School meals: state of the art and recommendations

School meals contribute substantially to overall energy and nutrient intake adequacy of children, but also play an important role in the development of child food habits and the socialisation process. Evidence shows that school based environmental actions, which include changes in school meals and school food policies related to increased availability and access to healthy foods and drinks while in the school are effective to foster healthy eating practices among children. A growing number of children engage in school meals. Available information to date shows that the quality of the food on offer is not always consistent with dietary guidelines. Vegetables and fish are served less often than desirable and excess added fats are used in food preparations. Norms and regulations are very detailed regarding food safety issues and administrative management of the service, including subcontracting of catering providers and care staff. Nutrition and health promotion issues should also be included in regulations by means of nutrition recommendations for school meals along with information on food based dietary guidelines and portion sizes. School meals should be part of the educational project using a whole school approach.     

Children''s nutrient intake at preschool and at home

A preschool-based dietary survey, using 7-d records, was carried out in a suburb of Stockholm. The aim was to assess the intake of food and the quality of the diet of preschool children aged 3-5 y at preschool and at home, and to compare the dietary intake with the Swedish dietary recommendations for preschool children. The respective mean intakes of protein, fat, carbohydrates and sucrose, expressed as a percentage of total energy intake were 14, 38, 50 and 9 at preschool, and at home 14, 36, 52 and 12 on weekdays, 14, 34, 55 and 16 on weekend days. The mean intakes of seven vitamins and minerals were low only for selenium as compared with the recommended level. No differences were found in nutrient density between diet at preschool and diet at home, with the exception of dietary fibre (higher at preschool). On weekdays there was a significantly higher nutrient density for calcium, zinc, selenium, vitamin A, riboflavin, vitamin C and dietary fibre compared with weekend days. Conclusion: The average intakes of energy and nutrients per meal at preschool compared with the recommended levels for children aged 4-6 y were low for all meals (breakfast, lunch and afternoon snack). This, however, was compensated for by home meals.     

Food-based recommendations to reduce fat intake: an evidence-based approach to the development of a family-focused child weight management programme

OBJECTIVES: To develop food-based recommendations to lower fat and energy intake for use in a family-focussed weight management programme for 6-9 year old children. METHODS: Secondary analysis of the 1995 National Nutrition Survey (NNS95) informed the development of food-based recommendations aiming to reduce fat and energy intake. Each recommendation was used to progressively modify a model 3-day high fat dietary intake with the accumulative effect on energy and nutrient intake of each recommendation assessed. RESULTS: Six to nine-year-olds in the NNS95 consuming 35-45% energy as fat (n= 280) consumed more total energy (mean +/- SD, 8671 +/- 2741 vs. 7571 +/- 2328 kJ/day) than children consuming a 'low fat' (23-27% energy as fat, n= 85) diet (P < 0.002). Food-based recommendations found to be most effective for reducing energy and fat intake included; changing to reduced fat milk, reducing intake of cereal-based and snack foods and replacing juice or soft drink with water. These changes, together with avoiding adding fat to vegetables and using sources of lean meat, reduced energy intake by approximately 10%, total fat intake by approximately 30% and saturated fat intake by 53%. CONCLUSIONS: Modifying six areas of food choices results in a moderate reduction in fat and energy intake. An eating pattern that is consistent with Australian dietary guidelines and uses foods commonly eaten by children is achievable for children aged 6-9 years. These food-based recommendations provide an evidence-based dietary framework for prevention and management of overweight in children.     

