Dietary Habits, BMI And Lifestyle Behavior Of Children In Mauritius – Do They Differ From The Rest Of The World?

Healthy eating is the basis for the health, growth, and development of children [1]. A child’s health is largely determined by his eating habits and health behavior adopted during childhood, and these are known to persist during adulthood [2].

Calorie-dense, less nutritious foods are, however, increasingly occupying large and disproportionate space on children’s plates, while intake of nutrient-rich, high-fiber foods, such as fruits and vegetables (FV), is within suboptimal range or declining [3]. Children are growing in an obesogenic environment where the presence of FV in the diet is less appreciated [4] despite the fact that FV are naturally packed with vitamins, minerals, fiber, and antioxidants that protect against chronic diseases [5].

Physical activity has been demonstrated as one of the best strategies to maintain healthy body weight as well as enhancing intellectual and motor skill of children [6]. Children should get at least 60 minutes of daily moderate-to-vigorous-intensity physical activity which can include play, games, sports, recreation, physical education, or structured exercise in a child’s familial, school, and community life [7]. A rise in sedentary behavior among children is, nevertheless, causing a drop in physical activity level (PAL) [8]. Children now devote more time to television (TV) viewing, which equally results in more calorie intake through snacking before the small screen, especially those unhealthy foods which are most regularly advertised [9,10].

Insufficient data on the dietary and behavioral lifestyle of children in Mauritius led us to conduct a survey among 336 children aged between 6 and 12 years, with the particular aim of determining their fruit and vegetable as well as energy intake gender-wise along with their sedentary behaviors. We found that while boys consume more food from protein sources, fruits and vegetables are the preferred food groups for females. Moreover, Mauritian children with higher nutritional knowledge consume fruits and vegetables more regularly, though they are more partial to choosing fruits over vegetables. Their mean calorie intake (1522 kcal/day) is close enough to the dietary recommendation set by the American Heart Association [11] and they have a within-range body mass index (BMI of 17.5). Nonetheless, they spend a long time in front of the TV accompanied with a usual intake of their main meals and sugar-sweetened beverages (SSBs), and boys tend to consume dairy products at a higher frequency than females. Likewise, the PAL of the children is below the recommended level, but boys are more active than girls.

Nutritional knowledge often determines dietary habits. However, the taste may be a stronger influencing factor, which indicates why children more often prefer fruits. Fruits are naturally sweeter than vegetables, and children find them “sweet,” “juicy,” or “fun to eat,” contrary to vegetables which are “bitter,” “ugly,” “boring,” or “horrible” [12]. Moreover, societies now exaggerate the importance of the ideal body image, often pushing the female population to opt for a strict dietary pattern consisting of more fruits and vegetables [13] while, surprisingly at the same time, forcing males to become more muscular [14], a plausible reason for their higher preference for protein sources.

Optimal energy consumption is the cornerstone of nutrition. While pediatric overweight and obesity problems are increasing, it is encouraging to see that Mauritian children track over a normal BMI range and follow an optimal energy intake pattern, almost similar to European children [15] and contrary to American and Indian children [16,17]. However, bad eating habits and sedentary lifestyles, such as eating unhealthy snacks in front of the TV, are major contributors vis-à-vis an unnecessary increase in energy intake. Eating meals before the small screen has already been associated with an increase in BMI in children [18]; accompanying the meals with SSBs only increases the risk of weight complications due to their high caloric load. Promotional messages disseminated by the media [19] may only amplify such choices, which may explain the higher dairy consumption among boys, especially if male characters are used as models in the promotional strategies [20].

Children’s failure to adhere to the recommended PAL may be accounted for by the growing outdoor insecurity [21] and homework load [22]. Furthermore, the fact that boys are usually keener than girls to participate in both physical education classes and extracurricular activities [23] may explain higher PAL among boys. A more sedentary home environment and less active family members are also factors that lead to less PAL among children.

