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Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence,...
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Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Endocrinology & Diabetes".

Deadline for manuscript submissions: 10 April 2025 | Viewed by 12758

Special Issue Editors

Dr. Stefania Moramarco

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Guest Editor
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 00133 Rome, Italy
Interests: nutrition and public health; food security; malnutrition; epidemiological surveillance
Prof. Dr. Ersilia Buonomo

E-Mail Website
Guest Editor
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 00133 Rome, Italy
Interests: epidemiology; global health; nutrition and public health; vaccine hesitancy

Special Issue Information

Dear Colleagues,

The increasing rates of malnutrition in children and adolescents have become a major public health concern, due to its negative effects during this critical period of development and also in adulthood. Within this context, metabolic disorders due to an excess of weight in childhood represent an alarming challenge because children with obesity are prone to remain obese throughout their lives and have an increased morbidity and mortality risk.

Therefore, the screening and assessment of the nutritional status, growth patterns, and eating behavior in children and adolescents are essential for preventing non-communicable diseases at early stages. Scientific research will contribute to updating the epidemiology of nutritional status of children and adolescents in different countries, understanding the diet patterns of new generations worldwide, and spreading information among public health stakeholders and policymakers.

Dr. Stefania Moramarco
Prof. Dr. Ersilia Buonomo
Guest Editors

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Keywords

  • nutritional assessment
  • food intake
  • eating behaviors
  • metabolic disorders
  • child obesity

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Published Papers (9 papers)

