Open Access

Preschool diets in children from Piła, Poland, require urgent intervention as implied by high risk of nutrient inadequacies

Journal of Health, Population and Nutrition201635:11

DOI: 10.1186/s41043-016-0050-4

Received: 11 July 2015

Accepted: 12 April 2016

Published: 19 April 2016

Abstract

Background

Among the studies published after the year 2000 which focused on nutrition at preschool, only three aimed to assess children’s intake of energy and selected nutrients at preschool. The purpose of this study was to assess dietary intake in children during their stay at preschool.

Methods

The studied population comprised 128 4–6-year-old children who attended preschools in Piła, Poland. Intakes of energy and macronutrients were estimated from a 5-day weighed food record completed by the preschool staff. Weight and height were measured, and BMI was calculated. Statistical analysis was carried out using the IBM SPSS Statistics 21.0 computer programme. The data were analysed according to gender.

Results

Energy intake was the lowest in children with underweight, 2004 kJ (478 kcal), and the highest in obese children, 3388 kJ (809 kcal). Energy intake from lactose was statistically significantly higher in boys than in girls, 3.0 vs 2.6 %. Statistically significantly higher percentage of boys in comparison to girls had intakes of vitamin C below 70 % of EAR, 56.9 vs 38.1 %. It is important to highlight the excessive intake of energy from saturated fatty acids and energy from sucrose, along with inadequate intake of energy from polyunsaturated fatty acids. We also found excessive intake of sodium and inadequate intakes of dietary fibre, water, vitamin D, vitamin E, folate, niacin, calcium and potassium.

Conclusions

Preschool diets need urgent improvement to prevent diet-related diseases in the studied preschoolers in the future. The inadequacies observed in these diets are in accordance with the previously reported inadequacies in menus planned for preschoolers. More research is needed to investigate dietary intake of children during their stay at preschool. Common regulations worked out for all preschools in the European Union would be a good way to provide adequate nutrition to preschool children.

Keywords

Preschool children Preschools Dietary intake Macronutrients Vitamins Minerals Diet-related diseases

Background

Nutrition in preschool age plays an important role as a significant factor which influences growth and development, as well as future risk of diet-related diseases [1, 2]. In Poland, as many as 69.9 % of children aged 3 to 6 years attend preschools and this percentage has been increasing since 2005 [3]. Children spend at preschools most of the time: 8 h a day and 5 days a week, and that is why preschool diet has considerable contribution to preschoolers’ daily dietary intake. Therefore, it is of greatest importance to provide balanced meals for children at preschools.

Most of the studies published after the year 2000 which focused on nutrition at preschool aimed to analyse and assess preschool menus [425] or to compare menus to actual foods and beverages served to children [26, 27]. In one study [28], foods offered to children were assessed using the Healthy Eating Index 2005. Two studies [29, 30] reported children’s intake of selected foods at preschool. Only three studies, carried out in Poland [31], the USA [32] and Sweden [33], aimed to assess children’s intake of energy and selected nutrients at preschools. In the study carried out in Szczecin, Poland [31], on a group of 78 children aged 4 to 6 years, intakes of energy and 20 nutrients at preschool were assessed using the method of a 3-day estimated food record. The authors also compared these intakes to the preschool menu and they reported children’s dietary intake at home. One of the purposes of the study carried out in New York City, USA [32], was to assess dietary intake in 240 preschool children aged 3 to 4 years. The authors used the method of direct observation in order to record children’s food intakes and they reported energy intake, as well as intakes of two macronutrients, 10 vitamins and five minerals. The study conducted in a suburb of Stockholm, Sweden [33], in a group of 109 preschool children aged 3 to 5 years included intakes of energy and 12 nutrients at preschool. In this study, weighed food record at preschool was used and intakes of energy, five macronutrients, three vitamins and four minerals were reported. It is important to note that all of the abovementioned studies which aimed to assess children’s food intake at preschool, except for two studies [31, 33], were carried out in the USA [2630, 32, 33].

Thus, assessing dietary intake of children at preschools is of great relevance. Future studies should fill this gap, and dietary intake at preschools in children from the European countries should be investigated. It is particularly important in the case of the countries which are European Union members because common regulations concerning nutrition at preschools may be imposed.

Therefore, the aim of this study was to assess dietary intake in Polish children during their stay at preschool.

Methods

Subjects

We randomly selected two preschools in Piła, a city located in north-western part of Poland. The directors of the preschools agreed to participate in the study. Parents of 234 children, that is all children who attended these preschools, were invited to take part in the study. Written consent was provided by parents of 154 children. However, at the very beginning of the study, parents withdrew 19 children either because their child fell ill or without giving any reason. The data obtained for two girls had to be excluded from the analysis because the girls had problems with adapting themselves to the new environment and their reaction to this stressful situation was refusal to eat almost all of the foodstuffs and dishes served at preschool. The children were aged 4 to 6 years, except for five 3-year-olds who were excluded from the analysis because they fall in a different age category in the dietary reference values. Therefore, the final population comprised 128 children, 63 girls and 65 boys, aged 4 to 6 years. The study was approved by the Bioethics Committee of the Poznan University of Medical Sciences.

