Food habits of the school population from La Mancha-Centro Health Area (Ciudad Real)

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González-González, M.P. Falero-Gallego, O. Redondo-González, A. Muñoz-Serrano" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "González-González" "email" => array:1 [ 0 => "abelg@sescam.jccm.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.P." "apellidos" => "Falero-Gallego" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "O." "apellidos" => "Redondo-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Muñoz-Serrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Apoyo a la Investigación; Unidad de Investigación, Docencia y Formación, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Patrón dietético de la población escolar del Área La Mancha-Centro (Ciudad Real)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1612 "Ancho" => 1474 "Tamanyo" => 98251 ] ] "descripcion" => array:1 [ "en" => "Percentage of children that consumed protein-rich foods from animal sources throughout the day." ] ] ] "textoCompleto" => "IntroductionAn adequate nutrient intake adapted to each age ensures the correct physical and cognitive development of the child, prevents acute nutrition problems, such as iron deficiency or tooth decay, and reduces the risk of chronic diseases such as cardiovascular disease, cancer or osteoporosis.<a class="elsevierStyleCrossRefs" href="#bib0115">1,2</a>Different healthy dietary patterns have been proposed both for the general population and for specific population subsets: children, the elderly, pregnant women, etc. Those addressing the healthy paediatric population are usually endorsed by various scientific associations or public health agencies, and tend to concur on important aspects, such as the daily distribution of food intake into several meals, the weekly frequency of consumption of various food groups, or the determination of specific foods or amounts of food that are recommended or recommended against.<a class="elsevierStyleCrossRefs" href="#bib0125">3–6</a>The dietary habits of children in developed countries have been changing in recent years. These changes in dietary patterns have contributed to increases in the prevalence of obesity and associated diseases, such as disorders of carbohydrate metabolism and dyslipidaemia.<a class="elsevierStyleCrossRef" href="#bib0145">7</a> This increase in the prevalence of obesity has been associated with an increase in the energy density of the foods consumed, but also with daily eating frequency, a reduced dietary diversity, or the more or less frequent consumption of certain food groups.<a class="elsevierStyleCrossRefs" href="#bib0150">8–10</a>The aim of this study was to analyse the dietary patterns of a representative sample of the population of schoolchildren in the Health Area of La Mancha Centro (Ciudad Real) in order to determine their dietary profile and compare it to the most common dietary patterns that are considered healthy.Materials and methodsStudy design, scope, and populationWe conducted a cross-sectional study on a representative sample of schoolchildren aged 6–12 years that resided in the Health Area of La Mancha Centro, which includes several towns in Ciudad Real, Cuenca and Toledo.We performed two-stage sampling in a population of 13,896 children enrolled in 73 schools, with probabilities proportional to the size of the primary units. In the first stage, 20 clusters (schools) were chosen, and in the second stage, 60 children were selected at random from each of these schools.We designed an ad hoc data collection model to gather information on aspects related to dietary patterns, which was recorded in two data collection notebooks (DCNs). The DCN1, filled out by the researchers, was used to evaluate the presence of iodine deficiency disorders, and the DCN2, completed by the parents and/or legal guardians of the children, were used to specifically analyse the diet.The study was approved by the clinical research ethics committee of the Hospital General La Mancha Centro. All participants were given an informed consent form that was signed by the parents or legal guardians.Description of the study variablesThe DCN2 was used to collect sociodemographic data, the relevant medical history of the child, the number of siblings and the educational attainment of the parents, and included a questionnaire designed to assess qualitative aspects of the diet: number of daily eating occasions (3, 4, 5 or >5), food preferences (most and least palatable), appetite (poor, fair, good and very good), consumption of dairy, consumption of fish, consumption of oil, and special diets. This questionnaire was supplemented with a record of the foods consumed in the past 24h (the amounts consumed were not documented), and the foods recorded in this log were later categorised into seven groups for the purposes of analysis (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Statistical analysisWe have summarised quantitative variables as measures of central tendency and dispersion (mean and standard deviation [SD]) and qualitative variables as absolute frequencies and relative frequencies expressed as percentages. We analysed the degree of association between dietary habits and age, sex, parental educational attainment, number of siblings, eating frequency and anthropometric measurements. The association was analysed by means of either ANOVA or the chi squared test and the Spearman correlation coefficient, depending on the type of variable. We performed the calculations with the statistical software PASW 18.0 and EPIDAT 3.1 (Xunta de Galicia, OPS).ResultsWe analysed the diet of a final sample of 1142 schoolchildren, including 612 boys (53.6%) and 530 girls (46.4%), aged between 5.8 and 13.2 years (mean±SD=9.3±1.7) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Two children (0.2%) completed the DCN themselves, including the section pertaining to appetite. Of all schoolchildren, 52.7% walked to school, and only 15.6% used the school lunch service.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Dietary patterns and food preferencesAppetiteThe information regarding the appetite of the children was obtained from the mother in 76.2%, the father in 9.4%, and both parents in 7.8% of cases. More than half of the sample under study (52.4%) reported their appetite as being “normal”, while 23.6% reported it being “very good”, 15.4% “fair” and only 3.6% “poor”. The appetite level was directly and significantly correlated to body weight and body mass index (BMI) (P<.001) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>), age (P=.02) and the number of daily eating occasions (P=.038), but not with sex, the number of siblings or parental educational attainment.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Number of daily eating occasionsThe mean number of daily eating occasions was 4.62±0.6. Most of the schoolchildren (59.8%) ate five times a day, and only a minority (4.8%) ate only three times a day. Eating frequency decreased with increasing age (P=.044) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and increased with parental educational attainment (P=.004). We did not find an association with other variables such as body weight, BMI, sex or number of siblings.