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Research

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26 pages, 1714 KiB  
Article
The Impact of WHO-2023 Malnutrition Criteria on Caseload of Infants Aged Under Six Months: Secondary Data Analysis
by Ayenew Negesse, Tsinuel Girma, Beruk Berhanu Desalegn, Melkamu Berhane and Marko Kerac
Children 2025, 12(2), 118; https://doi.org/10.3390/children12020118 - 22 Jan 2025
Viewed by 1008
Abstract
Background/Objectives: The 2023 World Health Organization (WHO) guideline on infants aged under six months (u6m) wasting now includes mid-upper arm circumference (MUAC) and weight for age Z score (WAZ) as malnutrition treatment programme enrolment criteria. Evidence for the new criteria and optimal cut-offs [...] Read more.
Background/Objectives: The 2023 World Health Organization (WHO) guideline on infants aged under six months (u6m) wasting now includes mid-upper arm circumference (MUAC) and weight for age Z score (WAZ) as malnutrition treatment programme enrolment criteria. Evidence for the new criteria and optimal cut-offs is, however, sparse. We aimed to explore the potential caseload implications of the new criteria and explore how different cut-offs might affect them. Methods: We conducted a secondary analysis of data from 1048 Ethiopian infants u6m using STATA software version 17. Frequency tables and percentages were used to present malnutrition across various characteristics. The chi-square test with 95% confidence intervals (CIs) at a p value of <0.05 was used to compare infant caseload identified by the WHO-2023 versus WHO-2013 criteria. Results: We found substantial overlaps among anthropometric indicators of malnutrition in infants defined by the WHO-2023 programme enrolment criteria. New WHO criteria result in a larger potential caseload (19.2% for 6 weeks to 6 months and 15.1% for infants under 6 weeks) compared with WHO-2013 criteria (2.4%). Whilst there are marked overlaps between low WAZ, low WLZ, and low MUAC, they capture different infants. An MUAC of <110 mm alone would capture only a third of all cases identified by WAZ and/or WLZ < −2. Conclusions: In Ethiopia, the WHO-2023 criteria markedly increase malnutrition caseloads compared with WHO-2013 criteria. There might be a case for increasing MUAC thresholds in MUAC-focused programs where WLZ or WAZ measurements are difficult. Future longitudinal data are needed to know which criteria best identify infants at highest risk of mortality/morbidity/poor development. Full article
(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)
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14 pages, 1798 KiB  
Article
Dietary Habits and Nutritional Status of Youths Living in Rural and Semi-Urban Albania in the Ongoing Nutrition Transition: Preliminary Results
by Ruden Cakoni, Stefania Moramarco, Argjend Kosiqi, Angela Andreoli and Ersilia Buonomo
Children 2025, 12(1), 98; https://doi.org/10.3390/children12010098 - 16 Jan 2025
Viewed by 905
Abstract
Background: Albania is undergoing a demographic, epidemiological, and nutrition transition leading to an increased prevalence of overweight and obesity among new generations. Comprehensive studies on the nutritional status and dietary patterns of youths in the country are still lacking. Methods: A cross-sectional study [...] Read more.
Background: Albania is undergoing a demographic, epidemiological, and nutrition transition leading to an increased prevalence of overweight and obesity among new generations. Comprehensive studies on the nutritional status and dietary patterns of youths in the country are still lacking. Methods: A cross-sectional study was conducted on a convenience sample of students (10–18 years) attending secondary schools in rural and semi-urban areas (October–November 2024). Information collected included socio-demographic data, anthropometric measurements (weight, height), and adherence to the Mediterranean Diet (MD) (KIDMED). Factors influencing dietary patterns were investigated, with a multivariate logistic regression performed to identify key drivers for poor MD adherence (AOR 95% CI). Results: In total, 426 children (47.2% females) were interviewed. Over 20% of the sample was overweight or obese, with the prevalence of these diseases decreasing with age regardless of gender. The KIDMED score highlighted suboptimal MD adherence (4.6 ± 2.5 SD), with significant differences between females and males (4.1 ± 2.4 SD vs. 5.1 ± 2.4 SD, p < 0.001), especially in rural areas (3.9 ± 2.4 SD vs. 4.9 ± 2.5 SD, p = 0.003). Dietary quality tended to decline with age. Female gender was the strongest predictor of poor MD adherence (AOR 2.08 CI: 1.34–3.22; p = 0.001). Conclusions: The MD is a cornerstone for ensuring the Albanian population’s long-term health and well-being. This study holds significant public health relevance in a country with high mortality rates due to cardiovascular diseases. Future nutrition interventions focused on the poor MD adherence of new generations should take into consideration geographic, cultural, and social dimensions, including gender equality. Full article
(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)
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10 pages, 235 KiB  
Article
Indicators of Glucose Metabolism in Children and Adolescents Characterized as Having “Metabolically Healthy” and “Metabolically Unhealthy” Obesity
by Maria Baltogianni, Niki Dermitzaki, Vasileios Giapros, Foteini Balomenou, Chrysoula Kosmeri, Fani Ladomenou, Evanthia Kantza and Anastasios Serbis
Children 2025, 12(1), 50; https://doi.org/10.3390/children12010050 - 1 Jan 2025
Viewed by 535
Abstract
