Introduction: Food selection and dietary pattern impact in weight at pediatric age. Unhealthy dietary habits, including foods with added sugar, sodium, and saturated fat, are associated with an increased risk of childhood obesity.

Objective: Determine the eventual relationship between the foods that are regularly purchased, offered and consumed, with the potential risk of generating overweight and obesity.

Materials and methods: An analytical and cross-sectional study was carried out using a structured and closed survey, from 1-1-19 to 31-7-19 in a representative sample of mothers of children from 1 to 10 years old. Data analysis was performed using the Epi Info 6 Program (CDC / WHO).

Results: 1144 surveys were carried out (50.09% girls; 49.91% boys. Mean age 5.59 ± 2.83 years). Aspect of the children: 20.6% were thin, 54.7% were normal, 18.4% were overweight, and 6.3% were obese. Foods that predisposde to overweight and obese children were: yogurt, juices, mustard, ketchup, cold cuts, sausages, hamburgers, ready sauces, desserts, soft drinks, cream, ice cream, canned fruits, meat mincemeat, preserves, fruit juice powders, chips and sticks. The five foods that generated the highest proportion of overweight and obese children, (mean 24.7%) were: sticks: 48.5%; cheese puffs: 42.4%; chips: 39.4%; soft drinks 37.9%; fruit juice powders at about 36.5%. When the "Distortions" were analyzed it appeared that mothers who saw themselves with less volume than they have, greatly increased the proportion of children who were overweight and obese.

Conclusions: 1) The existence at home of snacks and sugar-rich drinks and foods given on birthdays’ celebrations significantly determined the existence of overweight and obesity in children. Mothers who perceived themselves of lesser volume from that observed by the operator do increased the overweight and obese children proportion.

Keywords: feeding habits, pediatrics, weight excess.

The WHO¹ states that nutrition is the ingest of food in relation to the dietary needs of the organism. Good nutrition (a balanced diet combined with regularly physical exercise) is a key element of good health. Because of this, a bad nutrition can increase the vulnerability to diseases, alter physical and mental development, immune response, and even reduce productivity. Aguirre² says that “when facing the universality of the biologic fact we face infinite forms that has taken its satisfaction in people from different towns, different places and throughout the time. An important characteristic of the eating habits viewed from the anthropologic point of view is that the cultural ways of eating actually ended up by conditioning the biologic need of doing it”. Historically, man tried to store food by using different techniques, so that food could be available both in abundance and scarcity times. Some of these techniques consisted in storing together dry cereal grains, different meats, initially with small animals alive (goats, sheep, chickens, among others) or even through other store procedures such as salting, drying, smoking, by heat and acid means, or even by increasing the quantity of salt or sugar, in order to prevent the appearance of germs because of the lack of water in some (salting) and of acidification in the latter (sugaring).

Food industry has researched and implemented physical, chemical, genetic, biological and marketing processes in order to facilitate the preservation of foods but inevitably it has also altered or denaturalized the intrinsic characteristics of them. What above claimed is based on the new family dynamics, long working days and the lack of time that leads to scarce recreational or sport activities, eventually making population to opt for quick solutions when consuming food and therefore modifying the consumption patterns and placing on the highest of the podium ultra-processed foods and drinks that are largely responsible for todays’ health problems, particularly overweight. 

Industrialization food process in large scale has made transformations to the flavor, scent, color, texture and also modifications mainly of macro and micronutrients. These alterations are closely related to overweight and obesity, hepatic steatosis and metabolic syndrome, among others.

Because of these issues, we considered it was the case to analyze cultural aspects connected to children eating habits, both in house groceries as in the normal stock kept on the “larders” and to analyze childrens´ birthdays celebrations. In relation to the latest, we analyzed which food was offered and the entertaining activities carried out during the birthday celebration. The final purpose of the present work was to determine the possible relationships between the foods consumed daily with the potential risk that could be triggered on health level when in presence, or not, of these foods in the family and social environments. 

An analytical and cross-sectional study was carried out using a structured and closed survey from January 1^st 2019 until July 31^st same year, on a representative sample of mothers with children between the age of 1 and 10 years old. The interviewers were pediatricians and nutritionists from different provinces of the Argentine Republic.