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Food preferencesWhen children were asked about their favourite food, the most frequent answer was pasta (29.4%), followed by meat (13.9%) and rice (9.8%). The least preferred foods included vegetables (6%), legumes (3.9%) and fish (1.9%). Vegetables were the most disliked food in a majority (61.1% of surveyed children), followed by legumes (20%) and fruits (4.8%).Only 29% of children reported liking dairy products when specifically asked about it, although 90.6% consumed the equivalent of two or more glasses of milk a day. Of the children that did not like dairy, 87% would consume the equivalent of two or more glasses of milk a day, compared to 96.8% of children that reported enjoying dairy, a difference in consumption that was significantly associated to food preference (P<.001). Furthermore, 91.1% of boys consumed two or more glasses of milk a day compared to 87.3% of girls (P=.043). The intake was not associated with body weight, BMI, age, parental educational attainment or the number of siblings.Although only 22.6% of children liked fish, 55.5% had fish three or more times a week. Of the children that disliked fish, 49.2% consumed it fewer than three times a week, a percentage that was considerably lower (28.4%) in children that enjoyed fish. Thus, there was a significant correlation between food preference and actual fish intake (P<.001). Consumption of fish three or more times a week was inversely correlated to age (P=.036) and directly correlated to parental educational attainment (P=.001), but was not associated with sex, body weight, BMI or the number of siblings.Other dataOnly 3.3% of the children were on a special diet. The most frequent reason for it was celiac disease (25%). Other reasons included diabetes, excess weight, lactose intolerance, food allergies, etc.More than 70% of the sample consumed olive oil on a regular basis, compared to oils from other sources, such as sunflower seed or soy.Food log of the past 24hThe consumption by the children, at least once a day, of foods from the different food groups in decreasing order was: group 6 (92.8%); group 1 (90.45%); group 2 (88.7%; and within it subgroups 2a [83.36%], 2b [37.56%] and 2c [28.19%]); group 5 (68.12%); group 3 (44.5%) and group 4 (35.46%).The daily distribution of protein-rich foods (meat, fish and eggs) was considerably disparate: while meat and meat derivatives (2a) were consumed by similar percentages in every meal (ranging from 39.1% at dinner to 48.6% in the mid-morning) except at breakfast (only 0.9%), the consumption of fish (group 2b) and eggs (2c) was mostly concentrated on dinner (fish, 25.8%; eggs, 22.2%), with the consumption of these subgroups being considerably lower in other eating occasions (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Of all schoolchildren, 21.36% consumed meat or meat products at lunch and dinner, and 5.5% on four eating occasions during the day (mid-morning, lunch, afternoon and dinner).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Breakfast: 14.2% of the schoolchildren skipped breakfast. The most common breakfast (58.3%) consisted exclusively of a dairy product and one item from group 6 (bread, pasta or sugar), although the frequency of intake of foods from these two groups was higher if we included combinations with other foods. A dairy product was consumed during breakfast by 81.6% of children, alone or combined with other foods, and bread or cereal by 70.8%.Mid-morning snack: 87.1% of respondents had some type of mid-morning snack. The most frequent pattern was a combination of one item from group 6 (cereal) and one from subgroup 2a (meats and cured meats) (23.3%). Sixty-four percent of the children ate cereal-based foods, alone or combined with other foods, and 48.6% ate foods from group 2a.Afternoon snack: 84.6% ate an afternoon snack. The most common mid-afternoon snacking pattern consisted of a food from group 6 (cereal) and one from group 1 (dairy) (12.1%). The foods consumed most frequently in the afternoon snack, alone or combined with other foods, belonged to groups 6 (69.8%), 2a (39%) and 1 (38%).Lunch and dinner: the dietary patterns of the midday meal (lunch) and dinner were not as well defined as the patterns observed in breakfast and the mid-morning and afternoon snacks. There was greater variability in the two main meals. No single pattern (combination of food groups) exceeded a frequency of 6% for lunch or 5% for dinner. With that in mind, the most frequently consumed food groups, alone or in different combinations, were groups 6 (44.6%), 2a (43.7%) and 3 (36.2%) at lunch, and groups 2a (39.1%), 6 (38.2%) and 1 (34.2%) at dinner.DiscussionThe results obtained in this study allowed us to identify some of the main characteristics of the usual diet of schoolchildren in this geographical area of the Submeseta Sur (southern portion of the central plateau of the Iberian peninsula) where the provinces of Ciudad Real, Toledo and Cuenca meet.The size of the towns in the geographical area under study, in which there is a short distance between residences and schools, a social environment that allows children to eat at home and for appropriate school hours with an intensive morning schedule, may account for the fact that more than half of the children walked to school and only 15.6% used the school lunch service.Dietary behaviour is regulated by a complex neuroendocrine mechanism that is based on the interplay of hunger and satiety signals.<a class="elsevierStyleCrossRef" href="#bib0165">11</a> Eighty-six percent of the surveyed schoolchildren had a good or very good appetite, and appetite level was directly and significantly correlated to body weight, BMI, age and number of daily eating occasions. This could suggest that appetite provides an indirect measure of intake amounts, and thus that appetite is greater in children that are older, have a higher BMI or eat more frequently. However, age, BMI and eating frequency may influence how parents perceive the children's appetite, a hypothesis supported by the fact that we did not find and association between eating frequency and body weight or BMI.Most of the surveyed schoolchildren ate at least five times a day (breakfast, mid-morning snack, lunch, afternoon snack and dinner), and consequently the mean number of daily eating occasions was high. Eating frequency was higher in younger children and in children with parents with higher educational attainment. In the enKid study, Serra-Majem et al. also found that eating frequency decreased with increasing age.<a class="elsevierStyleCrossRef" href="#bib0170">12</a> We did not find an association between eating frequency and body weight or BMI. Several studies have suggested that a dietary pattern characterised by a higher eating frequency, especially if it is based on less energy-dense foods and offset with physical activity, has a positive impact on obesity, although this relationship has yet to be clearly established.