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To describe fruit and vegetable intake of 11-year-old children in ten European countries and compare it with current dietary guidelines.
Cross-sectional survey. Intake was assessed using a previously validated questionnaire containing a pre-coded 24 h recall and an FFQ which were completed in the classroom. Portion sizes were calculated using a standardized protocol.
Surveys were performed in schools regionally selected in eight countries and nationally representative in two countries.
A total of 8158 children from 236 schools across Europe participating in the PRO GREENS project.
The total mean consumption of fruit and vegetables was between 220 and 345 g/d in the ten participating countries. Mean intakes did not reach the WHO population goal of ≥400 g/d in any of the participating countries. Girls had a significantly higher intake of total fruit and vegetables than boys in five of the countries (Sweden, Finland, Iceland, Bulgaria and Slovenia). Mean total fruit intake ranged between 114 and 240 g/d and vegetable intake between 73 and 141 g/d. When using the level ≥400 g/d as a cut-off, only 23·5 % (13·8–37·0 %) of the studied children, depending on country and gender, met the WHO recommendation (fruit juice excluded).
Fruit and vegetable consumption was below recommended levels among the schoolchildren in all countries and vegetable intake was lower than fruit intake. The survey shows that there is a need for promotional activities to improve fruit and vegetable consumption in this age group.
The aim was to investigate autumn vitamin D intake and status in 7-year-old Icelanders, fitting BMI and cardiorespiratory fitness as predictors.
Three-day food records and fasting blood samples were collected evenly from September to November, and cardiorespiratory fitness was measured with an ergometer bike. Food and nutrient intakes were calculated, and serum 25-hydroxyvitamin D (s-25(OH)D) and serum parathyroid hormone were analysed. Suboptimal vitamin D status was defined s-25(OH)D <50 nmol/l, and deficient status as s-25(OH)D <25 nmol/l.
School-based study in Reykjavik, Iceland in 2006.
Of the 7-year-olds studied (n 265), 165 returned valid intake information (62 %), 158 gave blood samples (60 %) and 120 gave both (45 %).
Recommended vitamin D intake (10 μg/d) was reached by 22·4 % of the children and 65·2 % had s-25(OH)D <50 nmol/l. Median s-25(OH)D was higher for children taking vitamin D supplements (49·2 nmol/l v. 43·2 nmol/l, respectively; P < 0·0 0 1). Median s-25(OH)D was lower in November (36·7 nmol/l) than in September (59·9 nmol/l; P < 0·001). The regression model showed that week of autumn accounted for 18·9 % of the variance in s-25(OH)D (P < 0·001), vitamin D intake 5·2 % (P < 0·004) and cardiorespiratory fitness 4·6 % (P < 0·005).
A minority of children followed the vitamin D recommendations and 65 % had suboptimal vitamin D status during the autumn. Week of autumn was more strongly associated with vitamin D status than diet or cardiorespiratory fitness, which associated with vitamin D status to a similar extent. These results demonstrate the importance of sunlight exposure during summer to prevent suboptimal vitamin D status in young schoolchildren during autumn in northern countries. An increased effort is needed for enabling adherence to the vitamin D recommendations and increasing outdoor activities for sunlight exposure.
To examine which factors act as mediators between parental educational level and children's fruit and vegetable (F&V) intake in ten European countries.
Cross-sectional data were collected in ten European countries participating in the PRO GREENS project (2009). Schoolchildren completed a validated FFQ about their daily F&V intake and filled in a questionnaire about availability of F&V at home, parental facilitation of F&V intake, knowledge of recommendations about F&V intake, self-efficacy to eat F&V and liking for F&V. Parental educational level was determined from a questionnaire given to parents. The associations were examined with multilevel mediation analyses.
Schools in Bulgaria, Finland, Germany, Greece, Iceland, the Netherlands, Norway, Portugal, Slovenia and Sweden.
Eleven-year-old children (n 8159, response rate 72%) and their parents.
In five of the ten countries, children with higher educated parents were more likely to report eating fruits daily. This association was mainly mediated by knowledge but self-efficacy, liking, availability and facilitation also acted as mediators in some countries. Parents’ education was positively associated with their children's daily vegetable intake in seven countries, with knowledge and availability being the strongest mediators and self-efficacy and liking acting as mediators to some degree.
