Consumption and correlates of sweet foods, carbonated beverages, and energy drinks among primary school children in Saudi Arabia

Prevalence of energy drink consumption world-wide: A systematic review and meta-analysis

BACKGROUND AND AIMS

The increasing market for energy drinks (EDs) in recent years, as well as the health risks caused by their consumption, prompt calls to estimate the prevalence of ED use among different countries. This systematic review and meta-analysis aimed to synthesize the prevalence of ED use in different continents and age groups.

METHOD

We searched two databases (i.e. PubMed and PsycInfo) on 31 March 2023 to identify studies reporting the prevalence of ED use. A total of 192 studies (196 distinct samples; n = 1 120 613; 53.37% males) from the United States, Europe, Asia, Oceania and Africa were included in the analysis. A random-effects model was applied to estimate the overall pooled prevalence at several time-periods. Subgroup analyses were performed to provide prevalence based on continent and age group. The quality of articles was assessed using Joana Brigg's Institute (JBI) critical appraisal checklist. Measurements included prevalence of ED use (i.e. life-time, past 12 months, past 30 days, past 7 days and daily use), continent and age group (i.e. children, adolescents, young adults and adults).

RESULTS

The life-time ED use world-wide-pooled prevalence was estimated to be 54.7% [95% confidence interval (CI) = 48.8-60.6; I2  = 99.80], 43.4% (95% CI = 36.1-50.6; I2  = 99.92) in the past 12 months, 32.3% (95% CI = 28.8-35.8; I2  = 99.82) in the past 30 days, 21.6% (95% CI = 18.7-24.5; I2  = 99.95) in the past 7 days and 8.82% (95% CI = 6.3-11.4; I2  = 99.95) daily ED use. Subgroups analyses showed significant differences in ED life-time use within age groups (P = 0.002) and continents (P = 0.035).

CONCLUSIONS

The world-wide prevalence of energy drink use appears to be high, particularly among adolescents and young adults.

Change in Growth Status and Obesity Rates among Saudi Children and Adolescents Is Partially Attributed to Discrepancies in Definitions Used: A Review of Anthropometric Measurements

Anthropometric measurements are the first step in determining the health status in children and adolescents. Clinicians require standardized protocols for proper assessment and interpretation. Therefore, this study aims to review the literature of international and Saudi national guidelines and studies previously conducted in Saudi children and adolescents to provide recommendations to establish Saudi guidelines in line with the Saudi 2030 Vision. Systematic search was conducted in several databases: Medline, PubMed, Saudi Digital Library and Google Scholar from January 1990 to January 2021. Further, 167 studies measured anthropometrics in Saudi children/adolescents; 33 of these studies contributed to the establishment/adjustment of Saudi growth charts or specific cutoffs or studied the trend of growth in representative samples or adjusted the international curves to be used in Saudis. This review warrants updating growth charts and establishing the standard cutoffs of Saudi adolescent anthropometrics to avoid over/underreporting. This review provides insights and recommendations regarding the resources that can be used to establish national guidelines in anthropometric measurements for Saudi children/adolescents. This review will help policymakers and the Ministry of Health to establish standardized protocols to be used in Saudi Arabia for anthropometric measurements that may assist in detecting malnutrition.

Online Arabic Beverage Frequency Questionnaire (ABFQ): evaluation of validity and reliability

BACKGROUND

Obesity and chronic diseases are significant public health issues in the Middle East and North Africa region. A robust body of evidence demonstrated the association between beverage consumption, obesity, and chronic diseases. Therefore, the assessment of beverage consumption is gaining more interest in health policy development, food industry partnerships, research expansion and community involvement. Although beverage-consumption assessment tools have been developed for various populations, none were developed for the Arabic population. In this study, we developed and validated an online Arabic Beverage Frequency Questionnaire (ABFQ) to assess the total beverage intake among Arabic speaking population.

METHODS

A cross-sectional validation study was conducted among healthy adults aged between 18 and 55 years. Participants (n = 49) completed a 24-item ABFQ on two occasions and provided one 24-h urine sample. For validity, total beverage consumption (ABFQ1) was assessed against a 24-h urine sample using an osmolality test and correlation analysis. Reliability was assessed by comparing the participants' consumption in total and for every 24 individual items from ABFQ1 with the total and individual items in ABFQ2 using correlation and paired sample t-test.