Dietary intake

Data collection

Dietary intake was estimated from a 5-day weighed food record completed by the preschool staff. The food record covered only the time when the children stayed at preschool. The preschool staff was provided with scales to weigh all the foods and beverages served to each child. The members of the staff who were responsible for weighing were instructed how to do this and how to fill in the food diaries. The kitchen staff provided detailed information about the way of preparing meals, that is recipes, ingredients, cooking methods, etc. The preschool staff were also asked to weigh and write down all the foods and beverages which the children brought from home and ate at preschool. At the end of the data collection, 16 children fell ill. As a result, we obtained data from 5 days in the case of 112 children, data from 4 days in the case of 11 children and data from 3 days in the case of 5 children.

Dietary assessment

Dietary intake was calculated using the Dieta computer programme, version 4.0, worked out by the National Food and Nutrition Institute in Warsaw, Poland. The Dieta contains food composition database based on Polish food composition tables [34]. The programme was described in details in the previous articles [35, 36]. The database of the programme includes also nutritional value of typical Polish dishes; however, we did not use it. This is because the recipes applied by the National Food and Nutrition Institute in Warsaw in the Polish food composition tables [34] were different from the recipes used by the preschool kitchen staff. Therefore, we calculated nutritional value of the dishes served at preschools based on the recipes provided by the kitchen staff including the losses of nutrients resulting from food processing.

We obtained from the Dieta total energy intake (kJ, kcal) and intakes of 37 nutrients. Additionally, we used the Microsoft Excel 2010 to calculate total energy and total protein intakes per kilogramme of body weight, and animal and plant protein intakes expressed as percent of total protein intake. Although the Dieta provides the calculations of available carbohydrates, as well as energy from total protein, total fat and available carbohydrates, we had to calculate these in the Excel since we added nutritional values of some foodstuffs and dishes, as described in the previous paragraph. We calculated available carbohydrate intake as the difference between total carbohydrates and dietary fibre, that is in the same way as available carbohydrate intake obtained from the Dieta. Additionally, we calculated energy from fatty acids, lactose, sucrose and starch using the Excel. As mentioned in the previous article [35], total carbohydrate intake calculated by the Dieta based on Polish food composition tables was derived ‘by difference’, while dietary fibre intake calculated by the Dieta means dietary fibre determined using enzymatic-gravimetric method (AOAC 1990) [34, 37]. Total water intake obtained from the Dieta includes both water from beverages and water from food.

Comparison with nutritional guidelines

Energy intake from macronutrients and intake of cholesterol were compared to the recommendations in the prevention of diet-related diseases [38] similarly to the previous article [35]. To assess nutrient intakes, dietary reference values for Polish population [39] were used: Estimated Average Requirement (EAR) in the case of total protein (g/kg), vitamin A, B1, B2, B6, folate, vitamin B12, niacin, vitamin C, calcium, phosphorus, magnesium, iron, zinc, copper and iodine, and Adequate Intake (AI) in the case of dietary fibre, total water, vitamin E, sodium and potassium. Intake of vitamin D was compared to EAR worked out by the Food and Nutrition Board of the Institute of Medicine [40] because Polish dietary reference intakes include only AI. To assess manganese intake, we used AI worked out by the Food and Nutrition Board of the Institute of Medicine [41] because Polish dietary reference intakes do not include this mineral [39]. However, all intakes were compared to 70 % of EAR or 70 % of AI, because according to the Polish recommendations preschool meals should provide 70 % of dietary reference values [42].

Nutrient intakes were also compared to 70 % of Tolerable Upper Intake Level (UL) if available. Polish dietary reference values include UL only for sodium [39]. Therefore, we used UL worked out by the Scientific Committee on Food [43] in the case of retinol, vitamin D, E, B6, folate, zinc, copper and iodine, and UL worked out by the Food and Nutrition Board of the Institute of Medicine [40, 41, 4446] in the case of niacin, vitamin C, calcium, phosphorus, iron and manganese. We did not compare magnesium intake to UL since the UL was established for magnesium from nonfood sources, and the studied children did not take magnesium supplements.

Anthropometric measures

Weight and height were measured, and body mass index (BMI) was calculated, using the methods described in our previous article [47]. BMI was classified into percentile ranges using the tables provided by Kuczmarski et al. [48]. The percentile ranges were classified using the terminology recommended by the International Obesity Task Force [49]: below the 5th percentile—underweight; from the 5th to the 84th percentile—healthy weight; from the 85th to the 94th percentile—overweight; the 95th percentile or above—obesity [35, 47].