Contribution of snacks to dietary intakes of young children in the United States

Nutritional quality of children's diets is a public health priority in the fight against childhood obesity and chronic diseases. The main purpose of this study was to determine contribution of snacks to energy and nutrient intakes and to identify leading snack food sources of energy, total fat, and added sugars amongst young children in the United States. Using the 2005–2012 NHANES data, dietary intakes of 2‐ to 5‐year‐old children were analysed from a parent‐reported 24‐hour dietary recall (n = 3,429). Snacking occasions were aggregated to determine the proportion of total food/beverage intake obtained from snacks, estimate energy, and nutrient intakes, and identify the leading snack food sources of energy, added sugars, and total fat. Nearly all children consumed a snack on the reported day (62% morning, 84% afternoon, and 72% evening). Snacks accounted for 28% of total energy intake, 32% of carbohydrates, 39% of added sugars, and 26% of total fat and dietary fiber intakes for the day. Snacking occasions accounted for 46.6% of all beverages consumed on the reported day. Snacks and sweets food category (i.e., cookies and pastries) were the leading sources of energy (44%), total fat (52%), and added sugars (53%) consumed during snacking occasions. Sweetened beverages (e.g., fruit and sport drinks) contributed 1‐quarter of all added sugars obtained from snacks. Snacks contribute considerable amount of energy and nutrients to young children's diets, with a heavy reliance on energy‐dense foods and beverages. Targeted interventions are needed to improve the nutritional quality of snacks consumed by young children.     

Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight

Although a large body of research has assessed direct genetic links between parent and child weight status, relatively little research has assessed the extent to which parents (particularly parents who are overweight) select environments that promote overweight among their children. Parents provide food environments for their children's early experiences with food and eating. These family eating environments include parents' own eating behaviors and child-feeding practices. Results of the limited research on behavioral mediators of familial patterns of overweight indicate that parents' own eating behaviors and their parenting practices influence the development of children's eating behaviors, mediating familial patterns of overweight. In particular, parents who are overweight, who have problems controlling their own food intake, or who are concerned about their children's risk for overweight may adopt controlling child-feeding practices in an attempt to prevent overweight in their children. Unfortunately, research reveals that these parental control attempts may interact with genetic predispositions to promote the development of problematic eating styles and childhood overweight. Although the authors have argued that behavioral mediators of family resemblances in weight status, such as parents' disinhibited or binge eating and parenting practices are shaped largely by environmental factors, individual differences in these behaviors also have genetic bases. A primary public health goal should be the development of family-based prevention programs for childhood overweight. The findings reviewed here suggest that effective prevention programs must focus on providing anticipatory guidance on parenting to foster patterns of preference and food selection in children more consistent with healthy diets and promote children's ability to self-regulate intake. Guidance for parents should include information on how children develop patterns of food intake in the family context. Practical advice for parents includes how to foster children's preferences for healthy foods and how to promote acceptance of new foods by children. Parents need to understand the costs of coercive feeding practices and be given alternatives to restricting food and pressuring children to eat. Providing parents with easy-to-use information regarding appropriate portion sizes for children is also essential as are suggestions on the timing and frequency of meals and snacks. Especially during early and middle childhood, family environments are the key contents for the development of food preferences, patterns of food intake, eating styles, and the development of activity preferences and patterns that shape children's developing weight status. Designing effective prevention programs will, however, require more complete knowledge than currently available regarding behavioral intermediaries that foster overweight, including the family factors that shape activity patterns, meals taken away from home, the impact of stress on family members' eating styles, food intake, activity patterns, and weight gain. The research presented here provides an example of how ideas regarding the effects of environmental factors and behavioral mediators on childhood overweight can be investigated. Such research requires the development of reliable and valid measures of environmental variables and behaviors. Because childhood overweight is a multifactorial problem, additional research is needed to develop and test theoretic models describing how a wide range of environmental factors and behavioral intermediaries can work in concert with genetic predispositions to promote the development of childhood overweight. The crucial test of these theoretic models will be in preventive interventions.     

The nutrition of young diabetic patients

Objectives of management of insulin-dependent diabetes mellitus in pediatric patients include elimination of symptoms, achievement of normal growth and maintenance of blood glucose levels close to normal values. Nutritional management can contribute to achievement of these goals. In non-overweight children with diabetes mellitus, energy intake should not be restricted and distribution of nutrients should be identical to that recommended in normal children. Except in specific circumstances, reduced intake of pure, sweet-tasting carbohydrates is desirable. The central point is appropriate distribution of the main meals and snacks throughout the day. Food intake should occur at the times of peak insulin activity to avoid both hypoglycemia and postprandial hyperglycemia. Nutritional recommendations for the child and family should be part of the general guidelines for healthy eating appropriate for all individuals. Nutrition education, as well as education on use of insulin, are components of a program aimed at providing the patient with knowledge and know-how. Correction of eating mistakes and optimal adjustment of insulin dosages are the two main aspects of daily therapy.     