<a class="elsevierStyleCrossRefs" href="#bib0160">10,13,14</a>In our study, some of the foods at the base of the food pyramid, such as vegetables and legumes, were perceived to be among the least appetising, probably because these foods and the dishes in which they are prepared are less palatable. There is evidence that palatability influences food choices.<a class="elsevierStyleCrossRef" href="#bib0185">15</a> In our study, the two least-consumed food groups were also the two perceived as the least palatable.It is known that a varied diet facilitates adherence to dietary recommendations.<a class="elsevierStyleCrossRefs" href="#bib0190">16,17</a> The benefits of a dietary pattern like the Mediterranean diet (MD) derive not only from its dietary diversity, but also from the consumption of some of the specific foods that it includes, such as olive oil—as the main source of lipids—or considerable amounts of vegetables, fruits and legumes that, in addition to ensuring nutrient adequacy, have been shown to reduce the incidence of cardiovascular diseases and some types of cancer.<a class="elsevierStyleCrossRefs" href="#bib0200">18,19</a> According to the KIDMED study, less than 50% of the population of children and youth in Spain adhere to an optimal MD.<a class="elsevierStyleCrossRef" href="#bib0210">20</a> In this study, we did not use any validated instruments to assess adherence to a MD pattern, but the percentages of oil and cereal consumption (although it was not specified whether the cereal consumed was whole-grain or refined) were consistent with this dietary pattern. However, the intake of other foods deviated from this pattern, such as the low consumption of fruits and vegetables and excessive consumption of meats.Dietary variety was considerable in the two main meals (lunch and dinner), and low in other eating occasions, in which dietary patterns were quite homogeneous. More than 85% of schoolchildren had breakfast, in which dairy was the most frequently consumed food group, followed by foods from group 6 (essentially cereal). On this subject, there is evidence that food intake early in the day improves academic performance in children<a class="elsevierStyleCrossRef" href="#bib0115">1</a> and that the frequent consumption of cereals at breakfast may contribute to preventing overweight and obesity.<a class="elsevierStyleCrossRef" href="#bib0215">21</a> It is also worth noting that when it came to the distribution of foods throughout the day, fish and especially eggs were mostly consumed at dinner, probably due to sociocultural factors. We specifically assessed the intake of dairy and fish outside the 24-h recall questionnaire, as these foods have a high iodine content and we wanted to assess for consumption of the minimum amounts that would guarantee an adequate iodine intake. The actual intake of both food groups, and especially of dairy, was above the proposed cut-off point, despite the low preference for these foods.The limitations of this study mostly pertain to its retrospective nature and to the main source of data consisting of a 24-h diet intake recall; however, other authors have used a similar methodology.<a class="elsevierStyleCrossRef" href="#bib0220">22</a> On the other hand, its strengths are that it is the first study to describe the dietary pattern of these children from La Mancha, and that, given that the sample was representative of the population, its results can be counted on to be robust.In conclusion, the dietary pattern of schoolchildren in the towns belonging to the Health Area of La Mancha Centro maintains some of the characteristics of the traditional MD, such as the habit of daily breakfast and a high intake of olive oil and cereals, although it also has a low consumption of vegetables and fruits and an excessive consumption of meat.FundingThis study has received funding from a research grant from the Fundación Socio-Sanitaria de Castilla-La Mancha (AN-2010/44).Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres608979" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec622507" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres608978" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec622508" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design, scope, and population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Description of the study variables" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0035" "titulo" => "Dietary patterns and food preferences" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Appetite" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Number of daily eating occasions" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Food preferences" ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "Other data" ] ] ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Food log of the past 24 h" ] ] ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-22" "fechaAceptado" => "2015-06-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec622507" "palabras" => array:4 [ 0 => "Diet" 1 => "Food habits" 2 => "School" 3 => "Childhood" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec622508" "palabras" => array:4 [ 0 => "Dieta" 1 => "Hábitos dietéticos" 2 => "Escolares" 3 => "Infancia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo assess the dietary pattern of the school population from La Mancha-Centro Health Area (Ciudad Real). MethodologyA cross-sectional study conducted on a representative sample of schoolchildren aged 6–12 years, using a questionnaire to determine their general dietary habits and a record of their 24-h intake. ResultsA total of 1142 schoolchildren were included, with 612 boys (53.6%) and 530 girls (46.4%), and a mean age of 9.3±1.7 years of age. The frequency of food intake was 4.62±0.6 times a day, which decreased with the age of the schoolchildren (P=.044), and increased with the educational level of parents (P=.004). Food preference influenced the choice in the meals consumed. The level of appetite was related directly with weight and body mass index (BMI) (P<.001), age (P=.02), and number of daily food intakes by the children (P=.038). The food groups most frequently consumed were cereals and their derivatives (92.8%), milk and dairy products (90.45%), while vegetables were the least consumed (35.46%). Over 70% of the sample usually consumed olive oil. ConclusionThe dietary pattern of the school population maintains some of the features of traditional Mediterranean dietary pattern, such as the habit of daily breakfast, the greater consumption of olive oil and cereals. On the other hand, other characteristics are remarkable, such as the low consumption of fruit and vegetables and the high consumption of meat." