© Borgis - Postępy Nauk Medycznych 12/2012, s. 940-946
*Zofia Chwojnowska, Jadwiga Charzewska, Bożena Wajszczyk, Elżbieta Chabros, Aleksandra Urbańska
Niedobory żywieniowe w dietach dzieci przedszkolnych
Nutritional deficiencies in the diets of preschool children
Epidemiology of Nutrition and Dietarty Reference Intakes Labolatory, National Food and Nutrition Institute, Warsaw
Head of the Laboratory: prof. Jadwiga Charzewska, PhD biol. sc.
Wstęp. W okresie dzieciństwa organizm potrzebuje różnorodnych witamin i składników mineralnych w odpowiedniej ilości, aby zapewnić optymalny wzrost, prawidłowe tempo rozwoju fizycznego i umysłowego oraz odpowiednią sprawność fizyczną.
Cel. Celem pracy była ocena wartości energetycznej i zawartości podstawowych składników odżywczych w zwyczajowych dietach dzieci czteroletnich, pod względem adekwatności ich spożycia w relacji do znowelizowanych norm żywienia oraz analiza częstości występowania ryzyka niedoborów składników mineralnych i witamin.
Materiał i metody. Badanie przeprowadzono w roku 2005, w ogólnopolskiej grupie 396 dzieci w wieku 4 lat, wylosowanych z rejestru urodzeń PESEL.
Analizę zwyczajowego sposobu żywienia przeprowadzono na podstawie zapisu wszystkich produktów, potraw i napojów spożywanych przez dzieci w czasie 7 dni. Wartość energetyczną i odżywczą diet wyliczono za pomocą programu komputerowego DIETA 4,0. Do oceny częstości występowania diet niedoborowych w stosunku do Norm Żywienia z roku 2008, wykorzystano metodę oceny prawdopodobieństwa, przeprowadzoną zgodnie z rekomendacjami IOM USA.
Wyniki. Stwierdzono, że co czwarte czteroletnie dziecko wykazało niedoborową masę ciała świadczącą o przewlekłym niedożywieniu energetycznym, a co piąte dziecko miało zwiększoną masę ciała w postaci nadwagi lub otyłości (ocenione wg wskaźnika BMI i klasyfikacji Cole i wsp. 2000, 2003). Stwierdzono częste niedobory dotyczące 50% lub większego odsetka dzieci w wypadku witaminy D, potasu, wapnia i żelaza oraz niedobory dotyczące mniej niż 25% dzieci w wypadku witaminy E, i C oraz folianów.
Wnioski. Wyniki ogólnopolskiego badania sygnalizują pilną potrzebę edukacji zmierzającej do wzrostu spożycia przez dzieci składników o bardzo wysokich niedoborach w dietach. Szczególnie należy zwrócić uwagę na wapń i witaminę D, jako kluczowe składniki dla rozwoju i zachowania zdrowia tej grupy dzieci.
Introduction. During childhood, the body needs a diversity of vitamins and minerals in appropriate amounts to ensure optimal growth, proper physical and cognitive development, and appropriate physical fitness.
Aim. The objective of the paper was to evaluate the energy value and the content of basic nutrients in habitual diets of four--year-old children in terms of the adequateness of their intake with reference to current nutritional standards and to analyse the prevalence of mineral and vitamin deficiencies risk.
Material and methods. The study was carried out in 2005 across the Polish-nationwide group of 396 children aged 4, randomly selected from the PESEL – birth register, proportionally from urban and rural areas.
The analysis of the habitual nutrition was carried out on the basis of the record of all products, meals and drinks consumed by children over 7 days. The energy and nutritional values of diets were calculated using DIETA 4.0 computer software. To assess the prevalence of deficient diets with reference to 2008 Nutritional Standards, a probability evaluation method was applied and carried our in accordance, with US IOM recommendations.
Results. It was found that every 4th child aged four years had underweight reflecting prolonged energy malnutrition, and every 5th child had increased body mass in the form of overweight or obesity (evaluated according to BMI and Cole at al. classification 2000, 2003). Frequent vitamin D, potassium, calcium and iron deficiencies in 50% to 90% of children, and vitamin E and C and foliate deficiencies in less than 25% of children were observed.
