Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers' Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study.

BACKGROUND: The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. OBJECTIVE: This study aims to explore schoolchildren's knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. METHODS: A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. RESULTS: We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8% girls). Of the caregivers, 83% (3267/3937) were mothers, and 56.5% (2223/3937) had a secondary education. Only 5.2% (203/3937) of schoolchildren's homes did not have internet access; such access was through WiFi (2151/3937, 54.6%) and mobile internet (1314/3937, 33.4%). In addition, 95.3% (3753/3937) of schoolchildren's homes had a mobile phone; 31.3% (1233/3937) had computers. In relation to children's knowledge on healthy eating, 42.2% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7%) preferred to use a mobile phone. Only 38.3% (1509/3937) indicated they preferred a computer. In addition, 47.9% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. CONCLUSIONS: The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers' perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren's nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating.

Iron status and hemoglobin adjustment by altitude to define anemia in children aged 6 to 8 months living in Lima, Arequipa, Cusco and Puno. / Estado de hierro y propuesta de ajuste de hemoglobina por altitud en niños de 6 a 8 meses residentes en Lima, Arequipa, Cusco y Puno.

OBJECTIVE.: To describe the iron status profile and to propose hemoglobin adjustment factors for altitude for children aged 6 to 8 months in Lima, Arequipa, Cusco and Puno. MATERIALS AND METHODS.: Cross-sectional study in children aged 6 to 8 months from four cities. We measured hemoglobin and other iron biomarkers, C-reactive protein (CRP), among others. To estimate the adjustment equation, we applied an exponential regression. We excluded children with iron deficiency (ID) and/or inflammation. RESULTS.: The proportions of ID were higher in Puno and Arequipa, while inflammation did not exceed 19% in any of the cities. Hemoglobin showed an exponential increase at higher altitude. The adjustment equation was: 10.34249 x (1.00007 ^ Alt). CONCLUSIONS.: Children residing in Arequipa and Puno showed higher rates of ID and lower iron reserves; furthermore, the increase in hemoglobin by altitude was exponential, showing the need to adjust hemoglobin at altitude.

OBJETIVOS.: Caracterizar el estado del hierro y proponer factores de ajuste de hemoglobina por altitud, en niños de 6 a 8 meses de Lima, Arequipa, Cusco y Puno. MATERIALES Y MÉTODOS.: Estudio transversal en niños de 6 a 8 meses de edad en cuatro ciudades, se midió hemoglobina y otros biomarcadores de hierro, Proteína C reactiva (PCR), entre otros. Para estimar la ecuación de ajuste, se aplicó una regresión exponencial y excluimos a los niños con deficiencia de hierro (DH) y/o inflamación. RESULTADOS.: Las proporciones de DH fueron mayores en Puno y Arequipa, mientras que la inflamación no superó el 19% en ninguna de las ciudades. La hemoglobina mostró un incremento exponencial a mayor altitud. La ecuación de ajuste fue: 10,34249 x (1,00007

Analysis of the distribution of macronutrients of food baskets delivered by municipalities during the COVID-19 pandemic in Peru. / Análisis de la distribución de macronutrientes en canastas alimentarias entregadas por las municipalidades durante la pandemia de COVID-19 en Perú.

OBJECTIVES.: To evaluate and compare the macronutrient distribution of the food baskets delivered by Peruvian municipalities during the COVID-19 pandemic according to the geographic domain and assigned budget level. MATERIALS AND METHODS.: Secondary analysis of the database "Consultation of Acquisition and distribution of basic necessities of the basic family basket" of the General Comptroller of the Republic. Stratified probability sampling was carried out. The caloric intake distribution was calculated according to macronutrients and compared with the Acceptable Intervals of Macronutrient Distribution (IADM) of the Nutrition Institute of Central America and Panama (INCAP) and the National Institute of Civil Defense (INDECI). RESULTS.: At the national level, the median caloric intake of proteins was 7.7%; for carbohydrates it was 62.5%; and for fats it was 28.1%. The proportion of municipalities with protein deficit was 84%; Municipalities with excess carbohydrates ranged from 16.5% (according to INCAP) to 35.9% (according to INDECI), and with excess fat, it was between 61.6% (according to INCAP) and 20.2% (according to INDECI). According to INDECI, nationally only 9.2% of municipalities delivered baskets with an adequate distribution of macronutrients; Metropolitan Lima stands out with the highest proportions of adequate baskets, while in the Jungle region this percentage was less than 5%. CONCLUSIONS.: Most of the baskets delivered did not have adequate macronutrient distribution. Especially the baskets of municipalities outside of Metropolitan Lima or those that had smaller budget. Carbohydrates and fats were the nutrients that were included in excess, while proteins were deficient.