Statistical analysis

Statistical analysis was carried out using the IBM SPSS Statistics for Windows computer programme, version 21.0 (Armonk, NY: IBM Corp.). The data were analysed according to gender, except for energy intake which was also analysed according to the percentile categories for BMI. Means, standard deviations (SD), medians and standard errors (SE) were calculated for energy and nutrient intakes. In the case of total protein (% of energy), total fat (% of energy), saturated fatty acids (% of energy), polyunsaturated fatty acids (% of energy), monounsaturated fatty acids (% of energy), cholesterol (mg) and available carbohydrates (% of energy), the percentages of children with nutrient intakes below, within or above the recommendations were calculated. To investigate the prevalence of inadequate intake, we calculated the percentages of children with intakes below 70 % of EAR. Additionally, we calculated the percentages of children whose nutrient intakes were below 70 % of AI, as in the previous studies [35, 50], although it is important to note that AI cannot be used to estimate the prevalence of inadequate nutrient intakes for groups [51]. We also calculated the percentages of children with vitamin and mineral intakes above 70 % of UL.

Statistical significance for qualitative variables was determined using Pearson’s chi-square test. In the case of quantitative variables, the Shapiro-Wilk statistic for testing normality was used. Unpaired Student’s t test was applied to investigate statistically significant differences for normally distributed variables and the non-parametric Mann–Whitney U test was used in the case of skewed variables. The differences were considered significant at P ≤ 0.05.

Results

Socio-demographic characteristics of the studied preschool children were presented in the previous article [52].

Table 1 shows energy intake in the studied children according to the percentile categories for BMI. Energy intake was the lowest in children with underweight, 2004 kJ (478 kcal), and the highest in obese children, 3388 kJ (809 kcal).
Table 1

Energy intake in the studied preschool children according to the percentile categories for BMI

Percentile categories for BMI

Energy intake (kJ) [Energy intake (kcal)]

Population

Mean

SD

Median

SE

%

n

Below the 5th percentile (underweight)

2004

676

1758

302

3.9

5

[478]

[161]

[419]

[72]

5th–84th percentile (healthy weight)

2878

695

2929

72

72.6

93

[687]

[166]

[700]

[17]

85th–94th percentile (overweight)

3020

709

3116

148

18.0

23

[721]

[169]

[743]

[35]

95th percentile and above (obesity)

3388

789

2950

298

5.5

7

[809]

[189]

[705]

[71]

Table 2 presents energy and macronutrient intakes in the studied children, and Table 3 shows the percentages of the studied children in the reference ranges for macronutrient intake. Statistically significant difference was found only for energy intake from lactose, which was higher in boys than in girls, 3.0 % vs 2.6 %. It is important to highlight the excessive intake of energy from saturated fatty acids (mean intake of 13.9 % and as many as 93.0 % of children with intakes above the recommendations) along with inadequate intake of energy from polyunsaturated fatty acids (mean intake of 3.0 % and all children with intakes below the recommendations). Intake of energy from sucrose was very high, 20.3 %, while intakes of dietary fibre, 5.5 g, and water, 727 g, were very low.
Table 2

Energy and macronutrient intakes in the studied children during their stay at preschool

Energy/nutrient

Reference values

Girls (n = 63)

Boys (n = 65)

All children (n = 128)

P

Girls (n = 63)

Boys (n = 65)

All children (n = 128)

Mean

SD

Mean

SD

Mean

SD

Median

SE

Median

SE

Median

SE

Energy

              

 (kJ)

Body weight dependent

2922

732

2872

728

2897

727

NS

2961

92

2914

90

2939

64

 (kcal)

697

175

685

174

691

174

NS

707

22

695

22

702

15

 (kJ/kg body weight)

NA

145

35

142

37

143

36

NS

148

4

144

5

144

3

 (kcal/kg body weight)

NA

35

8

34

9

34

9

NS

35

1

34

1

34

1

Total protein

              

 (g)

Body weight dependent

20.2

5.7

20.0

5.7

20.1

5.7

NS

20.8

0.7

20.3

0.7

20.7

0.5

 (g/kg body weight)

0.59a

1.0

0.3

1.0

0.3

1.0

0.3

NS

1.0

0.0

1.0

0.0

1.0

0.0

 (% of energy)

10–15 %

11.5

1.3

11.6

0.9

11.6

1.1

NS

11.5

0.2

11.7

0.1

11.6

0.1

Animal protein

              

 (g)

NA

11.7

3.9

11.9

4.3

11.8

4.1

NS

12.1

0.5

11.6

0.5

12.1

0.4

 (% of total protein)

NA

56.4

9.6

58.4

8.4

57.4

9.0

NS

58.0

1.2

59.8

1.0

58.8

0.8

Plant protein

              

 (g)

NA

8.6

2.5

8.1

2.2

8.3

2.4

NS

8.4

0.3

8.0

0.3

8.2

0.2

 (% of total protein)

NA

43.4

9.7

41.3

8.6

42.4

9.2

NS

42.0

1.2

39.6

1.1

41.2

0.8

Total fat

              

 (g)

NA

24.1

7.5

23.9

8.0

24.0

7.8

NS

24.4

0.9

24.0

1.0

24.3

0.7

 (% of energy)

20–30 %

30.7

3.7

30.8

4.5

30.7

4.1

NS

31.2

0.5

32.1

0.6

31.6

0.4

Saturated fatty acids

              

 (g)

