Received date: January 15, 2016; Accepted date: June 21, 2016; Published date: June 28, 2016
Citation: Al-Agha AE, Al-Baradi WR, Al-Rahmani DA, Simbawa BM (2016) Associations between Various Nutritional Elements and Weight, Height and BMI in Children and Adolescents. J Pat Care 2:113 doi:10.4172/2573-4598.1000113
Copyright: © 2016 Al-Agha AE, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Purpose:This cross-sectional study included 653 children aged 2–18 years located in Jeddah, Saudi Arabia (2015–2016). This study aimed to determine the association between dietary intake (daily, weekly and rarely) and anthropometric measurements.
Method: Both child and family questionnaire was given, followed by weight and height measurements. The questionnaire consisted of general demographic information, anthropometric measurements, analysis of various nutritional element of daily intake. Using one-way ANOVA test after checked all assumptions. Also, Welch test was using whiles the assumption of homogeneity of variance not satisfied by levene test.
Results: Higher mean BMI in children consuming legumes daily than weekly and rarely and also higher BMI mean in children drinking milk rarely than daily and weekly. While lower mean BMI in children drinking soft drinks rarely. For children height, the means among eating proteins, vegetables and drinking milk daily have lower heights mean than weekly and rarely. Height means in children who eating and drinking daily fat, fast food, and soft drinks have higher heights mean than weekly and rarely. Weight SDs with various nutrition elements shows no significant relation.
Conclusion: Different type of nutritional elements and its effect on children’s growth so further studies should be made to identify the values of the level of food intake and its benefit on the child growth.
Growth; Nutrition; Children; Diet
Of children younger than 5 years old in 2013, it was estimated that 161.5 million were stunted, 50.8 million had low weight for height and 41.7 million were overweight or obese . Therefore, the association between nutrition and growth in children is becoming important, particularly given the reported associations, both significant and nonsignificant, between specific nutrients and weight, height, or body mass index (BMI). The estimated average of daily requirements should be met in order to have sufficient growth of the child.
Carbohydrates are the primary source of energy and play a key role in maintenance of body weight. Whole grains, fruits, vegetables, and beans should form the majority of carbohydrate intake, because these foods also provide the nutrients that support growth and development in children. Fruit and vegetable intake also helps to prevent weight gain and reduces the risk of obesity [2,3]. Furthermore, increasing overall carbohydrate intake might increase the risk of insulin resistance in children as they become obese .
Although dietary fat is essential, higher consumption is associated with multiple diseases. While height might not be affected by fat consumption, weight is definitely affected. An adequate balance of polyunsaturated and monounsaturated fats should be considered while limiting saturated and trans fat products . Protein is considered important for child growth. In particular, milk intake during childhood is crucial for growth and bone development, especially in girls .
The World Health Organization recommended that consumption of sugar-sweetened beverages should be reduced to <10% (equivalent to 50 g) of total intake  because of the limited nutritional value. However, because chocolate has a certain beneficial amount of protein, it is excluded from the sugar-related recommendations. Fast food is high in calories and low in nutritional value, increasing the risk of weight gain and serious diseases. Among adolescents, the consumption of fast food is highly associated with total energy and fat intake and inversely associated with daily intake of fruit, vegetables and milk .
This study aimed to determine the association between various nutritional elements and weight, height, and BMI in children and adolescents in Jeddah, Saudi Arabia.
This cross-sectional study was conducted in Saudi Arabia, Jeddah and included 653 children aged 2–18 years who were randomly selected in 2015–2016; children older than 18 years were excluded (n=36). The child and family were interviewed using a questionnaire, followed by measurement of the child’s weight and height. Written and verbal consent were obtained prior to completion of the questionnaire by the parents. Ethical approval for this study was obtained from the Research Ethics Committee of our hospital. Study setting: The questionnaire was been distributed randomly in multiple primary health care facilities coming for regular follow up.
The questionnaire consisted of general demographic information, anthropometric measurements and current frequency of intake (day, week or rarely) of protein (eggs, meat, chicken and fish), carbohydrates (bread, rice, macaroni and potatoes), fat (fried food, oils, butter and margarine) and legumes (beans, lentil and homos). A specific questionnaire was used to collect the frequency of intake (day, week or rarely) of milk, juice, fruits, vegetables, fast food, soft drinks and sweets.
Weight was measured in kg on a scale, with the subjects in light clothing without shoes. Height was measured in centimetres using a medical height scale. BMI was defined as weight in kilograms divided by height in metres squared (kg/m2) . Weight and height percentiles were determined for each subject according to the Centres for Disease Control and Prevention (CDC) growth chart . Normal weight was in the 5th–95th percentiles, and normal height was in the 5th–95th percentiles.
