Relationship of nutrition knowledge and obesity in adolescence

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Causes of Childhood Obesity

Questions were constructed based on reference books and journal articles and were checked and validated by panel of experts. A pilot study was conducted to ensure that the questions were appropriate for the targeted respondents. The questionnaire was written in the Malay language and included 11 questions related to nutritional knowledge, 6 questions on nutritional attitudes and 5 questions on nutritional practices.

The knowledge domain consisted of multiple-choice items for: Nutrition definition 2 itemsnutrition classification 1 itemfood pyramid 2 itemsnutrition source 2 itemsnutrition function 2 items and balanced foods and healthy eating 2 items. Only one question offered a "yes" or "no" answer. For the practice domain, higher scores were given to positive responses. The total scores for nutrition knowledge, attitude and practice were 40, 30 and 12, respectively.

The demographic profiles were presented descriptively.

Relationship of nutrition knowledge and obesity in adolescence.

Scores for knowledge, attitude and practice were obtained by summing all scores for each variable. Pearson correlation analysis was used to determine the relationship between nutritional knowledge, attitude and practice. Most of the participants had lived in the institution between 1 and 24 months and thus were considered to be newcomers.

The majority of study subjects had a normal BMI, while 4 were severely thin and 2 were thin. Meanwhile, 14 subjects were overweight and 13 were obese Table 1. The mean between 50th and 75th percentile nutritional knowledge, attitude and practice scores were: Most respondents scored as "poor" on knowledge of nutrition but received "good" scores for attitude and practice Table 3.

However, there was no correlation between knowledge and attitude or knowledge and practice Table 4. Several questions regarding nutritional practice had different response options. For example, the question, "How many times do you eat daily? For the question "How many times do you have breakfast in a week? Mostly the respondents Furthermore, a study of BMI in female children showed the same trend wherein most children were of normal weight For those children outside of the normal range, a previous study conducted using a correlation tool that used BMI as a variable found that for those children who had abnormal BMI values, the percentage of overweight and obese children was higher than that for children who were underweight Although the mean nutritional knowledge of the respondents was at the moderate level between 50th and 75th percentilethis value was barely above the 50th percentile, which indicated that the overall level was poor.

As for the category score, very few respondents achieved a "good" knowledge score. This result is in agreement with previous measurements of nutritional knowledge of high school adolescents that showed overall poor nutritional knowledge However, knowledge levels could be improved after appropriate interventions This study indicated that for nutritional attitudes, most respondents were in the "good" category. This result is encouraging given that a study in the Netherlands showed that nutritional attitude was identified as a significant correlate of healthy eating practices This result indicated that dietary patterns can likely be improved as was suggested by a longitudinal study conducted in the United Kingdom that showed nutritional awareness is among the important factors that drive dietary change Thus, awareness of the importance of having good nutrition can promote changes in nutritional attitudes.

Results from this study showed that a significant percentage This finding is a concern given that skipping breakfast is associated with weight problems that could arise from ensuing decreased physical activity The lack of breakfast may also have contributed to the number of overweight and obese 14 and 13, respectively respondents in this study.

Relationship of nutrition knowledge and obesity in adolescence.

This line of thinking is supported by a systematic review of studies on the effects of breakfast on cognitive performance among well-nourished and nutritionally at-risk or stunted children, which found that a positive effect of breakfast on cognitive performance was seen in both short and long-term studies Skipping breakfast is not recommended because it is highly associated with weight problems in children and adolescents, who may be less likely to engage in physical activity that in turn promotes weight gain Schools can and should play a central role in delivering interventions about these issues During adolescence, young people start to make lifestyle choices and adopt habits which generally become entrenched behaviours as they move into adulthood 28, Therefore, adolescence appears to be an ideal time to influence choices and shifts in behaviour and attitudes.

