Provision of special diets to children in public nurseries and kindergartens in Kraków (Poland).

Background: A specialized diet could be due to an allergy or other medical needs and also religious or cultural reasons. This study aimed to assess the availability and provision of special diets in kindergartens and nurseries financed by the Municipality of Kraków. Methods: This observational cross-sectional study was based on a diagnostic survey carried out using the Computer-Assisted Web Interview method and addressed to the managers of nurseries (n = 21) and kindergartens (n = 71) and, separately, to the parents of children attending these facilities (n = 1,096). Non-parametric tests were applied for an unadjusted comparison between children at nurseries and those at kindergartens. Results: Children with particular dietary requirements received special diet meals in 95.2% of nurseries and 60.5% of kindergartens. The availability of special diets was associated with the type of facility (p = 0.001), the number of children who ate in the facility (p = 0.032), and the daily cost of meals served to children (p = 0.009). The cost of meals was higher in kindergartens that offered special diets vs. those that did not offer such diets (p < 0.001). According to parents, 96.4% of the total number of children ate meals served in the facilities. In nurseries, 16.1% of children were on a special diet (as per the doctor's recommendations in 11.7% of cases and according to parents' own choice in 4.4%). In kindergartens, a special diet was served to 12.7% of children (doctor's recommendations, 8.5%; parents' own choice, 4.2%). The most common reason for using a special diet was food allergy (8.2% of children in nurseries and 5.8% of children in kindergartens). It was reported more often by the parents of children attending nurseries than by the parents of children attending kindergartens (8.0% vs. 4.2%, p = 0.007). The requirement for a special diet was found to be associated with the age of children (p < 0.033) and the use of oral treatment for chronic disease (p < 0.001). Conclusion: Providing special diets for children is better in nurseries than in kindergartens. Legal regulations are urgently needed to ensure equal access to adequate nutrition for all children with special dietary needs in childcare facilities.

Fluid Intake and the Occurrence of Erosive Tooth Wear in a Group of Healthy and Disabled Children from the Malopolska Region (Poland).

Background: The aim of this study was to analyse the relationship between the type and amount of fluid intake and the incidence of erosive tooth wear in a group of healthy children and children with disabilities. Methods: This study was conducted among children aged 6-17 years, patients of the Dental Clinic in Kraków. The research included 86 children: 44 healthy children and 42 children with disabilities. The prevalence of erosive tooth wear using the Basic Erosive Wear Examination (BEWE) index was assessed by the dentist, who also determined the prevalence of dry mouth using a mirror test. A qualitative-quantitative questionnaire on the frequency of consumption of specific liquids and foods related to the occurrence of erosive tooth wear, completed by the children's parents, was used to assess dietary habits. Results: The occurrence of erosive tooth wear was determined for 26% of the total number of children studied, and these were mostly lesions of minor severity. The mean value of the sum of the BEWE index was significantly higher (p = 0.0003) in the group of children with disabilities. In contrast, the risk of erosive tooth wear was non-significantly higher in children with disabilities (31.0%) than in healthy children (20.5%). Dry mouth was significantly more frequently identified among children with disabilities (57.1%). Erosive tooth wear was also significantly more common (p = 0.02) in children whose parents declared the presence of eating disorders. Children with disabilities consumed flavoured water or water with added syrup/juice and fruit teas with significantly higher frequency, while there were no differences in quantitative fluid intake between groups. The frequency and quantity of drinking flavoured waters or water with added syrup/juice, sweetened carbonated, and non-carbonated drinks were associated with the occurrence of erosive tooth wear for all children studied. Conclusions: The group of studied children presents inappropriate drinking behaviours regarding the frequency and amount of beverages consumed, which, especially in a group of children with disabilities, may contribute to the formation of erosive cavities.

The Severity of Obesity Promotes Greater Dehydration in Children: Preliminary Results.

