Dietary risk factors of physical growth of Filipino school-aged children
Abstract
Background: Adequate nutrition during childhood is essential to promote child growth and development.
Objective: The study evaluated the relationship of habitual nutrient intake and protein adequacy to the prevalence of child malnutrition.
Methods: Data were derived from a nationally representative sample of children aged 6–12 years. Two nonconsecutive day 24-h dietary recalls (24hR) were collected to estimate the individual food intake. PC-SIDE version 1.0 software (Software for Intake Distribution Estimation) was used to estimate the habitual intake of key nutrients accounting for between- and within-person differences in dietary intake. The 2007 WHO Protein Digestibility Corrected Amino Acid Score (PDCAAS) method was used to measure the protein quality or the utilizable protein intake. The nutritional status of the participants is reflected in the weight-for-age, height-for-age, and body mass index (BMI)-for-age z-scores using the WHO Growth Reference Standard (WHO, 2007).
Results: Undernourished school-aged children were found to have high protein inadequacy. Higher consumption of grains and cereal products, meat, and high-quality protein foods was associated with a lower risk of stunting. Higher intake of milk and milk products, grains and cereal products, high-quality protein foods, calcium, riboflavin, and vitamin C was associated with a lower risk of underweight. Higher consumption of grains and cereal products, riboflavin, thiamine, and fiber was associated with a lower risk of wasting. On the contrary, higher consumption of meat, milk and milk products, grains and cereal products, high-quality protein foods, and vitamin C was associated with a higher risk of obesity. Furthermore, linear growth of children was found to be associated with high-quality protein foods, calcium, vitamin B12, vitamin C, and vitamin D.
Conclusions: Malnutrition among Filipino children is influenced by nutrient intakes. However, the existence of malnutrition among children may be specifically attributed to the quality of protein consumed. Therefore, the study suggests that nutrition interventions and policies focusing on child malnutrition should improve not just the quantity but also the quality of protein sources consumed by children to aid in proper growth and development.
Downloads
References
- Demissie S, Worku A. Magnitude and factors associated with malnutrition in children 6–59 months of age in Pastoral community of Dollo Ado District, Somali Region, Ethiopia. Sci J Public Health 2013; 1: 175–83. doi: 10.11648/j.sjph.20130104.12
- Food and Agriculture Organization (FAO)/World Health Organization (WHO). Diet, nutrition and the prevention of chronic diseases. 2003. Available from: https://www.who.int/dietphysicalactivity/publications/trs916/en/gsfao_introduction.pdf [cited 20 August 2020].
- United Nations International Children’s Emergency Fund, World Health Organization & World Bank Group. Unicef/Who/World Bank Group Joint Child Malnutrition Estimates 2018. Levels and trends in child malnutrition. Key findings of the 2018 edition. 2018. Available from: http://www.who.int/nutgrowthdb/estimates/en [cited 20 February 2021].
- Abdel Wahed WY, Hassan SK, Eldessouki R. Malnutrition and its associated factors among rural school children in Fayoum Governorate, Egypt. J Environ Public Health 2017; 2017:1–9. doi: 10.1155/2017/4783791
- Wenhold F, Muehlhoff E, Kruger HS. Nutrition for school aged children. In: Temple N, Steyn NP, eds. Community nutrition for developing countries. Edmonton, AB, Canada: AU Press, Athabasca University; Pretoria, South Africa: UNISA; 2015. doi: 10.15215/aupress/9781927356111.01
- Neinstein LS, Katzman DK, Callahan ST, Gordon CM, Joffe A, Rickert VI. Chapter 1. Health of the World’s Adolescents and Young Adults. In: Neinstein LS, ed. Adolescent health care: a practical guide. 6th ed. Philadelphia, PA, USA: Lippincott, Williams, and Wilkins; 2016: 2–27. – Revised
- United Nations Children’s Fund Philippines (UNICEF Philippines). 2019, October 16. UNICEF: many children and adolescents in the Philippines are not growing up healthily. Available from: https://www.unicef.org/philippines/press-releases/unicef-many-children-and-adolescents-philippines-are-not-growing-healthily [cited 30 August 2020].