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methodology" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoValorar el patrón dietético de la población escolar del Área de Salud La Mancha Centro (Ciudad Real). MetodologíaEstudio transversal sobre una muestra representativa de los escolares de 6 a 12 años. Se utilizó un cuestionario para explorar los hábitos dietéticos generales y un recordatorio de ingesta de 24 h. ResultadosSe evaluó a 1.142 escolares, 612 niños (53,6%) y 530 niñas (46,4%), con una edad de 9,3±1,7 años. La frecuencia de la ingesta de alimentos, de 4,62±0,6 veces al día, decrecía de forma estadísticamente significativa con la edad de los escolares (p=0,044) y aumentaba con el nivel educativo de los padres (p=0,004). La preferencia era un factor influyente en la elección de los alimentos consumidos. El grado de apetito se relacionó de forma directa con el peso y el índice de masa corporal (p < 0,001), la edad (p = 0,02) y el número de ingestas diarias (p=0,038). Los grupos de alimentos más frecuentemente ingeridos fueron los cereales y derivados (92,8%), la leche y derivados (90,45%) y los menos, las verduras y hortalizas (35,46%). Más del 70% de la muestra consumía como aceite habitual el de oliva. ConclusiónEl patrón dietético de los escolares mantiene algunas de las características del patrón de dieta mediterránea tradicional, como el hábito de desayuno, el elevado consumo de aceite de oliva o de cereales, pero no otras, destacando el escaso consumo de verduras y frutas, y el elevado de carnes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Metodología" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: González-González A, Falero-Gallego MP, Redondo-González O, Muñoz-Serrano A. Patrón dietético de la población escolar del Área La Mancha-Centro (Ciudad Real). An Pediatr (Barc). 2016;84:133–138." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1169 "Ancho" => 1662 "Tamanyo" => 86198 ] ] "descripcion" => array:1 [ "en" => "Association between appetite level and body mass index (weight [kg]/height2 [m2])." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1126 "Ancho" => 1642 "Tamanyo" => 59834 ] ] "descripcion" => array:1 [ "en" => "Association between eating frequency and age of schoolchildren." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1612 "Ancho" => 1474 "Tamanyo" => 98251 ] ] "descripcion" => array:1 [ "en" => "Percentage of children that consumed protein-rich foods from animal sources throughout the day." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Food groups \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Included foods \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Milk and dairy products \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">2</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Meat and meat products (such as cured meats or pâtés) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fish \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2c \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Eggs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Potatoes, legumes and nuts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vegetables \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fruits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bread, pasta and sugar \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fats, oils and butter \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab996918.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distribution of foods into groups." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Data expressed as mean±standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Boys \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Girls \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.62±0.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.43±0.86 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.39±0.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.53±0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Height (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">136.56±0.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">139.47±2.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.57±0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.46±0.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Number of siblings \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.57±0.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.65±0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab996919.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of children by sex." ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Appetite \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">N (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">BMI (kg/m2)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean±SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Range \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Very good \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">320 (28.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.76±3.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.69–34.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">587 (52.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.41±3.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.11–34.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Fair \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">173 (15.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.07±1.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.63–24.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Poor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.51±2.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.79–24.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab996917.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "ANOVA (P<.001)." ] ] ] "descripcion" => array:1 [ "en" => "Average BMI by appetite level of children.<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Position of the Academy of Nutrition and Dietetics: Nutrition guidance for healthy children ages 2 to 11 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.N. 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Food habits of the school population from La Mancha-Centro Health Area (Ciudad Real)

Patrón dietético de la población escolar del Área La Mancha-Centro (Ciudad Real)

A. González-Gonzáleza,

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abelg@sescam.jccm.es

Corresponding author.

, M.P. Falero-Gallegob, O. Redondo-Gonzálezc, A. Muñoz-Serranob

a Sección de Endocrinología y Nutrición, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain

b Servicio de Pediatría, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain

