Nutrition knowledge and its relation with dietary behaviour in children and adolescents: a systematic review

Breakfast consumption, saturated fat intake, and body mass index among medical and non-medical students: a cross-sectional analysis

Changes in dietary patterns and body weight have become a focus of research in undergraduate students. This study compared breakfast consumption, intake of foods high in saturated fat, and BMI between medical and non-medical students. A comparative cross-sectional study was conducted in 4,561 Peruvian university students, of whom 1,464 (32.1%) were from the medical field and 3,097 (67.9%) from the non-medical field. We compared the frequency of breakfast consumption (categorized as regular: 6 to 7 days/week; occasional: 3 to 5 days/week; and rarely or never: 0 to 2 days/week) and the frequency of consumption of foods high in saturated fat. We created simple and multiple linear and Poisson regression models with robust variance to evaluate the association of the mentioned variables with academic fields. Non-medical students (Adjusted Prevalence Ratio [PR] = 0.92, 95% CI 0.86-0.99; p = 0.008) were less likely to eat breakfast regularly compared to medical students. Likewise, consumption of foods high in saturated fats was higher in non-medical students (B = 1.47, 95% CI 0.91-2.04; p < 0.001) compared to medical students. Similarly, the mean BMI of these students was significantly higher than that of medical students (B = 0.33, 95% CI 0.12-0.53; p = 0.002). Although medical students reported relatively healthy eating habits and a lower BMI, there is a widespread need to promote improved diet and lifestyle among the entire university population to reduce the risks of communicable diseases and improve quality of life.

Nutrition-Related Knowledge and Nutrition-Related Practice among Polish Adolescents-A Cross-Sectional Study

The aim of this study was to examine the association between nutrition-related knowledge (NRK) and nutrition-related practice (NRP) among 1440 Polish students (aged 10-18 years) and identify the determining factors. Questions about NRK and NRP were thematically similar and referred to the recommendations of the Polish Pyramid of Healthy Nutrition and Lifestyle for Children and Adolescents (4-18 years). A cross-sectional study was conducted using the CAWI method. The respondents obtained an average of 51% of points in the NRK examination and 32% of points in the NRP examination. It was shown that NRP was positively associated with NRK (p < 0.001). The students' NRK was positively determined by the following factors: being female (p < 0.001), older age of students (p < 0.001), living in a larger town (p = 0.012) and a higher level of education of the mother/legal guardian (p < 0.001). NRP was positively associated with greater physical activity of the students (p < 0.001). NRK and NRP were negatively associated with the subjects' BMI (p = 0.029; p = 0.040, respectively). The analysis of NRK shows that the students' knowledge regarding the consumption of milk, milk products and fish should be increased (17-20% correct answers). The analysis of NRP reveals that only 4-14% of students declared appropriate eating habits regarding the consumption of sweet and salty snacks, fish, wholegrain products and milk. This study highlights the need for targeted educational strategies to increase both the understanding and application of dietary guidelines among Polish adolescents for the prevention of diet-related diseases.

Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review

Nutrition knowledge (NK) impacts food choices and may be improved through educational programmes. Identifying knowledge gaps related to NK among adolescent athletes may guide future nutrition education programmes. This review aimed to systematically review the level of NK in adolescent athletes based on the currently available published literature. The protocol for this review was registered with PROSPERO (CRD42022321765). A literature search was conducted in April 2022 using MEDLINE, CINAHL, SPORTDiscus, Web of Science and SCOPUS databases. The study design was not restricted, provided that a quantitative NK score was reported for adolescent athletes. Studies were limited to the English language and published between 2010 and April 2022. Studies were assessed for quality and risk of bias using the Academy of Nutrition and Dietetics Quality Appraisal Checklist. Data extracted included demographics, questionnaire name, number of items, validation status and mean total and subsection NK scores. Meta-analyses were inappropriate due to the heterogeneity of NK assessment tools; therefore, results were presented narratively. Thirty-two studies that assessed NK of 4553 adolescent athletes and 574 comparison participants were included. Critical appraisal of studies resulted in neutral rating 'moderate quality' for most (n 30) studies. Studies lacked justification for sample size and often used inadequately validated questionnaires. NK scores ranged from poor (33·3 %) to excellent (90·6 %). The level of NK across studies is difficult to determine due to heterogenous questionnaires often lacking appropriate validation. NK should be assessed using tools validated in the relevant population or revalidated tools previously used for other populations.