Data was entered, coded, and analysed using statistical package for social science (SPSS), version 16. The analysis was done by finding the difference in BMI kg\m2, height cm and weight SDs means among dietary factor by using one-way ANOVA test after checked all assumptions. Also, Welch test was using whiles the assumption of homogeneity of variance not satisfied by levene test. Percentages and frequencies of dietary factors frequency were calculated as descriptive statistics. The results were considered to significant with P(less than) 0.05. For these analyses, frequency of intake was categorised as daily, weekly or rarely. Daily represent the intake once or more than once a day while weekly represents the intake of nutrition every week. And rarely represents the intake from time to time or rarely.
The study included 653 children and adolescence 304 boys, 313 girls (mean age: 8.9 ± 9 years; 50.2% males, 49.8% females). This study reported the daily intake of carbohydrate were 511 (90.3%), 32 (5.7%) were weekly. And daily intake of Juice were 383 (70.9%), 69 (12.8%) were weekly and 88 (16.3%) were rarely. The daily intake of Soft drinks were 151 (26.6%), 107 (18.8%) were weekly and 310 (54.6%) were rarely. The daily intake of Fruits were 254 (45.9%), 126 (22.8%) were weekly and 173 (31.3%) were rarely. And daily intake of Vegetables were 269 (48.7%), 91 (16.5%) were weekly and 192 (34.8%) were rarely. The daily intake of Protein were 453 (79.8%), 61 (10.7%) were weekly and 54 (9.5%) were rarely. And the daily intake of Milk were 387 (63.2%), 69 (11.3%) were weekly and 156 (25.5%) were rarely. The daily intake of Legumes were 159 (28.5%), 193 (34.6%) were weekly and 205 (36.8%) were rarely. And the daily intake of Fat were 300 (53.0%), 137 (24.2%) were weekly and 129 (22.8%) were rarely. The daily intake of Fast Food were 93 (16.3%), 274 (48.1%) were weekly and 203 (35.6%) were rarely. And the daily intake of Sweets were 425 (76.6%), 63 (11.4%) were weekly and 67 (12.1%) were rarely.
Mean BMI were higher with children consuming legumes daily than weekly and rarely (Figure 1). Mean BMI among drinking milk frequencies, p-value=0.051, children who rarely drinking milk have higher BMI than weekly and daily. Mean BMI among drinking soft drink frequencies, p-value=0.002, children who rarely drinking soft drink have lower BMI than weekly and daily (Table 1).
The mean height among children eating proteins frequencies, p-value=0.036, children who eating daily protein have lower height mean than weekly and rarely. For mean height among drinking milk frequencies, p-value=0.001, children who drinking daily milk have lower height mean than weekly and rarely. The mean of height among eating vegetables children who eating vegetables daily have lower height mean than weekly and rarely. Height means in children who eating and drinking daily fat, fast food, soft drinks have higher heights mean than weekly and rarely (Table 2).
|Dietary elements||Eating Frequencies||BMI kg\m2(Mean ± SD)||P-value|
|Weekly||15.9414 ± 2.75426|
|Rarely||16.5128 ± 2.49573|
|Fat||Daily||16.2007 ± 2.65757||0.893|
|Weekly||16.3344 ± 2.59152|
|Rarely||16.1952 ± 2.56510|
|Legumes||Daily||16.8109 ± 3.02461||0.012|
|Weekly||16.2241 ± 2.43730|
|Rarely||15.8290 ± 2.34873|
|Carbohydrates||Daily||16.2894 ± 2.66465||0.416|
|Rarely||15.8555 ± 2.04789|
|Milk||Daily||16.0643 ± 2.62181||0.051|
|Weekly||16.1811 ± 2.41450|
|Rarely||16.7976 ± 2.73345|