c Unidad de Apoyo a la Investigación; Unidad de Investigación, Docencia y Formación, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">An adequate nutrient intake adapted to each age ensures the correct physical and cognitive development of the child&#44; prevents acute nutrition problems&#44; such as iron deficiency or tooth decay&#44; and reduces the risk of chronic diseases such as cardiovascular disease&#44; cancer or osteoporosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Different healthy dietary patterns have been proposed both for the general population and for specific population subsets&#58; children&#44; the elderly&#44; pregnant women&#44; etc&#46; Those addressing the healthy paediatric population are usually endorsed by various scientific associations or public health agencies&#44; and tend to concur on important aspects&#44; such as the daily distribution of food intake into several meals&#44; the weekly frequency of consumption of various food groups&#44; or the determination of specific foods or amounts of food that are recommended or recommended against&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The dietary habits of children in developed countries have been changing in recent years&#46; These changes in dietary patterns have contributed to increases in the prevalence of obesity and associated diseases&#44; such as disorders of carbohydrate metabolism and dyslipidaemia&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">7</span></a> This increase in the prevalence of obesity has been associated with an increase in the energy density of the foods consumed&#44; but also with daily eating frequency&#44; a reduced dietary diversity&#44; or the more or less frequent consumption of certain food groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">8&#8211;10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to analyse the dietary patterns of a representative sample of the population of schoolchildren in the Health Area of La Mancha Centro &#40;Ciudad Real&#41; in order to determine their dietary profile and compare it to the most common dietary patterns that are considered healthy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design&#44; scope&#44; and population</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional study on a representative sample of schoolchildren aged 6&#8211;12 years that resided in the Health Area of La Mancha Centro&#44; which includes several towns in Ciudad Real&#44; Cuenca and Toledo&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We performed two-stage sampling in a population of 13&#44;896 children enrolled in 73 schools&#44; with probabilities proportional to the size of the primary units&#46; In the first stage&#44; 20 clusters &#40;schools&#41; were chosen&#44; and in the second stage&#44; 60 children were selected at random from each of these schools&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We designed an ad hoc data collection model to gather information on aspects related to dietary patterns&#44; which was recorded in two data collection notebooks &#40;DCNs&#41;&#46; The DCN1&#44; filled out by the researchers&#44; was used to evaluate the presence of iodine deficiency disorders&#44; and the DCN2&#44; completed by the parents and&#47;or legal guardians of the children&#44; were used to specifically analyse the diet&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The study was approved by the clinical research ethics committee of the Hospital General La Mancha Centro&#46; 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&#8220;fair&#8221; and only 3&#46;6&#37; &#8220;poor&#8221;&#46; The appetite level was directly and significantly correlated to body weight and body mass index &#40;BMI&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; age &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41; and the number of daily eating occasions &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;038&#41;&#44; but not with sex&#44; the number of siblings or parental educational attainment&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Number of daily eating occasions</span><p id="par0065" class="elsevierStylePara elsevierViewall">The mean number of daily eating occasions was 4&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6&#46; Most of the schoolchildren &#40;59&#46;8&#37;&#41; ate five times a day&#44; and only a minority &#40;4&#46;8&#37;&#41; ate only three times a day&#46; Eating frequency decreased with increasing age &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;044&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; and increased with parental educational attainment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#46; We did not find an association with other variables such as body weight&#44; BMI&#44; sex or number of siblings&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Food preferences</span><p id="par0070" class="elsevierStylePara elsevierViewall">When children were asked about their favourite food&#44; the most frequent answer was pasta &#40;29&#46;4&#37;&#41;&#44; followed by meat &#40;13&#46;9&#37;&#41; and rice &#40;9&#46;8&#37;&#41;&#46; The least preferred foods included vegetables &#40;6&#37;&#41;&#44; legumes &#40;3&#46;9&#37;&#41; and fish &#40;1&#46;9&#37;&#41;&#46; Vegetables were the most disliked food in a majority &#40;61&#46;1&#37; of surveyed children&#41;&#44; followed by legumes &#40;20&#37;&#41; and fruits &#40;4&#46;8&#37;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Only 29&#37; of children reported liking dairy products when specifically asked about it&#44; although 90&#46;6&#37; consumed the equivalent of two or more glasses of milk a day&#46; Of the children that did not like dairy&#44; 87&#37; would consume the equivalent of two or more glasses of milk a day&#44; compared to 96&#46;8&#37; of children that reported enjoying dairy&#44; a difference in consumption that was significantly associated to food preference &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Furthermore&#44; 91&#46;1&#37; of boys consumed two or more glasses of milk a day compared to 87&#46;3&#37; of girls &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;043&#41;&#46; The intake was not associated with body weight&#44; BMI&#44; age&#44; parental educational attainment or the number of siblings&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Although only 22&#46;6&#37; of children liked fish&#44; 55&#46;5&#37; had fish three or more times a week&#46; Of the children that disliked fish&#44; 49&#46;2&#37; consumed it fewer than three times a week&#44; a percentage that was considerably lower &#40;28&#46;4&#37;&#41; in children that enjoyed fish&#46; Thus&#44; there was a significant correlation between food preference and actual fish intake &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Consumption of fish three or more times a week was inversely correlated to age &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;036&#41; and directly correlated to parental educational attainment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; but was not associated with sex&#44; body weight&#44; BMI or the number of siblings&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Other data</span><p id="par0085" class="elsevierStylePara elsevierViewall">Only 3&#46;3&#37; of the children were on a special diet&#46; The most frequent reason for it was celiac disease &#40;25&#37;&#41;&#46; Other reasons included diabetes&#44; excess weight&#44; lactose intolerance&#44; food allergies&#44; etc&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">More than 70&#37; of the sample consumed olive oil on a regular basis&#44; compared to oils from other sources&#44; such as sunflower seed or soy&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Food log of the past 24<span class="elsevierStyleHsp" style=""></span>h</span><p id="par0095" class="elsevierStylePara elsevierViewall">The consumption by the children&#44; at least once a day&#44; of foods from the different food groups in decreasing