The state of hydration of the body depends on the balance between the amount of water and salt consumed and excreted (the urinary extraction of excess sodium requires water). Inappropriate nutrition, particularly consuming too much processed food, causes obesity in children and additionally causes excessive sodium consumption, thus increasing the risk of excessive water loss. The aim of this study was to assess the hydration status of children with obesity and the relation between hydration, body composition, urinary sodium extraction, and nutrient intake. The study group consisted of 27 patients with obesity, with a mean age of 12.89 ± SD 2.79. Each patient's height, weight, body composition (electrical bioimpedance (BIA)), diet (7-day record), and biochemical tests were assessed. The hydration status was assessed using 24-hour urine collection, 24-hour urine osmolality, and an ultrasound of the vena cava (IVC/Ao index). Overall, 55% of children (n = 15) had urine osmolality values above 800 mOsm/kgH2O, which indicates significant dehydration, and 53% (n = 14) were dehydrated, based on the IVC/Ao index. Children with obesity and dehydration had a significantly higher BMI (31.79 vs. 27.32; p = 0.0228), fat mass percentage (37.23% vs. 30.07% p = 0.0051), and fat mass in kg (30.89 vs. 20.55; p = 0.0158), and significantly higher sodium intake from their diet (3390.0 mg vs. 2921.0 mg; p = 0.0230), as well as their sodium/potassium ratio (2.4 vs. 2.0; p = 0.0043). The 24-hour urinary sodium excretion and osmolality values were directly related to fat-mass percentage and fat-mass (in kg) in a simple linear correlation analysis. Our preliminary results confirm that obesity is related to dehydration. The overall high sodium excretion in children with obesity indicates an excessive salt intake along with low potassium intake, which is a significant predictor of dehydration, regardless of the total water intake (TWI).

Proposition of a New POLA Index to Assess the Immunomodulatory Properties of the Diet and Its Relationship with the Gut Microbiota, Using the Example of the Incidence of COVID-19 in a Group of People without Comorbidities.

A rise in the incidence of infections with severe acute respiratory syndrome coronavirus 2 has sparked the search for protective strategies against the new pathogen. It is known that individual food components can interact with different immune cells, modulating the immune response of the body. The aim of this study was to develop an index assessing the immunomodulatory potential of diet (POLA index) and to test its utility for the prediction of coronavirus disease 2019 (COVID-19) in a group of healthy young people following a traditional or vegetarian diet. Data on body composition, anthropometric measurements, physical activity, dietary intake, and gut microbiota were obtained from 95 adults (mean age, 34.66 ± 5.76 years). There was a strong correlation between the dietary inflammatory index and the POLA index (r = 0.90; p < 0.0001). Based on Cohen's kappa statistic, there was a good agreement in qualitative interpretation between the two indices (kappa = 0.61; p < 0.0001). People on a diet with beneficial immunomodulatory effects had a lower risk of COVID-19 of approximately 80%, as compared with those on a diet with highly unbeneficial immunomodulatory effects. In daily practice, the POLA index might serve as a useful tool for dietitians to identify individuals whose diet is deficient in ingredients for optimal immune system function and change their dietary behavior to ensure optimal immune function that reduces the risk of infection.

Socio-Economic Factors Influencing the Use of Dietary Supplements by Schoolchildren from Malopolska Voivodship (Southern Poland).