OBJETIVOS.: Evaluar y comparar la distribución de macronutrientes de las canastas alimentarias entregadas por las municipalidades peruanas durante la pandemia de COVID-19 según dominio geográfico y nivel de presupuesto asignado. MATERIALES Y MÉTODOS.: Análisis secundario de la base de datos «Consulta de adquisición y distribución de bienes de primera necesidad de la canasta básica familiar¼ de la Contraloría General de la República. Se realizó un muestreo probabilístico estratificado. Se calculó la distribución del aporte calórico según macronutrientes y se comparó con los intervalos aceptables de distribución de macronutrientes (IADM) del Instituto de Nutrición de Centro América y Panamá (INCAP) y del Instituto Nacional de Defensa Civil (INDECI). RESULTADOS.: A nivel nacional la mediana del aporte calórico de las proteínas fue 7,7%; carbohidratos 62,5%, y grasas 28,1%. La proporción de municipalidades con canastas con déficit de proteínas fue de 84%. Las municipalidades con canastas con exceso de carbohidratos variaron de 16,5% (según INCAP) a 35,9% (según INDECI) y con exceso de grasas fue 61,6 % (según INCAP) y 20,2% (según INDECI). Según INDECI, a nivel nacional solo el 9,2% de municipalidades entregaron canastas con distribución adecuada de macronutrientes, aquí destaca Lima Metropolitana con las proporciones más altas; mientras que en la selva este porcentaje fue menor del 5%. CONCLUSIONES.: La mayoría de las canastas entregadas no tuvieron distribución adecuada de macronutrientes, en especial las canastas de municipalidades fuera de Lima Metropolitana o las que contaban con menor presupuesto. Los carbohidratos y las grasas fueron los nutrientes que se incluyeron en exceso, mientras que las proteínas tuvieron déficit.

Análisis de la distribución de macronutrientes en canastas alimentarias entregadas por las municipalidades durante la pandemia de COVID-19 en Perú / Analysis of the distribution of macronutrients of food baskets delivered by municipalities during the COVID-19 pandemic in Peru

RESUMEN Objetivos. Evaluar y comparar la distribución de macronutrientes de las canastas alimentarias entregadas por las municipalidades peruanas durante la pandemia de COVID-19 según dominio geográfico y nivel de presupuesto asignado. Materiales y métodos. Análisis secundario de la base de datos «Consulta de adquisición y distribución de bienes de primera necesidad de la canasta básica familiar¼ de la Contraloría General de la República. Se realizó un muestreo probabilístico estratificado. Se calculó la distribución del aporte calórico según macronutrientes y se comparó con los intervalos aceptables de distribución de macronutrientes (IADM) del Instituto de Nutrición de Centro América y Panamá (INCAP) y del Instituto Nacional de Defensa Civil (INDECI). Resultados. A nivel nacional la mediana del aporte calórico de las proteínas fue 7,7%; carbohidratos 62,5%, y grasas 28,1%. La proporción de municipalidades con canastas con déficit de proteínas fue de 84%. Las municipalidades con canastas con exceso de carbohidratos variaron de 16,5% (según INCAP) a 35,9% (según INDECI) y con exceso de grasas fue 61,6 % (según INCAP) y 20,2% (según INDECI). Según INDECI, a nivel nacional solo el 9,2% de municipalidades entregaron canastas con distribución adecuada de macronutrientes, aquí destaca Lima Metropolitana con las proporciones más altas; mientras que en la selva este porcentaje fue menor del 5%. Conclusiones. La mayoría de las canastas entregadas no tuvieron distribución adecuada de macronutrientes, en especial las canastas de municipalidades fuera de Lima Metropolitana o las que contaban con menor presupuesto. Los carbohidratos y las grasas fueron los nutrientes que se incluyeron en exceso, mientras que las proteínas tuvieron déficit.

