© Borgis - New Medicine 2/2008, s. 29-35
*Wojciech Chalcarz, Sylwia Merkiel, Zdzisława Hodyr
NUTRITIONAL STATUS OF PRESCHOOL CHILDREN FROM PABIANICE
Food and Nutrition Department of the Eugeniusz Piasecki University School of Physical Education in Poznan
Head of the Department: Dr hab. Wojciech Chalcarz, prof. nadzw. AWF
Summary
Aim: The aim of this study was to assess nutritional status in preschool children from Pabianice, a town in central Poland. Material and methods:Anthropometric and biochemical indices were used to assess nutritional status in 187 5-6-year-old children, including 78 girls and 109 boys, who attended preschools in Pabianice. Parents filled in questionnaires on general information about the children and their families and about health status of the children and their families. They also expressed their own opinion about their children´s body weight and health status. Statistical analysis was carried out by means of the SPSS 12.0 PL for Windows computer program. The studied population was divided according to gender. Gender had a statistically significant impact on taking medicines and on allergies other than food allergy, as well as on the following indices of nutritional status: chest circumference, eight skinfold thicknesses – subscapular, chest (axillary and lateral), triceps, biceps, suprailiac, abdominal and knee – serum protein and glucose, and atherogenic index LDL-Ch/HDL-Ch.
Results: The results of our study showed that anthropometric indices of nutritional status in the studied preschool children from Pabianice were similar to those measured in their peers from other regions of Poland, which indicates a lack of differences in somatic development.
Conclusion: Due to abnormal cholesterol concentration in serum in a high percentage of the studied children, it is essential to change their diets and, in individual cases, take pharmacotherapy into consideration. A nutritional education programme, including knowledge on physical activity, for parents and preschool staff, should be implemented.
Introduction
Monitoring food habits and nutritional status in people at various life stages, especially in preschool children, is of vital importance not only to the science of human nutrition but, above all, to public health. On one hand, it is due to the need to follow the children´s development in relation to food habits and physical activity (1). On the other hand, it is crucial for early prevention of diet-related diseases, with particular emphasis on overweight and obesity (2), cardiovascular diseases (3), type 2 diabetes (4) and hypertension (5).
It has been proved beyond doubt that adequate nutrition during childhood determines the child´s fitness in adulthood, protects against diet-related diseases (2) and prolongs life. The benefits of appropriate nutrition increase if it is accompanied by a physical activity programme (1, 2).
Aim
Keeping constant assessment of nutritional status in preschool children is even more important if we take into account the scarcity of articles on this issue published in Poland. Therefore, the aim of this study was to assess nutritional status in preschool children who attended preschools in Pabianice.
MATERIAL AND METHODS
Anthropometric and biochemical indices were used
to assess nutritional status in 187 5-6-year-old children, including 78 girls and 109 boys, who attended preschools in Pabianice. The research was approved by the Bioethics Committee of the Poznan University of Medical Sciences.
Anthropometric indices included body height and weight, shoulder and hip breadth, circumferences of arm, forearm, chest, waist, abdomen, hip, thigh and calf, and the following skinfold thicknesses: subscapular, chest (axillary and lateral), triceps, biceps, suprailiac, abdominal, knee and calf. Body mass index (BMI) was also calculated.
Percentile growth charts (6) were used to classify BMI as one of the following: below the 3rd percentile – considerably underweight; from the 3rd to the 10th percentile – underweight; from the 10th to the 25th percentile – slim; from the 25th to the 75th percentile – weight appropriate for height; from the 75th to 90th percentile – tendency to overweight; from the 90th to the 97th percentile – overweight; above the 97th percentile – obese.
Biochemical indices included protein, glucose, total cholesterol, HDL cholesterol and triacylglycerols measured in serum. Serum LDL cholesterol was determined from a regression equation (7). Atherogenic indices were also calculated: TCh/HDL-Ch and LDL-Ch/HDL-Ch, where TCh denotes total cholesterol [mg/dl]; HDL-Ch – HDL cholesterol [mg/dl]; and LDL-Ch – LDL cholesterol [mg/dl].
Serum protein and glucose were compared to the reference values of Jakubowski et al. (8) and lipids were compared to the values of Gidding et al. (9).
Parents filled in questionnaires on general information about the children and their families and about health status of the children and their families. They also expressed their own opinion about their children´s body weight and health status.