Conclusions. The results of the Polish-nationwide study of 4 years old indicate an urgent need for education aimed at increasing the consumption by children of these nutrients that are highly deficient in diets. Particular attention should be paid to calcium and vitamin D as key nutrients for the development and promotion of health across this group of children.
Proper nutrition in early childhood is of particular importance, because the body needs a diversity of vitamins and minerals in appropriate amounts over these periods to ensure optimal growth, proper physical and cognitive development and appropriate physical fitness (1, 2). Over the recent years more and more has been known about the importance of early nutrition programming which allows to maintain low cardiovascular disease risk profile in middle age (3). To educate or conduct intervention programs among small children, nutrient deficiencies or excesses occurring in usual diets of children should be well understood. Paradoxically, we don’t know much about early nutrition, and existing publications draw attention to some nutrition problems among children. The excessive sugar intake (sucrose) is the most frequently mentioned as an obesity risk factor and indicator of the children poor diet (4-6). Intervention programs are also undertaken to counteract high sucrose intake by children aged 13 months through 9 years, as a cardiovascular disease risk factor (7).
Knowledge about early nutrition and the most frequent problems is indispensable to undertake education among parents or persons responsible for nutrition of preschoolers.
The objective of the paper was to evaluate the energy value and the content of basic nutrients in habitual diets of four-year-old children in terms of the adequateness of their intake with reference to current nutritional standards and to analyse the prevalence of the mineral and vitamin deficiencies risk.
MATERIAL AND METHODS
Four-year-old children aged 4, were randomly selected from the PESEL – birth register and the whole country territory, proportionally from urban and rural areas, and attending and not attending preschools (2005). After questionnaire verification, 396 children were included in further analyses.
The habitual nutrition among four-year-old children was examined using a method of recording food intake over the 7-day period. In total, 2772 daily menus were examined. The field study was conducted by interviewers trained by the Department of Nutritional Epidemiology and Dietary Standards of the National Food and Nutrition Institute. Interviewers informed parents and carers at preschools of the manner of recording food consumed by children. Next, after all the recordings were completed, the questionnaires were reviewed and filled up, if necessary, by interviewers, and then by nutritionists from the National Food and Nutrition Institute. The energy and nutritional values calculated on the basis of recordings were analysed with reference to current human nutritional standards of 2008 (8) using DIETA 4.0 computer software for this purpose, developed at the Department of Nutritional Epidemiology of the National Food and Nutrition Institute.
To evaluate the prevalence of insufficient nutrient intake among children, a probability method was applied to evaluate deficiencies of all nutrients, that was proposed by IOM [Institute of Medicine (U.S.A.)], except for iron (the evaluation of insufficient intake is performed by comparing distributions of intake and distributions of reference intake for this nutrient due to skewed distributions of intake and requirement) (9, 10). In the statistical analysis intraindividual variability (day-to-day) was used to eliminate randomness from nutrition. DIETA 4.0 software enabled to estimate on the basis of usual distributions of nutrients intake the proportion of children, whose usual intake was below the specified reference value appropriate for each nutrient and appropriate standard level.
Energy and basic nutrients intake
The average energy value of diets among children aged 4 covered by the study was relatively high and equal to 1904 ± 488 kcal (tab. 1), exceeding by approximately 500 kcal the recommended values according to the estimated energy requirement (EER) depending on age, body weight, gender and physical activity. When evaluating the prevalence of insufficient energy intake using the probability method on the basis of 7-day recordings of intake it was found that the energy content was insufficient in diets of only 13% of children (tab.1). Due to the differences in body weight and physical activity levels among children, and also in view of the fact that energy intake and requirement are correlated, it is difficult to evaluate the appropriateness of energy intake versus EER, even with 7-day recordings of intake at disposal. Therefore, the evaluation of the appropriateness of energy delivered versus the requirement and versus standards for BMI (11) was performed. Across the analysed group of children, 25.2% had underweight, (criterion recommended by IOTF according to BMI classification, developed by Cole at al. (12, 13), (fig. 1) which indicated the usual insufficient energy intake in the diets of approximately 1/4 of studied children. At the same time, overweight was observed in 12.1% of children, and obesity in 8.1 % of children (fig. 1), which in turn allows to conclude that the energy intake as a part of the diet was too high compared with the requirement in 1/5th of children.