NA

10.81

3.72

10.95

3.88

10.88

3.79

NS

11.22

0.47

11.05

0.48

11.21

0.33

 (% of energy)

<10 %

13.7

2.3

14.0

2.4

13.9

2.4

NS

13.8

0.3

14.6

0.3

14.2

0.2

Polyunsaturated fatty acids

              

 (g)

NA

2.37

0.65

2.26

0.66

2.31

0.65

NS

2.38

0.08

2.25

0.08

2.30

0.06

 (% of energy)

6–10 %

3.1

0.4

3.0

0.4

3.0

0.4

NS

3.0

0.1

3.0

0.0

3.0

0.0

Monounsaturated fatty acids

              

 (g)

NA

9.26

2.85

9.03

3.07

9.14

2.96

NS

9.53

0.36

9.30

0.38

9.51

0.26

 (% of energy)

>10 %b

11.8

1.6

11.7

1.9

11.7

1.8

NS

12.0

0.2

12.3

0.2

12.1

0.2

Cholesterol

              

 (mg)

<210c

99

31

98

38

98

34

NS

102

4

94

5

101

3

Total carbohydrates

              

 (g)

NA

105.0

24.6

102.3

23.0

103.6

23.7

NS

104.3

3.1

106.4

2.8

105.5

2.1

Available carbohydrates

              

 (g)

91d

99.2

23.2

97.0

21.8

98.1

22.4

NS

99.4

2.9

100.9

2.7

99.8

2.0

 (% of energy)

55–70 %e

57.5

4.2

57.3

4.8

57.4

4.5

NS

56.7

0.5

55.9

0.6

56.4

0.4

Lactose

              

 (g)

NA

4.7

2.2

5.2

2.1

4.9

2.2

NS

4.9

0.3

5.0

0.3

5.0

0.2

 (% of energy)

NA

2.6

1.0

3.0

1.0

2.8

1.0

0.033

2.6

0.1

2.9

0.1

2.8

0.1

Sucrose

              

 (g)

NA

34.1

8.0

34.6

9.0

34.3

8.5

NS

34.1

1.0

33.8

1.1

34.0

0.8

 (% of energy)

NA

20.1

4.2

20.6

3.7

20.3

4.0

NS

19.8

0.5

20.5

0.5

20.2

0.4

Starch

              

 (g)

NA

52.2

15.5

49.6

13.9

50.9

14.7

NS

52.5

2.0

49.4

1.7

50.3

1.3

 (% of energy)

NA

30.0

4.6

29.2

5.3

29.6

5.0

NS

29.5

0.6

28.7

0.7

29.1

0.4

Dietary fibre

              

 (g)

9.8f

5.7

1.6

5.3

1.4

5.5

1.5

NS

5.6

0.2

5.3

0.2

5.5

0.1

Total water

              

 (g)

1120f

742

165

713

148

727

157

NS

747

21

717

18

734

14

P significance, NA not available, NS not significant (P > 0.05)

a70 % EAR

bCalculated by difference as: total fat − (saturated fatty acids + polyunsaturated fatty acids)

c70 % of the WHO recommendations

d70 % RDA

eCalculated by difference: as the percentage of total energy − energy from total protein − energy from total fat

f70 % AI

Table 3

The percentages of the studied children in the reference ranges for macronutrient intake during their stay at preschool

Nutrient

Girls (n = 63)

Boys (n = 65)

All children (n = 128)

P

%

%

%

Total protein (% of energy)

    

 Below the recommendations

3.2

4.6

3.9

NS

 Within the recommendations

96.8

95.4

96.1

Total fat (% of energy)

    

 Below the recommendations

1.6

3.1

2.3

NS

 Within the recommendations

36.5

33.8

35.2

 Above the recommendations

61.9

63.1

62.5

Saturated fatty acids (% of energy)

    

 Within the recommendations

7.9

6.2

7.0

NS

 Above the recommendations

92.1

93.8

93.0

Polyunsaturated fatty acids (% of energy)

    

 Below the recommendations

100.0

100.0

100.0

#

Monounsaturated fatty acids (% of energy)

    

 Below the recommendations

15.9

24.6

20.3

NS

 Within the recommendations

84.1

75.4

79.7

Cholesterol (mg)

    

 Within the recommendations

100.0

100.0

100.0

#

Available carbohydrates (% of energy)

    

 Below the recommendations

23.8

41.5

32.8

NS

 Within the recommendations

73.0

56.9

64.8

 Above the recommendations

3.2

1.5

2.3

Dietary fibre (g)

    

 Below 70 % AI

100.0

100.0

100.0

#

Total water (g)

    

 Below 70 % AI

100.0

100.0

100.0

#

P significance

#P cannot be calculated when percentage is 0.0 or 100.0

Tables 4 and 5 show vitamin and mineral intake in the studied children, respectively, whereas Tables 6 and 7 present the percentages of the studied children in the reference ranges for vitamin and mineral intake, respectively. Statistically significantly higher percentage of boys in comparison to girls had intakes of vitamin C below 70 % of EAR, 56.9 vs 38.1 %. Intakes of vitamin D and calcium were well below 70 % of EAR, 0.59 μg and 195 mg, respectively. Also intakes of folate and niacin were lower than 70 % of EAR, 84.8 μg and 3.72 mg, respectively. Intakes of vitamin E and potassium were below 70 % of AI, 2.31 and 947 mg, respectively, whereas intake of sodium was higher than 70 % of UL in as many as 71.1 % of the studied children.
Table 4