A closed and structured survey was carried out to collect data about food supplies and products stocked on larder/s and fridge/s, the foods and drinks offered on birthdays’ celebrations, as well as the active and passive activities carried out during the celebrations (see Annex 1). The tool used is original and was proposed and / or expanded by the pediatricians and nutritionists.

Nutritional status

Nutritional status was carried out on the self-perception of the surveyed mother and the interviewer's perception of the mother and child surveyed. The categories used were: thin, normal weight, overweight and obesity.

Data analysis

Data analysis was performed using the Epi Info 6 Program (CDC / WHO). Differences between averages and percentages were analyzed using ANOVA and Chi square, respectively.

1144 surveys were carried out, of which 50.09% (n = 573) corresponded to girls and 49.91% (n = 571) to boys, with a mean age of 5.59 ± 2.83 years.

Aspect of the children: 20.6% (n = 236) were thin, 54.7% normal (n = 626); 18.4% (n = 210) were overweight and 6.3% (n = 72) were obese.

Mothers’ self-perception: 15.0% perceived themselves as thin (n = 172); 53.1% as normal (n = 607); 23.4% as overweight (n = 268) and 8.5% as obese (n = 72).

Operator’s perception: 14.5% were perceived as thin (n = 166); 43.8% as normal (n = 607); 27.6% as overweight (n = 316) and 14.1% as obese (n = 161). 

Relation between children’s aspect and larder and fridge food stocks

Next there is the detailed order of foods with higher presence in homes and the correlation with children’s aspect. 

From Table 1 it can be deducted that there are products that do not modify children’s proportions which are identified with the letter Ω. Some other products which presence produces and increase in thin and normal children are identified with symbol @. Finally, the group of foods that increases overweight and obese children’s proportion are identified with the letter €. Last column of Table 1 shows the percentage of overweight and obese children in every food product evaluated. In this regard, the neutral (Ω) foods were: rice, pasta, eggs, salt, meat, sugar, milk, oil, flours, cheese, sweet biscuits, mayonnaise, marmalades, saltine crackers, caramelized milk, white bread, spreadable cheese, mineral water, butter, tomatoes, canned fish, cornflakes, olives, sandwich bread, lemonade and red peppers. 

Furthermore, the foods that were related to thin or normal weight (@) children were: fresh fruit, unprocessed fruit, pulses, mineral water and dry fruit. Differently, the foods that promoted an increase of overweight or obese (€) children were: yogurt, juices, mustard, ketchup, cold meats, sausages, hamburgers, ready sauces, desserts, soft drinks, cream, ice creams, canned fruit, ground beef, canned food, fruit juice powders, chips, cheese puffs and sticks. Five foods that were associated with the highest proportion of overweight and obese (which average is 24.7%) children were: sticks 48.5%, cheese puffs 42.4%, chips 39.4%, soft drinks 37.9% and fruit juice powders 36.5% (Table 1). 

Operator’s perception about mothers and the correlation with the food stocks on larder and fridge

Next there is the detailed order of foods with higher presence in homes and the correlation with mothers’ aspect according to the interviewer’s perception. In Table 2 there are products that did not modify the distribution’s proportions of the mothers in the thin, normal, overweight and obese categories. Then appears another group of foods that decreased the proportion of overweight and obese mothers and finally, the last group of foods which its presence causeed an increase of mothers that were overweight and obese. Foods that did not relate to weight categories (Ω) were: rice, pasta, eggs , salt, vegetables, meat, oil, fresh fruits and flours, unprocessed fruits, dulce de leche [sweet caramel], water, butter, mineral water, canned fish, cornflakes, sauces, cream, canned fruit, olives, lemonade and red peppers. Foods (@) that related with thin or normal weight mothers and that promoted an increase of thin or normal weight mothers were: pulses, spreadable cheese and dry fruits. Lastly, foods (€) that promoted an increase of overweight and obese mothers were: sugar, milk, cheese, sweet biscuits, mayonnaise, marmalade, saltine crackers, yogurt, juices, white bread, tomato, mustard, ketchup, cold meats, sausages, hamburgers, desserts, soft drinks, ice creams, ground beef, sandwich bread, canned food, fruit juice powders, chips, cheese puffs and sticks.