Table 1. Energy and nutrient mean intakes (sd), by 4 years old children, from 7 days records and percentage of children below standards. National sample, N = 396, 2005 y (data from food without supplements).
|Nutrients||X (SD)||Percentage of children below the standards calculated by the probability method (only from food)|
|Energy (kcal)||1904 (488)||13.0|
|Protein (g)||62.5 (16.1)||0.0|
|Protein in g per kg body mass (g/kg m.c.)||3.37 (1.00)||–|
|Fats (g)||68.0 (19.3)||24.6|
|Carbohydrates (g)||273.6 (73.1)||0.02**|
|Long-chain polyunsaturated fatty acids||0,108 (0.144)||87.5|
|Linolenic acid C18:3 (g)||1.5 (0,6)||81.9|
|Ratio of PUFA: SFA ||0.34|
|Cholesterol (mg)||246.8 (85.3)||–|
|Sugar (g)||84.2 (29.2)||–|
|Fiber (g)||14.8 (4.4)||–|
*SFA – saturated fatty acids, MUFA – monounsaturated fatty acids, PUFA – polyunsaturated fatty acids
**for the carbohydrate level necessary to ensure proper functioning of the brain
Fig. 1. Percentage of children under the age of 4 years in clusters of BMI classification (according to the criterion Cole and co. 2000, 2003).
Four-year-old children covered by the study consumed large amounts of protein in their habitual diets at an average level of 62.5 ± 16.1 g, which gives 3.4 g per 1 kilogram of body mass. No dietary protein deficiency was revealed among children after the probability method was applied to evaluate the occurrence of deficiencies with reference to EAR value. The average total fat intake is also high with 68.0 ± 19.3 g across children. However, the evaluation of deficiency occurrence using the probability method showed that around 1/5th of children consumed fat in less than recommended amounts. In particular, unfavourably low consumption of long chain polyunsaturated acids (EPA and DHA) was found in 87.5% of children, and omega-3 linolenic acids in 81.9% of children.
Carbohydrate intake oscillated within the recommended intake, and was equal to 273.6 ± 73.1 g. No deficiencies of available carbohydrates indispensable to ensure proper brain function versus EAR were observed after the evaluation using the probability method was applied.
The structure of energy from basic nutrients in children’s diets (tab. 2) was close to the recommended one. However, there was higher than recommended energy contribution of 10% from saturated fat acids, and large energy contribution from sugar of 17.6%. There was also high consumption of saturated fats and sugar among children and low fibre content. As results from (tab. 3), 9.3% of children consumed insufficient amounts of fibre, but there was high percentages of children with a high intake of total fat, saturated fat, sugar and cholesterol.
Table 2. The contribution of energy from the basic nutrients in the diets of 4 years old children, national sample, 2005 y.
|Contribution of energy from:||%|
|Total carbohydrates||55.2 (3.8)|
|Sugar (saccharose)||17.6 (3.6)|
Table 3. Percentage of children 4 years old who consume diets high in total fat amount, saturated fatty acids, sugar, cholesterol and too low and high amounts of fiber. National sample, 2005 y.
|Level of nutrients||% of children|
|Percentage of children with:|
|Low fat intake < 25% energy||1.8|
|The fat intake of 25-30% of energy||25.0|
|High intake of fat > 30% energy||73.2|
|Percentage of children consuming in diets:|
|SFA > 10% energy||91.4|
|Sugar > 10 % energy||98.4|
|Cholesterol > 300 mg||25.0|
|Fiber > 19 g||15.9|
|Fiber < 9.5 g||9.3|
Vitamin and mineral intake
The average content (taking into account only food) of minerals: calcium, phosphorus, magnesium, zinc and iron in diets was a little or much higher versus the recommended intake (except for potassium of which the consumption was lower than 3100 mg recommended by the standard at AI level).
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Płatny dostęp do wszystkich zasobów Czytelni Medycznej
1. Charzewska J, Weker H: Ogólnopolskie badanie nad zawartością wapnia i witaminy D w dietach dzieci w wieku 4 lat. Pediatria Współczesna, Gastroenterologia, Hepatologia i Żywienie Dziecka 2006; 8(2): 107-109.
2. Charzewska J, Chwojnowska Z, Wajszczyk B: Normy na energię i składniki odżywcze oraz ich rola w rozwoju dzieci w wieku przedszkolnym. [W:] Rekomendacje dla realizatorów żywienia z zakresu zasad prawidłowego żywienia dzieci w przedszkolach. Charzewska J (red.). Ministerstwo Zdrowia, IŻŻ, Warszawa 2011; 31-52.
