Effect of the Nutritional Intervention Program on Body Weight and Selected Cardiometabolic Factors in Children and Adolescents with Excess Body Weight and Dyslipidemia: Study Protocol and Baseline Data.

Excess body weight and associated dyslipidemia in children and adolescents are the main risk factors for cardiovascular diseases in young adults. There is a reasonable need to develop an effective lifestyle modification program that includes various dietary therapies. A low-glycemic index (GI) diet may be recommended in the treatment of obesity. Its use is also recognized as reasonable in cardiovascular diseases, including dyslipidemia. The aim of the presented nutritional intervention program was to evaluate the effectiveness of an energy-balanced diet based on the principal recommendation on Cardiovascular Health Integrated Lifestyle Diet-2 (CHILD-2) and low-GI products (LGI diet) in children and adolescents with excess body weight and dyslipidemia. The study involved 64 children and adolescents (44 boys and 20 girls) aged 8-16 with overweight or obesity and dyslipidemia. For 8 weeks, the participants followed a dietary treatment using two types of diets: one based on products with a low GI, and one standard therapy diet. During this time, they participated in three visits with a dietitian, during which the assessment of their current and habitual food intake was made, and anthropometric measurements and blood pressure were taken. Patients were under the care of a pediatrician who qualified them for the study and ordered lipid profile tests. This article presents the design, protocol of the nutritional intervention program, and baseline data. The collected results will be used to develop practical nutritional recommendations for children and adolescents with excess body weight and dyslipidemia.

Identification of Sociodemographic and Clinical Factors Influencing the Feeling of Stigmatization in People with Type 1 Diabetes.

BACKGROUND: A large percentage of people with type 1 diabetes experience stigma, which may directly affect diabetes management. Moreover, it may adversely influence the acceptance of the disease and, thus, the treatment process, including compliance with medical and dietary recommendations. Therefore, it is important to seek adequate forms of counteracting the phenomenon of stigmatization. Thus, the aim of the study was to determine the factors influencing the level of perceived stigma by T1D patients, with particular emphasis on sociodemographic factors (including sex, place of residence, and education) and clinical factors related to the course of the disease. METHODS: An observational cross-sectional online questionnaire was conducted in a group of 339 people with T1D. The link to the questionnaire was shared via social media. The DSAS-1 questionnaire translated into Polish was used as the research tool. RESULTS: A moderate level of stigmatization was found (49.78 ± 14.54 points). It was significantly lower in people living in small towns compared to rural residents (ß = -0.121, p = 0.038), lower in people in relationships compared to those who are single (ß = -0.175, p = 0.001), in people diagnosed with T1D at an older age (ß = -0.107, p = 0.048), and in those who rated their financial situation as very good vs. bad (ß = -0.314, p < 0.001). It was also found that the level of stigma significantly decreased with age (ß = -0.181, p = 0.001). In addition, a significantly higher stigma perception was uncovered in the group of people with HbA1C > 7% than in the group ≤ 7% (ß = 0.118, p = 0.030). CONCLUSIONS: Due to the occurrence of stigma among people with T1D, which can directly affect the management of diabetes, effective and comprehensive efforts should be made to provide support to people with diabetes. It is also necessary to raise awareness among the general public and disseminate knowledge about diabetes, which can reduce stigmatization as a result. Anti-stigma messages should be included in the prevention programs about the potential side effects and risks associated with mistreating people with T1D.

Sensitivity to Sweet and Salty Tastes in Children and Adolescents with Type 1 Diabetes.

