Comparison of attitudes towards breakfast by Turkish fourth graders living in Turkey and Germany.

The purpose of this article is to identify and compare Turkish fourth graders attitudes towards breakfast living in Turkey and Germany. A sample group of 882 Turkish students enrolled in fourth grade in Hamburg (Germany, N=422) and Konya (Turkey, N=460) were surveyed. Independent t-tests, chi(2) test and Pearson product-moment correlations were used. More students living in Turkey had breakfast and had enough time before going to school (P<0.01). Students living in Turkey reported that eating breakfast affected them positively (P<0.01). Students living in Germany reported that eating breakfast made them feel tired (P<0.01). The consumption of breakfast cereal (P<0.05) and fruit juice (P<0.01) that had not been consumed widely in Turkey increased in Germany. Students who eat breakfast also eat lunch (r=0.296 and -0.236, P<0.01, students living in Turkey and Turkish students living in Germany, respectively). Nutrition education programs in primary schools may change Student's attitudes about breakfast and offering a breakfast programme in schools may greatly improve breakfast consumption rates.

Design and descriptive results of the "Growth, Exercise and Nutrition Epidemiological Study In preSchoolers": the GENESIS study.

BACKGROUND: The Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) attempts to evaluate the food and nutrient intakes, as well as growth and development of a representative sample of Greek toddlers and preschool children. In the current work the study design, data collection procedures and some preliminary data of the GENESIS study are presented. METHODS: From April 2003 to July 2004, 1218 males and 1156 females 1 to 5 years old, stratified by parental educational level (Census 1999), were examined from 105 nurseries in five counties. Approximately 300 demographic, lifestyle, physical activity, dietary, anthropometrical and DNA variables have been recorded from the study population (children and parents). RESULTS: Regarding anthropometrical indices, boys were found to be taller than girls at all ages (P < 0.05) and heavier only for the age period from 1 to 3 years old (P < 0.05). No significant differences were found between genders regarding the prevalence of at risk of overweight (16.5% to 18.6% for boys and 18.5 to 20.6 % for girls) and overweight (14.0% to 18.9% for boys and 12.6% to 20.0% for girls). Additionally, boys older than 2 years of age were found to have a higher energy intake compared to girls (P < 0.05). A similar tendency was observed regarding the mean dietary intake of fat, saturated fat, carbohydrates and protein with boys exhibiting a higher intake than girls in most age groups (P < 0.05). CONCLUSION: The prevalence of overweight in the current preschool population is considerably high. Future but more extensive analyses of the GENESIS data will be able to reveal the interactions of the parameters leading to this phenomenon.

Schoolteachers' awareness about scholastic performance and nutritional status of Egyptian schoolchildren.

Malnutrition disorders affect more than 30% of schoolchildren in Egypt. This problem appears to be largely attributable to poor dietary quality and micronutrient deficiencies, such as iron and vitamin A. Inadequate nutrition intake has important implications because malnutrition has been shown to negatively affect the cognitive development of primary schoolchildren. This study assesses the awareness of schoolteachers about the impact of malnutrition on the scholastic performance of primary schoolchildren living in Egypt. Two focus group discussions were conducted with Egyptian schoolteachers from the Quena and Kharbia Governorates. The study indicates that schoolteachers consider low body weight and thinness as the primary signs of malnutrition. They do not prioritize malnutrition as a factor for poor scholastic performance. They also suggest that unhealthful eating habits, especially a lack of breakfast, negatively affect children's interaction with schoolteachers and their ability to excel in their studies. Schoolteachers endorse a more reliable and nutritionally valuable school-feeding program as a way to increase the scholastic performance of their students. The teachers advocate developing integrated programs between the Ministry of Education, the Ministry of Health and Population, teachers, children, and parents that provide nutrition education. A lack of awareness among teachers about the relationship of nutrition and cognitive function can lead to the misdiagnosis or delayed management of malnourished and scholastically challenged schoolchildren. This paper suggests that proper school-feeding programs and nutrition education programs, which integrate government ministries, teachers, children and parents, should be developed to improve the physical and cognitive health status of Egyptian schoolchildren.

Rationale for a follow-up study focusing on economic productivity.

Past studies of nutrition, human capital formation, and economic productivity have been limited by the fact that biomedical researchers and economists work largely in isolation, with loss of complementarity. Biomedical researchers are faulted for not adequately addressing bias and measurement issues and for naive analyses and interpretation of results, whereas economists are criticized for using simplistic nutrition and physiological measures and for relying on statistical methods rather than experimental designs. To avoid these problems, a multidisciplinary team of biomedical investigators and economists undertook a follow-up study in 2002-04 of a cohort of young men and women, who participated as young children in a randomized community trial of nutrition supplementation carried out from 1969-77 Previous studies, particularly the original trial and a 1988-89 follow- up, are described to provide an overview of the data available for linkage with the 2002-04 follow-up. Key results from these earlier studies are reviewed but judged inconclusive because the data used were collected when many subjects were still growing and developing physically, in school, unmarried, and/or not yet settled into occupations. The subjects were 26 to 41 years of age in 2003, permitting a more complete assessment of human capital and economic productivity. The experimental design of the 1969-77 original study, 35 years of follow-up, use of robust methods of data collection, and the participation of a multidisciplinary team will likely lead to the most comprehensive assessment to date of the importance of nutrition for economic productivity.

Nutrition education for illiterate children in southern Madagascar--addressing their needs, perceptions and capabilities.