RESULTS

The average daily consumption of beverages was 1504 ml/day, while the average urine osmolality/kg was 614. The validity assessment between ABFQ and urine osmolality indicates a negative correlation. However, the correlation was week and not statistically significant (r_s = -0.2, p = 0.12). In reliability test, correlation analysis was positive and acceptable in all beverage categories (r_s = 0.4 - 0.9; all p < 0.05) except flavored milk (r_s = 0.2; p < 0.181) and sweetened coffee (r_s = 0.3; p < 0.022). Furthermore, no significant differences were found between the means of total consumption in both ABFQ1 and ABFQ2.

CONCLUSIONS

The finding of this study suggest that the ABFQ is a reliable reproducible tool for assessing beverage consumption among Arabic-speaking consumers. However, the survey could not be validated using 24-h urine osmolality only and other methods such as multi dietary records may use in future re-assessment.

The Impact of the COVID-19 Lockdown on Sugar-Sweetened Beverage Consumption in Children in Saudi Arabia: A Mixed-Methods Study

(1) Background: In 2020, there seems to have been a global shift in lifestyle and eating habits with the emergence of the coronavirus disease 2019 (COVID-19) and the ensuing lockdowns implemented by national governments. This study assessed the impact of the COVID-19 lockdown on SSBs consumption among healthy 6-11 years old children in Saudi Arabia; (2) Methods: This is a mixed-methods study, incorporating a quantitative component, which was a validated Arabic online questionnaire completed by parents, and a qualitative component, involving structured interviews with 10 selected parents using a criterion sampling method; (3) Results: There was a small decrease in consumption reported during lockdown across all SSBs types (soft drinks, n = 58 (13.9%); juices: n = 115 (27.6%); flavored milk: n = 93 (22.3%)). The results showed that with every increase in the dental pain scale there was a positive odd (AOR:0.64; p = 0.001) of decreased consumption of SSBs. Several themes related to increase and decrease SSBs consumption emerged; (4) Conclusions: There was a small decrease in SSBs consumption during lockdown reported by parents. Several themes emerged that can be used to strategize against problematic eating behavior, enabling such provisions as family dietary interventions, which target both parents and children.

Risky behaviors, substance use, and other lifestyle correlates of energy drink consumption in children and adolescents: a systematic review

Increasing concerns have been raised on the health-related risks connected with energy drink (ED) consumption in children and adolescents, with high acute or chronic consumers exceeding 10% in either age group in Europe in 2011. Preliminary evidence has suggested a common pattern of ED and substance use, especially alcohol. Additional evidence has been accumulating very fast; in addition, other lifestyle and risky behaviors may contribute to shed light on the complex interplay of factors involved in ED consumption. We have undertaken a comprehensive systematic review of the evidence on psychosocial correlates of ED consumption in 0-18 years subjects, as published up to April 1, 2021, in MEDLINE/PubMed, PsycINFO, and Cochrane Reviews and Central Register of Controlled Trials, which allowed to select 104 original articles. Only ~ 10% of the papers provided results based on longitudinal analyses. A common pattern of ED consumption and polysubstance use, including alcohol, tobacco, and soft and hard drugs, was still confirmed in adolescents; violent and risky behaviors were also related to a higher ED consumption. In addition, frequent ED consumers are more likely to have bad dietary habits, including consumption of sugar-sweetened beverages and junk foods. A generally inconclusive evidence was found for sport/physical activities, although sedentary behaviors were generally related to ED consumption.

CONCLUSIONS

Frequent ED consumption might be a screening indicator to identify students at risk of substance use or other risky/problem behaviors; enquiring about an adolescent's recent ED consumption could create opportunities for early intervention/prevention by informed pediatricians.

WHAT IS KNOWN

• Substances, especially alcohol, are associated with energy drinks in most cross-sectional studies.

WHAT IS NEW

• Violent behaviors are associated with energy drink consumption, in the absence of longitudinal studies; problematic use of internet/videogames deserves further investigation; unhealthy dietary patterns are related to energy drinks; evidence on physical activity is inconclusive, but sedentary behaviors are related to energy drinks.