Insufficient energy and nutrient intake in children with motor disability

Aim:  Children with motor disabilities are at increased risk of compromised bone health due to impaired weight bearing. Poor nutritional status may be an additional risk factor. The aim of this study was to evaluate energy and nutrient intakes in children with motor disability.
Patients and Methods:  Fifty-four children with motor disability (cerebral palsy in 59%) were included. Three-day food diaries were collected and analysed. The results were compared with recommended dietary allowances for age and sex.
Results:  The median age was 10.9 years. The median energy intake was 76% of the recommendation and <80% in 57% of children. Of the total energy, 17% was from protein, 32% from fat and 50% from carbohydrates. The medians were for calcium intake 142% and for vitamin D intake 76% of the recommendation; serum 25-hydroxy-vitamin D concentrations were low (median 46 nmol/L). Children with low energy intake were shorter and lighter and had more severe motor disability than children with sufficient energy intake.
Conclusion: Insufficient energy and nutrient intake is common in children with motor disability. This may have adverse health effects especially when associated with low vitamin D intake. Energy and vitamin D supplements should be considered.     

Association between watching TV whilst eating and children's consumption of ultraprocessed foods in United Kingdom

This study aimed to assess the association between watching TV whilst eating and consumption of ultraprocessed foods amongst children aged 4–10 years old in the United Kingdom. Cross‐sectional data from the UK National Diet and Nutrition Survey (NDNS 2008–2012) were analysed. Dietary data were derived from 4‐day food diaries of 1,277 children, and the dietary contribution of ultraprocessed foods was assessed. Meals were classified based on time of day in which foods were consumed (lunch: 11 pm–3 pm and dinner: 6 pm–9 pm). Crude and adjusted linear regression models were employed to verify the effect of watching TV during meals on dietary contribution of ultraprocessed foods (% of total energy intake). More than 70% of the children watched TV during meals, and 31.4% presented the behaviour on both “lunch and dinner.” Children's mean total energy intake was 1,532.3 kcal/day, of which 65.8% came from ultraprocessed foods. Findings indicated that children who watched TV whilst having both meals (lunch and dinner) consumed on average 85.5 kcal/day and 6.1% more energy from ultraprocessed foods than those who did not. Children who watched TV only during dinner consumed on average 37.1 kcal/day and 3.4% more energy from ultraprocessed foods than those who did not. The behaviour of watching TV whilst eating meals was associated with higher total daily consumption of ultraprocessed foods by children in the United Kingdom. Therefore, interventions designed to promote healthy eating habits should include aspects related to the context of meals.     

Greek immigrant children in southern Sweden in comparison with Greek and Swedish children. III. Energy and nutrient intake

Greek immigrant children (GI) belonging to the second generation of immigrants in Sweden have been compared with Swedish children (S) and Greek children in Greece (G) regarding energy and nutrient intake. Twenty-four-hour recalls were obtained in the homes of the families. The mean energy intake was the same in all three groups and met the Swedish Nutrition Recommendations. The energy distribution for protein, carbohydrates and fat was also similar. The fat intake was far above the recommended level in all groups. The GI and the G group had a significantly higher mean daily intake of monounsaturated fatty acids than the S group (p less than 0.05 and p less than 0.001, respectively). Children aged four to eight years in the GI group had a significantly higher nutrient density of retinol, vitamin D, riboflavin, vitamin B6, calcium, iron, magnesium and sucrose compared to the G group, but compared to the S group they had a lower nutrient density of retinol, vitamin D, ascorbic acid, niacin, vitamin B12 and selen. The GI children consumed more milk than the G children but as much as the S children and they had started to use enriched low-fat milk in Sweden. In conclusion, the food quality in the GI group was better than in the G group and much the same as in the S group, and, with few exceptions, it met the Swedish Nutrition Recommendations.     