The use of regular supplementation may be important in alleviating the potential effects of specific nutrient deficiencies. The aim of this cross-sectional study was to assess the socio-economic and lifestyle factors influencing the administration of dietary supplements to schoolchildren from the Malopolskie voivodship. The study was conducted in March-June 2018 on 332 healthy children and adolescents (187 boys, 145 girls) aged 7-14 from the city and municipality of Niepolomice and the city of Kraków. The mean age of the subjects was 10.35 + 1.64 years. In order to assess their diet, a questionnaire was completed, by the parents or the child, on the frequency of consumption of specific products and foods (Food Frequency Questionnaire, FFQ) with added questions on the supplements provided. In assessing nutritional status, basic anthropometric measurements were taken and the BMI index was analysed. To check which factors influenced the use of supplements among respondents, the odds ratio (OR) was calculated. Approximately one-third of the total number of subjects (33.8%) took dietary supplements, most often supplements containing vitamins D and C, followed by multivitamin supplements and omega-3 fatty acids. The least common supplements contained calcium and iron. Dietary supplement intake was significantly higher among children living in rural areas compared to city areas (39.3% vs. 26.5% of respondents; p = 0.0150), and among boys compared to girls (37.3% vs. 27.8%; p = 0.048). It was observed that children more often received dietary supplements in multigenerational families and in families where at least one parent did not work. This is related to the place of residence of the respondent. Awareness of the need for, and the safe use of, dietary supplements is necessary among parents of children and adolescents.

Associations of Nutritional Behavior and Gut Microbiota with the Risk of COVID-19 in Healthy Young Adults in Poland.

The numerous consequences of the coronavirus disease 2019 (COVID-19) pandemic in healthy young people and the lack of clarity as to the long-term disease outcomes have spurred the search for risk factors for SARS-CoV-2 infection. We aimed to evaluate the associations of nutritional behaviors, gut microbiota, and physical activity with the risk of COVID-19 in healthy young nonobese people. Data on body composition, anthropometric measurements, physical activity, dietary intake, and gut microbiota were obtained from 95 adults (mean age, 34.66 ± 5.76 years). A balanced diet rich in vegetables and fruit, including nuts, wholegrain cereal products, and legumes, covers the need for vitamins and minerals. Such a diet can be an effective measure to reduce the risk of COVID-19 in nonobese healthy physically active young people with normal immune function. People with balanced diet and an average daily consumption of >500 g of vegetables and fruit and >10 g of nuts had an 86% lower risk of COVID-19 compared with those whose diet was not balanced and who consumed lower amounts of these products. It is well documented that proper nutrition, physical activity, and maintenance of normal weight facilitate good health by ensuring optimal immune function. The beneficial effects of these interventions should be strongly emphasized during the COVID-19 pandemic.

Body Composition and a School Day Hydration State among Polish Children-A Cross-Sectional Study.

BACKGROUND: Little is known on the relationship between obesity and hydration level in children. To explore the possible association between children's hydration status and body composition, we conducted this cross-sectional study. METHODS: The survey was carried out in 2018 in Preliminary and High Schools from the Malopolska Province, Poland. The study group consisted of 264 children aged 7-15 years. The level of hydration was assessed based on urine osmolality during a school day. The examined had anthropometric tests and body composition assessment (FM, BF%, FFM, TBW, TBW%). Odds ratio (OR) and 95% confidence interval (CI) were calculated using a logistic regression analysis. RESULTS: In the study group, 9.5% of the examined were overweight, 7.2% obese, and it referred more to the country than towns (p < 0.05). Improper hydration was found in 53% of children, and 16.3% of them were severely dehydrated during a school day (urine osmolality > 1000 mOsm/kgH2O). The level of dehydration was higher in children with excessive body fat (BF%) than in children with normal BF% [903.00 vs. 775 mOsm/kgH2O]. Older age (>10 y) showed inverse association with dehydration [OR 0.52 (95% CI; 0.28-0.99)] and excessed BF% showed 2.3-fold increase in odds of dehydration during a school day [OR 2.39 (95% CI; 1.15-4.94)]. Improper hydration was a risk factor of difficulties with concentration declared by students during a school day OR 2.85 (95% CI; 1.16-6.99). CONCLUSIONS: Attention should be paid to appropriate hydration especially in children with excessive body fat content who feature a higher risk of dehydration and fluid demand.

Prevalence and Factors Associated with Thinness in Rural Polish Children.