Eating behaviours and food choices are usually acquired in childhood but these are further shaped during adolescence and are influenced by a range of factors such as the media, socioeconomic status, peers, family and personal nutritional knowledge 19,28, Furthermore, physical activity levels were low, especially among female Emiratis and those living in urban areas Given that adolescence is the stage at which lifestyle behaviours and habits are adopted that will be carried into adulthood and the changing nutrition and lifestyle in the UAE, health care and educational providers need to pay careful attention this issue.

Targeted interventions that promote health by establishing healthy lifestyles and positive adaptive behaviours from a young age are required. In order to develop effective interventions that will be contextually relevant, baseline data for the UAE that measure the existing knowledge and attitudes of adolescents about healthy nutrition are required. The aim of this study therefore was to assess the nutritional knowledge and habits of adolescents attending schools in the UAE.

Methods Study design This was a cross-sectional survey study. This design is appropriate when the research purpose is to collect initial or original data in a large population group, to describe trends and to measure the knowledge, attitudes or behaviours of a particular group 32, A pragmatic decision was made to access the private school system because teaching is done in English and the students are thus competent in the language.

The tools used were written in English and no current validated Arabic versions of the tools were available. Given that private schools are not segregated by gender, unlike the segregated public education system in the UAE, private schools offered easier access to both male and female students in the same location. A 2-stage sampling process was undertaken. Each school was assigned a number and 4 numbers were randomly selected using True Random Number Generator software available online https: In the second stage, the same computerized software was used to select classes from each of the 4 schools; only classes that contained the target age group years were included in the random selection process.

Initially 4 classes from each school were selected with an average class size of 25 students.

Information about the study was provided to the parents and they were asked to sign a consent form if they agreed for their child to participate. Figure 1 illustrates the sampling process. Accessing participants On completion of the 2-stage sampling process, all students from the selected classes aged between 9 and 13 years who returned a valid signed consent form from their parents were included in this study.

Students who did not return the consent form or could not complete the study questionnaire were excluded from the study. Eligible students who had returned the signed consent were then approached by the school nurses to take part in the study; they were provided with information about the purpose of the study, the nature of their participation, and how to complete the study survey.

Students who agreed to participate were given a choice to complete the questionnaire immediately at school or later at home. In the second case, students were given an envelope and asked to return the questionnaire to the school nurse office. Students who chose to complete the survey at home were given one reminder to return their survey: Instrument The data collection tool was a self-administered nutrition survey, adapted from a similar study conducted in Kuwait one of the 6 GCC countries in the region The characteristics of Kuwaiti society in terms of culture, religion, politics and economics is very similar to that of the UAE as are the dietary habits and educational systems.

The questionnaire had 2 sections. Each question had 4 options for the answer. The content validity of the questionnaire was considered appropriate after evaluation by a panel of experts in the fields of nutrition and elementary education.

The second section evaluated dietary behaviours and included 5 questions that assessed consumption of fast foods, breakfast-skipping, caloric-dense food snacking, fruit intake and vegetable intake.

This section was adapted from the Health Behavior Questionnaire and the School-Based Nutrition Monitoring student questionnaire, both with an acceptable internal consistency of greater than 0. The level of knowledge about healthy nutrition was graded by the number of correct answers scored by the students on the relevant part of the questionnaire. The dietary behaviour part of the questionnaire included 5 Likert scale-type questions, where the student had to choose a correct answer from 4 options.

Examples of the questions on both sections are shown below. Sample question from the knowledge section. The total number of servings of fruits and vegetables that you should eat every day is: Sample question from the behaviour section. Think about last week, did you eat snacks like candy, chocolate, chips, cookies, cake or ice-cream?: No, I did not eat any of the food listed or similar; Yes, I ate 1 of these foods 1 time last week; Yes, I ate 1 of these foods 2 times last week; Yes, I ate 1 of these foods 3 or more times last week.

Ethical considerations Ethics approval for the study was obtained from the Ethical Review Committee for the Medical College and Health Sciences College for the University of Sharjah and was communicated to the participating schools.

As the proposed participants were minors, parental consent was required. An already established school protocol was used in which the school nurse liaised with the parents. Oral consent was sought from the students. Careful consideration was given to the potential for students to feel coerced into participating given the power imbalance between students, school nurses and researchers.