Vitamin intake in the studied children during their stay at preschool

Nutrient

Reference values

Girls (n = 63)

Boys (n = 65)

All children (n = 128)

P

Girls (n = 63)

Boys (n = 65)

All children (n = 128)

Mean

SD

Mean

SD

Mean

SD

Median

SE

Median

SE

Median

SE

Vitamin A (retinol equivalent) (μg)

210a

347

133

357

144

352

138

NS

349

17

352

18

350

12

Retinol (μg)

NA

164

52

177

72

171

63

NS

167

7

172

9

167

6

Beta-carotene (μg)

NA

1099

576

1082

520

1090

546

NS

1037

73

928

65

1015

48

Vitamin D (μg)

7a

0.59

0.21

0.59

0.25

0.59

0.23

NS

0.58

0.03

0.58

0.03

0.58

0.02

Vitamin E (mg)

4.2b

2.42

0.76

2.20

0.77

2.31

0.77

NS

2.38

0.10

2.12

0.10

2.26

0.07

Vitamin B1 (mg)

0.35a

0.393

0.129

0.367

0.118

0.380

0.123

NS

0.382

0.016

0.362

0.015

0.374

0.011

Vitamin B2 (mg)

0.35a

0.568

0.186

0.574

0.200

0.571

0.193

NS

0.584

0.023

0.577

0.025

0.580

0.017

Vitamin B6 (mg)

0.35a

0.59

0.19

0.56

0.17

0.57

0.18

NS

0.60

0.02

0.57

0.02

0.57

0.02

Folate (μg)

112a

86.9

24.4

82.7

23.7

84.8

24.0

NS

86.1

3.1

83.7

2.9

85.9

2.1

Vitamin B12 (μg)

0.7a

0.92

0.34

0.95

0.39

0.94

0.37

NS

0.93

0.04

0.93

0.05

0.93

0.03

Niacin (mg)

4.2a

3.90

1.33

3.56

1.12

3.72

1.24

NS

3.57

0.17

3.55

0.14

3.56

0.11

Vitamin C (mg)

28a

29.5

9.2

27.4

7.9

28.5

8.6

NS

31.1

1.2

26.0

1.0

28.4

0.8

NA not available, P significance; NS, P > 0.05

a70 % EAR

b70 % AI

Table 5

Mineral intake in the studied children during their stay at preschool

Nutrient

Reference values

Girls (n = 63)

Boys (n = 65)

All children (n = 128)

P

Girls (n = 63)

Boys (n = 65)

All children (n = 128)

Mean

SD

Mean

SD

Mean

SD

Median

SE

Median

SE

Median

SE

Calcium (mg)

560a

191

75

199

68

195

72

NS

185

10

200

8

191

6

Phosphorus (mg)

287a

346

103

346

104

346

103

NS

352

13

358

13

355

9

Magnesium (mg)

77a

82

23

79

20

80

22

NS

81

3

80

3

81

2

Sodium (mg)

700b

1240

371

1207

346

1223

357

NS

1221

47

1217

43

1220

32

Potassium (mg)

2170b

978

292

917

249

947

272

NS

938

37

940

31

939

24

Iron (mg)

2.8a

3.0

0.8

2.9

0.8

3.0

0.8

NS

3.0

0.1

2.9

0.1

3.0

0.1

Zinc (mg)

2.8a

2.8

0.8

2.8

0.8

2.8

0.8

NS

2.9

0.1

2.8

0.1

2.9

0.1

Copper (mg)

0.21a

0.31

0.09

0.30

0.08

0.31

0.09

NS

0.31

0.01

0.30

0.01

0.30

0.01

Manganese (mg)

1.05b

1.55

0.45

1.49

0.38

1.52

0.42

NS

1.50

0.06

1.38

0.05

1.47

0.04

Iodine (μg)

45.5a

51.5

18.3

50.2

16.9

50.9

17.5

NS

51.5

2.3

48.8

2.1

49.5

1.5

NA not available, P significance; NS, P > 0.05

a70 % EAR

b70 % AI

Table 6

The percentages of the studied children in the reference ranges for vitamin intake during their stay at preschool

Nutrient

Girls (n = 63)

Boys (n = 65)

All children (n = 128)

P

%

%

%

Vitamin A (retinol equivalent)

    

 Below 70 % EAR

11.1

13.8

12.5

NS

Retinol

    

 Above 70 % UL

0.0

0.0

0.0

#

Vitamin D

    

 Below 70 % EAR

100.0

100.0

100.0

#

Vitamin E

    

 Below 70 % AI

100.0

96.9

98.4

NS

 Above 70 % UL

0.0

0.0

0.0

#

Vitamin B1

    

