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Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition Methodology & Assessment".

Deadline for manuscript submissions: closed (5 February 2024) | Viewed by 22284

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Special Issue Editors

Dr. Laura D’Addezio

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CREA Council for Agricultural Research and Economics—Research Centre for Food and Nutrition, Via Ardeatina 546, 00178 Rome, Italy
Interests: dietary surveys; food patterns; food practices; sociodemographic and cultural factors

Dr. Laura Censi

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Guest Editor

CREA Council for Agricultural Research and Economics—Research Centre for Food and Nutrition, Via Ardeatina 546, 00178 Rome, Italy
Interests: nutritional status; anthropometry; body composition; energy metabolism; food habits; adherence to the Mediterranean diet; physical activity; obesity prevention
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Special Issue Information

Dear Colleagues,

This Special Issue focuses on dietary habits of European children, assessed through food consumption surveys. Children’s eating habits have drawn the attention of the research community due to the relationship between diet and nutrient intake during the developmental years, and the increasing risk of overweight and obesity.

Dietary surveys aim to evaluate the habitual food, energy and nutrient intake in the general population and to compare these with recommendations from dietary guidelines. Other aims include identifying potential critical nutrients, formulating nutrient intake recommendations, and developing programs for nutrition-related disease prevention.

Dietary data are analyzed in association with physical activity and lifestyle, demographic, socioeconomic, and cultural aspects. Anthropometric measures are of peculiar importance, expecially if measured according to standard protocols to obtain accurate estimates.

The aim of this Special Issue is to collect research studies based on nationally representative surveys across Europe, aimed to investigate the difference in food, energy and nutrient intake between different subgroups of the children population and to identify subgroups at risk for a deficient or excessive intake of specific foods or nutrients; to evaluate the anthropometry, physical activity and sedentary behaviour in relation to food and nutrient intake; explore the relationships between family characteristics, food practices, eating context, and diet quality or single foods/food groups consumption, such as fruits and vegetables, dairy products, snack foods, ultra-processed foods.

We also encourage the submission of studies on cross-country comparisons, validation of survey tools specifically designed for children, challenges faced by researchers such as development of food databases and their harmonization for comparisons between surveys or countries. Studies analyzing food consumption data from alternative sources that benchmark data from dietary suveys are welcome to explore their usability in monitoring changes in food consumption over the short or medium term when up-to-date dietary data are lacking.

Dr. Laura D’Addezio
Dr. Laura Censi
Guest Editors

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Keywords

dietary surveys
food consumption
dietary intake
anthropometric measures
nutritional status
lifestyle
food practices
population-based surveys
dietary assessment methods
food databases

Published Papers (12 papers)

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21 pages, 1448 KiB

Open AccessArticle

FoodEx2 Harmonization of the Food Consumption Database from the Italian IV SCAI Children’s Survey

by Laura D’Addezio, Stefania Sette, Raffaela Piccinelli, Cinzia Le Donne and Aida Turrini

Nutrients 2024, 16(7), 1065; https://doi.org/10.3390/nu16071065 - 05 Apr 2024

Viewed by 468

Abstract

Estimating the habitual food and nutrient intakes of a population is based on dietary assessment methods that collect detailed information on food consumption. Establishing the list of foods to be used for collecting data in dietary surveys is central to standardizing data collection. Comparing foods across different data sources is always challenging. Nomenclatures, detail, and classification into broad food groups and sub-groups can vary considerably. The use of a common system for classifying and describing foods is an important prerequisite for analyzing data from different sources. At the European level, EFSA has addressed this need through the development and maintenance of the FoodEx2 classification system. The aim of this work is to present the FoodEx2 harmonization of foods, beverages, and food supplements consumed in the IV SCAI children’s survey carried out in Italy. Classifying foods into representative food categories predefined at European level for intake and exposure assessment may lead to a loss of information. On the other hand, a major advantage is the comparability of data from different national databases. The FoodEx2 classification of the national food consumption database represented a step forward in the standardization of the data collection and registration. The large use of FoodEx2 categories at a high level of detail (core and extended terms) combined with the use of descriptors (facets) has minimized information loss and made the reference food categories at country level comparable with different food databases at national and international level. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