Einführung und Zusammensetzung der Beikost

In the second six months of life, complementary feeding becomes the central element of the infant diet. The available rational arguments regarding the total of complementary feeding are an interplay of scientific evidence, to a large part empirical knowledge and sometimes pragmatism. In Germany, current knowledge is reflected in the guidelines for complementary feeding of the ‘Dietary schedule for the first year of life’. Nutritional as well as developmental and preventive arguments call for an introduction of complementary feeding at the beginning of the 5th month of life at the earliest and at the beginning of the 7th month at the latest, accompanied by continued breastfeeding. Complementary feeding can either be home made by use of simple recipes or industrially produced meals can be chosen. Recent scientific knowledge calls for a variable selection of foods and renounces any dietary restrictions for allergy prevention. Three types of complementary meals are recommended that complement each other and, taken together with the remaining milk portion, result in an overall nutrient intake conform to the reference values. How dietary intake of nutrients like iron, iodine, protein and fat in complementary feeding can be sensibly evaluated is still debatable.     

Food consumption of infants and young children in France in 1997]

BACKGROUND: In 1981 and 1989, two French nationwide food consumption surveys reported the dietary intakes of infants and toddlers. In 1997, another survey was conducted. POPULATION AND METHODS: Six-hundred and sixty, 1 to 30-month-old infants and children were recruited. Food records were completed by their parents during a 3-day period. Energy, proteins, carbohydrates, total lipids, minerals, vitamins, linoleic acid contents were calculated. Energy contribution of various food groups and the pattern of the distribution of the different meals were indicated. RESULTS: Between 1989 and 1997, the contribution of milk-based infant formulas increased at 4, 5, 7 and 8-9 months. From the age of 5 months, approximately 75% of the children had a protein intake twice as high as the official recommendations. Mean iron intakes were higher than those calculated in 1989 at the age of 7, 8-9 and 10-12 months. The average daily intake of linoleic acid was lower than the recommended daily allowance from the age of 6 months. CONCLUSION: Trends in dietary intakes between 1989 and 1997 indicated that the nutritional needs of French infants and toddlers are better covered as recommended by scientific committees. More effective efforts are needed for improvement of their nutritional status particularly for iron and essential fatty acids. For example, weaning foods should be introduced later and toddler's formulas should be used more systematically and longer.     

Food consumption and nutrient intake of one- to two-year-old Finnish children

Food consumption data for 46, 1- to 2-year-old children in Helsinki were collected by means of 3-day food records. The mean daily energy intake was 1242 kcal for boys and 1092 kcal for girls. Protein accounted for 16% (range 9-24%), fat 33% (20-50%), total carbohydrates 51% (35-69%) and sucrose 12% (3-33%) of total energy intake. The mean ratio of polyunsaturated and saturated fatty acids was 0.43 (0.11-3.71). The average energy and nutrient intake met or exceeded the recommended amounts except for iron, zinc, fluorine and chromium. When the children were divided into four groups according to dietary fat content, the intake of several nutrients was lowest in the group with the highest fat content (40% or more of energy) even though energy intake did not differ. The wide variety observed, especially in the fat composition of the children's diets, indicates a need to reconsider the recommendations concerning the diet of young children after they have made the transition to family food.     

Ernährung und Bewegung im Kleinkindalter

Background

Nutrition and physical activity in early childhood influence the healthy development and well-being of children. The network “Healthy in life – Young Family Network”, a project by “IN FORM, German national initiative to promote healthy diets and physical activity”, has developed recommendations for nutrition and physical activity for children 1–3 years old.