Statistical analysis was carried out by means of the SPSS 12.0 PL for Windows computer program. The studied population was divided according to gender.
RESULTS
Table 1 shows general information about the studied children and their families, health status of the children and their families, and parents´ opinion on their children´s body weight and health status, according to gender. Gender had a statistically significant impact on taking medicines and suffering from allergies other than food allergy. The percentage of boys who took medicines was more than twice as high as girls, while the percentage of boys who suffered from other allergies was almost three times as high as girls.
Table 1. General information about the studied children and their families, health status of the children and their families, and parents´ opinion on their children´s body weightand health status, according to gender.
| No. | Parameter | Girls (n=78) | Boys (n=109) | Total (n=187) |
| 1. | Child´s age [%] | 5 yrs | 29.1 | 25.9 | 27.2 |
| 6 yrs | 70.9 | 74.1 | 72.8 |
| 2. | Mother´s age [years] | x?sd | 30.9?4.1 | 31.3?4.6 | 31.1?4.4 |
| 3. | Father´s age [years] | x?sd | 32.3?6.2 | 33.0?4.6 | 32.7?5.3 |
| 4. | Mother´s education [%] | Primary | 3.8 | 7.2 | 5.8 |
| Vocational | 30.4 | 25.2 | 27.4 |
| Secondary | 57.0 | 56.8 | 56.8 |
| Higher | 8.9 | 10.8 | 10.0 |
| 5. | Father´s education [%] | Primary | 2.6 | 3.6 | 3.2 |
| Vocational | 48.7 | 48.2 | 48.4 |
| Secondary | 42.1 | 40.0 | 40.9 |
| Higher | 6.6 | 8.2 | 7.5 |
| 6. | Family [%] | Two-parent | 88.6 | 90.1 | 89.5 |
| One-parent | 11.4 | 9.9 | 10.5 |
| 7. | Number of children in the family [%] | One | 38.0 | 33.0 | 35.1 |
| Two | 55.7 | 57.1 | 56.5 |
| Three | 5.1 | 5.4 | 5.2 |
| Four | 1.3 | 4.5 | 3.1 |
| 8. | The sequence of the child in the family [%] | First | 58.4 | 59.8 | 59.3 |
| Second | 37.7 | 34.8 | 36.0 |
| Third | 2.6 | 3.6 | 3.2 |
| Fourth | 1.3 | 1.8 | 1.6 |
| 9. | Birth weight [kg] | x?sd | 3.2?0.5 | 3.3?0.5 | 3.2?0.5 |
| 10. | Medicines being taken by the child [%] | 10.1 | 23.2 | 17.8 |
| 11. | Food allergies [%] | 5.1 | 9.8 | 7.9 |
| 12. | Other allergies [%] | 5.1 | 14.3 | 10.5 |
| 13. | Familial diabetes [%] | 22.8 | 15.2 | 18.3 |
| 14. | Familial obesity [%] | 20.3 | 19.6 | 19.9 |
| 15. | Familial myocardial infarction [%] | 21.5 | 17.0 | 18.8 |
| 16. | Familial hyperlipidaemia [%] | 1.3 | 1.8 | 1.6 |
| 17 | Parents´ opinion on their children´s body weight [%] | Underweight | 6.3 | 9.8 | 8.4 |
| Appropriate | 87.3 | 86.6 | 86.9 |
| Overweight | 0.0 | 0.9 | 0.5 |
| Obesity | 1.3 | 1.8 | 1.6 |
| I don´t know | 5.1 | 0.9 | 2.6 |
| 18. | Parents´ opinion on their children´s health status [%] | Good | 91.1 | 84.8 | 87.4 |
| Not good | 2.5 | 2.7 | 2.6 |
| I don´t know | 6.3 | 12.5 | 9.9 |
Bold type denotes statistical significance at p≤0.05.
Table 2 presents anthropometric indices in the studied children according to gender. Gender had a statistically significant impact on chest circumference and all of the skinfold thicknesses except for calf skinfold. Mean value of chest circumference was higher in boys and mean values of skinfold thicknesses were higher in girls.