Five foods that caused the highest proportion of overweight and obese (which average is 41.7%) mothers were: salty sticks 63.8%, cheese puffs 62.0%, ground beef 57.5%, soft drinks 55.9% and chips 54.3% (Table 2). 

Food consumption on birthdays and its correlation to child aspect

In relation to the products/foods given during birthdays’ celebrations, it was observed that soft drinks, cheese puffs, pizzas, sticks, mayonnaise, juices, hot dogs, pastry, savory pies, hamburgers, ketchup, ice cream, mustard, ham sandwich, fancy pastries, French pastries and savory biscuits had a direct link on children that were overweight (€); while the presence of water showed a relation with thin children (@). The rest of the foods, such as cakes, chips, candies, sandwiches, sweet biscuits, tomato, lettuce, salty peanuts and saltine crackers did not cause differences among the categories of the child’s nutrition state (Ω) (Table 3).

Food consumption on birthdays and its correlation to mother’s perception aspect

In relation to the products/foods given during birthdays’ celebrations, it was observed that in mothers´perception cakes, chips, cheese puffs, pizzas, mayonnaise, sandwiches, sausages, savory pies, hamburgers, ketchup, sweet biscuits, mustard, ham sandwich, fancy pastries, saltine crackers, French pastries and savory biscuits had a direct link on those mothers that were overweight (€); while the presence of water, tomato and fruits showed a relation with thin mothers(@). The rest of the products/foods, such as soft drinks, candies, sticks, fruit juice powders, ice cream, lettuce, salty peanuts and raw peanuts did not cause any difference among the categories of the mother’s nutrition state (Table 4). 

Relation between children’s aspect and the entertainment on birthdays

In relation to the different recreational activities during birthdays’ celebrations we saw that those called “static” activities as singing, story tales and clown shows, where children usually are seated, are related with an increase number of overweight and obese children (€). On the other hand, the “dynamic” activities such as playing with balloons or climbing up and down on slides, which require physical activity, do increase the proportion of thin or normal weight children (@), while the rest of the activities did not show a correlation between the weight categories (Table 5).

Fast food consumption and child’s aspect relation

Tables 6 (a&b) show the that as the frequency to fast food restaurants increased so did the proportion of overweight and obese children and mothers. Comparison between operator’s perception about the “volume” of the mother and the mothers’ self-perception about their body volume.

Body volume according to the operator: 14.5% (n= 161) were thin, 43.8% (n=501) were normal, 27.6% (n=316) were overweight and 14.1% (n=161) were obese. Self body volume according to the mother: 15% (n= 172) thin, 53.1% (n= 607) normal, 23.4% (n= 268) overweight and 8.5% (n= 97) obese. This difference of perception and self-perception was extremely significant. (chi: 350,93; gl: 9; p= <0.0001). If we proposed a correlation index (operator/mother) we can see that there is a high correlation with the “thin” woman (0.96), a lower correlation with the “normal” woman (0.82) and “overweight” woman (0.85) and a very low correlation with the obese woman (0.60) (Tables 7&8).

Observations about the distortion between perception and self-perception and the child’s aspects of distribution 

Finally, a distribution of child’s different aspects analysis was carried out in relation to the body volume and the operator’s perception and the mother’s self-perception. If we look at the child’s aspect distribution (thin, normal, overweight and obese) in relation to the distortion A, B and C, then groups B and C accumulate a higher significantly proportion of overweight and obese children. Chi 2 = 30.49 GL 6 P: 0.00003 (see chart).

After analyzing the different “Distortion” groups, it emerges that the mothers who perceived themselves as of greater volume actually increased the proportion of the overweight and obese children. But the mothers that perceived themselves as of lesser volume are the ones who increased the most these proportions. The value is highly significant on the mothers who perceived themselves thinner (Chart 1).

Figure 1 Children’s distribution aspect in relation to the mother’s body “ distortion”.

