Diet Modification Clinical Trial
Official title:
Impact of School Based Education Program on Dietary Knowledge, Attitude and Practice Among Preparatory School Girls in Assiut City
Good health is an important indicator of the quality of life, in which healthy nutrition and physical activity take an important place. Healthy nutrition and physical activity according to the guidelines of WHO are closely related to lower general and speciļ¬c mortality rates due to heart and coronary diseases and cancer, which are the top reasons for mortality from non-communicable diseases. Every year, 41 million people die from non-communicable diseases, which represents 71% of the total number of global deaths. This largely invisible epidemic is more serious in low- and middle-income countries, where 85% of non-communicable diseases premature deaths occur
As unhealthy diet, physical inactivity and tobacco use are common risk factors of the
non-communicable diseases, elimination of these modifiable risk factors would prevent 80% of
premature heart disease, 80% of premature stroke, 80% of type 2 diabetes and 40% of cancer.
Studies indicate that good nutrition is especially important during adolescence, which is a
period of biological and social change. These are crucial years for normal physical and
mental development, and the diet and eating behaviors that develop during these years tend to
persist throughout life. During adolescence, body size and composition, bodily functions and
physical abilities change rapidly, and under-nutrition can slow height and weight growth and
may delay puberty. In addition, healthful eating habits in young people not only help to
prevent under-nutrition, growth retardation and acute nutritional problems, but also can
enhance students' educational performance and learning . Nutrition-related health problems
among the youth are apparent in developing countries where, paradoxically, both over- and
under-nutrition can coexist.
At the global level, major modifications in the dietary habits have occurred since the second
half of the twentieth century; first in industrial regions and more recently in developing
countries. The concept of 'food' has changed from a means of nourishment to a marker of
lifestyle and a source of pleasure as portrayed by media. A large proportion of televised
food advertisements are of highly processed foods/convenient foods with, high caloric
content, large amounts of fat and sugar, and with little or no micronutrient content .
Also, due to low cost and easy availability, people are increasingly consuming
high-saturated-fat snacks, refined carbohydrates and sweetened carbonated beverages. There is
an increased inclination to replace traditional meals with energy-dense imbalanced foods.
Irregular meals, snacking, eating away from home, and following alternative dietary patterns
have already been frequently reported among adolescents in many countries.
The traditional Egyptian diet has also been modified in the recent decades with introduction
of new foods and eating habits.Such dietary patterns with inadequate physical activity
trigger the onset of fat deposition and lead to early metabolic derangements such as the
metabolic syndrome and type 2 diabetes mellitus .
A previous Egyptian study in Mansoura revealed unhealthy dietary habits of adolescents; as
fast foods and carbonated drinks were consumed on daily bases by more than two thirds and one
fifth of the participating students; respectively. It was also found that the majority of
students drink tea more than 3 times daily. Excess salt and excess sugar/sweet intake were
reported by more than half of the study participants.
Another study in the United Arab Emirates found that the majority of children and adolescent
participants had less than the recommended number of servings from milk and vegetables.
A study in Saudi Arabia showed that large proportions of Saudi adolescent school students
never consumed protein food sources or fresh fruits during the previous week, while the most
frequently consumed food items were rice and bread.
Moreover, the majority of Arab adolescents do not meet the recommended guidelines for daily
physical activity. It has been reported that more than 85% of girls and 75% of boys aged
13-15 years in seven Arab countries (Djibouti, Egypt, Jordan, Libya Morocco, Oman, and the
United Arab Emirates) did not engage in a sufficient amount of daily physical activity
(obtaining at least 60 minutes of physical activity per day).
A cross-cultural study on perceived barriers to healthy eating among adolescents in seven
Arab countries revealed that there are several personal, social, and environmental barriers
to healthy eating among adolescents in Arab countries; Lack of information on healthy eating,
lack of motivation to eat healthy diets, and not having time to prepare or eat healthy foods
due to school commitments were found to be the main barriers to healthy eating.
In order to promote healthier eating habits, nutrition knowledge is believed to be important.
However, nutrition knowledge alone may not be sufficient to change dietary habits hence in
addition there is need to mold a positive attitude toward healthy eating early in childhood.
With the current change in dietary habits to the western diet and increase in televised food
advertisements targeting children, there is even greater need to empower children with the
right knowledge and attitudes for making proper food choices. There is a growing evidence
suggesting that young children from developing countries are increasingly making unhealthy
food choices especially due to lack of knowledge and wrong perception towards healthy foods.
However, children do not always choose what they eat; very often parents decide and prepare
food for them. Clearly, parents, peers and teachers can play a crucial role in shaping each
child's outlook towards health.
Nutrition knowledge alone does not influence behavior, but does provide individuals with the
ability to know how to select a healthy diet. The nutritional knowledge and skills need to be
taught during childhood when firm eating practices are being established. Therefore, school
is the major area for providing young people with nutrition knowledge and skills.
Some previous studies revealed that school based nutritional education programs resulted in
significant positive changes in both nutrition knowledge and behaviors, while other studies
revealed non-significant changes.
Strategies are more effective when they include efforts to increase parental or family
support. Family involvement enhances the effectiveness of programs for younger children.
Objectives for the family component in successful programs focus on stimulating awareness and
gaining parental support to encourage variety in the diet and availability of healthy foods
at home. Methods used include brochures and activities with the Parents' Association and the
Parent-Teachers' Association.
Environmental interventions are important components of intervention programs, that
contribute to the creation of opportunities for action by removing barriers to following a
healthy diet.
School-based nutrition education should address the needs and interests of students, the
teachers and the school; take into account what children already know and can do; be
culturally appropriate; be delivered in a way children can understand and teach the skills
and knowledge required to improve or strengthen healthy eating habits. Several studies have
shown that using different teaching and learning strategies can enhance the learning outcomes
of school children as small group discussions, group work, demonstrations, art educational
drawing help in the success of the intervention program.
Efficacy of nutrition education interventions also depends on the duration and frequency of
intervention. Two systematic review concluded that educational interventions that are
sustained for a longer are more likely to be effective than those conducted for a short
period. Adequate time, intensity of the intervention, resources, as well as the provision of
suitable materials and teacher training opportunities are essential to program success.
Moreover having support from policy makers and school management affect the success of the
program.
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