Table 2. Anthropometric indices in the studied children according to gender.
| No. | Parameter | Girls (n=78) | Boys (n=109) | Total (n=187) |
| 1. | Body height [cm] | 114.8?5.2 | 115.2?6.2 | 115.0?5.8 |
| 2. | Body weight [kg] | 20.4?3.2 | 20.9?3.8 | 20.7?3.6 |
| 3. | BMI [kg/m2] | 15.4?1.6 | 15.7?1.7 | 15.6?1.6 |
| 1. | Shoulder breadth [cm] | 24.9?1.3 | 25.1?1.5 | 25.0?1.4 |
| 2. | Hip breadth [cm] | 18.2?1.0 | 18.4?1.3 | 18.3?1.2 |
| 3. | Arm circumference [cm] | 17.6?1.5 | 17.7?1.8 | 17.7?1.7 |
| 4. | Forearm circumference [cm] | 17.3?1.1 | 17.6?1.4 | 17.5?1.3 |
| 5. | Chest circumference [cm] | 55.1?3.3 | 56.0?3.5 | 55.6?3.4 |
| 6. | Waist circumference [cm] | 51.5?3.6 | 52.3?3.9 | 52.0?3.8 |
| 7. | Abdomen circumference [cm] | 54.4?4.9 | 54.4?5.1 | 54.4?5.0 |
| 8. | Hip circumference [cm] | 60.2?4.5 | 58.7?7.4 | 59.3?6.4 |
| 9. | Thigh circumference [cm] | 35.1?3.4 | 34.2?3.7 | 34.6?3.6 |
| 10. | Calf circumference [cm] | 23.9?1.7 | 23.7?1.9 | 23.7?1.9 |
| 11. | Subscapular skinfold thickness [mm] | 6.9?3.2 | 6.1?2.9 | 6.4?3.1 |
| 12. | Chest axillary skinfold thickness [mm] | 6.9?3.2 | 6.0?3.0 | 6.4?3.1 |
| 13. | Chest lateral skinfold thickness [mm] | 5.1?2.1 | 4.6?1.9 | 4.8?2.0 |
| 14. | Triceps skinfold thickness [mm] | 8.7?2.6 | 7. 8?2.6 | 8. 2?2.6 |
| 15. | Biceps skinfold thickness [mm] | 7.3?2.7 | 6.5?2.4 | 6.8?2.5 |
| 16. | Suprailiac skinfold thickness [mm] | 5.7?3.0 | 4.6?2.3 | 5.1?2.6 |
| 17. | Abdominal skinfold thickness [mm] | 8.6?4.0 | 7.5?4.1 | 8.0?4.1 |
| 18. | Knee skinfold thickness [mm] | 10.1?2.1 | 9.2?2.3 | 9.6?2.3 |
| 19. | Calf skinfold thickness [mm] | 5.3?1.6 | 5.3?1.6 | 5.3?1.6 |
Bold type denotes statistical significance at p≤0.05.
Table 3 shows the distribution of the studied children in percentile categories for BMI according to gender. No statistically significant differences were observed.
Table 3. Distribution of the studied children in percentile categories for BMI according to gender [%].
| No. | Parameter | Girls (n=78) | Boys (n=109) | Total (n=187) |
| 1. | Percentile categories for BMI | < 3 percentile (considerably underweight) | 17.9 | 19.6 | 18.9 |
| 3-10 percentile (underweight) | 13.4 | 14.1 | 13.8 |
| 10-25 percentile (slim) | 20.9 | 19.6 | 20.1 |
| 25-75 percentile (weight appropriate for height) | 31.3 | 26.1 | 28.3 |
| 75-90 percentile (tendency to overweight) | 10.4 | 14.1 | 12.6 |
| 90-97 percentile (overweight) | 4.5 | 5.4 | 5.0 |
| > 97 percentile (obese) | 1.5 | 1.1 | 1.3 |
Table 4 presents serum protein, glucose and lipids in the studied children according to gender. Gender had a statistically significant impact on serum protein and glucose. Protein concentration was higher in girls, whereas glucose concentration was higher in boys.