Taste function impairment is observed in people with type 1 diabetes (T1D). It is most often related to sweet taste. It is associated with such factors as diabetic neuropathy, smoking, age, duration of the disease and a rigorous diet that eliminates easily digestible carbohydrates. The aim of the study was to compare sensitivity to sweet and salty tastes between healthy children and adolescents and children and adolescents with T1D. The study group consisted of children with T1D (n = 35), with at least 5 years of disease history, while the group of healthy children included 46 individuals selected in terms of age, gender and BMI. A study concerning the perception of sweet and salty taste was carried out with the use of the specific gustometry method (examining the recognition and assessment of the intensity of taste sensations, performing a hedonic assessment). Children and adolescents from both groups had trouble recognising tastes. Children and adolescents with T1D were more likely to recognise sweet taste correctly even at its lower concentrations compared to healthy individuals (p = 0.04). Salty taste was significantly more often correctly identified by healthy children compared to T1D patients (p = 0.01). Children and adolescents with T1D reported a stronger intensity of perceived tastes than healthy ones. No significant differences in perceived pleasure were noted at lower sucrose concentrations in any group. The intensity score was higher in individuals with T1D at higher sucrose concentrations. No significant differences occurred in the assessment of salty taste intensity. The hedonic scoring of solutions with higher concentrations of sweet taste was higher in people with T1D than in healthy ones, while salty taste was assessed neutrally. Children and adolescents with T1D were demonstrated to have some taste recognition disorders. Therefore, monitoring taste function in pediatric diabetic clinical practice seems relevant, as it may be associated with important implications for the intake of a particular type of food and for the development of eating habits and preferences.

Nutritional Education Is an Effective Tool in Improving Beverage Assortment in Nurseries in Poland.

The aim of the study was to assess the impact of education on improving the assortment of beverages served in nurseries in Poland. This analysis focused on beverages served to children with meals and between meals. We examined: water, tea, juices, soft/fruit drinks, compote, milk, cocoa, and coffee substitute. The study involved 93 nurseries enrolled in the Eating Healthy, Growing Healthy project and was conducted from 2015 to 2017. Nutritional education was carried out by dieticians or nutritionists and included 24 h of lectures given to the staff of nurseries. Training was conducted in a form of workshops that were divided into 12 topics. Additionally, consultations regarding infants and young children nutrition were available to the staff. Typically, education training was completed within 1-2 months in each nursery. The effectiveness of education was verified based on data on beverage supply in 186 ten-day menus, 1860 daily inventory reports before (at baseline), and 3-6 months after staff training (post baseline). Data were analyzed in a total group, and separately for public and non-public nurseries. Statistical analyses for categorical variables were done with Chi2 Pearson test. The differences were considered significant at p < 0.05. After education, a significant increase in the supply of water as a beverage served with meals was observed in all nurseries (68% vs. 87%; p = 0.002), both in public (72% vs. 90%, p = 0.036) and non-public (62% vs. 84%, p = 0.017) ones. Moreover, a decrease in served tea was noted: in all nurseries (71% vs. 44%, p < 0.001) and in public nurseries (77% vs. 42%, p < 0.001). Water was available between meals in almost all nurseries. Nutritional education for staff is an important tool for improving adherence to the nutritional recommendation in the case of core beverage supply in Polish nurseries.

Impact of Lifestyle Intervention Programs for Children and Adolescents with Overweight or Obesity on Body Weight and Selected Cardiometabolic Factors-A Systematic Review.

Excessive body mass is a health problem among children and adolescents that contributes to the occurrence of lipid disorders and abnormal blood pressure. Effective treatment of excessive body mass in children is essential for the health of population in the future. The aim of the study was to identify universal components of lifestyle interventions in children and adolescents with overweight or obesity leading to weight loss and improvement of selected cardiometabolic parameters. The review included studies from the PubMed and Google Scholar databases published in 2010-2019, which were analyzed for eligibility criteria including age of the participants, BMI defined as overweight or obese, nutritional intervention and the assessment of BMI and/or BMI z-score and at least one lipid profile parameter. Eighteen studies were included in the review, presenting the results of 23 intervention programs in which a total of 1587 children and adolescents participated. All interventions, except one, were multi-component. Data analysis suggests a relationship between a decrease in BMI and/or BMI z-score with diet and physical activity, the involvement of a dietician/nutrition specialist and physician in the treatment team and a longer duration of intervention. Moreover, it seems that a decrease in BMI is mostly associated with decreases in total cholesterol, triglycerides, low density lipoprotein cholesterol and blood pressure. No change in BMI and/or BMI z-score is associated with no change in blood pressure. Our data can be used by public health authorities to design effective weight loss programs for children and adolescents.

Dissatisfaction with Body Weight among Polish Adolescents Is Related to Unhealthy Dietary Behaviors.