A lot of attention has been focused on obesity, however, the other extreme-thinness-may lead to inhibition of physical and intellectual development. The aim was to assess the prevalence of thinness and determine the associated factors in children from rural populations. We used data from the cross-sectional sample of 3048 children, examined in schools from a district in southern Poland. The sample included 89% of the district departments, and included a proportion of rural and small town populations-a representative one for the region. Thinness was determined based on the criteria proposed by Cole and Lobstein. Biological, sociodemographic and lifestyle factors were analysed. The odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression analysis. The prevalence of thinness was 11.5% in boys and 13.5% in girls. In the younger group, it was similar in boys and girls at 11.8%; whereas in the older group, it was 11.1% and 14.5%, respectively. The prevalence of thinness Grade 3 in girls was two times higher than in boys. The increased index of leisure time physical activity was connected with thinness in prepubertal boys. The mechanism determining the development of thinness is very complex and further exploration of this trend is recommended.

Risk Factors and Prevalence of Abdominal Obesity among Upper-Secondary Students.

Inadequate eating habits, as well as a low level of physical activity, influence adipose tissue deposition. The aim of the study was to assess the prevalence of central obesity in upper-secondary students and to determine the factors related to its occurrence. The survey included 309 participants, aged 16 to 18 years from Krakow (Poland). Anthropometric measurements were taken during the periodic assessment of students' health status. An anonymous questionnaire was used to assess the nutritional and non-nutritional risk factors of participants. According to different methods of measurement, abdominal obesity (AO) was observed in 15.5% (WC-waist circumference), 10.7% (WHtR-waist to height ratio) or 21.7% (WHR-waist to hip ratio) participants. Abdominal obesity (WC) was significantly associated with family history of excess body weight and higher economic status of the family. The risk of AO (WC) was significantly lower among adolescents who declared higher physical activity. Boys who eat first breakfasts have lower AO risk according to WHtR interpretation. Abdominal obesity in gender group was related to the self-esteem of one's own appearance according to WHtR and WC. Abdominal obesity was associated with the family environment and modifiable lifestyle factors and was dependent on gender.

Evaluation of Caffeine Consumption among Pregnant Women from Southern Poland.

Caffeine is the most widely consumed stimulant worldwide, including by pregnant women. Products containing caffeine should be limited in accordance with the recommendations for pregnancy. The purpose of this study was to evaluate consumption of caffeinated products and daily caffeine intake from food by pregnant women. The study was conducted on a group of healthy pregnant women: attendees of antenatal classes (n = 70) and patients of an outpatient gynecological clinic (n = 70) from Krakow (Southern Poland). A questionnaire about the frequency of consumption of selected foods and drinks containing caffeine was used. The average caffeine content in food products obtained from other Polish studies was used to estimate average daily caffeine intake in our study group. Mean daily caffeine intake was 49.60 ± 59.15 mg/day and the maximum was 498.0 mg/day. The main sources of caffeine were as follows: black tea (bags, leaf), instant coffee and ground coffee. No statistically significant differences in caffeine intake between the groups were found. A weak negative correlation (rs) = -0.28 (p = 0.0208) between month of pregnancy and caffeine intake was observed among attendees of antenatal classes. Mean daily caffeine intake did not exceed the maximum recommended dose in our study group.

Prevalence of food neophobia in pre-school children from southern Poland and its association with eating habits, dietary intake and anthropometric parameters: a cross-sectional study.