Parental educational level correlated positively with children's daily F&V intake in most countries and the pattern of mediation varied among the participating countries. Future intervention studies that endeavour to decrease the educational-level differences in F&V intake should take into account country-specific features in the relevant determinants of F&V intake.
To assess the effects of a school-based intervention on the diets of 7–9-year-olds.
Dietary intake of children in second and fourth grades was assessed with 3d weighed dietary records in autumn 2006 and autumn 2008, before and after a school-based intervention that started in the middle of second grade, and compared with control schools with no intervention. The diet was evaluated by comparison with food-based dietary guidelines (FBDG) and reference values for nutrient intake. The intervention aimed at several determinants of intake: knowledge, awareness, preferences/taste, self-efficacy and parental influence. Nutrition education material was developed for the intervention and implemented in collaboration with teachers. The main focus of the intervention was on fruit and vegetable intake as the children’s intake was far from meeting the FBDG on fruit and vegetables at baseline.
Elementary schools in Reykjavik, Iceland.
Complete dietary records were available for 106 children both at baseline and follow-up.
Total fruit and vegetable intake increased by 47 % in the intervention schools (mean: 61·3 (sd 126·4) g/d) and decreased by 27 % in the control schools (mean: 46·5 (sd 105·3) g/d; P < 0·001). The majority of the children in the intervention schools did still not meet the FBDG on fruits and vegetables at follow-up. Fibre intake increased significantly in the intervention schools, as well as that of potassium, magnesium, β-carotene and vitamin C (borderline).
The school-based intervention in 7–9-year-olds was effective in increasing fruit and vegetable intake, by 47 % increase from baseline, which was mirrored in nutrient intake.
To evaluate the diet of 7-year-old children by comparison with food-based dietary guidelines (FBDG) and reference values for nutrient intake.
Food and nutrient intake was assessed by 3 d weighed dietary records of 7-year-olds in six randomly chosen schools in Reykjavik, Iceland. Height and weight were measured. The diet of 165 children (62 % of sample) was evaluated by the Icelandic FBDG and the Nordic reference values (NRV) for nutrient intake.
Six randomly chosen schools in Reykjavik, Iceland.
The FBDG on fruits and vegetables was reached by less than 20 % of the children. A total of 52 % reached the FBDG to eat fish twice a week and 41 % to use vitamin D supplement. The FBDG on dairy was reached by 66 % of the children. Mean intake of SFA gave 13·9 % of the total energy intake (E%), which is higher than the NRV, 9·3E% of MUFA and 3·8E% of PUFA, both lower than the NRV (for all differences P < 0·001). Added sugar gave 12·1E%, which exceeds the upper level (P < 0·001). Fibre intake was 2·1 g/MJ and lower than the NRV (P < 0·001). Mean intake of micronutrients was above the recommended intake (RI), except for iodine, 109·0 μg/d, and vitamin D, 6·1 μg/d, which was lower than the RI (P = 0·006 and P < 0·001, respectively).
Fruit, vegetable, fish and dairy, as well as vitamin D supplement, need to be increased in the diet of 7-year-old children to reach the FBDG and the reference values for nutrient intake. Dietary changes to increase the quality of fat and carbohydrate are needed as well.
To study the differences between children’s self-reports and parents’ reports on environmental determinants of fruit and vegetable intake among 11-year-old children in the European country with the lowest reported consumption. A second objective was to examine the observed variance in fruit and vegetable intake among the children.
A cross-sectional survey was performed in Iceland as a part of the Pro Children cross-Europe survey. Children’s usual fruit and vegetable intake and its determinants were assessed through self-reports from the children (n 963) and their parents’ reports.
Children reported lower availability and accessibility of fruits at home than did their parents, while the reports of children and parents for vegetables were more in agreement. A larger proportion of the observed variance in children’s fruit and vegetable intake could be explained by the child’s perception than by the parent’s perception of determinants. The strongest determinants for fruit and vegetable intake according to the children’s reports were availability at home, modelling, demanding family rule and knowledge of recommendations. The strongest modelling determinant for fruit was the father’s fruit intake while for vegetables it was eating vegetables together with the family.
Eleven-year-old children should be asked themselves what determines their fruit and vegetable intake. However, children reported determinants in the physical and social environment, of which the parents are a part, as an important determinant for their intake. Interventions aiming to increase fruit and vegetable intake among children must therefore target the parents.
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