Helping our children adopt and improve their eating habits and lifestyle behavior need urgent actions. Parents play a critical role vis-à-vis dietary behavior of children. Therefore, educating parents first about nutrition and health is primordial [24]. A school environment conducive to healthy behavior adoption is equally important. Accessibility to low-cost nutritious foods in school premises is necessary [25] especially in low income and impoverished areas. Nutrition education programs at school should be more of an activity than a theory class [26] and include the participation of parents, teachers, and other stakeholders. Promoting nutritious foods through media may undeniably be helpful as well. Such targeted approaches will ultimately help children eat right and move more to always keep them on the go with a healthy body and mind and reduce anticipated health-related problems with our future generation.

 “Investing in our children health should not be viewed only as a long-term national interest but our responsibility as well. Vaccination programmes have resulted in major disease prevention to safeguard our health. Now is the time for Nutrition and Physical Activity Programs!”  (Dr. R Jeewon)

These findings are described in the article entitled Dietary intake and lifestyle behaviors of children in Mauritius, recently published in the journal Heliyon. This work was conducted by Digvijayini Bundhun, Sillma Rampadarath, Daneshwar Puchooa, and Rajesh Jeewon from the University of Mauritius.

References: 

1. S. Kumar, G.S. Preetha, Health promotion: an effective tool for global health, Indian J. Community Med. 37 (2012) 5e12.
2. D. Neumark-Sztainer, M. Wall, N.I. Larson, M.E. Eisenberg, K. Loth, Dieting and disordered eating behaviors from adolescence to young adulthood: findings from a 10-year longitudinal study, J. Am. Diet Assoc. 111 (2011) 1004e1011.
3. G.L. Ambrosini, P.M. Emmett, N. Northstone, L.D. Howe, K. Tilling, S.A. Jebb, Identification of a dietary pattern prospectively associated with increased adiposity during childhood and adolescence, Int. J. Obesity 36 (2012) 1299e1305.
4. A.M. Fogel, Internal and External Predictors of Fruits and Vegetable Consumption in Children, Doctor of Philosophy, University of Birmingham, United Kingdom, March 2015.
5. Non-Communicable Disease Watch, The True Colors of Fruits and Vegetables, Centre for Health Protection, 2013, pp. 1e10. Available online: http:// www.chp.gov.hk/files/pdf/ncd_watch_jan2013.pdf. (Accessed 26 April 2018)
6. IOM (Institute of Medicine), Educating the Student Body: Taking Physical Activity and Physical Education to School, The National Academies Press, Washington, DC, 2013.
7. World Health Organisation, Physical Activity and Young People, 2018. Available online: https://www.who.int/dietphysicalactivity/factsheet_young_people/en/. (Accessed 26 August 2018).
8. A.M. McManus, P.N. Ainslie, D.J. Green, R.G. Simair, K. Smith, Nia Lewis, Impact of prolonged sitting on vascular function in young girls, Exp. Physiol. 100 (11) (2015) 1379e1387.
9. S.H. Ng, B. Kelly, C.H. Se, S. Sahathevan, K. Chinna, M.N. Ismail, T. Karupaiah, Reading the mind of children in response to food advertising: a cross-sectional study of Malaysian school children’s attitudes towards food and beverages advertising on television, BMC Publ. Health 15 (2015) 1047.
10. L.M. Powell, R.M. Schermbeck, G. Szczypka, F.J. Chaloupka, C.L. Braunschweig, Trends in the nutritional content of TV food advertisements seen by children in the US: analyses by age, food categories and companies, Arch. Pediatr. Adolesc. Med. 165 (2011) 1078e1086.