 Below 70 % EAR

36.5

41.5

39.1

NS

Vitamin B2

    

 Below 70 % EAR

11.1

15.4

13.3

NS

Vitamin B6

    

 Below 70 % EAR

6.3

10.8

8.6

NS

 Above 70 % UL

0.0

0.0

0.0

#

Folate

    

 Below 70 % EAR

84.1

92.3

88.3

NS

 Above 70 % UL

0.0

0.0

0.0

#

Vitamin B12

    

 Below 70 % EAR

23.8

24.6

24.2

NS

Niacin

    

 Below 70 % EAR

65.1

78.5

71.9

NS

 Above 70 % UL

0.0

0.0

0.0

#

Vitamin C

    

 Below 70 % EAR

38.1

56.9

47.7

0.033

 Above 70 % UL

0.0

0.0

0.0

#

P significance; NS, P > 0.05

#P cannot be calculated when percentage is 0.0 or 100.0

Table 7

The percentages of the studied children in the reference ranges for mineral intake during their stay at preschool

Nutrient

Girls (n = 63)

Boys (n = 65)

All children (n = 128)

P

%

%

%

Calcium

    

 Below 70 % EAR

100.0

100.0

100.0

#

Phosphorus

    

 Below 70 % EAR

22.2

27.7

25.0

NS

 Above 70 % UL

0.0

0.0

0.0

#

Magnesium

    

 Below 70 % EAR

39.7

46.2

43.0

NS

Sodium

    

 Below 70 % AI

7.9

7.7

7.8

NS

 Above 70 % UL

73.0

69.2

71.1

NS

Potassium

    

 Below 70 % AI

100.0

100.0

100.0

#

Iron

    

 Below 70 % EAR

38.1

43.1

40.6

NS

 Above 70 % UL

0.0

0.0

0.0

#

Zinc

    

 Below 70 % EAR

44.4

52.3

48.4

NS

 Above 70 % UL

0.0

0.0

0.0

#

Copper

    

 Below 70 % EAR

11.1

10.8

10.9

NS

 Above 70 % UL

0.0

0.0

0.0

#

Manganese

    

 Below 70 % AI

9.5

6.2

7.8

NS

 Above 70 % UL

11.1

4.6

7.8

NS

Iodine

    

 Below 70 % EAR

44.4

41.5

43.0

NS

 Above 70 % UL

0.0

0.0

0.0

#

P significance; NS, P > 0.05

#P cannot be calculated when percentage is 0.0 or 100.0

Discussion

The advantage of our study was that the probability that the preschool staff underreported children’s food intake is very low because the staff showed full involvement in recording children’s food intake and considered this difficult task as a challenge they should rise to. Energy intake in the studied preschoolers increased through the percentile categories for BMI which confirms that the preschool staff recorded the children’s food intakes very precisely. In the studies which aimed to assess daily food intake, energy intake was usually lower in obese subjects due to underreporting; however, underreporting in preschoolers has been little explored as discussed in the previous article [35]. In the previous study on 6-year-old Polish children, daily energy intake increased through all of the percentile categories, except for obese children whose energy intake was lower not only than in overweight children but even than in their peers with healthy weight [35]. Another study on Polish preschoolers reported that daily energy intake in children with tendency to overweight and in overweight children was lower even than daily energy intake of their underweight peers [53]. Also other studies on children of various age reported lower energy intakes in those with higher body weight [5456].

Our study showed adequate intakes of total protein, monounsaturated fatty acids and cholesterol. There was also little risk of inadequate intakes of vitamin A, B2, B6, copper and manganese. However, although mean energy intake from available carbohydrates was within the recommended in most of the studied children, a substantial percentage of them fell below the recommendations. What is even more disconcerting, a high percentage of energy came from sucrose. Energy intake from sucrose was twice as high as the recommended intake of added sugars [38]; therefore, intake of all added sugars must have been even higher. Such high sucrose intake increases the risk of dental caries [57] and may adversely influence lipid profile [58] favouring atherogenesis.

It is unfavourable that most of the studied preschoolers were characterised by excessive intake of energy from total fat. Also, the structure of fatty acid intake was adverse due to high intake of saturated fatty acids along with very low intake of polyunsaturated fatty acids. High energy intake from saturated fatty acids increases the risk of developing atherosclerosis. Lowering intake of energy from this macronutrient is of greatest importance since ischaemic heart disease and stroke, which result from atherosclerosis, are the two most common causes of death all over Europe [59]. It is also emphasised that preventing atherosclerosis should start as early as in childhood [2]. On the other hand, energy intake from polyunsaturated fatty acids in the studied children during their stay at preschool was much lower than the recommended. Such low intake of energy from this macronutrient not only increases cardiovascular risk [60] but may also impair cognitive development [61].

Another adverse characteristic of the studied children’s dietary intake at preschool was intake of dietary fibre lower than 70 % of AI in all of the studied children. An intervention study in 7–11-year-olds showed that children accepted high-fibre snacks [62]; thus, introducing high-fibre foods to preschool menu should also be successful leading to increased dietary fibre intake. High fibre intake is essential in the prevention of diet-related diseases, such as obesity, type 2 diabetes and cardiovascular diseases [63], and decreases the likelihood of constipation [64].