Development of a Food Frequency Questionnaire for Assessing Habitual Intake of Free Sugar Among Children in Saudi Arabia

The World Health Organization emphasizes the urgency to assess and limit the intake of free sugar (FS) among individuals in order to prevent several non-communicable diseases. However, data regarding intake of FS are lacking in Saudi Arabia and in the Middle East. A reliable valid tool is needed to assess children's habitual intake of FS. Thus, we aimed to develop and validate a food frequency questionnaire (FFQ) that assesses children's habitual intake of FS in Saudi Arabia. In this cross-sectional study, 424 healthy Saudi children ages 6–12 years were included using river sampling method. Sociodemographic data and contact information were collected from mothers using an online survey. Dietary data were collected using 24-h dietary recalls (reference method) and a semi-quantitative FFQ through phone interviews. Items and food groups included in the initial draft of the FFQ were adopted from previous work. Content validity was done to the FFQ with total of 12 food groups and 41 food items. Next, a pilot study was conducted to estimate the sample size needed for the study and to ensure that all items reported in the 24-h dietary recalls were included in the final draft of the FFQ. Finally, data were collected to assess the validity and reliability of the FFQ at the population level. Mean intake of FS assessed by the FFQ was significantly higher than that assessed by the 24-h dietary recalls. Spearman's correlation between total FS assessed by the FFQ and 24-h dietary recall was positively low (rs = 0.30, p &lt; 0.001). The coefficient alpha indicated an acceptable level of internal consistency (α = 0.74, p &lt; 0.001). Test-retest reliability for total FS intake assessed by the FFQ was positively high (rs = 0.82). A slight agreement between FS intake assessed by the FFQ and the 24-h dietary recall was seen among the study sample (κ = 0.21, p &lt; 0.001). The newly developed FFQ was found to be reasonably valid in assessing children's habitual intake of FS in Saudi Arabia. Validating the instrument among older population in Saudi Arabia is warranted.

Associations between self-rated health, life satisfaction and physical activity among adolescents in Saudi Arabia

Empirical evidence has shown that health status and life satisfaction are strongly correlated and connected to physical activity. However, no previous research has examined the association of physical activity (PA) with self-rated health (SRH) and life satisfaction (LS) among adolescents in Saudi Arabia. Therefore, a cross-sectional study was conducted among a sample of male adolescents (n=453; age 15–20 years) in Riyadh, Saudi Arabia. The objective was to investigate the association between LS and SRH with PA in adolescents, taking into account socio-demographic variables. A pre-tested validated questionnaire was used to collect data using a stratified sampling technique. An estimated 354 (78.5%) adolescents reported being healthy, and 98 (21.7%) were satisfied with their lives. The logistic regression analysis revealed that adolescents’ SRH was independently associated with their sense of LS (AOR=2.5, 95%CI: 1.5-4.3, P≤0.001). Also, the odds of reporting being healthy increased 2.5 times for being moderate active (95%CI: 1.5-4.3, P<0.001) and 3.4 times for being highly active (95%CI: 2.0-5.8, P≤0.001), as compared to non-active adolescents. Moreover, adjusted logistic regression showed that adolescents’ LS was independently associated with high level of their father’s education (AOR=1.8, 95%CI: 1.2-3.0, P=0.023); studying in private schools (AOR=1.9, 95%CI: 1.3-2.9, P≤0.011) and being highly active (AOR=3.0, 95%CI: 1.6-4.2, P=0.007). SRH and LS are determinants of each other, and both variables were independently associated with PA levels. Programs that increase PA may promote life satisfaction and health status in the adolescent population. Therefore, it is important to promote physical activity amongst them, create a sport-friendly environment, and engage adolescents in physical activity during their free time by broadening access to more sports classes and other forms of assistance. This is also an important method of enhancing adolescents’ life satisfaction and better health.

Nutrient intake and gender differences among Saudi children

Dietary surveillance is necessary to determine community needs for nutrition interventions. Yet, the nutrient intake of Saudi children has not been previously investigated. The objective of the present study is to evaluate dietary data of Saudi children and investigate gender differences in nutrient intake. In this cross-sectional study, dietary data of 424 Saudi children (6–12 years of age) were collected using telephone-administered single 24-h dietary recall. Three 24-h dietary recalls were collected from a subsample of 168 children (39⋅6 %) and compared with the Dietary Recommended Intakes (DRIs). Nutrient intakes and proportions of children meeting the DRI requirements were similar and did not vary by children's gender. Over two-thirds of the children had an adequate usual intake of vitamin B12, and over half had adequate intakes (AIs) of vitamin C and phosphorus. On the other hand, our data indicated that low proportions of children consumed adequate usual intakes of magnesium and vitamin E. Over half of the children in our sample met the AI for sodium and vitamin D. Only small proportions of children met the AI for calcium, potassium and fibre. Cholesterol and saturated fat intake exceeded the limits of 300 mg and 10 % of total energy intake by 13⋅7 % (n 23) and 80⋅4 % (n 135) of the sample, respectively. Suboptimal intake of several micronutrients was observed among children, suggesting an urgent need to identify barriers to high-quality diet and to develop evidence-based interventions to promote optimal dietary efficacy for children in Saudi Arabia.