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12 pages, 486 KiB

Open AccessArticle

Trend in Breakfast Consumption among Primary School Children in Italy

by Silvia Ciardullo, Michele Antonio Salvatore, Donatella Mandolini, Angela Spinelli, Mauro Bucciarelli, Silvia Andreozzi, Marta Buoncristiano and Paola Nardone

Nutrients 2023, 15(21), 4632; https://doi.org/10.3390/nu15214632 - 31 Oct 2023

Viewed by 918

Abstract

Eating breakfast daily improves cognitive function, may contribute to learning and academic performance in children and can decrease the risk of childhood obesity. The aim of this study was to analyse how breakfast consumption changed in the period from 2008/9 to 2019 in Italy among children aged 8–9 years old participating in the OKkio alla SALUTE surveys and to explore the associations with some socio-demographic and lifestyle factors. Information about children’s daily breakfast consumption (adequate, inadequate, and no breakfast) and the socio-demographic characteristics of the children and their mothers was collected through four questionnaires addressed to parents, children, teachers and head teachers. Data were analysed for the 272,781 children from 21 Italian regions from 2008/9 to 2019. The prevalence of adequate breakfast decreased from 60.7% in 2008/9 to 55.7% in 2019 and no breakfast from 10.9 to 8.7%; conversely, inadequate breakfast increased from 28.4 to 35.6%. Logistic regression models showed that the occurrence of inadequate or no breakfast consumption was significantly higher among girls, children living in the southern regions and children with less educated mothers. These findings highlight the need for effective interventions to increase daily breakfast consumption and its adequacy among children. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

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15 pages, 702 KiB

Open AccessArticle

Inequalities in Childhood Nutrition, Physical Activity, Sedentary Behaviour and Obesity in Italy

by Angela Spinelli, Laura Censi, Donatella Mandolini, Silvia Ciardullo, Michele Antonio Salvatore, Gianfranco Mazzarella and Paola Nardone

Nutrients 2023, 15(18), 3893; https://doi.org/10.3390/nu15183893 - 07 Sep 2023

Cited by 1 | Viewed by 1320

Abstract

Unhealthy diets, physical inactivity and high body mass index (BMI) are preventable risk factors for non-communicable diseases throughout a person’s lifespan. The higher prevalence of these risk factors in children from lower socio-economic groups has been generally observed. The aim of this study is to explore the effect of parents’ socio-economic conditions on children’s consumption of fruit, vegetables and sugar-sweetened drinks, and inactivity, sedentary behaviour, overweight and obesity. This study used data from the sixth cross-sectional survey of the surveillance “OKkio alla Salute” (Italian COSI), involving 2467 schools and 53,275 children in 2019. All the information was collected through four questionnaires addressed to parents, children, teachers and head teachers. The weights and heights of the children were measured with standard techniques and equipment to classify overweight/obesity according to the WOF-IOTF cut-offs. The results showed a high percentage of children who do not adhere to health recommendations and a high prevalence of overweight and obesity. In particular, “less healthy” behaviours and higher BMI were more frequent in children from families with a lower socio-economic status and those residing in Southern Italy. These findings highlight the need for effective interventions that address the differences in these health-related behaviours. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

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14 pages, 286 KiB

Open AccessArticle

Changes in Food Consumption and Eating Behaviours of Children and Their Families Living in Italy during the COVID-19 Pandemic: The EPaS-ISS Study

by Paola Nardone, Angela Spinelli, Marta Buoncristiano, Silvia Andreozzi, Mauro Bucciarelli, Marco Giustini, Silvia Ciardullo and on behalf of the EPaS-ISS Group

Nutrients 2023, 15(15), 3326; https://doi.org/10.3390/nu15153326 - 26 Jul 2023

Cited by 1 | Viewed by 786

Abstract

The aim of the EPaS-ISS study was to describe the changes in food consumption and eating behaviours of children (mainly aged 8–9 years) and their families between the pre-COVID-19 period (before February/March 2020) and the COVID-19 period (from February/March 2020 to April 2022). A web questionnaire completed by parents was used to collect data. The sociodemographic characteristics of the children and their parents were also explored through the web questionnaire. Seventeen regions out of nineteen and the two autonomous provinces (PA) of Italy participated in the study. The survey was completed for 4863 children (47.9% females). The study showed that only small changes in children’s food consumption happened between the pre-COVID-19 period and the COVID-19 period; in particular, about 25% of parents reported an increase in savoury snacks and sweet food. A decrease in fruit and vegetable (about 8%) and fish (14%) consumption was also found. However, the changes seem to have mainly affected children from most disadvantaged families. The results also indicate positive changes during the COVID-19 pandemic in some families’ eating behaviours, such as eating more home-cooked meals (42%) and family meals (39%), as well as cooking more with children (42%). Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