Similarly to dietary fibre intake, also mean total water intake did not reach 70 % of AI and all of the studied children fell below 70 % of AI. It is noteworthy, that at preschool the children were not only served beverages with meals, but also had access to water so that they could drink it whenever they wanted to. However, children are often so absorbed in playing that they do not pay attention to being thirsty. That is why they should be encouraged by the preschool teachers to drink water. Although the children were asked to inform the teacher every time they wanted to drink water and the teachers did their best to control water drinking by the children, there is still a possibility that they may have failed to fully control it. Nevertheless, these results are not surprising since many studies reported inadequate water intake in children of various ages all over the world (e.g. [65, 66]). The preschool staff should be educated about the strategies of increasing water intake in children at preschool and about the importance of good hydration, including influence on physical and cognitive performance, reduced incidence of constipation, as well as possible association with diet-related diseases such as hypertension, fatal coronary heart disease or stroke [67].

Many inadequacies were found for vitamin intakes. Although mean intakes of vitamin B1, B12 and C were higher than 70 % of EAR, substantial percentages of children fell below 70 % of EAR, especially in the case of vitamin C. Major concerns are inadequate intakes of vitamin D, folate and niacin, and the fact that almost all of the studied children had intakes of vitamin E lower than 70 % of AI. Such inadequacies in children’s preschool diets increase the risk of diet-related diseases. Inadequate intake of vitamin D is not only linked to osteoporosis risk [68] but also cardiovascular diseases [69], type 2 diabetes [70] and most probably even cancer [71]. Folate and vitamin B12 were reported as factors protecting against coronary heart disease (e.g. [72]) and have been recognised to play an important role in bone health [73]. High folate intake also appears to reduce the risk of colon and breast cancer [74]. Additionally, inadequate intake of folate may be associated with mental degenerative disorders such as Alzheimer’s disease [75, 76]. Vitamin E seems to play a role in coronary heart disease prevention [74], especially together with vitamin C [74, 77]. Moreover, diets rich in vitamin C are associated with decreased risk of cancer [74]. Also niacin is important because it was reported one of the lipid-altering agents which decreases mortality due to heart attacks [78]. Therefore, it is indispensable to modify preschool diet to provide adequate amounts of all the vitamins to the studied children.

Also in the case of minerals, many inadequacies were found. Calcium intake indicates high risk of inadequate intake. It is surprising that preschool staff failed to provide adequate calcium content in the diet or failed to encourage children to eat more milk and dairy products. The importance of adequate calcium intake with milk has been widely spread in Poland for many years, even in special television campaigns. Such low calcium intake may predispose the studied preschoolers to osteoporosis later in life [79], since increased intake of dietary calcium/dairy products increases total body and lumbar spine bone mineral content [80]. It is even more disconcerting when taking into account the abovementioned inadequate intake of vitamin D. Another major concern is that mean intake of potassium was more than twice lower than 70 % of AI and that all of the studied preschoolers had lower intakes of this mineral than 70 % of AI. Adequate intake of potassium is one of the key factors in nutritional prevention of hypertension [81], thus the observed low intake of this mineral poses increased risk of developing future hypertension in the studied children. This effect may be aggravated by the observed excessive sodium intake which is another factor for hypertension development [81]. Adequate potassium and sodium intakes may also be important in osteoporosis prevention, since adequate potassium intake exerts protective effect on age-related bone loss [82], while high sodium intake increases the loss of urinary calcium [83].

Although mean intakes of magnesium, iron and iodine were higher than 70 % of EAR, and mean intake of zinc reached 70 % of EAR, more than 40 % of the studied preschoolers had intakes lower than 70 % of EAR. Therefore, content of these minerals in the preschool diet should be increased. It is very important since magnesium intake has been negatively associated with insulin resistance, type 2 diabetes, metabolic syndrome, hypertension, and cardiovascular diseases [84] and positively associated with bone mass [84]. Apart from the well-known effect of inadequate iron intake, which is anaemia, iron intake was also found to be inversely associated with coronary heart disease incidence [85]. Moreover, iodine, iron and zinc are suggested to be essential nutrients in cognitive performance and development of children [61], and preventing deficiencies of these nutrients is key in achieving full potential cognitive capacity and unnecessary loss of mental capacity [86].

The numerous inadequacies in children’s diets at preschool are the risk factors for developing diet-related diseases. Of course, preschool diet is not the whole day diet; therefore, the question arises whether foods eaten by the children outside preschool are capable of providing energy and nutrients in amounts and proportions which will balance the daily diet.