- United Nations Children’s Fund Philippines (UNICEF Philippines). Child survival. 2014. Available from: https://www.unicef.org/philippines/child-survival [cited 1 September 2020].
- World Bank Group. Undernutrition in the Philippines: scale, scope, and opportunities for nutrition policy and programming. World Bank; 2021. Available from: https://www.worldbank.org/en/country/philippines/publication/-keyfindings-undernutrition-in-the-philippines [cited 2 September 2020]
- United Nations System in the Philippines. Supporting inclusive, sustainable and resilient development: The United Nations Development Assistance for the Philippines. 2011. Available from: https://www.unfpa.org/sites/default/files/portal-document/Philippines_UNDAF%202012-2018.pdf.pdf [cited 1 September 2020].
- Laguna E. Sizing up: the stunting and child malnutrition problem in the Philippines. Philippines: Save the Children Philippines; 2015. Available from: https://resourcecentre.savethechildren.net/node/13449/pdf/save-the-children-lahatdapat-sizing-up-the-stunting-and-child-malnutrition-problem-in-the-philippines-report-september-2015.pdf [cited 10 September 2020].
- Food and Nutrition Research Institute-Department of Science and Technology (FNRI-DOST). Philippine nutrition facts and figures 2013: anthropometric survey. Taguig City, Metro Manila, Philippines: FNRI-DOST; 2015.
- Story M, Stang J. Nutrition needs of adolescents. In: Stang J, Story M, eds. Guidelines for adolescent nutrition services. Minneapolis, MN: University of Minnesota; 2005, pp. 21–34.
- Weichselbaum E, Buttriss J-L. Diet, nutrition and schoolchildren: an update. Nutr Bull 2014; 39(1): 9–73. doi: 10.1111/nbu.12071
- Corkins MR, Daniels SR, de Ferranti SD, Golden NH, Kim JH, Magge SN, Schwarzenberg SJ. Nutrition in children and adolescents. Med Clin N Am 2016; 100(6): 1217–35. doi: 10.1016/j.mcna.2016.06.005
- Semba RD, Shardell M, Sakr Ashour FA, Moaddel R, Trehan I, Maleta KM, et al. Child stunting is associated with low circulating essential amino acids. EBioMedicine 2016; 6: 246–52. doi: 10.1016/j.ebiom.2016.02.030
- Michaelsen KF, Greer FR. Protein needs early in life and long-term health. Am J Clin Nutr 2014; 99: 718S–22S. doi: 10.3945/ajcn.113.072603
- Joint WHO/FAO/UNU Expert Consultation. Protein and amino acid requirements in human nutrition. World Health Organization Technical Report Series, 935. World Health Organization: Geneva, Switzerland. 2007:161–178.
- Thorisdottir B, Gunnarsdottir I, Palsson GI, Halldorsson TI, Thorsdottir I. Animal protein intake at 12 months is associated with growth factors at the age of six. Acta Paediatr 2014; 103: 512–7. doi: 10.1111/apa.12576
- Günther AL, Remer T, Kroke A, Buyken AE. Early protein intake and later obesity risk: which protein sources at which time points throughout infancy and childhood are important for body mass index and body fat percentage at 7 y of age? Am J Clin Nutr 2007; 86(6): 1765–72. doi: 10.1093/ajcn/86.5.1765
- Nuss ET, Tanumihardjo S. Quality protein maize for Africa: closing the protein inadequacy gap in vulnerable populations. Adv Nutr 2011; 2: 217. doi: 10.3945/an.110.000182
- Samuel A, Wuehler S, Gibbs M, Moges T, Tesfaye B, Kebede A, et al. Overview of The Ethiopian National Food Consumption Survey (Nfcs): implications for fortification programs. Eur J Nutr Food Saf 2015; 5: 961–2. doi: 10.9734/EJNFS/2015/21186
- Angeles-Agdeppa I, Toledo M. Usual nutrient and food intake of Filipino stunted children: does it matter? J Food Nutr Res 2020; 8: 516–27. doi: 10.12691/jfnr-8-9-8
- Angeles-Agdeppa I, Denney L, Toledo M, Obligar V-A, Jacquier, E-F, Carriquiry A-L, et al. Inadequate nutrient intakes in Filipino schoolchildren and adolescents are common among those from rural areas and poor families. Food Nutr Res 2019; 63: 10.29219/fnr.v63.3435. doi: 10.29219/fnr.v63.3435
- Food and Nutrition Research Institute – Department of Science and Technology (FNRI-DOST). Facts and figures 2013, 8th National Nutrition Survey Dietary Survey. Metro Manila, Philippines: Food and Nutrition Research Institute, Department of Science and Technology; 2015.