The aims of the study were to determine the socio-demographic factors that may affect body weight dissatisfaction and to analyze the relationship between eating habits and dissatisfaction with body weight among a national random sample of Polish adolescents aged 13-19 years. Data on gender, age, level of education, body weight status, screen time, body weight satisfaction and selected nutritional behaviors were collected using a questionnaire. Body mass status was assessed based on weight and height measurements. A total of 14,044 students from 207 schools participated in the study. A significant effect of gender, age, level of education, body weight status and screen time status on the participants' dissatisfaction with the body weight was observed. The greater prevalence of body weight satisfaction was observed among boys, younger subjects, secondary school students, adolescents with normal body weight status and those with screen time up to 2 h. Whereas girls, older study participants (17-19 years old), overweight/obese adolescents and subjects with screen time over 4 h were more often dissatisfied with body weight. Furthermore, it has been shown that participants dissatisfied with their body weight less often met dietary recommendations. These findings can help dietitians, nutritionists and healthcare professionals to provide age-specific and gender-specific nutrition strategies to promote healthy lifestyle among school-going adolescents.

Reduced Screen Time is Associated with Healthy Dietary Behaviors but Not Body Weight Status among Polish Adolescents. Report from the Wise Nutrition-Healthy Generation Project.

Screen time (ST) not only affects physical activity but can also be associated with dietary behaviors. Both of these factors determine the health and development of adolescents. The aims of the study were: 1. to analyze the relationship between ST and nutritional behaviors among adolescents; 2. to examine this association in relation to body weight status. Data on the ST duration and nutritional behaviors were collected using a questionnaire. Body mass status was assessed based on weight and height measurements. A total of 14,044 students aged 13-19 years old from 207 schools participated in the study. A significant relationship between ST and gender, age and type of school was observed, but not body weight status. The average ST duration increased with age (from 2.6 h among 13 years old to 3.2 h among 19 years old), and was significantly higher among boys in all age categories (2.7 h vs. 2.5 h in the youngest age group, and 3.5 h vs. 3.0 h in the oldest age group, respectively). The chance for meeting the recommendation for ST in a group of girls (regardless of age) was almost 50% higher compared to boys. Meeting ST recommendation (≤2 h) was associated with a greater odds ratio for favorable nutritional behaviors in the whole group, with exception of drinking milk or milk beverages, and significantly reduced the odds ratio of adverse dietary behaviors (drinking sweet beverages, consumption of sweets and fast food) in the whole group and by gender. More research is needed to clarify the possible cause-and-effect relationships between ST and dietary behaviors.

Eating Healthy, Growing Healthy: Outcome Evaluation of the Nutrition Education Program Optimizing the Nutritional Value of Preschool Menus, Poland.

Staff education can improve the quality of nutrition in childcare centers, but an objective assessment of the change is necessary to assess its effectiveness. This study evaluated the effectiveness of the multicomponent educational program for improving the nutritional value of preschools menus in Poland measured by the change in nutrients content before (baseline) and 3-6 months after education (post-baseline). A sample of 10 daily menus and inventory reports reflecting foods and beverages served in 231 full-board government-sponsored preschools was analyzed twice: at baseline and post-baseline (in total 4620 inventory reports). The changes in 1. the supply of nutrients per 1 child per day; 2. the nutrient-to-energy ratio of menus; 3. the number of preschools serving menus consistent with the healthy diet recommendations, were assessed. Education resulted in favorable changes in the supply of energy, fat and saturated fatty acids. The nutrient-to-energy ratio for vitamins A, B1, B2, B6, C, folate and minerals Calcium, copper, iron, magnesium, phosphorus, potassium and zinc increased significantly. The percentage of preschools implementing the recommendations for energy, share of fat, saturated fatty acids and sucrose as well as calcium, iron and potassium increased significantly. However, no beneficial effects of education on the content of iodine, potassium, vitamin D and folate were observed. This study indicates the potentially beneficial effect of education in optimizing the quality of the menu in preschools. However, the magnitude of change is still not sufficient to meet the nutritional standards for deficient nutrients.

Nutritional Behaviors of Polish Adolescents: Results of the Wise Nutrition-Healthy Generation Project.