In addition to the parental and student consent process, the adolescents were consulted regarding their preferences on when to complete the survey, which took 15 minutes on average to complete. Throughout the entire research process, regular checks were undertaken to ensure that the participants were happy to continue, and they were reminded that they could withdraw temporarily or permanently at any stage without any consequences.

Participant confidentiality and privacy were protected by ensuring that no personal information that would enable later identification was collected. Students were also reminded that they were not required to provide any identifying information while completing the survey. All study data were stored securely and were accessible only to the study researchers.

Data analysis The surveys were graded manually. Data were coded, examined and prepared for analysis with SPSS, version In the knowledge section, each correct response was allocated 1 point and each incorrect or no response was allocated 0 points.

The 5 questions on dietary behaviours were assessed individually on a 4-point Likert scale: The maximum score for knowledge was 16 and the highest mean score for the behaviour was 4. Higher scores indicated higher knowledge about nutrition and better dietary behaviour. Results The age and sex of the study participants are shown in Table 1.

Table 2 shows the nutritional knowledge and behaviour levels of the students. Table 3 shows the percentage of correct and incorrect answers on each of the individual knowledge of nutrition questions according to sex.

The questions on which knowledge was particularly low were: Table 4 shows the reported eating behaviours of the students categorized by sex. The issue of adolescent nutrition and its effect on obesity has become a public health priority, both nationally within the UAE and globally Rapid and substantial societal changes have taken place in the UAE and other GCC countries over the past few decades, which have resulted in marked changes to the diet and lifestyle of much of the population.

In response, the UAE government has outlined health promotion activities of importance and has specifically identified key objectives, including to implement school-based strategies to promote healthy nutritional habits among children and to increase activity levels to improve future health and reduce obesity 31,38, The results of our study are consistent with those of other reports that identified healthy nutrition knowledge gaps and negative nutritional habits among adolescents ,7,8.

A study in Morocco in identified moderate levels of overweight and obesity and undernourishment among Moroccan adolescents 1. Similarly a cross-sectional study in Mozambique in identified several serious micronutrient deficiencies among adolescent girls which could lead to serious health consequences, especially given that adolescent marriage and motherhood is a common practice 3.

Likewise, a study reported on the nutritional profiles of adolescents of South Asian Indian descent in the USA 5. They found dietary patterns characterized by high levels of saturated fats with low potassium, magnesium, calcium, vitamin D, and fibre intake. Such dietary habits are likely to predispose to future disease risk. Positively influencing nutritional intake and promoting healthy behaviours is a challenge facing both developed and developing countries. However, the importance of addressing this issue early has been established with a focus on directing interventions towards children and adolescents within the school setting Young people spend a lot of their time at school; they are learning rapidly and their behaviours are potentially more amenable to change than adults.

It is thus suggested that school-based interventions that incorporate and promote healthy lifestyle behaviours are timely and potentially more effective during these formative years. Integrating current knowledge of nutrition into the overall curriculum and embedding healthy living practices within the educational system are important components to bring about the societal changes needed to protect the young people of the UAE from the health-related problems associated with obesity and related nutritional deficiencies.

Prior to planning and delivering interventions designed to promote healthy behaviours and improve nutritional knowledge, it is essential to identify the current nutritional knowledge and health habits of adolescents in the UAE context. The data obtained from this survey can inform future initiatives targeting specific areas requiring attention in young people aged years.

Our results show a great lack of knowledge of healthy nutrition and healthy eating habits and suggest that, without active intervention, these young people are at risk of obesity, nutritional deficiencies and associated health problems. Consistent with previous research 21, 40 findings reporting a strong association between the nutritional knowledge of adolescents and their eating habits, our findings also showed a positive association between higher levels of nutritional knowledge and healthier eating habits, including eating more fruit and vegetables, eating breakfast more regularly, and eating fewer unhealthy snacks and less fast food.