Table 4. Serum protein, glucose and lipids in the studied children according to gender.
| No. | Parameter | Girls (n=78) | Boys (n=109) | Total (n=187) |
| 1. | Protein [g/dl] | 7.2?0.4 | 7.0?0.4 | 7.1?0.4 |
| 2. | Glucose [mg/dl] | 71.4?7.9 | 75.4?10.4 | 73.6?9.5 |
| 3. | Total cholesterol [mg/dl] | 184.3?34.3 | 186.0?33.7 | 185.3?33.9 |
| 4. | HDL cholesterol [mg/dl] | 52.6?12.2 | 52.7?12.6 | 52.7?12.4 |
| 5. | HDL cholesterol [%] | 26.3?5.2 | 26.4?5.7 | 26.4?5.4 |
| 6. | LDL cholesterol [mg/dl] | 137.0?23.4 | 137.9?27.7 | 137.5?25.7 |
| 7. | LDL cholesterol [%] | 123.8?19.9 | 126.3?17.1 | 125.1?18.4 |
| 8. | Triacylglycerols [mg/dl] | 82.1?34.4 | 83.2?35.3 | 82.7?34.8 |
| 9. | Atherogenic index TCh/HDL-Ch | 4.0?1.0 | 3.9?0.9 | 4.0?0.9 |
| 10. | Atherogenic index LDL-Ch/HDL-Ch | 2.6?0.7 | 2.6?0.8 | 2.6?0.7 |
Bold type denotes statistical significance at p≤0.05.
Table 5 shows percentages of the studied children who met the norms for serum protein, glucose and lipids, according to gender. Gender had a statistically significant impact on the percentages of children who met the norms for atherogenic index LDL-Ch/HDL-Ch. Normal values of this index were observed in 75.0% of girls and 94.9% of boys.
Table 5. Percentages of the studied children who met the norms for serum protein, glucose and lipids, according to gender.
| No. | Parameter | Girls (n=78) | Boys (n=109) | Total (n=187) |
| 1. | Protein | Normal | 92.9 | 100.0 | 96.8 |
| Above normal | 7.1 | 0.0 | 3.2 |
| 2. | Glucose | Below normal | 41.1 | 29.3 | 34.5 |
| Normal | 58.9 | 69.6 | 64.8 |
| Above normal | 0.0 | 1.1 | 0.6 |
| 3. | Total cholesterol | Normal | 37.8 | 42.1 | 40.2 |
| Borderline | 32.4 | 30.5 | 31.4 |
| Abnormal | 29.7 | 27.4 | 28.4 |
| 4. | HDL cholesterol | Abnormal | 8.3 | 7.8 | 8.0 |
| Normal | 91.7 | 92.2 | 92.0 |
| 5. | LDL cholesterol | Normal | 3.1 | 12.8 | 8.5 |
| Borderline | 34.4 | 23.1 | 28.2 |
| Abnormal | 62.5 | 64.1 | 63.4 |
| 6. | Triacylglycerols | Normal | 97.9 | 98.3 | 98.1 |
| Abnormal | 2.1 | 1.7 | 1.9 |
| 7. | Atherogenic index TCh/HDL - Ch | Normal | 91.7 | 85.9 | 88.4 |
| Above normal | 8.3 | 14.1 | 11.6 |
| 8. | Atherogenic index LDL-Ch/HDL - Ch | Normal | 75.0 | 94.9 | 85.9 |
| Above normal | 25.0 | 5.1 | 14.1 |
Bold type denotes statistical significance at p≤0.05
DISCUSSION
The studied preschool children lived in Pabianice, a town in central Poland. It is disconcerting that a high percentage of children suffered from allergies other than food allergy. Most probably, the children were treated with anti-allergic agents which resulted in a relatively high percentage of children who took medicines, much higher in boys than girls. It is widely known that allergies are the most prevalent among preschool children and, unfortunately, are becoming more and more common. Researchers also report that factors affecting the foetus during pregnancy, such as mother´s diet, birth order or maternal smoking, may have a considerable influence on the onset of allergy in children (10). Taking into account the immense importance of this issue to both individuals and society, more extensive research in this field should be carried out in Polish preschool children.
Mean body height and weight of the studied preschool girls and boys from Pabianice were similar to those measured in their female and male peers from other Polish cities: Kielce (11), Kraków (12), Poznań (13, 14), Szczecin (15) and Warszawa (6). Also mean BMI values in the studied preschool girls and boys from Pabianice were not considerably different from those observed in preschool girls and boys from other regions of Poland – Kraków (12), Poznań (16), Warszawa (6) – however, it is noteworthy that these values were the lowest in the studied children. In comparison to their peers from the United States (17), Australia (18), Greece (19) and Sweden (20), the studied children from Pabianice were characterised by lower BMI values as well. Only in German preschool children were lower values of this index observed (21). It is worth emphasising that BMI values measured in the studied girls and boys from Pabianice correspond to these values observed in their peers from the United States in 1971-74 (17). Since that time, in American children BMI values have been increasing along with the percentage of overweight and obese children.