Maternal Knowledge, Attitude and Practices toward Free Sugar and the Associations with Free Sugar Intake in Children

Research addressing factors related to free sugar (FS) consumption among children in Saudi Arabia is lacking. We aimed to evaluate maternal knowledge, attitude, and practices toward FS and the associations with children's intake of FS. This cross-sectional study included 424 Saudi children aged 6-12 years and their mothers. Data related to maternal knowledge, attitude, and practices were collected using an online survey. Data concerning children's habitual intake of FS were collected through phone interviews using a validated food frequency questionnaire. Limited knowledge on FS was observed among mothers of children [median 7.00 [interquartile range 6.00-8.00] out of 11.0. Maternal knowledge was not correlated with maternal attitude or practices toward FS. Maternal knowledge towards FS did not predict children's intake of FS, whereas maternal attitude and practices toward limiting the consumption of FS predicted lower intake of FS among Saudi children, particularly the FS consumed from solid food sources (B: -5.73 [95% confidence interval (CI): -9.79 to -1.66]) and (B: -6.85 [95% CI: -11.9 to -1.80]), respectively. Despite the limited knowledge pertaining to FS among mothers in Saudi Arabia, they were making efforts to limit their children's consumption of FS.

Consumption of Free Sugar Predicts Nutrient Intake of Saudi Children

Data concerning the association between free sugar intake and nutrient intake in children in the Middle East are not available. This study aimed to explore the association between the consumption of free sugar and nutrient intake among Saudi children. A cross-sectional study included 424 Saudi children ages between 6 and 12 years old and their mothers. An online survey collected sociodemographic data from mothers. Trained data collector personal contacted mothers to arrange for a phone interview in order to collect 24-h dietary recall to assess the dietary intake of children. Only 0.90% of children consumed free sugar within the recent recommendation of the World Health Organization (WHO) of <5% of total energy intake, whereas 10.6% of children consumed free sugar <10% of total energy intake. The percentage of free sugar intake was negatively associated with total energy intake. Multiple linear regression analysis of free sugar consumption and nutrient intake adjusted for children's age and sex indicated that a higher percentage of free sugar intake significantly predicted lower intake of saturated fat, fiber, sodium, potassium, calcium, iron, zinc, and vitamin B₁₂. Excessive intake of free sugar predicted a lower intake of many essential nutrients. Interventions that aim to reduce the intake of free sugar are urgently needed in order to improve diet of growing children. Future research to explore top food sources of free sugar is needed to establish effective interventions that aim to limit free sugar intake among children.

Efficacy of lifestyle intervention program for Arab women with prediabetes using social media as an alternative platform of delivery

AIMS/INTRODUCTION

This 6-month interventional study aimed to investigate the effectiveness of different educational programs among Saudi women with prediabetes referred by primary care.

MATERIALS AND METHODS

A total of 253 (100 group education program [GEP], 84 WhatsApp education program [WEP] and 69 control group [CG]) eligible participants were invited to take part in the study, out of whom 120 received intervention (40 GEP, 43 WEP and 37 CG). GEP participants received focused, individualized lifestyle modification advice with bimonthly support sessions, WEP participants received the same intervention, but delivered through social media (WhatsApp). The CG received standard care. Anthropometrics, biochemical profiles and macronutrient intake were measured at baseline, and 3 and 6 months. The primary end-points were glycated hemoglobin and weight, with lipids and dietary changes as secondary outcomes.