Relationship between food insecurity and a gestational diabetes risk reduction intervention: outcomes among American Indian and Alaska Native adolescent and young adult females

American Indian and Alaska Natives (AI/ANs) are disproportionately impacted by gestational diabetes mellitus (GDM), subsequent type 2 diabetes, and food insecurity. It is prudent to decrease risk of GDM prior to pregnancy to decrease the intergenerational cycle of diabetes in AI/AN communities. The purpose of this project is to describe and examine food insecurity, healthy eating self-efficacy, and healthy eating behaviors among AI/AN females (12-24 years old) as related to GDM risk reduction. Methods included: secondary analysis of healthy eating self-efficacy and behaviors, and household-level food insecurity measures from an randomized controlled trial that tested the effect of engagement in a GDM risk reduction educational intervention on knowledge, behavior, and self-efficacy for GDM risk reduction from baseline to 3-month follow-up. Participants were AI/AN daughters (12-24 years old) and their mothers (N = 149 dyads). Researchers found that more than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p = .045) and cohabitating dyads (p = .002). By 3 months healthy eating self-efficacy (p = .048) and limiting snacking between meals (p = .031) improved more in the control group than the intervention group only for cohabitating dyads. For the full sample, the intervention group had increases in times eating vegetables (p = .022) and fruit (p = .015), whereas the control group had declines. In the full sample, food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p ≥ .05) but did moderate the group by time interaction for times drinking soda (p = .004) and days eating breakfast (p = .013). For cohabitating dyads, food insecurity did moderate self-efficacy for eating 3 meals a day (p = .024) and days eating breakfast (p = .012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on "upstream causes" of GDM health disparities among AI/AN communities.

Factors that influence food choices in secondary school canteens: a qualitative study of pupil and staff perspectives

Background

Adolescence is recognised as a period of nutritional vulnerability, with evidence indicating that United Kingdom adolescents have suboptimal dietary intakes with many failing to meet dietary recommendations. Additionally, adolescence is a time of transition when they become more independent in their dietary choices and begin to develop their own sense of autonomy and are less reliant on their parent's guidance, which is reported to lead to less favourable dietary behaviours. Reducing the prevalence of poor dietary intakes and the associated negative health consequences among this population is a public health priority and schools represent an important setting to promote positive dietary behaviours. The aim of this school-based study was to explore the factors and barriers which influence food choices within the school canteen and to identify feasible strategies to promote positive dietary behaviours within this setting.

Methods

Thirteen focus groups with 86 pupils in Year 8 (n = 37; aged 11-12 years) and Year 9 (n = 49; aged 12-13 years) in six secondary schools across Northern Ireland, United Kingdom were conducted. Additionally, one-to-one virtual interviews were conducted with 29 school staff [principals/vice-principals (n = 4); teachers (n = 17); and caterers (n = 7)] across 17 secondary schools and an Education Authority (EA) senior staff member (n = 1). Focus groups and interviews were audio-recorded, transcribed, and analysed following an inductive thematic approach.

Results

Using the ecological framework, multiple factors were identified which influenced pupils' selection of food in the school canteen at the individual (e.g., time/convenience), social (e.g., peer influence), physical (e.g., food/beverage placement), and macro environment (e.g., food provision) level. Suggestions for improvement of food choices were also identified at each ecological level: individual (e.g., rewards), social (e.g., pupil-led initiatives), physical (e.g., labelling), and macro environment (e.g., whole-school approaches).

Conclusion

Low-cost and non-labour intensive practical strategies could be employed, including menu and labelling strategies, placement of foods, reviewing pricing policies and whole-school initiatives in developing future dietary interventions to positively enhance adolescents' food choices in secondary schools.