BACKGROUND: Recognition of the dominant dietary behaviors with respect to gender and specific age groups can be helpful in the development of targeted and effective nutritional education. The purpose of the study was to analyze the prevalence of the selected eating behaviors (favorable: Consuming breakfasts, fruit, vegetables, milk and milk beverages, whole grain bread and fish; adverse: Regular consumption of sweets, sugared soft drinks and fast-foods) among Polish adolescents. METHODS: Data on the nutritional behaviors were collected using a questionnaire. Body mass status was assessed based on weight and height measurements. RESULTS: 14,044 students aged 13-19 years old from 207 schools participated in the study. Significant differences were found in the nutritional behaviors depending on age, gender and nutritional status. Favorable nutritional behaviors corresponded with each other, the same relationship was observed for adverse behaviors. The frequency of the majority of healthy eating behaviors decreased with age, whereas the incidence of adverse dietary behaviors increased with age. Underweight adolescents more often consumed sugared soft drinks, sweets and fast food compared to their peers with normal and excessive body mass. CONCLUSIONS: A significant proportion of adolescents showed unhealthy nutritional behaviors. Showing changes in the incidence of nutritional behaviors depending on age, gender and body weight status, we provide data that can inform the development of dietary interventions tailored to promote specific food groups among adolescents on different stages of development to improve their diet quality.

Types of Milk and/or Its Substitutes Are Given to Children (6⁻36 Months) in Nurseries in Poland: Data from the Research and Education Project "Eating Healthy, Growing Healthy".

The purpose of the study was to evaluate the types of milk and/or its substitutes given to children (aged 6⁻36 months) in nurseries in Poland. Methods: The study was conducted in 211 nurseries across Poland. The supply of milk and its substitutes was checked in ten-day menus and inventory documents. In total, 211 ten-day menus and 2110 daily inventory reports were analyzed. Additionally, data were obtained by interviews with day-care center (DCC) directors and/or staff responsible for nutrition. Results: Compared to non-public nurseries, public ones were characterized by a higher average number of children, most often maintained their own kitchens, and charged a lower financial fee. Public DCCs also more often employed dietitians. The type of milk and its substitutes offered to children in nurseries was dependent on the age of the children and type of DCC. In a larger percentage of public DCCs infants received a milk formula, and in smaller percentage they received breast milk. This regularity also occurred in older children's diets (13⁻36 months). In toddlers' diets in public nurseries, cow's milk was more common. The share of other milk substitutes in the nutrition of children from both age groups was negligible. Conclusion: The types of milk given to children in nurseries in Poland varied and depended on the age of children and the type of DCCs. It is necessary to provide education to DCC staff regarding the type of milk recommended for children under one year of age.

Impact of Nutrition Education on the Compliance with Model Food Ration in 231 Preschools, Poland: Results of Eating Healthy, Growing Healthy Program.

To ensure the adequate supply of nutrients, a model food ration (MFR) should be used for planning the menu. The purpose of the study was to determine the effects of the nutrition education program on the compliance with MFR in 231 preschools. The average supply of food products (per child/day) with reference to the MFR was examined on the baseline and 3 to 6 months after education on the basis of 10-day menus and daily inventory reports (4620 in total). According to the recommendations, preschool should implement 70⁻75% of the recommended daily intake standards. Examined menus had too high content of meat and meat products, whereas vegetables, milk and fermented milk beverages, cottage cheese and eggs were served in scarce. Education significantly reduced the amount of meat (47.7 vs. 44.5 g), processed meat (16.2 vs. 14.4 g), sugar and sweets (15.9 vs. 14.4 g) and increased the amount of cereals, groats, rice (17.7 vs. 18.5 g), vegetables (164.3 vs. 170.8 g), milk and fermented milk beverages (200.3 vs. 209.5 g) but the compliance with the MFR remained poor. The evaluation of menus stressed the need for further modifying their composition. Education can positively affect the quality of nutrition; however, introduction of the legal nutritional regulations should be recommended.

Eating Healthy, Growing Healthy: Impact of a Multi-Strategy Nutrition Education on the Assortments of Beverages Served in Preschools, Poland.