18 pages, 2288 KiB

Open AccessArticle

Assessment of Nutrient Intake and Diet Quality in Adolescent Dietary Supplement Users vs. Non-Users: The CRO-PALS Longitudinal Study

by Željana Mudnić, Amanda Gaši, Josip Rešetar, Jasenka Gajdoš Kljusurić, Marjeta Mišigoj-Duraković, Maroje Sorić, Ines Panjkota Krbavčić and Zvonimir Šatalić

Nutrients 2023, 15(12), 2783; https://doi.org/10.3390/nu15122783 - 17 Jun 2023

Viewed by 1460

Abstract

Dietary supplement users tend to have a better diet quality and overall prudent lifestyle. The main goals of this research were to report the prevalence and type of dietary supplements among Croatian adolescents and to examine the differences in the diet quality among dietary supplement users vs. non-users at the beginning (15/16 y) and at the end of high school education (18/19 y). This research is based on results of the longitudinal CRO-PALS study in which 607 adolescents participated, who had complete dietary, anthropometric, and physical activity data at the beginning (15/16 y) and at the end of their high school education (18/19 y). The dietary assessment method used was a single multi-pass 24 h recall. Dietary supplement users were divided into two groups for the purposes of statistical analysis—users of vitamin and multivitamin preparations (VMV) and users of mineral and multivitamin preparations (MMV). As they aged, there was an increase in the consumption of dietary supplements, and the most frequently used preparation in both age groups was vitamin C (23.7% of users). Dietary supplement users had a higher intake of non-carbonated sweetened drinks and a lower intake of fruits and vegetables in both genders and both age groups. Fast food intake was higher among dietary supplement girl users and boys who were not dietary supplements users in both age groups. Dietary supplement users had a higher achieved average intake of most micronutrients (values obtained only from food) in both genders and both age groups (with exceptions for certain vitamins and minerals). By observing other parameters for assessing the diet quality in this research, we can conclude that girls who do not use dietary supplements have a better diet quality in both age groups. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

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12 pages, 292 KiB

Open AccessArticle

The Correlation between Adolescent Daily Breakfast Consumption and Socio-Demographic: Trends in 23 European Countries Participating in the Health Behaviour in School-Aged Children Study (2002–2018)

by Giacomo Lazzeri, Silvia Ciardullo, Angela Spinelli, Daniela Pierannunzio, Anna Dzielska, Colette Kelly, Einar B. Thorsteinsson, Gentiana Qirjako, Anouk Geraets, Kristiina Ojala, Manon Rouche and Paola Nardone

Nutrients 2023, 15(11), 2453; https://doi.org/10.3390/nu15112453 - 24 May 2023

Cited by 1 | Viewed by 1957

Abstract

Breakfast is often considered the most important meal of the day and can benefit adolescent health in several ways. The aims of the present study were (1) to identify adolescents’ socio-demographic (sex, family affluence and family structure) determinants of daily breakfast consumption (DBC) and (2) to describe trends in DBC among adolescents across 23 countries. Cross-sectional surveys of nationally representative samples of adolescents (aged 11, 13, and 15 years) (n = 589,737) participating in the Health Behaviour in School-aged Children (HBSC) survey from 2002 to 2018 were used. Multilevel logistic regression analyses modeled DBC over time, adjusted for family affluence, family structure and year of survey. Four countries showed an increased trend in DBC (the Netherlands, Macedonia, Slovenia, and England). A significant decrease in DBC was observed in 15 countries (Belgium-Fr, France, Germany, Croatia, Portugal, Spain, Hungary, Poland, Russian Federation, Ukraine, Denmark, Finland, Latvia, Lithuania and Sweden). In 4 countries no significant change was observed (Czech Republic, Scotland, Ireland and Norway). In most of the countries (n = 19), DBC was higher among the adolescents from high-affluence homes. In all the countries analysed, the adolescents living in two-parent households report higher DBC use than those in single-parent households. More than half of the countries showed a decrease in DBC. There is a need to implement key interventions by developing different strategies (education, incorporating educational curriculum and counselling programmes) to increase DBC. Comparing DBC patterns across HBSC countries is important for understanding regional and global trends, monitoring strategies, and developing health promotion programmes. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