Strategies for reducing meat consumption within college and university settings: A systematic review and meta-analysis

Introduction

Despite the considerable public and planetary health benefits associated with reducing the amount of meat consumed in high-income countries, there is a limited empirical understanding of how these voluntary changes in food choice can be effectively facilitated across different settings. While prior reviews have given us broad insights into the varying capacities of behavior change strategies to promote meaningful reductions in meat consumption, none have compared how they perform relative to each other within a uniform dining context.

Methods

To address this gap in the literature, we synthesized the available research on university-implemented meat reduction interventions and examined the variations in the success rates and effect estimates associated with each of the three approaches identified in our systematic review.

Results

From our analyses of the 31 studies that met our criteria for inclusion (n = 31), we found that most were successful in reducing the amount of meat consumed within university settings. Moreover, independent of the number of individual strategies being used, multimodal interventions were found to be more reliable and effective in facilitating these changes in food choice than interventions targeting the choice architecture of the retail environment or conscious decision-making processes alone.

Discussion

In addition to demonstrating the overall value of behavior change initiatives in advancing more sustainable dining practices on college and university campuses, this study lends further insights into the merits and mechanics underlying strategically integrated approaches to dietary change. Further investigations exploring the persistence and generalizability of these effects and intervention design principles are needed.

Systematic review registration

https://doi.org/10.17605/OSF.IO/DXQ5V, identifier: 10.17605/OSF.IO/DXQ5V.

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.

Theory-based behavioral change interventions to improve periodontal health

Periodontal disease is a significant global health burden affecting half of the world's population. Given that plaque and inflammation control are essential to the attainment of periodontal health, recent trends in preventive dentistry have focused on the use of behavioral models to understand patient psychology and promote self-care and treatment compliance. In addition to their uses in classifying, explaining and predicting oral hygiene practices, behavioral models have been adopted in the design of oral hygiene interventions from individual to population levels. Despite the growing focus on behavioral modification in dentistry, the currently available evidence in the field of periodontology is scarce, and interventions have primarily measured changes in patient beliefs or performance in oral hygiene behaviors. Few studies have measured their impact on clinical outcomes, such as plaque levels, gingival bleeding and periodontal pocket reduction, which serve as indicators of the patient's disease status and quality of oral self-care. The present narrative review aims to summarize selected literature on the use of behavioral models to improve periodontal outcomes. A search was performed on existing behavioral models used to guide dental interventions to identify their use in interventions measuring periodontal parameters. The main models were identified and subsequently grouped by their underlying theoretical area of focus: patient beliefs (health belief model and cognitive behavioral principles); stages of readiness to change (precaution adoption process model and transtheoretical model); planning behavioral change (health action process approach model, theory of planned behavior and client self-care commitment model); and self-monitoring (self-regulation theory). Key constructs of each model and the findings of associated interventions were described. The COM-B model, a newer behavioral change system that has been increasingly used to guide interventions and policy changes, is discussed with reference to its use in oral health settings. Within the limitations of the available evidence, interventions addressing patient beliefs, motivation, intention and self-regulation could lead to improved outcomes in periodontal health. Direct comparisons between interventions could not be made due to differences in protocol design, research populations and follow-up periods. The conclusions of this review assist clinicians with implementing psychological interventions for oral hygiene promotion and highlight the need for additional studies on the clinical effects of behavioral model-based interventions.

The Suitability of Questionnaires for Exploring Relations of Dietary Behavior and Tooth Wear

Tooth wear is a relevant oral health problem, especially at a young age. Although ongoing acid exposures may contribute to tooth wear, the role of acidic dietary components in this context remains unclear. To date, in tooth wear studies, dietary behavior has been assessed using traditional questionnaires, but the suitability of this approach has not been investigated so far. In our longitudinal study, we followed 91 participants (21.0 ± 2.2 years) over a period of 1 year (373 ± 19 days) and monitored tooth wear with an intraoral scanner. At baseline (T0) and at the end (T1), we assessed dietary behavior with questionnaires asking about the consumption frequencies of acidic dietary components and the acid taste preferences. Complete data were available from 80 subjects. The consumption frequencies of T0 and T1 correlated weakly to moderately. Taste preferences seem to be a more consistent measure, but there was predominantly no significant correlation with the corresponding consumption frequencies. None of the dietary parameters showed a significant relation with tooth wear. The suitability of dietary questionnaires to assess tooth-relevant dietary behavior seems to be limited.