Recommendations

Regular mealtimes should be alternated with periods of abstinence from eating. Communal mealtimes in a friendly atmosphere are desirable. Paying attention to signs of hunger and satiety from children contributes to development of a healthy eating behavior. A balanced family diet rich in variety can fulfil the needs of infants. Nuts, almonds and hard pieces of food represent a danger due to aspiration. Raw animal meat and uncooked meals prepared from it should be avoided. A confirmed medical diagnosis is necessary before food can be excluded from nutrition due to incompatibility. The physical activity of infants should be actively supported and the natural urge for movement should not be restricted. Inactivity should be limited.     

Recomendaciones nutricionales para el niño deportista

Several health benefits have been attributed to sports practice, and an adequate nutrition status helps to maintain an optimal performance. Children most frequently practice non-competitive and non-endurance activities in a school setting. The dietary intake of children who practice sports should be similar to the general population, properly meeting their energy and nutrient requirements. During the activity performance, correct hydration should be aimed for, with water appearing to be an adequate source in most cases. General calorie and micronutrient supplementation should not be commonly recommended in children. Paediatricians must control nutritional status and dietary habits of children who practice sports, especially in those cases when weight-loss is aimed for, as well as take into account the psychological implications of competitive sports practice.     

Gender differences and typical nutrition concerns of the diets of preschool children – the results of the first stage of an intervention study

Background

Nutrition in children has an important influence on health both in childhood and adulthood. Actions aimed at improving children’s nutrition are essential, not only to the children and their families, but also to the whole society. The aim of the study was to present the results of nutrient intake before starting a nutrition and physical activity intervention programme, to investigate gender differences in nutrient intake and to discuss whether the preschoolers’ nutrient intake is similar to the intake of their peers from other countries.

Methods

Nutrient intake was estimated from seven-day weighed food records kept by parents and preschool staff individually for 122 4–6-year-old children who attended two preschools in Pi?a, north-western Poland. Nutrient intake was calculated using Dieta 4.0 computer programme including water intake and intake of nutrients from dietary supplements. Statistical analysis was performed using the IBM SPSS Statistics computer programme, version 21.0, according to gender. The study was approved by the Bioethics Committee of the Poznan University of Medical Sciences (reference number 886/08).

Results

Boys, in comparison to girls, were found to have statistically significantly higher intakes of total protein, total protein per kg of body weight, saturated fatty acids, total carbohydrates, available carbohydrates, lactose, sucrose, total water, vitamin A, beta-carotene, vitamin B₂, vitamin B₁₂, vitamin C, calcium, phosphorus, and magnesium. Statistically significantly higher percentage of girls than boys had intakes of vitamin E below AI.

Conclusions

Gender was a significant factor of nutrient intake in the studied preschool children. The main nutritional concerns in the studied preschoolers’ diets, irrespective of gender, are typical of the diets of preschool children from various parts of Europe and indicate the need to work out common nutritional strategies to improve preschoolers’ nutrition across Europe to reduce future burden of diet-related diseases to the European societies.

     

Aetiology of overweight and obesity in children and adolescents

The epidemic diffusion of obesity in industrialised countries has promoted research on the aetiopathogenesis of this disorder. The purpose of this review is to focus mainly on the contribution that European research has made to this field. Available evidence suggests that obesity results from multiple interactions between genes and environment. Parents obesity is the most important risk factor for childhood obesity. Twin, adoption, and family studies indicated that inheritance is able to account for 25% to 40% of inter-individual difference in adiposity. Single gene defects leading to obesity have been discovered in animals and, in some cases, confirmed in humans as congenital leptin deficiency or congenital leptin receptor deficiency. However, in most cases, genes involved in weight gain do not directly cause obesity but they increase the susceptibility to fat gain in subjects exposed to a specific environment. Both genetic and environmental factors promote a positive energy balance which cause obesity. The relative inefficiency of self-adapting energy intake to energy requirements is responsible for fat gain in predisposed individuals. The role of the environment in the development of obesity is suggested by the rapid increase of the prevalence of obesity accompanying the rapid changes in the lifestyle of the population in the second half of this century. Early experiences with food, feeding practices and family food choices affect children's nutritional habits. In particular, the parents are responsible for food availability and accessibility in the home and they affect food preferences of their children. Diet composition, in particular fat intake, influences the development of obesity. The high energy density and palatability of fatty foods as well as their less satiating properties promotes food consumption. TV viewing, an inactivity and food intake promoter, was identified as a relevant risk factor for obesity in children. Sedentarity, i.e. a low physical activity level, is accompanied by a low fat oxidation rate in muscle and a low fat oxidation rate is a risk factor of fat gain or fat re-gain after weight loss. Conclusion Further research is needed to identify new risk factors of childhood obesity, both in the genetic and environmental areas, which may help to develop more effective strategies for the prevention and treatment of obesity.     

