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      Water and Beverage Consumption among Children Aged 4–13 Years in Lebanon: Findings from a National Cross-Sectional Study

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          Abstract

          This study evaluates total water intake (TWI) from plain water, beverages and foods among Lebanese children and compares TWI to dietary reference intakes (DRIs). In a national cross-sectional survey, data on demographic, socioeconomic, anthropometric, and physical activity characteristics were obtained from 4 to 13-year-old children ( n = 752). Food and beverage consumption patterns were assessed using a validated food-frequency questionnaire. TWI was estimated at 1651 mL/day, with beverages contributing 72% of the TWI compared to 28% from foods. Beverages with the highest contribution to TWI included plain water, fruit juice and soda. A significantly higher proportion of 9–13-year-old children failed to meet the DRIs compared to 4–8 years old (92%–98% vs. 74%). Gender differentials were observed with a significantly higher proportion of boys meeting the DRIs compared to girls. The water to energy ratio ranged between 0.84 and 0.87, which fell short of meeting the desirable recommendations. In addition, children from higher socioeconomic status had higher intakes of water from milk and bottled water, coupled with lower water intakes from sodas. The study findings show an alarming high proportion of Lebanese children failing to meet TWI recommendations, and call for culture-specific interventions to instill healthy fluid consumption patterns early in life.

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          A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message--'keep your waist circumference to less than half your height'.

          To examine the influence of age and gender on the waist:height ratio (WHTR) in children and to compare changes over time in WHTR, a measure of central fatness in British children. Representative cross-sectional surveys in 1977, 1987 and 1997. Great Britain and Northern Ireland. Survey 1: children aged 5-16 years measured in 1977 (boys) and 1987 (girls) (BSI, n=8135) and Survey 2: children aged 11-16 measured in 1997 (NDNS, n=773). From Survey 1, waist: height ratio related to age and sex and the proportion of children with a WHTR greater than 0.500 (a boundary value suggested for adults). From Survey 2, comparison of WHTR in children with that from Survey 1 and the actual proportion of children with a WHTR greater than 0.500 compared with the expected proportion using the survey 1 as reference. WHTR decreased with age (P<0.01 for trend), with the mean WHTR being significantly lower in girls (P<0.01). WHTR was significantly greater in children in Survey 2 compared with those measured 10 and 20 years earlier in Survey 1 (P<0.0001). The proportion of children where WHTR exceeded the 0.500 boundary value in Survey 2 was 17% of boys and 11.7% of girls (against 5.0 and 1.5%, respectively, in Survey 1, P<0.0001). The increase in WHTR in boys exceeded that in girls. Values of WHTR during the past 10-20 years have increased greatly showing that central fatness in children has risen dramatically. WHTR is more closely linked to childhood morbidity than body mass index (BMI) and we suggest it should be used as an additional or alternative measure to BMI in children as well as adults. A simple public health message that is the same for adults and children of both sexes and all ages could be stated as 'keep your waist circumference to less than half your height'.
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            Changes in beverage intake between 1977 and 2001.

            To examine American beverage consumption trends and causes. Nationally representative data from the 1977-1978 Nationwide Food Consumption Survey, the 1989-1991 and 1994-1996 (also for children aged 2 to 9 years in 1998) Continuing Surveys of Food Intake by Individuals (CSFII), and 1999-2001 National Health and Nutrition Examination Survey were used in this study. The sample consisted of 73,345 individuals, aged >or=2 years. For each survey year, the percentage of total energy intake from meals and snacks was calculated separately for respondents aged 2 to 18 years, 19 to 39, 40 to 59, and >or=60. The percentage of energy intake by location (at home consumption or preparation, vending, store eaten out, restaurant/fast food, and school), as well as for specific beverages was computed separately for all age groups. The proportion consumed, mean portion size, and number of servings were calculated. For all age groups, sweetened beverage consumption increased and milk consumption decreased. Overall, energy intake from sweetened beverages increased 135% and was reduced by 38% from milk, with a 278 total calorie increase. These trends were associated with increased proportions of Americans consuming larger portions, more servings per day of sweetened beverage, and reductions in these same measures for milk. There is little research that has focused on the beneficial impacts of reduced soft drink and fruit drink intake. This would seem to be one of the simpler ways to reduce obesity in the United States.
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              Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children.

              To determine whether using a combination of body mass index (BMI) and waist circumference (WC) or waist-to-height ratio (W/Hr) is clinically helpful in identifying children with high metabolic and cardiovascular risks. Caucasian children (M/F: 740/739; n = 1479; ages 5 to 15 years) were studied. Anthropometry, blood pressure, and venous fasting blood samples tested for triacylglycerol, HDL cholesterol, and glucose were measured. Overweight children with a large waist (>90(th) percentile) or high W/Hr (>0.5) but not obese or normal-weight children had significantly greater chances of being at high metabolic and cardiovascular risk than normal-weight children (OR: 7; 95% CI: 3.63-13.48; P < .001, OR: 8.16; 95% CI: 3.87-17.23; P < .001, respectively) with a low waist measurement (
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                08 September 2016
                September 2016
                : 8
                : 9
                : 554
                Affiliations
                [1 ]Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0.236, Riad El Solh, Beirut 11072020, Lebanon; lj18@ 123456aub.edu.lb (L.J.); nahla@ 123456aub.edu.lb (N.H.)
                [2 ]Nestle Waters, 12 boulevard Garibaldi, Issy-les-Moulineaux, Paris 92130, France; Florence.Constant@ 123456waters.nestle.com
                Author notes
                [* ]Correspondence: fn14@ 123456aub.edu.lb (F.N.); ln10@ 123456aub.edu.lb (L.N.); Tel.: +961-1-35000 (ext. 4504) (F.N.); +961-1-35000 (ext. 4547) (L.N.); Fax: +961-1-744460 (L.N. & F.N.)
                [†]

                These authors contributed equally to this work.

                Article
                nutrients-08-00554
                10.3390/nu8090554
                5037539
                27618092
                ef35de14-c8a0-441a-b866-b71d05aa62a8
                © 2016 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 29 July 2016
                : 30 August 2016
                Categories
                Article

                Nutrition & Dietetics
                water intake,beverage consumption,water adequacy,hydration,children,lebanon
                Nutrition & Dietetics
                water intake, beverage consumption, water adequacy, hydration, children, lebanon

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