- Food and Nutrition Research Institute – Department of Science and Technology (FNRI-DOST). Facts and figures 2013, 8th National Nutrition Survey Overview. Metro Manila, Philippines: Food and Nutrition Research Institute, Department of Science and Technology; 2015.
- World Health Organization. WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Height and Body Mass Index-for-Age. 2007. Geneva: WHO. World Health Organization (WHO). Child growth standards. Available from: https://www.who.int/tools/child-growth-standards [cited 18 February 2021].
- Institute of Medicine (US). Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: National Academies Press; 2005, p. 3313. Available from: https://www.nal.usda.gov/sites/default/files/fnic_uploads/energy_full_report.pdf [cited 18 September 2018].
- Lopez-Olmedo N, Carriquiry AL, Rodriguez-Ramirez S, Ramirez-Silva I, Espinosa-Montero J, Hernandez-Barrera L, et al. Usual intake of added sugars and saturated fats is high while dietary fiber is low in the Mexican population. J Nutr 2016; 146(9): 1856S–65S. doi: 10.3945/jn.115.218214
- World Health Organization. Protein and amino acid requirements in human nutrition: report of a Joint WHO/FAO/UNU Expert Consultation (WHO Technical Report Series) (1st ed.). World Health Organization: Geneva, Switzerland. 2007: 94–95.
- Shivakumar N, Jackson AA, Courtney-Martin G, Elango R, Ghosh S, Hodgkinson S, et al. Protein quality assessment of follow-up formula for young children and ready-to-use therapeutic foods: recommendations by the FAO Expert Working Group in 2017. J Nutr 2020; 150(2): 195–201. doi: 10.1093/jn/nxz250
- Department of Science and Technology - Food and Nutrition Research Institute (DOST-FNRI). Taguig City: Philippine Dietary Reference Intakes 2015.
- Guenther PM, Kott PS, Carriquiry AL. Development of an approach for estimating usual nutrient intake distributions at the population level. J Nutr 1997; 127: 1106–12. doi: 10.1093/jn/127.6.1106
- Joseph ML, Carriquiry A. A measurement error approach to assess the association between dietary diversity, nutrient intake, and mean probability of adequacy. J Nutr 2010; 140(11): 2094S–101S. doi: 10.3945/jn.110.123588
- Givens DI. Review: dairy foods, red meat and processed meat in the diet: implications for health at key life stages. Animal 2018; 12(08): 1709–21. doi: 10.1017/s1751731118000642
- Taher E, ElKoly M, Zaghloul S, Mohammed H. Predictors of stunting among children attending the National Nutrition Institute in Egypt. Egypt J Community Med 2018; 36(01): 45–60. doi: 10.21608/ejcm.2018.6869
- Dror DK, Allen LH. The importance of milk and other animal-source foods for children in low-income countries. Food Nutr Bull 2011; 32(3): 227–43. doi: 10.1177/156482651103200307
- Ellis, 2020: Ellis E. Nutrition for Growing Bodies. Academy of Nutrition and Dietetics. 2020. Available from: https://www.eatright.org/health/wellness/healthy-aging/nutrition-for-growing-bodies [cited 21 February 2021].