Background/Objectives: Some individuals with obesity may exhibit fewer metabolic disturbances and face a lower long-term risk of complications; however, the existence of this so-called “metabolically healthy obesity” (MHO) compared to “metabolically unhealthy obesity” (MUO) remains controversial. We hypothesized that children with MHO might [...] Read more.
Background/Objectives: Some individuals with obesity may exhibit fewer metabolic disturbances and face a lower long-term risk of complications; however, the existence of this so-called “metabolically healthy obesity” (MHO) compared to “metabolically unhealthy obesity” (MUO) remains controversial. We hypothesized that children with MHO might have a more favorable profile than children with MUO. Markers of glucose metabolism and insulin sensitivity were compared between children and adolescents diagnosed with MHO and MUO. Methods: This study recruited prospectively 104 children and adolescents (aged 6–16 years, 47 boys) with obesity. All participants underwent an oral glucose tolerance test (OGTT), and a comparative analysis was performed on HOMA-IR, QUICKI, insulin sensitivity index (ISI), insulinogenic index (IGI), disposition index (DI), and oral disposition index (oDI). Glucose metabolism indices were compared in these subgroups according to pubertal status. Results: Forty-seven children (45.2%) were diagnosed with MHO. The whole-body ISI differed significantly between the MHO and MUO groups (4.02 vs. 2.7, p < 0.01). The IGI was statistically lower in the MHO group compared to MUO (1.26 vs. 1.54, p < 0.01), while neither the DI nor the oDI differed significantly. A higher ISI (4.5 vs. 3.9, p < 0.01) was observed in prepubertal MHO individuals compared to MHO adolescents. Conclusions: Children classified as MHO according to the more recent criteria exhibit a more favorable metabolic profile than those with MUO. However, a completely healthy profile was not demonstrated in the MHO group, as many crucial metabolic profile parameters were comparable to those observed in the MUO group. The findings of this study indicate that all children with obesity, irrespective of whether they are categorized as having MUO or MHO, necessitate close monitoring. Full article
(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)
13 pages, 522 KiB  
Article
Impact of Soft Drink Intake on Bone Development and Risk of Fractures in a Danish Cohort of Schoolchildren
by Helene Hermansen, Mina Nicole Händel, Malene Søborg Heidemann and Niels Wedderkopp
Children 2025, 12(1), 43; https://doi.org/10.3390/children12010043 - 30 Dec 2024
Viewed by 580
Abstract
Background and Aims: Soft drink consumption is suspected to negatively impact bone health in children, but longitudinal evidence is limited. This study assessed the association between soft drink intake and bone health outcomes in Danish schoolchildren aged 7.7–12 years, within a physical activity [...] Read more.
Background and Aims: Soft drink consumption is suspected to negatively impact bone health in children, but longitudinal evidence is limited. This study assessed the association between soft drink intake and bone health outcomes in Danish schoolchildren aged 7.7–12 years, within a physical activity intervention framework. Methods: This study was nested in the CHAMPS-DK trial, a quasi-experimental study. Participants (n = 529) were recruited from intervention schools offering 270 min of physical education (PE) per week (active arm) and control schools with 90 min of standard PE. Soft drink intake was assessed via a food-frequency questionnaire at baseline. Dual-energy X-ray absorptiometry (DXA) was used to measure Bone Mineral Content (BMC), Bone Area (BA), and Bone Mineral Density (BMD) at baseline and two-year follow-up (primary outcomes). Fracture incidence over a five-year period was recorded using the SMS-Track parental reporting system (secondary outcome). Multilevel mixed-effects linear regression and Weibull survival models were used to analyze associations. Results: Soft drink intake of more than twice per month did not significantly affect BMC, BA, or BMD over two years (Total body BMD: β = 0.004; 95% CI: (−0.007; 0.016). Adjustment for confounders such as age, sex, BMI, pubertal status, socioeconomic status, and physical activity did not change the results. Additionally, no significant difference in fracture risk was observed (HR = 0.86; 95% CI: [0.43; 1.71]). Conclusions: Soft drink intake had no measurable impact on bone health indices or fracture risk in children, irrespective of PE intervention. Future studies should investigate the effects of specific soft drink types (carbonated vs. non-carbonated) on bone development. Full article
(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)
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11 pages, 261 KiB  
Article
High Serum Irisin Concentration Is Associated with More Disturbed Behavioural Eating Pattern in Adolescent Rhythmic Gymnasts
by Liina Remmel, Jaak Jürimäe, Anna-Liisa Tamm, Priit Purge and Vallo Tillmann
Children 2024, 11(11), 1384; https://doi.org/10.3390/children11111384 - 14 Nov 2024
Viewed by 679
Abstract
Background/Objectives: There are strict demands on body weight and shape in highly trained adolescent female athletes, and they are in the highest risk group for the development of eating disorders. This study aims to compare the behavioural eating patterns between highly trained [...] Read more.
