 ± 8.4 kg, and height 177.5 ± 6.4 cm) performed a battery of physical fitness tests (sit-and-reach test, SAR; physical working capacity in heart rate 170, PWC170; and Wingate anaerobic test, WAnT) and completed an 11-item nutrition knowledge questionnaire (NKQ). Low to moderate Pearson correlations (0.15 < r < 0.34, p < 0.05) of NKQ with age, weight, height, fat free mass (FFM), SAR, peak power, and mean power of WAnT were observed. Soccer players with high score in NKQ were older (4.4 yr (2.2; 6.6), mean difference (95% confidence intervals)) and heavier (4.5 kg (0.6; 8.3)) with higher FFM (4.0 kg (1.1; 6.8)) and peak power (59 W (2; 116)) than their counterparts with low score. The moderate score in the NKQ suggests that soccer players should be targeted for nutrition education. Although the association between NKQ and physical fitness was low to moderate, there were indications that better nutrition knowledge might result in higher physical fitness and, consequently, soccer performance.

Differences in beliefs and home environments regarding energy balance behaviors according to parental education and ethnicity among schoolchildren in Europe: the ENERGY cross sectional study

Background

To explore differences in personal and home environmental factors that are regarded as determinants of energy balance-related behaviors (EBRBs) according to parental education and ethnic background among 10–12 year old schoolchildren across Europe.

Methods

A school-based survey among 10–12 year olds was conducted in eight countries across Europe. A range of personal and home environment variables relevant for soft drink consumption, daily breakfast, sport participation and TV time was assessed by means of child report. Personal factors included attitude, health beliefs, and preference/liking. Home environment factors included parental subjective norm, modeling, support, practices and home availability. Children were classified based on parental education (i.e., low vs. high) and ethnic background (i.e., native vs. non-native). Data from 6018 children originating from 83 schools were included in the analyses.

Results

Multilevel logistic regression analyses showed that the majority of the factors tested –and especially home environment variables- were more favorable among children from higher educated parents and from native ethnicity. None of the personal and home environment factors was found to be more favorable among children from lower educated parents or non-native ethnicity.

Conclusions

The present study indicates that schoolchildren from lower educated and non-native parents across Europe have EBRB-related beliefs and are exposed to home environments that are less favorable for engagement in healthy EBRBs.

Nutritional knowledge in an Italian population of children, pre-adolescents and adolescents

OBJECTIVE

To evaluate general knowledge about nutrition in an Italian population of children, pre-adolescents and adolescents.

DESIGN

Knowledge about nutrition-related items such as healthy eating, breakfast, snacks, fast food, beverages, fruits and vegetables, cereals and tubers, meat/fish/legumes/eggs, milk and dairy products, fats and dressings, and sweets was analysed by means of a self-administered questionnaire (QuesCA IT) containing thirty-one questions, that was translated and adapted from a Swiss version (QuesCA) previously used in Geneva and Vaud.

SETTING

North of Italy (Bergamo, Milan).

SUBJECTS

Students (n 614) belonging to two different age groups: 9-11 years (GR1) and 12-16 years (GR2).

RESULTS

Data analysis showed that nutritional knowledge varied in relation to the age of the participants, increasing in particular in the older group, although this difference was not statistically significant for all the considered items. Nutritional knowledge also varied in relation to the gender of the participants, with females in particular seeming to possess better cognition. For each age group there was poor knowledge about the items healthy diet, snacks, milk and dairy products, meat/fish/legumes/eggs, and fats and dressings. Moreover, the percentage of participants who declared own knowledge as insufficient was higher in GR2 compared with GR1.

CONCLUSIONS

The present research demonstrates a lack of knowledge about the main concepts of healthy nutrition both in the youngest and oldest participants of the survey. This evidence, together with the presence of higher self-consciousness in GR2, should be taken into account in specific educational interventions during the school period.