RESULTS

Glycated hemoglobin significantly improved in all groups post-intervention (GEP baseline 6.0 ± 0.2 vs 6 months 5.5 ± 0.54; P < 0.001, WEP 6.0 ± 0.26 vs 5.3 ± 0.51; P < 0.001, CG 6.0 ± 0.37 vs 5.7 ± 0.49; P < 0.001), but with no difference in between-group comparisons (P = 0.33). Within-group comparisons showed a reduction in weight, but only in the GEP group (90.6 kg ± 27.3 vs 84.8 kg ± 24.3; P < 0.01), and this was significant in between-group comparison (P = 0.003). Significant between-group comparisons with respect to energy (g) intake (P = 0.005) were also observed, as well as triglycerides (P < 0.001) and low-density lipoprotein cholesterol (P = 0.001), all in favor of the GEP group.

CONCLUSIONS

Diabetes prevention programs, whether delivered through a focused educational group, social media or standard care, are equally efficacious in improving glycated hemoglobin levels among Saudi women with prediabetes, but a focused educational group was more effective in terms of successful weight loss.

Taxation of Sugar-Sweetened Beverages and its Impact on Dental Caries: A Narrative Review

Dental caries is one of the largest health concerns worldwide, and a key causative factor is excess sugar intake. Sugar-sweetened beverages (SSBs) are one of the largest sources of added sugars, which significantly contribute to adverse oral and general health. To reduce SSB consumption and its consequent impact on health, including dental caries, several interventional measures have been implemented; sugar taxation is one such measure. This review aimed at understanding the current knowledge available regarding the effect of sugar taxation on dental caries. Accordingly, PubMed, the Cochrane Library, Web of Science, and Scopus were searched with relevant keywords and findings from the identified studies are discussed in this review article.

The awareness of water intake and its correlation with BMI among students attending national and international secondary schools in Riyadh, Saudi Arabia

Dehydration is linked to worse cognitive functions and preference for beverages that are linked to obesity and other health conditions. Saudi Arabia’s hot climate can exacerbate these effects and it is important to ensure that children in the region understand the benefits of adequate water intake. To evaluate secondary school student perceptions and practices regarding water intake, investigate how water intake is related to BMI and school performance, and compare international schools to national schools. This cross-sectional study surveyed understanding and practices relating to water intake of national and international secondary school students using a questionnaire based on a random selection of schools and students. One-hundred and sixty-two students from international schools (I) and 157 from national schools (N) responded. Most were aged 16 and 17 years old (I:61.1%, N:76.5%, p = .005). The average BMI of all students was 24.9 ± 6.013 (I:23.6 ± 4.658, N:26.1 ± 6.931, p < 0.001). Students understood beverages do not replace water intake (I:80.2%, N:75.8%, p = .337) and preferred water when thirsty (I:77.8%, N:75.2%, p = .549). However, water consumption was low with more than 50% of students drinking less than 1500 ml a day (I:54.3%, N:70.7%, p = .002). A positive correlation between BMI and water intake was observed only among international school students. Students have inadequate water intake despite understanding the importance of hydration. There are some differences between international school students and national school students that can be attributed to the availability and sources of water, though other factors cannot be excluded.

What Have We Learned about the Effects of the COVID-19 Pandemic on Consumer Behavior?

Background: This study aims to examine how behavioral variables interact with and stimulate purchasing decisions and influence the process of purchasing healthy foods during the COVID-19 pandemic. Method: Principal component analysis was carried out on a sample of 100 consumers of healthy foods in Saudi Arabia, and this made it possible to adapt the items to the context of the study. Exploratory and confirmatory analysis with 360 people was carried out. Confirmatory factor analysis provided reliable and valid scales, and multivariate analysis using structural equations and binary logistic regressions made it possible to validate the hypotheses. Results: The intention to buy increased among consumers of healthy foods. Women were more anxious about the COVID-19 pandemic than men, and they took considerable precautions to avoid contamination. The fear of COVID-19 was also more intense among the elderly population than younger people. The respondents indicated reduced visits to shops, restaurants, and markets. Gender and age moderated the relationship between the fear of COVID-19 and purchasing intention. Consumption risk also negatively affected purchasing intention. However, buying experiences and intention to buy led to increased purchases of healthy foods compared to other goods.