11. The American Heart Association, Dietary Recommendations for Healthy Children, 2018. Available online: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/dietary-recommendations-for-healthy-children#.WFE9BtV961s. (Accessed 26 April 2018).
12. R. Krùlner, M. Rasmussen, J. Brug, K. Klepp, M. Wind, P. Due, Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part II: qualitative studies, Int. J. Behav. Nutr. Phys. Act. 8 (2011) 1e38.
13. K.H. Gattario, A. Frisén, E. Anderson-Fye, Body image and child well-being, in: A. Ben Arieh, F. Casas, I. Frùnes, J.E. Korbin (Eds.), Handbook of Child Well-being, Springer, 2014, pp. 2409e2436.
14. M. Drummond, C. Drummond, It’s all about the six-pack: boys’ bodies in contemporary western culture, J. Child Health Care (2014) 1e9.
15. A. Hebestreit, C. B€ornhorst, G. Barba, A. Siani, I. Huybrechts, G. Tognon, G. Eiben, L.A. Moreno, J.M. Fernández Alvira, H.M. Loit, E. Kovacs, M. Tornaritis, V. Krogh, Associations between energy intake, daily food intake and energy density of foods and BMI z-score in 2e9-year-old European children, Eur. J. Nutr. 53 (2014) 673e681.
16. M.A. Mendez, D. Sotrez-Alvarez, D.R. Miles, M.M. Slining, B.M. Popkin, Shifts in the recent distribution of energy intake among U.S. children aged 2e18 years reflect potential abatement of earlier declining trends, J. Nutr. 144 (2014) 1291e1297.
17. A.V. Khadilkar, S.A. Chiplonkar, N.A. Kajale, V.H. Ekbote, L. Parathasarathi, R. Padidela, V.V. Khadilkar. Impact of dietary nutrient intake and physical activity on body composition and growth in Indian children. Pediatric Reasearch. 2018. DOI: 10.1038/pr.2017.322.
18. F.N. Vik, H.B. Bjùrnara, N.C. éverby, N. Lien, O. Androutsos, L. Maes, N. Jan, E. Kovacs, L.A. Moreno, A. D€ossegger, Y. Manios, J. Brug, E. Bere, Associations between eating meals, watching TV while eating meals and weight status among children, ages 10-12 years in eight European countries: the ENERGY cross-sectional study, Int. J. Behav. Nutr. Phys. Act. 10 (2013) 58.
19. D. Marchiori, L. Waroquier, O. Klein, ‘‘Split Them!’’ Smaller item sizes of cookies lead to a decrease in energy intake in children, J. Nutr. Educ. Behav. 44 (2012) 251e255.
20. D.J. Anschutz, R.C.M.E. Engels, T. Van Strien, Side effects of television food commercials on concurrent nonadvertised sweet snack food intakes in young children, Am. J. Clin. Nutr. 89 (2009) 1328e1333.
21. A.O. Oluyomi, C. Lee, E. Nehme, D. Dowdy, M.G. Ory, D.M. Hoelscher, Parental safety concerns and active school commute: correlates across multiple domain in the home-to-school journey, Int. J. Behav. Nutr. Phys. Act. 11 (2014) 32.
22. S. De Baere, J. Lefevre, K. De Martelaer, R. Philippaerts, J. Seghers, Temporal patterns of physical activity and sedentary behavior in 10-14 year-old children on weekdays, BMC Publ. Health 15 (2015) 791.
23. R.M. Telford, R.D. Telford, L.S. Olive, T. Cochrane, R. Davey, Why are girls less physically active than boys? Findings from the LOOK longitudinal study, PLoS One 11 (2016), E150041.
24. D. A. Dev, C. Byrd-Williams, S. Ramsay, B. McBride, D. Srivastava, A. Murriel, C. Arcan, A. M. Adachi-Mejia. Engaging parents to promote children’s nutrition and health: Providers’ barriers and strategies in head start and child care centers. Am J Health Promot. 31 (2017). DOI: 10.1177/0890117116685426.
25. J.A. Ladapo, L.M. Bogart, D.J. Klein, B.O. Cowgill, K. Uyeda, D.G. Binkle, E.R. Stevens, M.A. Schuster. Cost and cost-effectiveness of Students for Nutrition and Exercise (SNaX). Acad Pediatr. 16 (2016). DOI:  10.1016/j.acap.2015.07.009.
26. T. Perera, S. Frei, B. Frei, S.S Wong, G. Bobe. Improving nutrition education in U.S. elementary schools: challenges and opportunities. Journal of Education and Practice. 30 (2015). ISSN 2222-288X. Available from: https://files.eric.ed.gov/fulltext/EJ1081364.pdf (Accessed on 26 April 2018).