Day-care centers are the ideal place for conducting nutrition intervention to improve children’s nutrition. The aim of this study is to evaluate the effectiveness of a multi-strategy childcare-base intervention in improving compliance with nutrition guidelines regarding beverages supply in preschools. The intervention included the staff training, audit, feedback, and ongoing support provided by trained educators. The emphasis was put on adequate nutrition, including recommended beverages, reducing sugar-sweetened beverages and increasing water availability. Enrolled were 478 full-board preschools from Poland (4.2% of all preschools in the country). The assortment of beverages served to children within ten consecutive days was assessed based on menus and inventory reports at the baseline, and three months after the intervention. Education increased significantly the percentage of preschools serving water to meals and between meals (67% vs. 83% and 93% vs. 99%, respectively), fruit/herbal tea (75% vs. 81%), and natural fruit juices (46% vs. 56%). The percentage of preschools offering fruit/soft drinks decreased from 23% to 15%. This study shows that education has a great potential in improving the assortment of beverages served in preschools. Future research is needed to determine barriers in better optimizing the assortment of beverages in preschool settings.

Implementation of Dietary Reference Intake Standards in Preschool Menus in Poland.

Although the nutritional value of preschool menus largely determines the proper nutrition of attending children, their nutrient composition often does not meet the standards. The purpose of the study was to assess the nutritional value of menus served in preschools throughout Poland. We analyzed a sample of 10 daily menus and inventory reports reflecting foods and beverages served in 270 full-board government-sponsored preschools. Nutrient content was calculated per child per day, and compared with 70% of dietary reference intake (DRI) for children aged 1⁻3 and 4⁻6. The content of energy, protein, fat, and carbohydrates generally exceeded 70% of DRI. The amount of vitamins was correct, with the exception of vitamin D (100% of daycare centers (DCCs) were below the recommendations); in ≤3% of preschools vitamin E, folate, and niacin were below DRI. Calcium was too low in 63% of preschools for children aged 1⁻3 years and in 99% for 4⁻6-year-olds. A shortage of iodine, iron, and potassium (especially for 4⁻6-year-olds) was observed in a small number of preschools. Our study highlights the need for uniform legal standards of nutrition in childcare centers, based on the current recommendations for the age group.

Nutrition practices in nurseries in Poland - initial results of nationwide study

Background: Rational nutrition of infants and toddlers is essential for their normal growth and development, and for the development of proper nutritional habits. It should be preceded by proper planning. Objective: The aim of the study was to evaluate of the planning and organization of nutrition in nurseries. Material and methods: In the research conducted within the program "Eating healthy, growing healthy" (EHGH), 128 crèches from all over Poland participated. The nurseries were attended by 8182 children under the age of 3. The research was carried out between 2015 and 2016. Data on the organization and quality of nutrition were collected through direct interviews with directors and / or staff responsible for feeding in crèches. In addition, analysis of the decade's menu of the participating institutions (128 menus) and daily inventory reports (1280 documents) were analyzed. The data were analyzed for the total number and the type (public and non-public) of institution. The program Statistica Version 13.1 was used. Results: Half of the surveyed DCCs planned in the menu whole grains, nearly all of them served fresh vegetables and fruits to the children, and every third added them to every meal. The most common drink during the meal was compote. Access to water between meals was offered to children in majority of the DCCs. The quality of diet was differentiated by the type of nursery: depending on the type (public vs non-public), the differences in salting and sweetening meals have been shown. Public DCCs had a much lower average amount of money allocated per day to feed a child compared to non-public, most of these managed own kitchens and did not employ a dietitian. Despite the higher nutritional rates in non-public crèches, some errors in nutrition planning have been observed. Conclusions: Higher average amount of money allocated per day to feed a child in non-public nurseries did not provide adequate nutrition. There is a need to publish standardized, understandable and practical recommendations in nutrition of children in nurseries. Adopting such recommendations in daily practice in all public and non-public crèches should improve the nutrition of children.