order was&#58; group 6 &#40;92&#46;8&#37;&#41;&#59; group 1 &#40;90&#46;45&#37;&#41;&#59; group 2 &#40;88&#46;7&#37;&#59; and within it subgroups 2a &#91;83&#46;36&#37;&#93;&#44; 2b &#91;37&#46;56&#37;&#93; and 2c &#91;28&#46;19&#37;&#93;&#41;&#59; group 5 &#40;68&#46;12&#37;&#41;&#59; group 3 &#40;44&#46;5&#37;&#41; and group 4 &#40;35&#46;46&#37;&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The daily distribution of protein-rich foods &#40;meat&#44; fish and eggs&#41; was considerably disparate&#58; while meat and meat derivatives &#40;2a&#41; were consumed by similar percentages in every meal &#40;ranging from 39&#46;1&#37; at dinner to 48&#46;6&#37; in the mid-morning&#41; except at breakfast &#40;only 0&#46;9&#37;&#41;&#44; the consumption of fish &#40;group 2b&#41; and eggs &#40;2c&#41; was mostly concentrated on dinner &#40;fish&#44; 25&#46;8&#37;&#59; eggs&#44; 22&#46;2&#37;&#41;&#44; with the consumption of these subgroups being considerably lower in other eating occasions &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Of all schoolchildren&#44; 21&#46;36&#37; consumed meat or meat products at lunch and dinner&#44; and 5&#46;5&#37; on four eating occasions during the day &#40;mid-morning&#44; lunch&#44; afternoon and dinner&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Breakfast</span>&#58; 14&#46;2&#37; of the schoolchildren skipped breakfast&#46; The most common breakfast &#40;58&#46;3&#37;&#41; consisted exclusively of a dairy product and one item from group 6 &#40;bread&#44; pasta or sugar&#41;&#44; although the frequency of intake of foods from these two groups was higher if we included combinations with other foods&#46; A dairy product was consumed during breakfast by 81&#46;6&#37; of children&#44; alone or combined with other foods&#44; and bread or cereal by 70&#46;8&#37;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Mid-morning snack</span>&#58; 87&#46;1&#37; of respondents had some type of mid-morning snack&#46; The most frequent pattern was a combination of one item from group 6 &#40;cereal&#41; and one from subgroup 2a &#40;meats and cured meats&#41; &#40;23&#46;3&#37;&#41;&#46; Sixty-four percent of the children ate cereal-based foods&#44; alone or combined with other foods&#44; and 48&#46;6&#37; ate foods from group 2a&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Afternoon snack</span>&#58; 84&#46;6&#37; ate an afternoon snack&#46; The most common mid-afternoon snacking pattern consisted of a food from group 6 &#40;cereal&#41; and one from group 1 &#40;dairy&#41; &#40;12&#46;1&#37;&#41;&#46; The foods consumed most frequently in the afternoon snack&#44; alone or combined with other foods&#44; belonged to groups 6 &#40;69&#46;8&#37;&#41;&#44; 2a &#40;39&#37;&#41; and 1 &#40;38&#37;&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Lunch and dinner</span>&#58; the dietary patterns of the midday meal &#40;lunch&#41; and dinner were not as well defined as the patterns observed in breakfast and the mid-morning and afternoon snacks&#46; There was greater variability in the two main meals&#46; No single pattern &#40;combination of food groups&#41; exceeded a frequency of 6&#37; for lunch or 5&#37; for dinner&#46; With that in mind&#44; the most frequently consumed food groups&#44; alone or in different combinations&#44; were groups 6 &#40;44&#46;6&#37;&#41;&#44; 2a &#40;43&#46;7&#37;&#41; and 3 &#40;36&#46;2&#37;&#41; at lunch&#44; and groups 2a &#40;39&#46;1&#37;&#41;&#44; 6 &#40;38&#46;2&#37;&#41; and 1 &#40;34&#46;2&#37;&#41; at dinner&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The results obtained in this study allowed us to identify some of the main characteristics of the usual diet of schoolchildren in this geographical area of the Submeseta Sur &#40;southern portion of the central plateau of the Iberian peninsula&#41; where the provinces of Ciudad Real&#44; Toledo and Cuenca meet&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The size of the towns in the geographical area under study&#44; in which there is a short distance between residences and schools&#44; a social environment that allows children to eat at home and for appropriate school hours with an intensive morning schedule&#44; may account for the fact that more than half of the children walked to school and only 15&#46;6&#37; used the school lunch service&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Dietary behaviour is regulated by a complex neuroendocrine mechanism that is based on the interplay of hunger and satiety signals&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">11</span></a> Eighty-six percent of the surveyed schoolchildren had a good or very good appetite&#44; and appetite level was directly and significantly correlated to body weight&#44; BMI&#44; age and number of daily eating occasions&#46; This could suggest that appetite provides an indirect measure of intake amounts&#44; and thus that appetite is greater in children that are older&#44; have a higher BMI or eat more frequently&#46; However&#44; age&#44; BMI and eating frequency may influence how parents perceive the children&#39;s appetite&#44; a hypothesis supported by the fact that we did not find and association between eating frequency and body weight or BMI&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Most of the surveyed schoolchildren ate at least five times a day &#40;breakfast&#44; mid-morning snack&#44; lunch&#44; afternoon snack and dinner&#41;&#44; and consequently the mean number of daily eating occasions was high&#46; Eating frequency was higher in younger children and in children with parents with higher educational attainment&#46; In the enKid study&#44; Serra-Majem et al&#46; also found that eating frequency decreased with increasing age&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> We did not find an association between eating frequency and body weight or BMI&#46; Several studies have suggested that a dietary pattern characterised by a higher eating frequency&#44; especially if it is based on less energy-dense foods and offset with physical activity&#44; has a positive impact on obesity&#44; although this relationship has yet to be clearly established&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">10&#44;13&#44;14</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">In our study&#44; some of the foods at the base of the food pyramid&#44; such as vegetables and legumes&#44; were perceived to be among the least appetising&#44; probably because these foods and the dishes in which they are prepared are less palatable&#46; There is evidence that palatability influences food choices&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a> In our study&#44; the two least-consumed food groups were also the two perceived as the least palatable&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">It is known that a varied diet facilitates adherence to dietary recommendations&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">16&#44;17</span></a> The benefits of a dietary pattern like the Mediterranean diet &#40;MD&#41; derive not only from its dietary diversity&#44; but also from the consumption of some