ABSTRACT Objectives. To evaluate and compare the macronutrient distribution of the food baskets delivered by Peruvian municipalities during the COVID-19 pandemic according to the geographic domain and assigned budget level. Materials and methods. Secondary analysis of the database "Consultation of Acquisition and distribution of basic necessities of the basic family basket" of the General Comptroller of the Republic. Stratified probability sampling was carried out. The caloric intake distribution was calculated according to macronutrients and compared with the Acceptable Intervals of Macronutrient Distribution (IADM) of the Nutrition Institute of Central America and Panama (INCAP) and the National Institute of Civil Defense (INDECI). Results. At the national level, the median caloric intake of proteins was 7.7%; for carbohydrates it was 62.5%; and for fats it was 28.1%. The proportion of municipalities with protein deficit was 84%; Municipalities with excess carbohydrates ranged from 16.5% (according to INCAP) to 35.9% (according to INDECI), and with excess fat, it was between 61.6% (according to INCAP) and 20.2% (according to INDECI). According to INDECI, nationally only 9.2% of municipalities delivered baskets with an adequate distribution of macronutrients; Metropolitan Lima stands out with the highest proportions of adequate baskets, while in the Jungle region this percentage was less than 5%. Conclusions. Most of the baskets delivered did not have adequate macronutrient distribution. Especially the baskets of municipalities outside of Metropolitan Lima or those that had smaller budget. Carbohydrates and fats were the nutrients that were included in excess, while proteins were deficient.

Validación del cuestionario de elección de alimentos en jóvenes de Lima Metropolitana, Perú, 2017

RESUMEN En el actual contexto de transición nutricional es necesario explorar los factores que afectan la elección de alimentos en la población peruana, por ello el objetivo del estudio fue validar el instrumento Food Choice Questionnaire (FCQ) en Lima Metropolitana. Se realizó un estudio de corte transversal para validar el instrumento FCQ diseñado por Steptoe. Se desarrollaron 4 etapas: revisión del FCQ y adecuación al español, validación semántica y de contenido con expertos, validación de constructo utilizando el análisis factorial de componentes principales y análisis de fiabilidad con el Alfa de Cronbach. Los resultados de la validez semántica y de contenido permitieron obtener un instrumento modificado agregándose el factor "Entorno social". En la validación de constructo se realizó un análisis factorial y luego de 4 iteraciones se depuraron 7 ítems resultando un instrumento con 10 factores y 36 ítems, que respondían al 62,6% de la varianza; posteriormente con los resultados del análisis de fiabilidad, el cuestionario FCQ se redujo a 8 factores y 32 ítems. En conclusión, se obtuvo una versión validada del cuestionario FCQ para ser utilizado en población de 18 a 29 años de la capital del Perú. El cuestionario validado consta de 8 factores incluyéndose el "Entorno social". Son necesarios otros estudios en diferentes regiones y grupos poblacionales para recoger nuevos factores que influyen en la elección de alimentos.

ABSTRACT In the current nutrition transition context, the exploration of associated factors with food choices in the Peruvian population is necessary; therefore the study's objective was to validate the Food Choice Questionnaire (FCQ) in Metropolitan Lima. A cross-sectional design was conducted to validate the FCQ instrument designed by Steptoe. It was developed in 4 stages: FCQ's review and adaptation to Spanish, semantic and content validation with experts, construct validity using factorial analysis of principal components, and reliability analysis using Cronbach's Alpha. The results of the semantic and content validity produced a modified instrument with one "social environment" factor and 6 more items. For construct validity, a factorial analysis was performed and after 4 iterations, 7 items were removed, resulting an instrument with 10 factors and 36 items, which explained 62.6% of the variance. Finally, with the results of the reliability analysis, the FCQ questionnaire was reduced to 8 factors and 32 items. In conclusion, a validated version of the FCQ questionnaire was obtained to be used in 18 to 29 years old population of the capital city of Peru. The questionnaire validated consists of 8 factors including the "social environment". Other studies in different regions and population groups are necessary to collect new factors that influence food choices.