- Wang Y, Beydoun MA. Meat consumption is associated with obesity and central obesity among US adults. Int J Obes 2009; 33(6): 621–8. doi: 10.1038/ijo.2009.45
- Tessema M, Gunaratna N, Brouwer I, et al. Associations among high-quality protein and energy intake, serum transthyretin, serum amino acids and linear growth of children in Ethiopia. Nutrients 2018; 10(11): 1776. doi: 10.3390/nu10111776
- Uauy R, Kurpad A, Tano-Debrah K, Otoo GE, Aaron GA, Toride Y, et al. Role of protein and amino acids in infant and young child nutrition: protein and amino acid needs and relationship with child growth. J Nutr Sci Vitaminol 2015; 61: S192–4. doi: 10.3177/jnsv.61.S192
- Ghosh S, Suri D, Uauy R. Assessment of protein adequacy in developing countries: quality matters. Br J Nutr 2012; 108: 484–9. doi: 10.1017/S0007114512002577
- U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 dietary guidelines for Americans. 2012. Available from: http://health.gov/dietaryguidelines/2015/guidelines/ [cited 20 September 2020].
- Michaelsen KF, Hoppe C, Ross N, Kaestel P, Stougaard M, Lauritzen L, et al. Choice of foods and ingredients for moderately malnourished children 6 months to 5 years of age. Food Nutr Bull 2009; 30(3 Suppl): S343–404. doi: 10.1177/15648265090303S303
- Yisak H, Tadege M, Ambaw B, Ewunetei A. Prevalence and determinants of stunting, wasting, and underweight among school-age children aged 6–12 years in South Gondar Zone, Ethiopia. Pediatr Health Med Ther 2021; 12: 23–33. doi: 10.2147/PHMT.S287815
- Vanderhout SM, Corsi DJ. Milk consumption and childhood anthropometric failure in India: analysis of a national survey. Matern Child Nutr 2020; 17(2): e13090. doi: 10.1111/mcn.13090
- Ayogu R. Energy and nutrient intakes of rural Nigerian schoolchildren: relationship with dietary diversity. Food Nutr Bull, 2019: 40(2): 241–253. doi: 10.1177/0379572119833854
- Khamis AG, Mwanri AW, Ntwenya JE, Kreppel K. The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania. BMC Pediatr 2019; 19: 518. doi: 10.1186/s12887-019-1897-5.
- Barrett B. Nutrition profile of Cambodia: a review of current conditions and strategies to prevent macronutrient and micronutrient deficiencies. 2020. Available from: https://www.sharingfoundation.org/wp-content/uploads/2021/03/Nutrition-Study-for-RCC-Nov-2020.pdf [cited 20 September 2020].
- Mwaniki EW, Makokha AN. Nutrition status and associated factors among children in public primary schools in Dagoretti, Nairobi, Kenya. Afr Health Sci 2013; 13(1): 39–46. doi: 10.4314/ahs.v13i1.6
- Roxas BV, Intengan CL, Juliano BO. Effect of zinc supplementation and high-protein rice on the growth of preschool children on a rice-based diet. Qual Plant Plant Foods Hum Nutr 1981; 30(3–4): 213–22. doi: 10.1007/bf01094026
- Michigan State University. New research demonstrates role of grain legumes in fighting malnutrition. AgBioResearch; 2018. Available from: https://www.canr.msu.edu/news/new-research-demonstrates-role-of-grain-legumes-in-fighting-malnutrition [cited 18 January 2021].
- Rouhani MH, Salehi-Abargouei A, Surkan PJ, Azadbakht L. Is there a relationship between red or processed meat intake and obesity? A systematic review and meta-analysis of observational studies. Obes Rev 2014; 15(9): 740–8. doi: 10.1111/obr.12172
- Kim GH, Shin SW, Lee J, Hwang JH, Park SW, Moon JS, et al. Red meat and chicken consumption and its association with high blood pressure and obesity in South Korean children and adolescents: a cross-sectional analysis of KSHES, 2011–2015. Nutr J 2017; 16: 31. doi: 10.1186/s12937-017-0252-7
- Cockburn H. Meat contributes to obesity as much as sugar, research suggests. The Independent; 2016, August 4. Available from: https://www.independent.co.uk/life-style/health-and-families/health-news/meat-obesity-sugar-protein-fat-research-a7168066.html [cited 10 February 2021].