The German philosopher and anthropologist Ludwid Feurerbach, wrote in 1850 in “Nutrition education”, the famous phrase “We are what we eat”. Effectively, this phrase applies to the observations and evident relations shown in our work between the consumption of ultra-processed foods with a higher index of overweight/obesity. The importance of the results obtained and the evident direct relationship before mentioned, doesn’t derive from the perception that the observer or interviewed could have about the physical image, but far more from the consequence that the overweight/obesity can eventually trigger in a person, the consequences that this can provoke, and increasing the risk when the equation is composed by consumption of foods rich in saturated fat and low in essential nutrients (both macro and micro nutrients). Every day it is more evident and alarming the increasing percentage of population coping with overweight and obesity problems; being relevant the increase in the pediatric population. It is also alarming to see how the population is not conscious of what the excess body fat really implies, not because of the person’s physical aspect but far more because of the impact and pathologic associations that this condition can entail. Child overweight and obesity are well known risk indicators of obesity in adulthood. Furthermore, they are risk factors for developing non-communicable diseases such as arterial hypertension, dyslipidemia, hepatic disease (fatty liver), diabetes, polycystic ovary syndrome and obstructive sleep apnea. It can also entail psychosocial problems that include discrimination, isolation, low self esteem and bullying; therefore causing negative repercussion on person’s health, education and quality life. It is believed that between 40-60% of obese children will turn into obese adults with obvious consequences to their health.^3–13

Foods preferences and a dietary pattern impact on weight from the pediatric age. Non healthy dietary habits that include foods with added sugar, sodium, and saturated fat are associated with increased risk of pediatric obesity.

It is actually during infancy, mainly when food transition from exclusively milk to nutrition that includes more semi-solid foods, when diet turns into a challenge in many occasions. In this stage is where many of the problems begin because, with the aim of feeding the child, it is likely to give non healthy foods which are tasty to the palate but end up having an addictive and counter-productive effect on the child. It is remarkable that, even with the important divulgation that exists nowadays and the public knowledge about the advantages of a healthy nutrition, the epidemiologic data obtained through surveys reveal that between 6 and 11 months of age 25% children do not consume vegetables and 17% do not eat a single fruit during the day. From 11 months on the frequency and consumption of non-healthy food is every time higher. 

Nevertheless, it is important to highlight the difficult task of battling against this situation because the increase of the epidemic observed in relation to the infancy obesity, does coincide with the marketing and already wide publicity of industrialized foods, the higher consumption frequency of snacks and the high- calory foods. Because the diet that a person follows is determined by a pattern of food consumption, and the diet itself is a risk factor that can be modified, trying to understand the different food patterns and the real influence that these pattern directly with the overweight and obesity becomes crucial. As long as it is not granted the corresponding value to the necessity of increasing the consumption of healthy foods rich in fibers and vitamins, leaving aside the excess sugar and fat, we are condemned to be witnesses of the silent and fatal impact from these excesses. Diseases like fat liver, diabetes, arterial hypertension or even lipid disorders, that where once considered “adulthood” diseases are now seen in infancy. In despite of this, these disease are secondary to bad nutrition habits, lack of physical activity and an increase of not healthy behaviors (use of computers, isolation, excessive use of technology) which are triggering an in advance time presentation of these diseases in relation to the age, together with the impact this produces. There are more children nowadays with adulthood diseases, revealing new clinical findings of chronicity and damage to target organs with biochemical variables altered. This study puts into evidence that people who adhere to dietary patterns full of fat, added sugar and addictive foods will be have more probabilities of developing overweight and obesity than those who do not follow these diet patterns. 

It is highly important the vision the parents have about themselves in relation to their body image because this vision will be extrapolated to their sons and it is what will determine eventually the future of the son regarding nutrition and the healthy state or not. Parent’s diet patterns and what they consider to be allowed to be included on the larder and therefore on family birthdays, show a direct relation with the physical aspect of the parent and the son. It is important to understand that the decisions we take about what we eat must be taken very seriously because these are tendency markers and can foresee probably future consequences that would modify the life quality.

1. The mere existence of some foods as a cultural habit of provision in the family, very significantly conditions the trend of overweight and obesity.
2. Foods given on birthdays’ celebrations significantly determine the existence of overweight and obese children.
3. It impacts much more what is offered at home than what is offered on birthdays.
4. The higher the frequency attendance to fast food restaurants by children, the higher the number of overweight and obese children will be.
5. Mothers who perceive themselves of lesser volume from that observed by the operator do increase the overweight and obese children proportion.

To Nutritionists Agustina Palacio, María Belén Perez Agaard and to Lorena Fernández for her unselfish collaboration in the field work.
References

Author declare that there is no conflict of interest.

None.

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