10 pages, 278 KiB

Open AccessArticle

Development and Implementation of a Nutritional Education Program Aimed at Improving the Integration Process of Young Orphan Refugees Newly Arrived in Portugal

by Bárbara Oliveira, Manuel Bicho and Ana Valente

Nutrients 2023, 15(2), 408; https://doi.org/10.3390/nu15020408 - 13 Jan 2023

Viewed by 1659

Abstract

(1) Background: Refugees are a population group at imminent risk of death, being forced to migrate to countries with different cultures. Many of the refugees are at great risk of malnutrition, especially adolescent orphans. The aim of the study was to establish a nutritional and food education program to improve the integration process of young orphan refugees newly arrived in Portugal. (2) Methods: A nutrition and food education program with nine sessions of food and nutrition education over 12 weeks was carried out by a nutritionist from March to June 2016, in 15 young residents of the Reception Center for Refugee Children. The program included the application of a nutritional knowledge questionnaire, an anthropometric assessment, and the collection of data on food habits and lifestyle. The evaluation of the program was carried out by comparing the initial and final scores of the nutritional knowledge questionnaire. (3) Results: There was an improvement in nutritional knowledge among the adolescents, and a direct relationship between attendance at the sessions and improvement of this knowledge was found. Non-significant changes were observed in some anthropometric measurements between the beginning and the ending of the program. (4) Conclusions: This food education program contributed to a better understanding by young orphan refugees newly arrived in Portugal of the foods available in Portugal and of the Portuguese gastronomy. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

19 pages, 1380 KiB

Open AccessArticle

Reliability of Self-Reported Height and Weight in Children: A School-Based Cross-Sectional Study and a Review

by Magali Rios-Leyvraz, Natalia Ortega and Arnaud Chiolero

Nutrients 2023, 15(1), 75; https://doi.org/10.3390/nu15010075 - 23 Dec 2022

Cited by 5 | Viewed by 2016

Abstract

Since anthropometric measurements are not always feasible in large surveys, self-reported values are an alternative. Our objective was to assess the reliability of self-reported weight and height values compared to measured values in children with (1) a cross-sectional study in Switzerland and (2) a comprehensive review with a meta-analysis. We conducted a secondary analysis of data from a school-based study in Switzerland of 2616 children and a review of 63 published studies including 122,629 children. In the cross-sectional study, self-reported and measured values were highly correlated (weight: r = 0.96; height: r = 0.92; body mass index (BMI) r = 0.88), although self-reported values tended to underestimate measured values (weight: −1.4 kg; height: −0.9 cm; BMI: −0.4 kg/m²). Prevalence of underweight was overestimated and prevalence of overweight was underestimated using self-reported values. In the meta-analysis, high correlations were found between self-reported and measured values (weight: r = 0.94; height: r = 0.87; BMI: r = 0.88). Weight (−1.4 kg) and BMI (−0.7 kg/m²) were underestimated, and height was slightly overestimated (+0.1 cm) with self-reported values. Self-reported values tended to be more reliable in children above 11 years old. Self-reported weight and height in children can be a reliable alternative to measurements, but should be used with caution to estimate over- or underweight prevalence. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

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15 pages, 345 KiB

Open AccessArticle

Eating Behavior Associated with Food Intake in European Adolescents Participating in the HELENA Study

by Ivie Maneschy, Luis A. Moreno, Azahara I. Ruperez, Andrea Jimeno, María L. Miguel-Berges, Kurt Widhalm, Anthony Kafatos, Cristina Molina-Hidalgo, Dénes Molnar, Fréderic Gottrand, Cinzia Le Donne, Yannis Manios, Evangelia Grammatikaki, Marcela González-Gross, Mathilde Kersting, Jean Dallongeville, Sonia Gómez-Martinez, Stefaan De Henauw, Alba M. Santaliestra-Pasías and on behalf of the HELENA Study Group