|Fast Food||Daily||16.4093 ± 2.57207||0.122|
|Weekly||16.4542 ± 2.82590|
|Rarely||15.9047 ± 2.40759|
|Soft Drinks||Daily||16.7011 ± 2.78687||0.002|
|Weekly||16.8452 ± 2.73009|
|Rarely||15.8672 ± 2.49064|
|Juices||Daily||16.1074 ± 2.58090||0.511|
|Weekly||16.4300 ± 2.70880|
|Rarely||16.4489 ± 2.81486|
|Fruits||Daily||16.0097 ± 2.40413||0.220|
|Weekly||16.2946 ± 2.97629|
|Rarely||16.5082 ± 2.69905|
|Vegetables||Daily||16.1034 ± 2.54806||0.623|
|Weekly||16.1485 ± 2.74109|
|Rarely||16.3736 ± 2.64522|
|Sweets||Daily||16.1020 ± 2.51673||0.114|
|Weekly||17.1587 ± 3.29436|
|Rarely||16.0994 ± 2.53670|
Table 1: Differences in body mass index (BMI) based on consumption frequency of various dietary elements by children aged 2–18 years in Saudi Arabia
|Dietary elements||Eating Frequencies||Height cm (Mean ± SD)||P-value|
|Protein||Daily||118.6 ± 19.51873||0.036|
|Weekly||121.03 ± 19.81525|
|Rarely||126.13 ± 19.02476|
|Fat||Daily||121.2 ± 19.39712||0.043|
|Weekly||120.1 ± 20.70607|
|Rarely||115.6 ± 18.23115|
|Carbohydrates||Daily||119.4 ± 19.60474||0.546|
|Weekly||123.5 ± 16.12127|
|Rarely||119.8 ± 23.34302|
|Milk||Daily||117.4 ± 19.57259||0.001|
|Rarely||125.2 ± 18.91114|
|Fast Food||Daily||123.9 ± 19.36573||0.014|
|Weekly||120.7 ± 19.66110|
|Rarely||116.7 ± 19.21640|
|Soft Drinks||Daily||127.4 ± 20.14589||0.0001|
|Weekly||122.2 ± 19.75927|
|Rarely||115.4 ± 18.12335|
|Juices||Daily||118.9 ± 19.24429||0.423|
|Weekly||122.1 ± 19.30925|
|Rarely||121.3 ± 22.15197|
|Fruits||Daily||118.1 ± 19.57903||0.138|
|Weekly||120.3 ± 17.89437|
|Rarely||122.2 ± 20.51811|
|Vegetables||Daily||116.7 ± 19.30312||0.006|
|Weekly||121.3 ± 17.64534|
|Rarely||122.9 ± 20.37128|
|Sweets||Daily||119.3 ± 18.99979||0.149|
|Rarely||117.9 ± 21.65378|
Values are reported as mean ± standard deviation.
Table 2:Differences in height based on consumption frequency of various dietary elements by children aged 2–18 years in Saudi Arabia
|Dietary elements||Eating Frequencies||Weight SD
(Mean ± SD)
|Protein||Daily||-1.0769- ± 1.41749||0.570|
|Weekly||-.8481- ± 1.97376|
|Rarely||-1.2055- ± .94734|
|Fat||Daily||-1.2043- ± 1.32095||0.170|
|Weekly||-.9072- ± 1.54124|
|Rarely||-.9229- ± 1.63523|
|Legumes||Daily||-.8119- ± 1.41580||0.071|
|Weekly||-1.0493- ± 1.55371|
|Rarely||-1.2594- ± 1.37757|
|Carbohydrates||Daily||-1.0524- ± 1.44995||0.070|
|Weekly||-.6930- ± 1.56526|
|Rarely||-1.8731- ± 1.31065|
|Milk||Daily||-1.1238- ±± 1.47401||0.405|
|Weekly||-1.0446- ± 1.46520|
|Rarely||-.8728- ± 1.42109|
|Fast Food||Daily||-1.2639- ±1.04036||0.228|
|Weekly||-.9559- ± 1.54601|
|Rarely||-1.0933- ± 1.50271|
|Soft Drinks||Daily||-1.0043- ± 1.52601||0.289|
|Weekly||-.8361- ± 1.44442|
|Rarely||-1.1487- ±± 1.43208|
|Juices||Daily||-1.1805- ±± 1.35510||0.224|
|Weekly||-1.2252- ± 1.33688|
|Rarely||-.8252- ± 1.70934|
|Fruits||Daily||-1.1633- ± 1.42488||0.317|
|Weekly||-1.2006- ± 1.41879|
|Rarely||-.9275- ± 1.49888|
|Vegetables||Daily||-1.2285- ± 1.40318||0.229|
|Weekly||-.8976- ± 1.47094|
|Rarely||-1.0069- ± 1.47089|
|Sweets||Daily||-1.0656- ± 1.45868||0.603|
|Weekly||-1.0608- ± 1.36758|
|Rarely||-1.3181- ± 1.43233|
Values are reported as mean ± standard deviation.
Table 3:Differences in weight based on consumption frequency of various dietary elements by children aged 2–18 years in Saudi Arabia.
There were no significant correlation between weight SDs and various nutritional elements (protein, carbohydrates, fat, legumes, milk, juice, fruits, vegetables, fast food, soft drinks and sweets) (Table 3).