- Nezami M, Gina S-S, Beeson W, Sabaté J. Associations between consumption of dairy foods and anthropometric indicators of health in adolescents. Nutrients 2016; 8(7): 427. doi: 10.3390/nu8070427
- Snijder MB, van der Heijden AA, van Dam RM, Stehouwer CD, Hiddink GJ, Nijpels G, et al. Is higher dairy consumption associated with lower body weight and fewer metabolic disturbances? The Hoorn Study. Am J Clin Nutr 2007; 85: 989–95. doi: 10.1093/ajcn/85.4.989
- Wiley AS. Does milk make children grow? Relationships between milk consumption and height in NHANES 1999–2002. Am J Hum Biol 2005; 17: 425–41. doi: 10.1002/ajhb.20411
- Berkey CS, Rockett HR, Willett WC, Colditz GA. Milk, dairy fat, dietary calcium, and weight gain: a longitudinal study of adolescents. Arch Pediatr Adolesc Med 2005; 159: 543–50. doi: 10.1001/archpedi.159.6.543
- Dhir S, Tarasenko M, Napoli E, Giulivi C. 2019. Neurological, psychiatric, and biochemical aspects of thiamine deficiency in children and adults. Front Psychiatry 2019; 10: 1. doi: 10.3389/fpsyt.2019.00207
- Greene-Finestone LS, Garriguet D, Brooks S, Langlois K, Whiting SJ. 2017. Overweight and obesity are associated with lower vitamin D status in Canadian children and adolescents. Paediatrics & Child Health, 22(8), 438–444. doi: 10.1093/pch/pxx116.
- Johnson L, Mander AP, Jones LR, Emmett PM, Jebb SA. 2008. Energy-dense, low-fiber, high-fat dietary pattern is associated with increased fatness in childhood. The American Journal of Clinical Nutrition, 87(4), 846–854. doi: 10.1093/ajcn/87.4.846
- Zhou SS. 2014. Excess vitamin intake: An unrecognized risk factor for obesity. World J Diabetes, 5(1), 8. doi: 10.4239/wjd.v5.i1.1
- Mosites E, Aol G, Otiang E, Bigogo G, Munyua P, Montgomery J M, et al. 2016. Child height gain is associated with consumption of animal-source foods in livestock-owning households in Western Kenya. Public Health Nutrition, 20(2), 336–345. doi: 10.1017/s136898001600210x
- Wang W, Wu Y, Zhang D. Association of dairy products consumption with risk of obesity in children and adults: a meta-analysis of mainly cross-sectional studies. Ann Epidemiol 2016; 26(12): 870–82.e2. doi: 10.1016/j.annepidem.2016.09.005
- Yasmin G, Kustiyah L, Dwiriani C-M. Stunted children has higher risk of overweight: a study on children aged 6–12 years in eight provinces in Indonesia. Pak J Nutr 2019; 18(5): 455–63. doi: 10.3923/pjn.2019.455.463
- Bes-Rastrollo M, Sánchez-Villegas A, Gómez-Gracia E, Martínez JA, Pajares RM, Martínez-González MA. Predictors of weight gain in a Mediterranean cohort: the Seguimiento Universidad de Navarra Study 1. Am J Clin Nutr 2006 Feb; 83(2): 362–70; quiz 394–5. doi: 10.1093/ajcn/83.2.362
- Rosell M, Appleby P, Spencer E, Key T. Weight gain over 5 years in 21,966 meat-eating, fish-eating, vegetarian, and vegan men and women in EPIC-Oxford. Int J Obes 2006 Sep; 30(9): 1389–96. doi: 10.1038/sj.ijo.0803305
- Vergnaud AC, Norat T, Romaguera D, Mouw T, May AM, Travier N, et al. Meat consumption and prospective weight change in participants of the EPIC-PANACEA study. Am J Clin Nutr. 2010; 92: 398–407. doi: 10.3945/ajcn.2009.28713