Nutrition-related practices in kindergartens in the context of changes to legal regulations on foodstuffs used in canteen menus for children

Background: In order to improve the quality of nutrition in care and educational institutions, in year 2015 a restrictive law regulation was introduced. The following year this regulation was withdrawn, and a new legal policy has been introduced. However, data on the impact of these legislations on nutrition in kindergartens are lacking. Objective: The aim of the study was to evaluate the compliance with mandatory nutrition recommendations in preschools. Material and methods: The study included 706 institutions. Data were collected during the periods when two consecutive Regulation of the Minister of Health were in force (I - 01.09.2015 - 31.08. 2016 and II - 01.09.2016 to 30.05.2017). Data were obtained by face-to-face interviews with staff with a validated questionnaire. Parameters characterizing the quality of nutrition were analyzed with focus on compliance with legal regulations. 706 decade's menus and 7060 daily inventory reports were analyzed to verify information on vegetables and fruit supply, frequency of frying and type of fat used, sweetening and salting practices. Statistical significances were determined in Statistica 13.1 with t-Student and Chi2 tests (p< 0.05).The study included 706 institutions. Data were collected during the periods when two consecutive Regulation of the Minister of Health were in force (I - 01.09.2015 - 31.08. 2016 and II - 01.09.2016 to 30.05.2017). Data were obtained by face-to-face interviews with staff with a validated questionnaire. Parameters characterizing the quality of nutrition were analyzed with focus on compliance with legal regulations. 706 decade's menus and 7060 daily inventory reports were analyzed to verify information on vegetables and fruit supply, frequency of frying and type of fat used, sweetening and salting practices. Statistical significances were determined in Statistica 13.1 with t-Student and Chi2 tests (p< 0.05). Results: The preschools have implemented regulations concerning the supply of fresh fruit and vegetables (~93%), the amount of fried dish per week (~75%), and the use of suitable frying fat (~95%). About half of institutions managed to serve vegetables and/or fruits in every meal. Compliance with the regulations on sweetening and salting was unsatisfactory: about » of institutions used banned sugar, and 46% regular salt. Conclusions: Legislations influenced nutrition practices in preschools, but additional support is needed to bring all institutions into compliance with the current policies. The current law regulations are general, and allow a great flexibility in planning menus, which might has an adverse effect on menus quality. Therefore, nutrition education and more detailed mandatory nutrition standards for kindergartens are crucial.

Do Preschools Offer Healthy Beverages to Children? A Nationwide Study in Poland.

BACKGROUND: Children's beverage consumption patterns have received increased attention in light of the obesity epidemic in this group. In day care centers (DCCs), children spend up to 10 h a day, and typically consume half to three quarters of their daily food intake. The purpose of the study was to investigate what beverages are typically served to children in preschools in Poland, and to evaluate the practices associated with adding sugar and other sweetening agents to beverages. METHODS: Direct interviews with preschools staff were conducted with a questionnaire regarding offered beverages and adding sugar and other sweetening agents. The menu of 10 consecutive days and inventory reports were analyzed to verify information. RESULTS: A total of 720 preschools were included in the study. Cocoa and milk coffee substitute were served in 95% of preschools, followed by compote (92%), tea (84%), fruit/herbal tea (73%) and water (69%). Water was the only beverage available between meals (93% DCCs). 86% of preschools added sugar to tea/cocoa/coffee substitute drinks, and 74% to compote. CONCLUSIONS: In the majority of preschools, beverages which are not recommended were offered. Such an assortment of beverages and common practice of sweetening can increase the amount of added sugar in a children diet. Nutrition education and legal regulations concerning the assortment of beverages served in preschools are urgently needed.

[The assessment of nutritional habits of men with coronary heart disease over 60 years old]. / Ocena sposobu zywienia pacjentów z niedokrwienna choroba serca w wieku powyzej 60 lat.

The objective of the research was to assess nutritional habits of men with coronary heart disease aged > 60 years old (n=132), stratified by educational level. The examined men were divided into 3 groups: group I--men with primary education (n=33), group II--men with secondary education (n=42), group III--men with higher education (n=57). Nutritional habits of examined men were assessed on the basis of a 3-day food record. The research showed that nutritional habits of examined men were characterized by too much saturated fat and cholesterol and were in accordance to hipolipemic diet. Educational level did not significantly influence the parameters of the subjects' diet, but had an impact on the structure of the intake of selected products.