The purpose of this study is to test the association between various nutritional elements and child height, weight and BMI with a random sample in Jeddah, Saudi Arabia. The studied sample included 2–18 year old participants. The previous findings regarding fat intake and anthropometric measures in children have been conflicting. Total fat consumption was not associated with height, weight or BMI in 215 Hispanic children . A study in Munich, Germany proposed that higher rates of obesity were present in 158 primary school children who had a higher fat intake than in those with either a higher protein or carbohydrate intake; therefore, reduced total fat and saturated fat consumption is advised to improve health and reduce the risk of obesity . Furthermore, calorie (fat) intake is correlated with weight . In southwest Britain, the mean height and weight of children increased with reduced fat intake [12,13]. In Peru, weight and fat intake in children were strongly correlated, while height and fat intake were not correlated. Nutrition has an important impact on children growth and further studies need to be conducted . A previous study on the patterns of growth and nutrition in children proposed that the level of effective protein intake is the principal factor controlling height growth. Children consuming adequate amounts of protein showed an optimal height for their age .
In the previous studies regarding carbohydrate intake; it was negatively correlated with both weight and height . However, a high fibre intake does not affect child growth and is strongly associated with a reduced risk of obesity, particularly when consumed in the form of fruit, vegetables, legumes, and whole grains . However, in the present study, BMI was significantly higher with more frequent legume intake, while height and weight did not differ based on legume intake.
A previous study conducted in the USA showed that milk intake in 4 year olds is positively associated with BMI ; another study conducted in the USA showed that milk intake is associated with only height among 2–4 year olds, and there were no associations in children aged 5–10 years . However, previous studies have shown that juice consumption is associated with shorter stature and greater weight. In the USA, 42% of children consuming ≥ 12 fl oz/day of juice had short stature (height <20th sex-specific percentile for age) vs. 14% of children drinking <12 fl oz/day, and obesity was more common in the children drinking the greater amount of juice ; these findings were supported by a study conducted in Tennessee, USA in which excessive fruit juice intake was associated with short stature and obesity in preschool children. The consistent lack of a relationship between fruit juice intake and growth parameters in children in the study does not support previous recommendations to limit the intake of 100% fruit juice to <12 fl oz/day . Regarding soft drink consumption, there are more than 15 teaspoons of sugar and 240 calories in a 20 ounce soft drink . From 1989 to 2008, calories from sugary soft drinks increased by 60% (from 130 to 209 cal/day) in children aged 6–11 years, and the percentage of children consuming soft drinks increased from 79% to 91% . In the present study, a significant relation existed between soft drink consumption and mean BMI that showed lower mean BMI in children drinking soft drinks rarely than daily and weekly. Height was also significantly different based on soft drink consumption, higher heights mean when drinking soft drinks daily than weekly and rarely. In contrast, the differences in weight based on soft drink consumption were not significant.
Children are recommended to consume at least 5 servings of fruits and vegetables a day . In a previous study in the USA, 95% of 866 children aged 2–5 years consumed fruit, vegetable(s), or both as part of their food intake on the recorded day. The majority of children were 2 years of age (34%), male (53%), and non-Hispanic White (35%). Only 12% of the children were identified as overweight .
The majority of research to date has focused on the relationship between fast food consumption and childhood obesity [23,24]; however, in a previous study involving 72,900 children (17 countries) and 199,135 adolescents (36 countries), frequent and very frequent fast-food consumption was reported in 23% and 4% of children and 39% and 13% of adolescents, respectively. Children in the frequent and very frequent groups had significantly higher BMIs than those in the infrequent group (P<0.001). However, adolescents in the frequent and very frequent groups had BMIs that were significantly lower than those in the infrequent group (P<0.001) . Interestingly, recent research also indicates that fast food consumption might influence academic achievement and cognitive development . One possible mechanism for a link between fast food and academic growth is the consumption of fewer specific nutrients. Because fast food meals are often deficient in a range of nutrients , children who eat fast food several times per week may be at risk of not receiving enough of these nutrients to develop optimally.
Regarding sweets, in a previous study conducted in the USA, candy consumers were less likely to be overweight/obese than the non-candy consumers in a sample of children and adolescents 2–18 years of age (n=11,182), despite higher energy and added sugar intake by the candy consumers .
In present there was a relationship between milk intake with both height and BMI. A stepwise reduction in total fat and saturated fat intake is desirable in primary school children and adolescents to improve health and prevent obesity. Families should be encouraged to increase fruit and vegetable consumption by children as sources of nutritional factors that support their growth. In addition, the consumption of soft drinks, fast food and sweets should be discouraged in primary school children and adolescents.
The authors declare that there are no competing interests.
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