Børns mad, mellemmåltider og hovedmåltider: i et folkesundhedsperspektiv

Ida Husby

Publikation: Ph.d. afhandling/ kandidat/ diplomPh.d. afhandlingForskning

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Diet is an important component of public health and determinant of diseases such as cancer, vascular disease and overweight. The challenge of public health nutrition in relation to the diet of children is to increase fruit and vegetable consumption and to decrease the intake of added sugar e.g. soft drinks. Some studies have pointed out associations between meal pattern and the nutritional quality of the diet, and highlighted that snacks more that main meals contribute to unhealthy food intake. However, few studies focus on children.
When the goal is to promote healthy diet, it is not enough to identify determinants of health. It is important to identify determinants of behaviour and reveal how groups of people experience their every day life. Knowledge about meals, defined as the social structuring of eating, and about meal
patterns, defined as how eating is organized in terms of time, number and type of meals, can contribute to understanding the meaning of food and meals, and the determinants of dietary habits. There are several intervention studies on how the school as a setting for health can contribute to the promotion of healthy dietary habits.The point of departure of this thesis is an intervention project in a Danish municipality. With the goal to promote health and well-being, a special intervention on physical activity and healthy school meals was initiated.
The overall objective of this thesis is to contribute to the understanding of how you can promote healthy dietary habits among children, using both quantitative and qualitative research. The aims of the thesis were to:
1. study whether there was an association between meal patterns and the nutritional quality of the diet of 6-7-year-old children;
2. examine whether body mass index, physical activity, or parents’ socio-economic position or their body mass index influenced these associations;
3. compare two groups of children who have a less healthy diet with those who have a more healthy diet, and understand how meals and snacks were experienced by the children; and
4. assess whether a school meal intervention developed by a local municipality had an impact on the diet of one group of school children compared to a comparable group children, and to elucidate the process of implementation.
The main findings of this research were as follows:
1. There was an association between the 6-7-year-old children’s meal pattern and the nutritional quality of their diet. Snacks contributed to 20 E% of the total energy intake, and independently of how much energy the children got from snacks, their intake of added sugar was too high. When the energy intake from snacks increased by 10 E%, the intake of added sugar increased
with 15 g, corresponding to an increase of 2.6 E% from added sugar; when energy intake from snacks increased with 10 E%, the intake of soft drinks increased by 82 cl.
2. Analyses adjusted for BMI and physical activity, and the parents’ school education and BMI as well as the mother’s weekly work hour showed virtually similar associations. BMI and socioeconomic position did not interact or confound the associations between meal pattern and
nutritional quality of the diet. However, the length of the parents’ school education influenced children’s intake of sugar and soft drinks, and children of mothers with higher BMI had a higher
sugar intake. But it is important to bear in mind that the differences were small.
3. There were differences in the way 10-11-year-old children with healthier eating habits and less healthier diet, respectively, experienced their food and meals. Among children with healthier eating habits, both snacks and meals tended to be shared social events and items of poor nutritional quality were markers of a special social occasion. This was not the case among
children with less healthy eating habits. All children described particular rules governing food consumption within their families. Although only some of the children had participated in the development of these rules, and despite the fact that the rules were different, all the children tended to accept them.
4. The study of a school meals intervention developed by local government in a municipality showed significant changes in intake of fruit and vegetables for both boys and girls compared to children living in a comparable municipality. However, a qualitative study of the implementation process of the school meals intervention showed that the declared goals were not reached, collaboration between food service staff and teachers did not take place, and a lack
of resources had serious consequences for the project. It was not possible to identify mediators of the fruit and vegetable intake.
Implications for future research on how to promote healthy dietary habits of children underpin the need for a focus on meal patterns and the sociability of meals. Besides research in health, more work is needed to elucidate the meaning of food and meals in different groups. Such studies can contribute to designing culturally appropriate interventions. Furthermore, interventions should be
designed on theory and evidence and with a research design that makes it possible to reveal and analyse factors that have mediated potential effects.
The results of this thesis point to the following implications for health promotion practitioners.
Snacks should be considered when designing interventions to lower sugar intake. The development of interventions should build on research concerning the social context of eating, particularly in relation to snacks. Snacks consumed as shared social events may help limit the overall consumption of unhealthy foods such as sweets and soft drinks. Furthermore, interventions to promote healthy diet at school should be developed as an integral part of the school setting. The design of such interventions should be based on principles and planning tools commonly used in the field of public health.
StatusUdgivet - 2 dec. 2008


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