- Neo J, Binte Mohamed Salleh S, Toh Y, How K, Tee M, Mann K, et al. Whole-grain food consumption in Singaporean children aged 6–12 years. J Nutr Sci 2016; 5: E33. doi: 10.1017/jns.2016.25
- Zanovec M, O’Neil C, Cho S, Kleinman R, Nicklas T. Relationship between whole grain and fiber consumption and body weight measures among 6- to 18-year-olds. J Pediatr 2010; 157(4): 578–83. doi: 10.1016/j.jpeds.2010.04.041
- Choumenkovitch SF, McKeown NM, Tovar A, Hyatt RR, Kraak VI, Hastings AV, et al. Whole grain consumption is inversely associated with BMI Z-score in rural school-aged children. Public Health Nutr 2013 Feb; 16(2): 212–8. doi: 10.1017/S1368980012003527
- Herber C, Bogler L, Subramanian SV, & Vollmer S. 2020. Association between milk consumption and child growth for children aged 6–59 months. Scientific Reports, 10(1), 1–8. doi: 10.1038/s41598-020-63647-8
- Michaelsen KF, Neufeld LM, Prentice AM, eds. Global landscape of nutrition challenges in infants and children. Nestlé Nutr Inst Workshop Ser. Vol. 93. Basel: Nestlé Nutrition Institute, Switzerland/S. Karger AG, © 2020, pp. 77–90. doi: 10.1159/000503357
- Ernalia Y, Dwi Utari LS, Restuastuti T. Different intakes of energy and protein in stunted and non-stunted elementary school children in Indonesia. KnE Life Sci 2018; 4(4): 556. doi: 10.18502/kls.v4i4.2318
- De Vries-Ten Have J, Owolabi A, Steijns J, Kudla U, Melse-Boonstra A. Protein intake adequacy among Nigerian infants, children, adolescents and women and protein quality of commonly consumed foods. Nutr Res Rev 2020; 33(1): 102–20. doi: 10.1017/S0954422419000222
- Pimpin L, Jebb S, Johnson L, Wardle J, Ambrosini GL. Dietary protein intake is associated with body mass index and weight up to 5 y of age in a prospective cohort of twins 1,2. Am J Clin Nutr 2015; 103(2): 389–97. doi: 10.3945/ajcn.115.118612
- Cuadrado-Soto E, López-Sobaler AM, Jiménez-Ortega AI, Aparicio A, Bermejo LM, Hernández-Ruiz N, et.al. 2020. Usual Dietary Intake, Nutritional Adequacy and Food Sources of Calcium, Phosphorus, Magnesium and Vitamin D of Spanish Children Aged One to <10 Years. Findings from the EsNuPI Study. Nutrients, 12(6), 1787. doi: 10.3390/nu12061787
- Rubio-López N, Llopis-González A, Morales-Suárez-Varela M. Calcium intake and nutritional adequacy in Spanish children: the ANIVA study. Nutrients 2017; 9(2): 170. doi: 10.3390/nu9020170
- García OP, Ronquillo D, Del Carmen Caamaño M, Martínez G, Camacho M, López V, et al. Zinc, iron and vitamins A, C and E are associated with obesity, inflammation, lipid profile and insulin resistance in Mexican school-aged children. Nutrients 2013; 5(12): 5012–30. doi: 10.3390/nu5125012
- Mathai J, Liu Y, Stein H. Values for digestible indispensable amino acid scores (DIAAS) for some dairy and plant proteins may better describe protein quality than values calculated using the concept for protein digestibility-corrected amino acid scores (PDCAAS). Br J Nutr 2017; 117(4): 490–9. doi: 10.1017/S0007114517000125
- Gilani GS, Cockell KA, Sepehr E. Effects of antinutritional factors on protein digestibility and amino acid availability in foods. J AOAC Int 2005; 88: 967–87. doi: 10.1093/jaoac/88.3.967
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to SNF Swedish Nutrition Foundation. Read the full Copyright- and Licensing Statement.