Influence of parental socio-economic status on diet quality of European adolescents: results from the HELENA study

Diet quality is influenced by socio-economic and geographical factors. The present study sought to assess whether adolescents' diet quality is affected by their parents' socio-economic status and whether the relationship between these factors is similar in northern and southern Europe. Data collected in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study in eight European countries were analysed. Dietary intake data were recorded via repeated 24 h recalls (using specifically developed HELENA Dietary Intake Assessment Tool software) and converted into an adolescent-specific Diet Quality Index (DQI-AM). Socio-economic status was estimated through parental educational level (Par-Educ-Lev) and parental occupation level (Par-Occ-Lev) as reported by the adolescents in a specific questionnaire. The DQI-AM data were then analysed as a function of Par-Educ-Lev and Par-Occ-Lev in northern European countries (Austria, Belgium, France, Germany and Sweden) and southern European countries (Greece, Italy and Spain). We studied a total of 1768 adolescents (age 14·7 (sd 1·3) years; percentage of girls: 52·8 %; 1135 and 633 subjects from northern and southern Europe, respectively). On average, the DQI-AM score was higher in southern Europe than in northern Europe (69·1 (sd 0·1) v. 60·4 (sd 2·8), respectively; P< 0·001; Δ = 12·6 %). The DQI was positively correlated with both paternal and maternal Par-Educ-Lev. However, this association was more pronounced in northern Europe than in southern Europe (P interaction = 0·004 for the mother and 0·06 for the father). The DQI was also positively correlated with Par-Occ-Lev (all P trends < 0·01), but this correlation was independent of the geographical area (P interaction = 0·51 for the mother and 0·50 for the father). In conclusion, Par-Educ-Lev and Par-Occ-Lev are associated with diet quality in adolescents in Europe. However, this association differs between northern Europe and southern Europe.

Can ethnic background differences in children's body composition be explained by differences in energy balance-related behaviors? A mediation analysis within the energy-project

Background

In affluent countries, children from non-native ethnicity have in general less favourable body composition indicators and energy balance-related behaviors (EBRBs) than children from native ethnicity. However, differences between countries have been reported.

Methodology/Principal Findings

A school-based survey among 10–12 years old children was conducted in seven European countries with a standardized protocol. Weight, height and waist circumference were measured; engagement in EBRBs was self-reported. For those countries with significant ethnic differences in body composition (Greece and the Netherlands), multilevel mediation analyses were conducted, to test the mediating effect of the EBRBs in the association between ethnic background and body composition indicators. Analyses were adjusted for gender and age, and for parental education in a later step. Partial mediation was found for sugared drinks intake and sleep duration in the Greek sample, and breakfast in the Dutch sample. A suppression effect was found for engagement in sports activites in the Greek sample.

Conclusions/Significance

Ethnic differences in children’s body composition were partially mediated by differences in breakfast skipping in the Netherlands and sugared drinks intake, sports participation and sleep duration in Greece.

Dietary habits among adolescent girls and their association with parental educational levels

BACKGROUND

Adolescence is a period of rapid psychological development and the appearance of secondary sex characteristics. Changes in facial structure are the most visible manifestation during this period. It is during adolescence period that the importance of optimal nutrients is greatest. Improving the nutrition of teenage girls especially is important girls because consequently will affect the health in future. In present study hypothesis is that improving the nutrition of teenage girls is correlated with the level of parental education and the adolescents' eating habits.

METHODS

In this study, 386 random selected adolescent girls were selected by cluster sampling. We used questionnaire to study the level of knowledge to major nutritional problems and consuming optimal nutrients. Finally, collected data were analyzed by using descriptive techniques and statistical analysis.

RESULTS

According to the results of present study the mean of age, weight and height of the participants were 13/2 years, 159/1 cm, and 52.05 kg respectively. The 48.4 percent of the participants not eat breakfast. The 67.4 percentages of girls daily were consuming bread and cereals, 57.5 fruits and vegetables, 62.7 dairy products, and 27.7 meat and eggs. In addition, 36.3 percentages of these girls consumed sweets everyday as part of their diet. The nutritional knowledge of participating in diet was on the average and common source of information were counselors and teachers at school (36 percentages). The results of our study revealed that there was a significant relationship between variations in level of parental educational level and dietetic safety of offspring (p < 0.05). Our conclusion is the interactive education and parental literacy especially is important regarding to the adolescent nutrition and health.