The conceptual framework for a combined food literacy and physical activity intervention to optimize metabolic health among women of reproductive age in urban Uganda

Background

Metabolic health of urban Ugandans, mostly women, has increasingly become sub-optimal. As women are strategic for family behavioral change and do not meet WHO recommendations regarding dietary and physical activity (PA), there is an urgent need for science-based interventions to tackle unhealthy dietary and PA behaviors.

Objective

To develop a food literacy and PA promotion intervention to optimise metabolic health among women of reproductive age in urban Uganda.

Methodology

Steps 1- 6 of the Intervention Mapping protocol were used to design the intervention.

Results

Notable determinants from Step 1 were health/beauty paradox, nonfactual nutrition information, socio-cultural misconceptions around moderate PA, fruits, and vegetables. Others included gaps in food/PA knowledge, skills, and self-efficacy. We hypothesised that changing the overall existing behaviours in one intervention may meet strong resistance. Thus, we decided to go for gradual stepwise changes. Hence in step 2, three behavioural intervention objectives were formulated; (1) women evaluate the accuracy of nutrition and PA information., (2) engage in moderate intensity PA for at least 150 min a week, and (3) consume at least one portion of vegetables and one portion of fruit every day. Based on the food literacy model, intervention objectives were formulated into performance objectives and matrices of change objectives. In step 3 a combination of eleven behavioural change techniques were selected and translated into practical strategies to effect changes in determinants. In step 4, intervention components and materials were developed. The intervention consists of five interactive group sessions, 150 min each. Infographics on benefits/recommendations, vegetable recipes, and practical tips to eat more fruits, vegetables, and to engage more in PA are included. Personalised goals and action plans tailored to personal metabolic health and lifestyle needs, and environmental opportunities form the basis of the intervention. A randomized controlled trial is being conducted to evaluate the intervention (https://clinicaltrials.gov/ct2/show/NCT04635332).

Conclusions

The intervention is novel, based on a holistic food literacy model. The intervention is built on determinants specific to urban Uganda, evidence based behavioural change theoretical models and techniques, detailing the hypothesised behavioural change mechanism. If effective, an evidence-based intervention will become available for reference in urban Uganda.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12740-w.

The Outcome of COVID-19 Lockdown on Changes in Body Mass Index and Lifestyle among Croatian Schoolchildren: A Cross-Sectional Study

Globally, the COVID-19 pandemic altered adults' and children's lifestyles and habits, causing an increase in body weight. Adolescents are sensitive to habit changes and, because of their insufficient capacity to deal with the unexpected COVID-19 changes, were at greater risk of noncommunicable disease development due to the consequences of adopting unhealthy habits. The survey aimed to reveal the changes in nutritional status and lifestyle habits of school children in Croatia and to assess their nutrition knowledge and emotional state and feelings about COVID-19 lockdown. Self-reported data from 1370 school children aged 10 to 15 years were obtained to examine the influence of the lockdown on their nutritional status, lifestyle and emotional status, and to assess their nutrition knowledge. The study revealed that the COVID-19 lockdown has caused an increase in the proportion of overweight and obesity among Croatian school children who changed their lifestyle habits towards being less physically active, spending more time using screen-based media and revealing potential psychological distress. However, the schoolchildren had a high adherence to the Mediterranean diet assessed with the Mediterranean Diet Quality Index for children and adolescents KIDMED index and had good nutrition knowledge. Public health programs promoting a healthy lifestyle and involving the whole family, in a school environment, could provide children with a healthy adulthood.