OBJECTIVE: A Knowledge, Attitudes and Practices (KAP) study was conducted in three villages of Bekily District in southern Madagascar prior to the implementation of a health education programme with children. The participatory learning concept of the Child-to-Child approach was followed to involve the children in the planning and implementation of the programme, which was covered by the German Agency for Technical Cooperation. DESIGN: To this effect, qualitative research methods such as Participatory Learning and Action techniques (focus group discussions, mapping and matrix ranking, etc.) were applied. SUBJECTS: The survey was conducted between August and December 1999. It involved a total of 55 school-aged children (6-14 years) along with 21 mothers and 34 fathers, representing different ethnic groups and educational backgrounds. RESULTS: The results show that children's KAP related to health and nutrition strongly reflect those of adults. They are not aware of a possible link between bad hygiene and the occurrence of diseases. According to them, diarrhoea or malaria is caused by consuming too large amounts of certain foods. Even if they know about certain elementary hygiene behaviours, they do not practise this in their everyday life. CONCLUSION: A major objective of the health education programme for children should be to tackle the discrepancy between hygiene-related knowledge and behaviour. Through the participatory study approach the children revealed their ability to contribute to the programme development. In using appropriate communication channels, the Child-to-Child health education programme is expected to influence the health behaviours of both adults and children. The health education programme should be combined with a literacy programme to address the children's desire to learn reading and writing.

A longitudinal assessment of the diet and growth of malnourished children participating in nutrition rehabilitation centres in Accra, Ghana.

OBJECTIVE: To examine the adoption of feeding recommendations among caregivers of children recuperating from malnutrition and assess the determinants of growth of children attending a nutrition rehabilitation centre (NRC) in Accra, Ghana. DESIGN: Longitudinal study in which attendance and maternal programme participation were recorded daily and children's anthropometry and dietary intake were measured at four time points (admission, interim, exit, post-exit) at the NRC and participants' homes. SETTING: NRCs at four polyclinics and participants' homes in Accra, Ghana. SUBJECTS: One hundred and eight caregivers and their 116 children referred to an NRC between November 1999 and July 2000. RESULTS: Most caregivers attended the NRC sporadically (effective length of stay was 1.4+/-0.1 months). Use of NRC-promoted foods in the home after discharge was low due to inaccessibility of the food items, lack of preparation knowledge or money, child preferences and the common practice of purchasing ready-to-eat foods. Although there were significant increases in children's weight-for-age (P=0.048) and weight-for-height (P=0.002) Z-scores between enrollment and discharge, most children discontinued programme participation before adequate recuperation. CONCLUSIONS: The NRC education did not address the use of street foods for child feeding and was unsuccessful in changing in-home feeding behaviour. The prominence of street foods in children's diets warrants re-evaluation of the NRC's educational approaches to enhance their responsiveness to caregivers' needs and effectiveness for the continued recuperation of malnourished children at home. NRC feeding strategies need improvement to ensure adequate provision of energy and nutrients to support catch-up growth in children.

Health and fitness series--6. Child health: how nutrition affects growth.

Dr Margaret Lawson summarises the relationship between childhood growth and nutrition, and the effect of early nutrition on health in later life. She explains why children should be encouraged to eat a varied diet that includes foods from each of the four main food groups. The need to monitor children's growth is discussed, as are some of the nutritional pitfalls that may prevent children achieving their optimum growth and health.

Time trends in the intrafamily distribution of dietary energy in rural India.

The intrafamily distribution of dietary energy in 5,458 households from seven states in India was assessed from 24-hour dietary recall data collected by the National Nutrition Monitoring Bureau during 1996-97. The energy consumption, expressed as percentage of recommended dietary intake (%RDI), of preschool children, schoolchildren, and adolescents was compared with that of adult men and women in the same households. Time trends in the intrafamily distribution of dietary energy were assessed by comparing the data with those collected in 1975-80 using the same procedures in the same villages. About one-third of the preschool children had an inadequate intake of energy, even when their adult counterparts had an adequate intake, whereas only about 7% of the preschoolers and their parents were consuming inadequate amounts of energy. The extent of energy inadequacy was much less in adolescents and school-age children than in preschool children. This was true even when the adults in the same households had an adequate energy intake. In 1996-97, there was a significant increase in the proportion of households with preschool children consuming inadequate energy, although both adult men and women were consuming energy-adequate diets as compared with the dietary data collected in the same villages in 1975-80. The results indicate the need to provide effective nutrition education for parents regarding the nutritional needs of their children.

Response to and range of acceptable fat intakes in infants and children.

The maximum and minimum fat intakes that are physiologically tolerable by healthy infants and young children are not well defined. The maximum tolerable fat intake appears to be limited by the minimum requirements of protein, carbohydrates and micronutrients. It is unresolved whether or not there is a minimum metabolic requirement of dietary fat, beyond the requirements of essential fatty acids and lipid soluble vitamins and the effects on energy density and an adequate total energy intake. The first postnatal months of the human infant are characterized by a rapid weight gain and extensive fat deposition. Body fat deposition equals 25% of the total energy intake during the first 2 and 16% during the third and fourth months, respectively. The provision of dietary lipids in amounts at least matching the needs for tissue storage and fat oxidation appears to be of advantage for energy balance and physiological growth. Some reports have associated low fat diets with less than 30% of energy as fat with adverse effects on child growth beyond infancy, but it remains unresolved whether these effects were caused by an associated effect on dietary energy density and total intake of energy and other nutrients. Closely supervised, healthy infants from an affluent population grew normally with a diet providing about 30% of the energy as fat from the seventh month of life onwards, but it is not known to what extent adaptive mechanisms such as a reduction of physical activity may have been required. It is not known whether infants and young children stressed by frequent occurrence of diarrhea and infections may adapt to a 30% fat diet as well or not. No evidence is available for a health benefit of a low total fat intake in infancy. In view of the limited available information, further research is required to define optimal fat intakes in early childhood since this question is of major importance for child health.