3. Liu K, Daviglus ML, Loria CM et al.: Healthy Lifestyle Through Young Adulthood and the Presence of Low Cardiovascular Disease Risk Profile in Middle Age. The Coronary Artery Risk Development in (Young) Adults (CARDIA) Study. Circulation 2012; 125: 996.
4. Livingstone MBE, Rennie KL: Added sugars and micronutrient dilution. Obesity Reviews 2009; 10 (Suppl. 1): 34-40.
5. ?verby NC, Lillegaard IT, Johansson L, Andersen LF: High intake of added sugar among Norwegian children and adolescents. Public Health Nutr 2004; 7: 285-293.
6. Forshee RA, Storey ML: The role of added sugars in the diet quality of children and adolescents. J Am Coll Nutr 2001; 20: 32-43.
7. Ruottinen S, Niinikoski H, Lagström H et al.: High Sucrose Intake Is Associated With Poor Quality of Diet and Growth Between 13 Months and 9 Years of Age: The Special Turku Coronary Risk Factor Intervention Project. Pediatrics 2008; 121: 1676-1685.
8. Normy żywienia człowieka. Podstawy prewencji otyłości i chorób niezakaźnych. Jarosz M, Bułhak-Jachymczyk B (red.): Warszawa, PZWL 2008.
9. Dietary Reference Intakes: Applications in Dietary Assessment. Food and Nutrition Board, Institute of Medicine, the National Academies Press Washington D.C. 2000.
10. Dietary Reference Intakes: Applications in Dietary Planning. Food and Nutrition Board, Institute of Medicine, the National Academies Press Washington D.C. 2003.
11. Suitor CW, Gleason M: Using Dietary Reference Intake-based methods to estimate the prevalence of inadequate nutrient intake among school-aged children. J Am Diet Assoc 2002; 102: 530-536.
12. Cole JT, Flegal KM, Nicholls D et al.: Body mass index cut offs to define thinness in children and adolescents: international survey. Br Med J 2007; 335: 194-202.
13. Cole TJ, Bellizi MC, Flegal KM, Dietz H: Establishing a standard definition for child over-weight and obesity worldwide: international survey. Br Med J 2000; 320(6): 1240-1243.
14. Joyce T, McCarthy SN, Gibney MJ: Relationship between energy from added sugars and frequency of added sugars intake in Irish children, teenagers and adults. Br J Nutr 2008; 99: 1117-1126.
15. Farris RP, Nicklas TA, Myers L, Berenson GS: Nutrient Intake and Food Group Consumption of 10-Year-Olds by Sugar Intake Level: The Bogalusa Heart Study. Journal of the American College of Nutrition 1998; 17(6): 579-585.
16. Frary CD, Johnson RK, Wang MQ: Children and adolescents’ choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups. J Adolesc Health 2004; 34: 56-63.
17. Moshfegh A, Goldman J, Jaspreet A et al.: What We Eat In America NHANES 2005-2006: Usual nutrient intake from food and water compared to 1997 Dietary References Inatake for Vitamin D, Calcium, Phosphorus, and Magnesium. U.S. Department of Agriculture, Agricultural Research Service 2009; http://www.ars.usda.gov/ba/bhnrc/fsrg
18. Weker H, Barańska M: Kompleksowa ocena sposobu żywienia dzieci w wieku 13-36 miesięcy w Polsce. Wyniki badań 2010-2011. Warszawa, Instytut Matki i Dziecka 2011.
19. Major GC, J. Chaput P, Ledoux M et al.: Tremblay A.: Recent developments in calcium-related obesity research. Obesity Reviews 2008; 9: 428-445.
20. Moshfegh A, Goldman J, Cleveland L: What we eat in America, nhanes 2001-2002: usual nutrient intakes from food compared to dietary reference intake. U.S. Department of Agriculture, Agricultural Research Service 2005, http://www.ars.usda.gov/Services/docs.htm?docid=13793
21. Stankiewicz M, Pęgiel-Kamrat J, Zarzeczna-Baran M et al.: Styl żywienia dzieci przedszkolnych w opinii ich rodziców. Probl Hig Epidemiol 2006; 87(4): 273-277.