OBJECTIVES: The present study aimed to assess the prevalence of food neophobia in pre-school children and its association with eating habits, dietary intake and anthropometric parameters. DESIGN: Cross-sectional survey performed in 2012-2013. The Child Food Neophobia Scale (CFNS) adapted by Wardle, Carnell and Cooke was used to assess the level of food neophobia. Dietary intake was measured using an FFQ and dietary records from three days. Anthropometric measurements were taken to determine children's nutritional status and BMI was computed based on Polish growth charts. Wilcoxon's rank test and Pearson's rank-correlation coefficient were applied to compare the level of food neophobia and frequency of consumption of food products and nutrient intakes. SETTING: Kindergartens in southern Poland located in or near Cracow. SUBJECTS: Three hundred and twenty-five pre-school children and their parents. RESULTS: Low neophobia was observed in 12·3 % and high neophobia in 10·8 % of the children examined. Children with a high level of neophobia were significantly less likely (P<0·05) to eat eggs, raw or cooked vegetables and legumes, whereas they tended to eat sweets and snacks more frequently; these foodstuffs were also eaten more often between meals. Because the neophobic children ate vegetables very rarely, their intakes of vitamin C (36 % of RDA) and thiamin (84 % of RDA) were far below the norms. No differences in anthropometric parameters according to level of food neophobia were observed. CONCLUSIONS: High levels of neophobia are associated with diet variation and may enhance the risk of nutritional deficiencies in children.

Policies to promote healthy eating in Europe: a structured review of policies and their effectiveness.

This review provides a classification of public policies to promote healthier eating as well as a structured mapping of existing measures in Europe. Complete coverage of alternative policy types was ensured by complementing the review with a selection of major interventions from outside Europe. Under the auspices of the Seventh Framework Programme's Eatwell Project, funded by the European Commission, researchers from five countries reviewed a representative selection of policy actions based on scientific papers, policy documents, grey literature, government websites, other policy reviews, and interviews with policy-makers. This work resulted in a list of 129 policy interventions, 121 of which were in Europe. For each type of policy, a critical review of its effectiveness was conducted, based on the evidence currently available. The results of this review indicate a need exists for a more systematic and accurate evaluation of government-level interventions as well as for a stronger focus on actual behavioral change rather than changes in attitude or intentions alone. The currently available evidence is very heterogeneous across policy types and is often incomplete.

Assessment of evaluations made to healthy eating policies in Europe: a review within the EATWELL Project.

OBJECTIVE: To identify and assess healthy eating policies at national level which have been evaluated in terms of their impact on awareness of healthy eating, food consumption, health outcome or cost/benefit. DESIGN: Review of policy documents and their evaluations when available. SETTING: European Member States. SUBJECTS: One hundred and twenty-one policy documents revised, 107 retained. RESULTS: Of the 107 selected interventions, twenty-two had been evaluated for their impact on awareness or knowledge and twenty-seven for their impact on consumption. Furthermore sixteen interventions provided an evaluation of health impact, while three actions specifically measured any cost/benefit ratio. The indicators used in these evaluations were in most cases not comparable. Evaluation was more often found for public information campaigns, regulation of meals at schools/canteens and nutrition education programmes. CONCLUSIONS: The study highlights the need not only to develop harmonized and verifiable procedures but also indicators for measuring effectiveness and success and for comparing between interventions and countries. EU policies are recommended to provide a set of indicators that may be measured consistently and regularly in all countries. Furthermore, public information campaigns should be accompanied by other interventions, as evaluations may show an impact on awareness and intention, but rarely on consumption patterns and health outcome.

[How to effectively change health behaviours of patients at old age]. / Jak skutecznie zmieniac zachowania zdrowotne pacjentów w starszym wieku.

UNLABELLED: In the frame of the international CHANGE Project a training course for nurses has been elaborated in order to improve their interpersonal communication skills in motivating older patients to change their health behaviours. Family nurses, caring for community-dwelling older patients applied their newly-developed competences to promote healthy nutrition and regular physical activity among their patients. OBJECTIVES: To assess the effectiveness of the nurse training. Changes in physical activity and nutritional habits of older patients resulting from nurses' performance were evaluated as well as patients' intentions to change those behaviours. METHODS: During the 2 weeks following the training 108 older patients at age avg. 69.6 (SD 60-87) in Krakow city, were initially interviewed by nurses with a questionnaire assessing health behaviours (frequency of intake of particular food products, frequency of different types of physical activity) and motivation to change those behaviours. The nurses provided consultancy directly after questionnaire interviews, then visited patients for consultancy at least once and repeated their assessment 6-8 weeks after the first one. Wilcoxon's matched pairs test and paired t-test were applied to measure the effectiveness of the intervention. RESULTS: The results have shown a significant improvement in duration (p<0.04) and frequency (p=0.0531) of walking, change of attitudes toward physical activity (p<0.003), and intentions to exercise regularly (p<0.01), higher level of self-satisfaction with personal physical capacity (p<0.006) and well-being (p<0.005). The frequency of intake of fresh fruit, vegetables and water (p<0.0001), pasta, cereal or bread (p<0.02) has also increased significantly. CONCLUSIONS: The nurses' training in motivating older patients to change their health behaviours exerted an effect on patients' health beliefs, intentions and health behaviours.