Exploring health-risk behaviors related to road safety and car drifting among adolescents in Saudi Arabia: the co-occurrence of multiple risk behaviors

Objectives Adolescence is a fundamental stage of life where they go through huge changes and development. As a result, they are more likely to engage in behaviors that may jeopardize their life and health. The main objectives of this paper is to investigate risky-behaviors related to road traffic safety and dangerious car drifting among adolescents in Saudi Arabia. Methods This was a school-based cross-sectional study conducted among male school adolescents in Riyadh, Saudi Arabia. A multi-stage probability sampling technique was performed to recruit the participants. A total of 1,501 male adolescents were included in this study, studying in private and public high schools. Results A total of 78.7% of the students were found to be driving cars, which indicated that a high proportion of adolescents drive without a license. A total of 96% and 97.7% of adolescents do not use seat belt when driving nor when riding a vehicle as a passenger, respectively. Using helmet was a very rare practice among adolescents since only 1.4% and 2.0% wore a helmet when using non-motorized and motorized vehicles, respectively. Attending car drifting events, joining people while performing car drifting and actual performing car drifting were prevalent as 46.7%, 42.9%, 36.1%, respectively. About 58% of the adolescents reported not been taught about how to avoid traffic accidents, and 80% reported the need for more health education regarding traffic safety. The logistic regression analysis indicates adolescents car drifting was independently associated with adolescents' age (OR = 1.2; 95%CI = 1.1-1.3; p < 0.01), studying in private schools (OR = 1.2; 95%CI = 1.2-2.0; p≤ 0.015), being Saudi (OR = 2.5; 95%CI = 1.9-2.8; p < 0.001), do not like schools (OR = 1.7; 95%CI = 1.4-2.4; p < 0.001) and poor academic performance (OR = 1.7; 95%CI = 1.3-2.3; p < 0.001). Also, the adjusted logistic regression confirmed that car drifting was independently associated with several health risk behaviors including joining people performing car drifting, attending car drifting events, not brushing teeth, smoking behavior, want to use drugs, carrying weapons, and taking part in bullying others. Conclusion Large proportions of adolescents engage in multiple risky road traffic behaviors. Therefore, it is strongly advisable for policymakers and other stakeholders to devise national strategies that consider road safety and risky driving behaviors among adolescents and school students. This study calls for a strategic intervention plan to change the culture of risky driving through a structured and comprehensive curriculum in school settings.

Association between soft drink consumption, gastric reflux, dental erosion, and obesity among special care children

OBJECTIVES

This study assessed the association between soft drink consumption, gastric reflux, dental erosion, and obesity among special care children.

MATERIALS AND METHODS

A total of 350 special care children (male-131, female-219) mean age of 12.6 (± 2.6) years were included. Detection of dental erosion was performed according to the World Health Organization criteria. The medical evaluation assessed body mass index (BMI). With appropriate sample weighting, relationships between dental erosion prevalence and obesity were assessed using multivariable logistic regression.

RESULTS

Overall prevalence of dental erosion was 36%. Mean BMI for entire study population was 24.7 (± 7.8). Regression analysis showed strong association between dental erosion prevalence and consumption of soft drinks (adjusted odds ratio = 1.8; 95% CI = 0.71-2.92, P < .05), bulimia (adjusted odds ratio = 2.27; 95% CI = 0.99-4.28, P < .001), and gastric reflux (adjusted odds ratio = 2.24; 95% CI = 0.82-4.1, P < .001). Bivariate analysis showed high prevalence of dental erosion among obese children compared to children with normal weight (P = .04).

CONCLUSION

The present study demonstrated a significant association between dental erosion prevalence and consumption of soft drinks and gastric reflux among special care children.

Energy drinks and population health: consumption pattern and adverse effects among Saudi population

BACKGROUND

Caffeine containing energy drinks (EDs) are heavily consumed, particularly among young adults. The number of reports of caffeine intoxication from caffeinated EDs and problems related to caffeine dependence and withdrawal is increasing. The objective was to assess the knowledge and perceived beneficial effects of EDs consumers, to assess consumption patterns and determine the adverse effects experienced by different EDs consumer groups residing in Saudi Arabia.

METHODS

An observational cross-sectional study with data from a randomly selected Saudi population was conducted during the period of January 15th, 2015, to April 15th, 2015, using a pre-tested 43-item questionnaire. The data were obtained and collected using interview questionnaires. Sociodemographic characteristics and data on EDs consumption patterns, the level of awareness among study subjects, and the purported benefits and reported adverse effects of EDs were collected. Frequency, percentage, and arithmetic means were calculated using Chi-square and ANOVA tests, and data with p < 0.05 were considered significant.