Prevention of childhood obesity

The increasing prevalence of childhood obesity, its attendant morbidity, and the limited success of therapy mandate increased attention to preventive approaches. Environmental and family variables serve to identify families with children at risk for the development of obesity. Although the behavioral correlates that link these risk factors to childhood obesity remain unclear, inactivity and increased dietary intake of fat appear at this time to be the most logical foci for preventive interventions. Television viewing, which promotes both increased food consumption and reduced activity, represents a major concern at which counseling should be directed.     

重庆市丰都县学龄儿童高血压发生与营养的关系

目的探讨重庆丰都县学龄儿童高血压的发生与营养的关系。方法采用整群随机抽样方法,选取重庆丰都县2所公立小学且户籍为该学校所在街道的8 033名儿童作为研究对象,进行身高、体重和血压测定,采用半定量食物频率问卷进行膳食调查,分析体重指数(BMI)、膳食营养素与儿童高血压发生的关系。结果最终纳入7 538名儿童进行分析,肥胖、超重、高血压检出率分别为9.11%、12.27%、11.83%;肥胖、超重儿童中高血压检出率分别为33.62%、17.84%,分别是正常儿童的4.02、2.13倍。Logistic多因素逐步回归分析显示,钙、钠摄入增加会增加高血压发生的风险(分别OR=1.003、1.002),而铁、单位体重钙摄入增加会降低高血压发生的风险(分别OR=0.979、0.926)。结论重庆丰都县学龄儿童高血压、肥胖流行趋势严峻,BMI和膳食营养素与儿童高血压发生密切相关,需积极控制儿童体重、调整饮食结构、限制钠摄入,以降低儿童高血压的发生。     

Maternal Mindfulness Is Associated With Lower Child Body Mass Index Z Score

BackgroundParental mindfulness may be a novel intervention target for child obesity prevention.ObjectiveTo examine associations between maternal mindfulness and child body mass index z-score (BMIz).MethodsIn a secondary data analysis of preintervention data from a randomized controlled trial, we assessed survey and anthropometric data from English-speaking mother/child dyads enrolled in Head Start in south central Michigan (n = 105). Surveys included demographic information, child dietary intake, family meal frequency, and the Philadelphia Mindfulness Questionnaire. Multivariable linear regression examined associations between maternal mindfulness and child BMIz, child intake of fruits and vegetables, and frequency of family meals.ResultsChildren were M = 53.7 (standard deviation [SD] 7.5) months old, and mothers were M = 31.6 (SD 8.3) years old. The sample of children was 39% white, 26% black, 14% Hispanic, and 35% of children were overweight or obese. Mean maternal BMI was 32.0 (SD 8.3). Greater mindfulness was associated with child BMIz (β = ?.02 (SE 0.01), P = .027) adjusting for child race/ethnicity, household food security, maternal education, maternal age, and maternal BMI. Mindfulness was not associated with child fruit intake, child vegetable intake or frequency of family meals. The results were consistent with alternative outcomes of BMI percentile (P = .016) and BMI at the trend level (P = .0595) at the trend level.ConclusionsGreater maternal mindfulness was associated with lower child BMIz. Future work should consider mechanisms of association. Pediatric providers might consider supporting maternal mindfulness as one element of multicomponent strategies for child obesity prevention.