It is highly favourable that in the studied children from Pabianice only one girl and one boy were assessed as obese and the percentage of overweight children or children showing a tendency to overweight was very low. By comparison, a study carried out in a representative population of Polish preschool children (22) showed that 11.0% of girls and as many as 23.1% of boys had a tendency to overweight, 2.4% of girls and as many as 10.3% of boys were overweight and 8.5% of girls and 11.5% of boys were obese. Among Greek preschool children (19), 20.0% of girls and 18.9% of boys were overweight and 20.5% of girls and 16.5% of boys were at risk of overweight. Even more unfavourable tendencies were reported in a study on Spanish preschoolers, in which the percentage of overweight children ranged from 27.87% to 32.50% depending on the region of the country, and the percentage of obese children ranged from 8.46% to 15.72% (23). These observations indicate that the prevalence of obesity among Polish children is increasing more slowly than in the United States, Australia and Western European countries and show the need to take, as soon as possible, action aimed at prevention of obesity in the Polish population based on the experience of other countries (2, 24, 25). Otherwise, Polish society will face and will have to deal with increasing morbidity from diet-related diseases, especially obesity and obesity-related diseases.
The results of skinfold thickness measurements confirm early gender differentiation in body composition, which consists in the fact that as early as in preschool years females are characterised by a higher percentage of adipose tissue, which in turn is reflected in higher values of skinfold thicknesses in girls compared to boys, irrespectively of the part of the world (6, 12, 13, 21).
In the studied population of preschool children from Pabianice, the mean value of suprailiac skinfold thickness was lower in girls compared to their female peers from Kraków (12) and Warszawa (6) and was also lower in boys compared to their male peers from Warszawa (6). Suprailiac skinfold thickness in boys from Pabianice was the same as in their male peers from Kraków (12). Mean values of abdominal skinfold thickness in preschool girls and boys from Pabianice were higher in comparison to preschoolers from Kraków (12), whereas mean values of triceps and suprailiac skinfold thickness in the studied children were lower than those of their peers from Kraków (12).
Preschool girls and boys from Pabianice were also characterised by higher values of subscapular and biceps skinfold thickness in comparison with their female and male peers from Germany (21). However, mean values of suprailiac and triceps skinfold thickness were much lower in the studied children from Pabianice compared to German preschoolers (21).
We found no published data on serum protein and glucose in healthy children. As regards serum lipids, the studied children from Pabianice had the highest concentrations of total cholesterol, LDL cholesterol and triacylglycerols in serum and slightly higher or similar concentration of HDL cholesterol compared to Polish children aged 4 to 7.9 years from Lublin (26), 7-year-old children from Katowice (27), 1-10-year-olds from Warszawa (28) and 2-10-year-old children following a vegetarian or traditional diet (29), as well as 7-year-old Chinese children (30), 6-year-olds from Greece (31) and 6-8-year-olds from the United States (32). The percentages of the studied children from Pabianice who met the norms for lipids were highly adversely distributed because of the very high percentage of both girls and boys with abnormal concentrations of total cholesterol and LDL cholesterol. As many as 25% of the studied preschool girls were characterised by atherogenic index LDL-Ch/HDL-Ch values above the norm. This puts the studied preschoolers at risk of cardiovascular diseases in the near future. Most probably, it results from inadequate food habits in the studied population of preschoolers as well as their parents, which is suggested by relatively high morbidity in the children´s families from such diseases as diabetes, obesity or the consequence of atherosclerosis, which is myocardial infarction.
CONCLUSIONS
1. Anthropometric indices of nutritional status in the studied preschool children from Pabianice were similar to those measured in their peers from other regions of Poland, which indicates a lack of differences in somatic development.
2. Due to abnormal serum cholesterol in a high percentage of the studied children, it is crucial to change their diets and, in individual cases, take pharmacotherapy into consideration.
3. A nutritional education programme, including knowledge on physical activity, for parents and preschool staff, should be implemented.
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