Background/Objectives: There are strict demands on body weight and shape in highly trained adolescent female athletes, and they are in the highest risk group for the development of eating disorders. This study aims to compare the behavioural eating patterns between highly trained female adolescent athletes and untrained controls (UCs), and to describe the associations between behavioural eating patterns and different energy homeostasis hormones. Methods: A total of 33 rhythmic gymnasts (RGs), 20 swimmers (SWs), and 20 UCs (n = 20) that were 14 to 18 years old participated in this investigation. Anthropometric measurements, body composition, training volume, 3-consecutive-day energy intake, and different energy homeostasis hormones were measured. For the evaluation of the individual behavioural eating pattern, an eating disorders assessment scale (EDAS) questionnaire with different subscales was used. Results: The mean EDAS subscale of restrained eating score was significantly higher in the RG group compared to the UC group (17.2 ± 7.4 vs. 11.5 ± 5.8; p < 0.05). The EDAS total score (r = 0.380) and the subscale score of preoccupation with body image and body weight (r = 0.371) were both positively correlated (p < 0.05) with serum irisin concentrations in the RG group. Conclusions: In conclusion, female rhythmic gymnasts reported a more often restrained eating pattern than untrained controls, and their more disturbed behavioural eating pattern was associated with a higher serum irisin concentration. Full article
(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)
15 pages, 306 KiB  
Article
Ultra-Processed Foods and Nutritional Intake of Children and Adolescents from Cantagalo, São Tomé and Príncipe
by Rita Morais, Mónica Rodrigues, Francisca Ferreira, Renata Barros, Patrícia Padrão, Madalena Ortigão, Maria Tavares and Pedro Moreira
Children 2024, 11(9), 1089; https://doi.org/10.3390/children11091089 - 5 Sep 2024
Viewed by 1301
Abstract
Background: Globally, dietary patterns are shifting toward an increased consumption of ultra-processed foods, raising the risk of some metabolic and nutritional diseases from a young age. This trend is now also affecting low- and middle-income countries. Considering this, we aimed to assess the [...] Read more.
Background: Globally, dietary patterns are shifting toward an increased consumption of ultra-processed foods, raising the risk of some metabolic and nutritional diseases from a young age. This trend is now also affecting low- and middle-income countries. Considering this, we aimed to assess the contribution of ultra-processed foods to total energy intake and their association with the nutritional intake of children and adolescents in Cantagalo, São Tomé and Príncipe. Methods: We conducted a cross-sectional study with a sample of 546 households. Data were collected on anthropometrics, sociodemographic characteristics, and lifestyle, including 24 h food recall questionnaires for children and adolescents. The reported foods were nutritionally assessed and categorized according to the NOVA classification to estimate the contribution of ultra-processed foods. Logistic regression models were used to estimate the magnitude of the associations between higher consumption of ultra-processed foods and nutritional intake, adjusting for confounders. Results: The contribution of ultra-processed foods to daily energy intake was 9.5% for girls and 8.5% for boys. Higher consumption of ultra-processed foods was significantly associated with a lower intake of fiber (OR = 0.932; 95%CI, 0.872–0.996), vitamin B12 (OR = 0.812; 95%CI, 0.668–0.985), and zinc (OR = 0.443; 95%CI, 0.308–0.639) and a higher intake of iron (OR = 1.479; 95%CI, 1.065–2.055) and sodium (OR = 1.001; 95%CI, 1.000–1.001), after adjusting for confounders. Conclusion: Higher consumption of ultra-processed foods was especially associated with a lower intake of fiber, vitamin B12, and zinc, and with a higher intake of iron. Full article
(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)
12 pages, 604 KiB  
Article
Effects of Ramadan Fasting on Sleep and Physical Fitness among Young Female Handball Players
by Mohamed Alaeddine Guembri, Ghazi Racil, Mohamed Tounsi, Chirine Aouichaoui, Luca Russo, Gian Mario Migliaccio, Yassine Trabelsi, Nizar Souissi and Johnny Padulo
Children 2024, 11(8), 954; https://doi.org/10.3390/children11080954 - 7 Aug 2024
Cited by 1 | Viewed by 1343
Abstract
Objectives: This study examines the potential impact of Ramadan fasting on sleep patterns and physical fitness in under 14 (U14) and under 17 (U17) female handball players. Methods: For this study, sixty-five female handball players’ (U14, n = 33 and U17, n = [...] Read more.
Objectives: This study examines the potential impact of Ramadan fasting on sleep patterns and physical fitness in under 14 (U14) and under 17 (U17) female handball players. Methods: For this study, sixty-five female handball players’ (U14, n = 33 and U17, n = 32) sleep habits were assessed before (BR) and during the first (R1) and last weeks (R4) of Ramadan using: the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). Physical ability tests including balance and jumps were conducted throughout these periods.; Results: During Ramadan, both groups noted significant increases in PSQI and ISI scores during R1 (p < 0.01 and p < 0.05, respectively) and R4 (p < 0.05 and p < 0.05, respectively) compared to before Ramadan (BR). For the U14 group, a significant increase occurred in ESS scores during R1 (p < 0.01) and R4 (p < 0.05), whereas for the U17 group, this increase was limited over the R1 period (p < 0.05). In contrast, for all physical ability parameters, both groups showed no significant difference during R1 and R4; Conclusions: During adolescence, Ramadan fasting may alter sleep patterns in young female athletes but appears to have no effect on their performance in short-duration exercises. Full article
(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)
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Review