of the specific foods that it includes&#44; such as olive oil&#8212;as the main source of lipids&#8212;or considerable amounts of vegetables&#44; fruits and legumes that&#44; in addition to ensuring nutrient adequacy&#44; have been shown to reduce the incidence of cardiovascular diseases and some types of cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">18&#44;19</span></a> According to the KIDMED study&#44; less than 50&#37; of the population of children and youth in Spain adhere to an optimal MD&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> In this study&#44; we did not use any validated instruments to assess adherence to a MD pattern&#44; but the percentages of oil and cereal consumption &#40;although it was not specified whether the cereal consumed was whole-grain or refined&#41; were consistent with this dietary pattern&#46; However&#44; the intake of other foods deviated from this pattern&#44; such as the low consumption of fruits and vegetables and excessive consumption of meats&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Dietary variety was considerable in the two main meals &#40;lunch and dinner&#41;&#44; and low in other eating occasions&#44; in which dietary patterns were quite homogeneous&#46; More than 85&#37; of schoolchildren had breakfast&#44; in which dairy was the most frequently consumed food group&#44; followed by foods from group 6 &#40;essentially cereal&#41;&#46; On this subject&#44; there is evidence that food intake early in the day improves academic performance in children<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> and that the frequent consumption of cereals at breakfast may contribute to preventing overweight and obesity&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> It is also worth noting that when it came to the distribution of foods throughout the day&#44; fish and especially eggs were mostly consumed at dinner&#44; probably due to sociocultural factors&#46; We specifically assessed the intake of dairy and fish outside the 24-h recall questionnaire&#44; as these foods have a high iodine content and we wanted to assess for consumption of the minimum amounts that would guarantee an adequate iodine intake&#46; The actual intake of both food groups&#44; and especially of dairy&#44; was above the proposed cut-off point&#44; despite the low preference for these foods&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The limitations of this study mostly pertain to its retrospective nature and to the main source of data consisting of a 24-h diet intake recall&#59; however&#44; other authors have used a similar methodology&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> On the other hand&#44; its strengths are that it is the first study to describe the dietary pattern of these children from La Mancha&#44; and that&#44; given that the sample was representative of the population&#44; its results can be counted on to be robust&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In conclusion&#44; the dietary pattern of schoolchildren in the towns belonging to the Health Area of La Mancha Centro maintains some of the characteristics of the traditional MD&#44; such as the habit of daily breakfast and a high intake of olive oil and cereals&#44; although it also has a low consumption of vegetables and fruits and an excessive consumption of meat&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">This study has received funding from a research grant from the <span class="elsevierStyleGrantSponsor" id="gs1">Fundaci&#243;n Socio-Sanitaria de Castilla-La Mancha</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs1">AN-2010&#47;44</span>&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the dietary pattern of the school population from La Mancha-Centro Health Area &#40;Ciudad Real&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methodology</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study conducted on a representative sample of schoolchildren aged 6&#8211;12 years&#44; using a questionnaire to determine their general dietary habits and a record of their 24-h intake&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 1142 schoolchildren were included&#44; with 612 boys &#40;53&#46;6&#37;&#41; and 530 girls &#40;46&#46;4&#37;&#41;&#44; and a mean age of 9&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7 years of age&#46; The frequency of food intake was 4&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;6 times a day&#44; which decreased with the age of the schoolchildren &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;044&#41;&#44; and increased with the educational level of parents &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#46; Food preference influenced the choice in the meals consumed&#46; The level of appetite was related directly with weight and body mass index &#40;BMI&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; age &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;02&#41;&#44; and number of daily food intakes by the children &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;038&#41;&#46; The food groups most frequently consumed were cereals and their derivatives &#40;92&#46;8&#37;&#41;&#44; milk and dairy products &#40;90&#46;45&#37;&#41;&#44; while vegetables were the least consumed &#40;35&#46;46&#37;&#41;&#46; Over 70&#37; of the sample usually consumed olive oil&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The dietary pattern of the school population maintains some of the features of traditional Mediterranean dietary pattern&#44; such as the habit of daily breakfast&#44; the greater consumption of olive oil and cereals&#46; On the other hand&#44; other characteristics are remarkable&#44; such as the low consumption of fruit and vegetables and the high consumption of meat&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Valorar el patr&#243;n diet&#233;tico de la poblaci&#243;n escolar del &#193;rea de Salud La Mancha Centro &#40;Ciudad Real&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Metodolog&#237;a</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal sobre una muestra representativa de los escolares de 6 a 12 a&#241;os&#46; Se utiliz&#243; un cuestionario para explorar los h&#225;bitos diet&#233;ticos generales y un recordatorio de ingesta de 24 h&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se evalu&#243; a 1&#46;142 escolares&#44; 612 ni&#241;os &#40;53&#44;6&#37;&#41; y 530 ni&#241;as &#40;46&#44;4&#37;&#41;&#44; con una edad de 9&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7 a&#241;os&#46; La frecuencia de la ingesta de alimentos&#44; de 4&#44;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6 veces al d&#237;a&#44; decrec&#237;a de forma estad&#237;sticamente significativa con la edad de los escolares &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#41; y aumentaba con el nivel educativo de los padres &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41;&#46; La preferencia era un factor influyente en la elecci&#243;n de los alimentos consumidos&#46; El grado de apetito se relacion&#243; de forma directa con el peso y el &#237;ndice de masa corporal &#40;p &#60; 0&#44;001&#41;&#44; la edad &#40;p &#61; 0&#44;02&#41; y el n&#250;mero de ingestas diarias &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;038&#41;&#46; Los grupos de alimentos m&#225;s frecuentemente ingeridos fueron los cereales y derivados &#40;92&#44;8&#37;&#41;&#44; la leche y derivados &#40;90&#44;45&#37;&#41; y los menos&#44; las verduras y hortalizas &#40;35&#44;46&#37;&#41;&#46; M&#225;s del 70&#37; de la muestra consum&#237;a como aceite habitual el de oliva&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El patr&#243;n diet&#233;tico de los escolares mantiene algunas de las caracter&#237;sticas del patr&#243;n de dieta mediterr&#225;nea tradicional&#44; como el h&#225;bito de desayuno&#44; el elevado consumo de aceite de oliva o de cereales&#44; pero no otras&#44; destacando el escaso consumo de verduras y frutas&#44; y el elevado de carnes&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Metodolog&#237;a"