School health promotion: organization of services and roles of health professionals in seven European countries.

BACKGROUND: This comparative study is intended to provide a better understanding of how health promotion services are organized in school settings in Europe and to show how health professionals involved outside or within the school setting help to improve young people's health. METHODS: This study was based on an analysis of school health policies and the organization of school health services, where these existed, as well as on interviews with health and education professionals. The countries concerned were Belgium (French-speaking community), Denmark, France, Spain (Catalonia), Switzerland (Jura), Poland and Portugal. RESULTS: Although the provision of health services for children and adolescents varied considerably, the health services available were very similar in each of the countries. The emphasis put on particular aspects of these services varied depending on the political and institutional culture in each country. Three different types of school health service provision were identified: community-based, school-based or health needs-focused. CONCLUSION: All countries had health education and health promotion services but the provision of these services varied considerably from country to country. They were provided either by a specific category of professionals (health personnel or teachers) or considered to be the responsibility of the educational community as a whole.

[Influence of nutrition on selected metabolic cardiovascular risk factors among female residents of Krakow]. / Wplyw zywienia na wystepowanie wybranych metabolicznych czynników ryzyka chorób ukladu krazenia wsród mieszkanek Krakowa.

The study involved influence of nutritional factors on select anthropometrical and lipid indices (total cholesterol, LDL, HDL) in female residents of Krakow who were voluntarily participating in the investigation. Only women free of diagnosed cardiovascular diseases were included. The study group consisting of 100 women aged 30-65 years, was divided into two groups: pre-menopause (PM, n=47) and after menopause (AM, n=53). The anthropometrical measurements, % of fat tissue - Tanita scale and Body Mass Index (BMI) was calculated. The energy value and the consumption of basic nutrients intake were calculated using 24-hour recalls from the day before the examination. The AM group presented higher anthropometrical and metabolic risk profile: overweight and obesity (BMI-PM = 25.51 +/- 4.16 kg/m2; AM = 28.28 +/- 4.89 kg/m2) and central adiposity type (WC-PM = 81.04 +/- 10.00 cm; AM = 86.46 +/- 11.73 cm); lipids (Total cholesterol-PM = 5.14 +/- 0.87 mmol/l, AM = 5.67 +/- 1.10 mmol/l; LDL-chol-PM = 2.98 +/- 0.90 mmol/l, AM = 3.40 +/- 0.93 mmol/l; HDL-chol-PM = 1.65 +/- 0.39 mmol/l; AM = 1.63 + 0.46 mmol/l). The irregular participation of fatty acids, proteins from plant sources and dietary fibers in daily diet were found (%Energy PM: SFA = 11.66 +/- 4.34, MUFA = 10.91 +/- 4.04, PUFA = 4.76 +/- 2.75, Keys index = 41.89 +/- 14.91; %EnergyAM: SFA = 11.48 +/- 3.86, MUFA = 11.02 +/- 4.12, PUFA = 4.89 +/- 2.92, Keys index = 40.87 +/- 14.4). Women in the AM group represented healthier nutritional behaviors. Results presented indicate that in further study concerning evaluation of nutrients consumption among women the fact of natural menopause should be considered.