Nutrients 2022, 14(15), 3033; https://doi.org/10.3390/nu14153033 - 24 Jul 2022

Cited by 4 | Viewed by 2684

Abstract

Adolescence is recognized as a time of rapid physiological and behavioral change. In this transition, eating behavior is still being formed and remains an integral part of a person’s lifestyle throughout his or her life. This study aims to assess eating behavior and associations with food intake in European adolescents. We included 2194 adolescents (45.9% boys), aged 12.5 to 17.5 years, from the cross-sectional HELENA study, with two completed 24 h recalls and complete questionnaire data on their eating behavior (Eating Behavior and Weight Problems Inventory for Children- EWI-C). Three subscales of the EWI were evaluated; they measured Strength and motivation to eat (EWI 1), Importance and impact of eating (EWI 2), and Eating as a means of coping with emotional stress (EWI 3). Since these subscales were specially focused on eating behavior, participants were classified as either Low (≤P75) or High (>P75) on each of the subscales. Our results showed a higher consumption of different types of food, in the EWI 1 scales, linked to the hunger and interest in eating, and we observed a relationship with the consumption of energy-dense products. This result was repeated in EWI 3, the subscale linked to emotional eating, where we also found higher consumption of energy-dense products. This study suggests that special features of eating behavior are associated with food intake in adolescents. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

14 pages, 334 KiB

Open AccessArticle

Combined Body Mass Index and Waist-to-Height Ratio and Its Association with Lifestyle and Health Factors among Spanish Children: The PASOS Study

by Maria del Mar Bibiloni, Laura Gallardo-Alfaro, Santiago F. Gómez, Julia Wärnberg, Maddi Osés-Recalde, Marcela González-Gross, Narcís Gusi, Susana Aznar, Elena Marín-Cascales, Miguel González-Valeiro, Lluís Serra-Majem, Nicolás Terrados, Marta Segu, Camille Lassale, Clara Homs, Juan Carlos Benavente-Marín, Idoia Labayen, Augusto G. Zapico, Jesús Sánchez-Gómez, Fabio Jiménez-Zazo, Pedro E. Alcaraz, Marta Sevilla-Sánchez, Estefanía Herrera-Ramos, Susana Pulgar, Clara Sistac, Helmut Schröder, Cristina Bouzas and Josep A. Tur Show full author list Hide full author list

Nutrients 2022, 14(2), 234; https://doi.org/10.3390/nu14020234 - 06 Jan 2022

Cited by 3 | Viewed by 3684

Abstract

Background and Aims: The World Health Organization recommended simultaneous measurement of body mass index (BMI) and waist circumference (WC) and suggested joint use to predict disease risks. The aim of this study was to assess the prevalence of BMI and waist-to-height ratio (WHtR) categories among Spanish children and adolescents, as well as their associations with several lifestyle factors. Methods: Cross-sectional analysis of 8–16-year-old children and adolescents (n = 3772) were included in the PASOS nationwide representative study. Children/adolescents and their mothers/female caregivers answered a questionnaire on lifestyle and health factors. Child/adolescent anthropometrics were measured. Four combined BMI-WHtR disease risk categories were built. Results: A third of participants showed combined BMI-WHtR categories with high disease risk (12.3% ‘increased risk’, 9.7% ‘high risk’, 14.3% ‘very high risk’). Participants in the ‘very high risk’ group were less likely to be females (odds ratio 0.63; 95% CI: 0.52–0.76) and adolescents (0.60; 95% CI: 0.49–0.72), to practice ≥60 min/day of moderate-vigorous physical activity (MVPA) (0.73; 95% CI: 0.57–0.93), and to watch <120 min/day of total screen time on weekdays (0.61; 95% CI: 0.49–0.76). Mothers of participants in the ‘very high risk’ group were less likely to have a high educational level, be in the overweight or normal range, have never smoked or were former smokers, and watch <120 min/day of total screen time on weekends. Participants in the ‘increased’ and ‘high risk’ categories had mothers with normal weight and ≥60 min/day of MVPA. Participants in the ’high risk’ group did not achieve ≥60 min/day of MVPA and showed lower adherence to the Mediterranean diet. Conclusions: Adherence to a healthy lifestyle in children and adolescents, but also in their mothers/female caregivers during offspring’s childhood and adolescence, is associated with low BMI-WHtR disease risk. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