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          2 => array:2 [
            "identificador" => "abst0035"
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            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Gonz&#225;lez-Gonz&#225;lez A&#44; Falero-Gallego MP&#44; Redondo-Gonz&#225;lez O&#44; Mu&#241;oz-Serrano A&#46; Patr&#243;n diet&#233;tico de la poblaci&#243;n escolar del &#193;rea La Mancha-Centro &#40;Ciudad Real&#41;&#46; An Pediatr &#40;Barc&#41;&#46; 2016&#59;84&#58;133&#8211;138&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Association between appetite level and body mass index &#40;weight &#91;kg&#93;&#47;height<span class="elsevierStyleSup">2</span> &#91;m<span class="elsevierStyleSup">2</span>&#93;&#41;&#46;</p>"
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        "etiqueta" => "Figure 2"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Association between eating frequency and age of schoolchildren&#46;</p>"
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        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr3.jpeg"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Percentage of children that consumed protein-rich foods from animal sources throughout the day&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Included foods&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Milk and dairy products&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">2</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meat and meat products &#40;such as cured meats or p&#226;t&#233;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fish&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eggs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Potatoes&#44; legumes and nuts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">4</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vegetables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fruits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">6</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bread&#44; pasta and sugar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">7</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fats&#44; oils and butter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                0 => "xTab996918.png"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Distribution of foods into groups&#46;</p>"
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        "etiqueta" => "Table 2"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Boys&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;62<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Height &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">136&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Number of siblings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;57<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Appetite&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Very good&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">320 &#40;28&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;69&#8211;34&#46;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;11&#8211;34&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Fair&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;63&#8211;24&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Poor&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;79&#8211;24&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Average BMI by appetite level of children&#46;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:22 [
            0 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Position of the Academy of Nutrition and Dietetics&#58; Nutrition guidance for healthy children ages 2 to 11 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;N&#46; Ogata"
                            1 => "D&#46; Hayes"
                          ]
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2015.06.016

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Year/Month	Html	Pdf	Total

2024 November	6	7	13
2024 October	39	41	80
2024 September	44	25	69
2024 August	51	63	114
2024 July	30	31	61
2024 June	58	28	86
2024 May	41	27	68
2024 April	41	28	69
2024 March	40	37	77
2024 February	51	25	76
2024 January	34	27	61
2023 December	40	12	52
2023 November	15	28	43
2023 October	29	25	54
2023 September	26	16	42
2023 August	39	14	53
2023 July	32	18	50
2023 June	44	25	69
2023 May	42	24	66
2023 April	24	14	38
2023 March	33	19	52
2023 February	22	17	39
2023 January	19	16	35
2022 December	38	25	63
2022 November	46	33	79
2022 October	34	40	74
2022 September	39	32	71
2022 August	33	46	79
2022 July	35	34	69
2022 June	26	33	59
2022 May	35	33	68
2022 April	31	36	67
2022 March	33	37	70
2022 February	35	30	65
2022 January	39	27	66
2021 December	33	31	64
2021 November	43	44	87
2021 October	54	42	96
2021 September	34	27	61
2021 August	36	37	73
2021 July	24	30	54
2021 June	34	41	75
2021 May	38	27	65
2021 April	91	61	152
2021 March	68	26	94
2021 February	57	17	74
2021 January	38	25	63
2020 December	45	22	67
2020 November	37	22	59
2020 October	23	17	40
2020 September	27	24	51
2020 August	32	31	63
2020 July	17	35	52
2020 June	21	11	32
2020 May	38	21	59
2020 April	22	16	38
2020 March	29	22	51
2020 February	20	9	29
2020 January	23	15	38
2019 December	50	24	74
2019 November	18	9	27
2019 October	32	11	43
2019 September	32	11	43
2019 August	64	19	83
2019 July	20	33	53
2019 June	27	30	57
2019 May	42	21	63
2019 April	30	24	54
2019 March	32	20	52
2019 February	29	12	41
2019 January	22	19	41
2018 December	46	18	64
2018 November	71	21	92
2018 October	89	10	99
2018 September	49	11	60
2018 July	3	0	3
2018 June	3	0	3
2018 May	5	0	5
2018 April	17	0	17
2018 March	14	0	14
2018 February	15	0	15
2018 January	6	0	6
2017 December	10	0	10
2017 November	12	0	12
2017 October	22	0	22
2017 September	16	0	16
2017 August	15	0	15
2017 July	20	0	20
2017 June	20	12	32
2017 May	13	4	17
2017 April	8	4	12
2017 March	5	2	7
2017 February	8	2	10
2017 January	3	4	7
2016 December	19	8	27
2016 November	33	7	40
2016 October	25	7	32
2016 September	20	7	27
2016 August	21	2	23
2016 July	22	7	29
2016 June	1	0	1
2016 May	1	0	1
2016 March	4	0	4

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