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32 pages, 850 KiB  
Review
Associations between Meal Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review of Longitudinal Studies and Randomised Controlled Trials
by Georgios Saltaouras, Athanasia Kyrkili, Eirini Bathrellou, Michael Georgoulis, Mary Yannakoulia, Vasiliki Bountziouka, Urška Smrke, George Dimitrakopoulos and Meropi D. Kontogianni
Children 2024, 11(9), 1100; https://doi.org/10.3390/children11091100 - 7 Sep 2024
Viewed by 2105
Abstract
Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity—MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this [...] Read more.
Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity—MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2–19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted. Full article
(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)
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Other

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13 pages, 682 KiB  
Systematic Review
Nutritional Deficiencies and Associated Oral Health in Adolescents: A Comprehensive Scoping Review
by Man Hung, Amy Blazejewski, Samantha Lee, Johanna Lu, Andres Soto, Connor Schwartz and Amir Mohajeri
Children 2024, 11(7), 869; https://doi.org/10.3390/children11070869 - 18 Jul 2024
Viewed by 3494
Abstract
Introduction: The shift to processed foods in American diets has increased vitamin and mineral deficiencies among adolescents, impacting growth and health, often manifesting as oral lesions. This review study aimed to explore the link between nutritional deficiencies and adolescent oral health to improve [...] Read more.
Introduction: The shift to processed foods in American diets has increased vitamin and mineral deficiencies among adolescents, impacting growth and health, often manifesting as oral lesions. This review study aimed to explore the link between nutritional deficiencies and adolescent oral health to improve guidance and prevent long-term issues. Methods: A systematic review of literature from 2013 to 2023 was conducted on adolescents aged 10–19 years, using PRISMA guidelines. Searches in PubMed, Web of Science, Dentistry & Oral Sciences Source—Ebscohost, and Scopus included peer-reviewed articles, excluding reviews and non-empirical studies. Data were screened and extracted with independent reviews for accuracy. Results: Malnutrition strongly correlates with poor oral health. Undernourished children have a 60% increase in dental caries, exacerbated by high sugar intake. Early malnutrition delays dental eruption, temporarily protecting against caries, while stunting and infections cause enamel defects. Chronic conditions like cerebral palsy and celiac disease worsen oral health, with risks persisting into adulthood. Conclusions: Nutritional deficiencies and oral health are interconnected, requiring integrated healthcare. Early interventions and holistic strategies can improve outcomes and reduce long-term burdens. Comprehensive health education and routine dental evaluations are essential for prevention and treatment, enhancing health across all demographics. Full article
(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)
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