RESULTS

Of the 816 individuals invited to participate in the study, 783 participants responded and completed interviews, response rate was 96%. Consumers attributed the popularity of EDs to massive advertising media (46.7%) and their stimulating and invigorating effects (37.5%). EDs are consumed by subjects for their effects on fatigue reduction (64.6%), increased alertness and focus (75.8%), and assistance during long driving trips (75.7%). Study subjects reported suffering from adverse effects, including mainly diuresis (53.7%), palpitations (50.7%), insomnia (50.7%). Importantly, an inverse association was identified between knowledge of EDs and consumption rate, and a proportional association was identified between experienced adverse effects and consumption frequency. Lower knowledge scores were identified in daily consumers than in 1-3 times monthly consumers; higher adverse events were experienced by daily consumers than by 1-3 times monthly consumers. The majority of consumers (84.6%) recommended that authorities should regulate EDs consumption.

CONCLUSIONS

Excessive EDs consumption is associated with an increased risk of experiencing several adverse events, which is commensurate with published studies. Increasing knowledge about EDs and their possible risks could decrease their consumption by the general public.

Do Parenting Styles Affect Children's Oral Health in Saudi Arabia?

Objective The purpose of the study is to correlate the parenting styles of parents with the oral health of their children, in Riyadh, Saudi Arabia. Study design Two hundred and eighty healthy preschool children, who have never been to the dentist, were recruited. Parenting style was determined by the Parenting Style and Dimensions Questionnaire (PSDQ). World Health Organization (WHO) criteria and simplified debris index (DI-S) were used for the diagnosis of dental caries and oral hygiene of the children respectively. Results Two parenting styles were identified among Saudi parents; authoritative (94%, n = 265) and permissive (6%, n = 17). The majority of children were brushing by themselves (n = 130, 46.1%) and once per day (n = 163, 57.8%). Significant correlations were detected between parenting style and children's brushing times (P-value of 0.016) and the number of meals consumed by children (P-value of 0.031). The age of the child and oral hygiene score were significantly correlated to dental caries (P-value < 0.05). Conclusion Two parenting styles were identified among Saudi parents. Parenting style influenced the child's oral health but not significantly. Early childhood caries and fair to poor oral hygiene were commonly detected among children. Clinically interesting correlations were identified regarding factors affecting the child's oral health status.

Intake of fruit, vegetables and milk products and correlates among school boys in Saudi Arabia

BACKGROUND

Healthy dietary behaviors have a significant impact on children's health and development. Diets high in fruit and vegetables demonstrate a strong and consistent pattern for decreasing the risk of and providing benefits against cardiovascular disease, diabetes, obesity and many cancers. Yet, little is known about the pattern of fruit, vegetables and dairy products consumption among children in Saudi Arabia.

OBJECTIVES

The aim of this study was to investigate the consumption of fruit, vegetables and milk products and their dietary correlates among school boys in Saudi Arabia.

MATERIALS AND METHODS

A multistage stratified cluster cross-sectional survey, using a pre-tested questionnaire was conducted among school-children. The study sample comprised of 725 school students from ten randomly selected schools in Saudi Arabia.

RESULTS

All surveyed schools (100%) neither provide nor sell fruit, fresh juices or vegetables on their premises. During regular weekdays, the majority of the children did not consume fruit (69%) and vegetables (71.4%) on daily basis. More than one third (32.4%) of the children did not consume dairy products daily. The daily consumption of fruit and dairy products were associated with young age [odds ratio (OR) = 1.5, confidence interval (CI): 1.1-2.2, p = 0.040] and (OR = 2.4, CI: 1.6-3.7, p = 0.001), respectively. Daily consumption of fruit was positively associated with daily consumption of vegetables (OR = 6.6, CI: 4.5-9.5, p = 0.001). Also, daily consumption of vegetables was positively associated with daily consumption of dairy products (OR = 1.5, CI: 1.1-2.2, p = 0.040) and inversely correlated with daily consumption of sweets (OR = 0.6, C.I: 0.4-0.9, p = 0.012). Moreover, the daily consumption of dairy products was associated with consuming high fat food daily (OR = 1.7, CI: 1.2-2.4, p = 0.002).

CONCLUSION

The findings indicated that a high percentage of children in Saudi Arabia had an unhealthy low consumption of fruit, vegetables and milk products. Thus, an intervention program to promote healthy dietary patterns is highly recommended. Improving school environments and establishing school-based nutrition programs are extremely needed to promote healthy dietary behaviors among this age group.