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21 pages, 982 KiB

Open AccessStudy Protocol

by Jadwiga Hamulka, Ewa Czarniecka-Skubina, Krystyna Gutkowska, Małgorzata Ewa Drywień and Marta Jeruszka-Bielak

Nutrients 2024, 16(1), 4; https://doi.org/10.3390/nu16010004 - 19 Dec 2023

Cited by 3 | Viewed by 1179

Abstract

Increasing students’ nutrition knowledge is an important goal of school education which may improve their lifestyle and consequently reduce the incidence of non-communicable chronic diseases, including obesity. This research aimed at assessing the dietary habits, nutrition-related knowledge and attitudes, and nutritional status of Polish students aged 7–12 years. Additional objectives included recognizing nutrition-related knowledge among their parents and teachers as well as the school food and nutrition environment. The final goal was to develop a nutrition education program. This study protocol presents a general and detailed approach for realizing the above-mentioned issues, including conducting quantitative and qualitative research. The study was designed as cross-sectional, covering primary school students from all over Poland, including rural, town, and metropolitan areas. Data on eating habits, lifestyle, nutrition-related knowledge, and attitudes were collected with questionnaires. Measurements of body weight, height, waist and hip circumferences, and handgrip strength were performed in accordance with the International Standards for Anthropometric Assessment (ISAK) recommendations. Body composition was assessed with bioelectrical impedance analysis. Ultimately, 2218 schools from all 16 voivodeships in Poland registered for the project. In total, quantitative data were collected among 27,295 students, 17,070 parents, and 2616 teachers. Anthropometric measurements were taken among 18,521 students. The results allow us to develop a multifaceted educational program based on knowledge and adapted to the perception of students. Our research may contribute to the identification of subpopulations of children and adolescents at risk of excessive body weight and define the predictors of obesity risk in Poland. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

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8 pages, 277 KiB

Open AccessBrief Report

Association between Meal Frequency and Weight Status in Spanish Children: A Prospective Cohort Study

by Charlotte Juton, Paula Berruezo, Silvia Torres, Olga Castañer, Genís Según, Montserrat Fitó, Clara Homs, Santiago F. Gómez and Helmut Schröder

Nutrients 2023, 15(4), 870; https://doi.org/10.3390/nu15040870 - 08 Feb 2023

Cited by 2 | Viewed by 2430

Abstract

Childhood obesity is a major international problem, and unhealthy eating habits remain widespread. Increasing the frequency of meals of nutritious food can help children to regulate their appetite and maintain a healthy weight. However, there is scarce prospective evidence on the relationship between the meal frequency and weight outcomes. Therefore, the objective of the present study was to determine the prospective association between the meal frequency, body mass index, and waist circumference in Spanish children. Additionally, we analyzed the impact of the meal frequency on the incidence of excessive weight and abdominal obesity. The study included 1400 children with a mean (SD) age of 10.1 (0.6) and an average follow-up of 15 months. Anthropometric measurements, including the body weight, height, and waist circumference, were measured by trained personnel, and children were asked about whether they usually had the following meals: breakfast, a mid-morning snack, lunch, an afternoon snack, and dinner. Multiple linear regression models revealed a significant (p < 0.05) inverse association between the meal frequency with a standardized BMI (zBMI) and the waist-to-height ratio (WHtR) after adjusting for sex, age, allocation to an intervention group, school, maternal education, physical activity, diet quality, and for the corresponding outcome variable at the baseline. Furthermore, the odds of developing abdominal obesity or excessive weight during the follow-up significantly decreased with an increase in the meal frequency after controlling for the same confounders. In conclusion, a higher meal frequency at the baseline was predictive for a lower zBMI, WHtR, and odds of the incidence of excessive weight and abdominal obesity. Full article

(This article belongs to the Special Issue Dietary and Nutritional Status Assessment in Children and Adolescents in European Countries)

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