Our study also showed that dietary intakes at preschool were similar in the studied girls and boys, and only two statistically significant differences were found. Quite opposite, the studies which reported daily dietary intakes in children often showed statistically significant differences according to gender [35, 50, 8789]. The preschool menu is the same for all children, and the preschool staff encourages each child to eat all meals, irrespective of gender, while parents most probably hold stereotypical beliefs that preschool girls have different nutritional needs than boys and that some foods are more suitable for children depending on their gender. These beliefs may lead parents to offering different foods to their sons and daughters and to serve different portion sizes, for example to feed their sons larger portions of meat than their daughters. This is very interesting and should be investigated in the future studies.

In comparison to the previously studied dietary intake at preschool in Polish 4–6-year-old children from Szczecin [31], intakes of energy and all nutrients, except for sodium, were higher. Sodium intake in the studied children was twice higher compared to their previously studied peers [31]. The preschoolers from Szczecin [31] were characterised by inadequate intakes of vitamin E, calcium and potassium, similarly to the studied children.

It is interesting that although the studied preschoolers were older than the previously studied Swedish preschool children aged 3 to 5 years [33], they were characterised by lower intakes of energy and total protein, much lower energy intakes from protein and fat, and much higher energy intakes from carbohydrates and sucrose. Intakes of micronutrients cannot be compared because mineral and vitamin intakes were presented either as daily intakes or as nutrient densities expressed per MJ.

In comparison to 3–4-year-old children from New York City [32], the studied preschoolers were also characterised by lower intake of total protein; however, intake of energy was higher. Moreover, intakes of vitamin A and E in the studied children were twice higher than those in children from New York City [32], intakes of magnesium and sodium were much higher, intakes of folate, vitamin B12 and iron were lower, intakes of vitamin D, niacin, vitamin C and calcium were much lower, while intakes of vitamin B1, B2, B6 and zinc were similar.

Previous studies which aimed to assess nutritional value of menus planned for children at preschools [49, 11, 1318, 2025] included various nutrients; however, all seven studies which included vitamin D [7, 11, 15, 20, 22, 24, 25] and eight [57, 11, 17, 18, 22, 24] out of ten [57, 11, 17, 18, 2225] studies which included calcium reported their inadequate contents, whereas six [11, 17, 18, 2325] out of seven [7, 11, 17, 18, 2325] studies which included sodium and the only two studies [13, 16] which included sucrose reported their excessive contents. Moreover, the only four studies [4, 13, 16, 18] which included polyunsaturated fatty acids reported their inadequate content and all six studies [4, 13, 16, 21, 23, 25] which included saturated fatty acids reported their excessive content. Also a study designed to determine fat and fatty acid content in preschool meals in Wrocław, Poland [90], using chemical analysis showed excessive content of saturated fatty acids along with inadequate content of polyunsaturated fatty acids. In all of the abovementioned studies which aimed to assess nutritional value of preschools menus, the children’s actual dietary intake was not investigated. However, if the nutritional content of preschool menus was not balanced, it is not surprising that the result is preschoolers’ inadequate intake. The inadequacies found in the studied children’s dietary intake at preschool are in accordance with most of the inadequacies found in preschool menus in the previous studies [47, 11, 13, 1518, 2025, 90].

To prevent health effects resulting from inadequate and excessive intakes of nutrients, it is indispensable to plan balanced preschool menus. For this purpose, a dietician should be employed in preschools. In Poland, it is not a common practice.

Conclusions

In conclusion, preschool diets need urgent improvement to prevent diet-related diseases in the studied preschoolers in the future. The inadequacies observed in these diets are in accordance with the previously reported inadequacies in menus planned for preschoolers. More research is needed to investigate dietary intake of children during their stay at preschool. Common regulations worked out for all preschools in the European Union would be a good way to provide adequate nutrition to preschool children. One of such regulations which should be imposed by the European Union on preschools should be the obligation to employ a dietician.

Declarations

Acknowledgements

The authors would like to thank the directors and the staff of the preschools in Piła for their help in collecting the data on children’s dietary intake at preschool.

Source of funding

This study was financed by the Polish National Science Centre from the resources for financing research in the years 2010–2014 as a research project N N404 140437.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Food and Nutrition Department, The Eugeniusz Piasecki University School of Physical Education in Poznan

References

  1. Merkiel S, Chalcarz W. Nutrition in preschool age: Part 1. Importance, reference values, methods of research and their application. Review. New Med (Wars). 2007;11:68–73.Google Scholar
  2. Magnussen CG, Niinikoski H, Juonala M, Kivimäki M, Rönnemaa T, Viikari JSA, et al. When and how to start prevention of atherosclerosis? Lessons from the Cardiovascular Risk in the Young Finns Study and the Special Turku Coronary Risk Factor Intervention Project. Pediatr Nephrol. 2012;27:1441–52.View ArticlePubMedGoogle Scholar
  3. Falkowska E, Telusiewicz-Pacak A. Dzieci w Polsce. Dane, liczby, statystyki, in Polish (Children in Poland. Data, numbers, statistics). Warszawa: Polski Komitet Narodowy UNICEF; 2013.Google Scholar
  4. Grajeta H, Ilow R, Prescha A, et al. Ocena wartości energetycznej i odżywczej posiłków przedszkolnych, in Polish (Evaluation of energy and nutritional value of nursery school meals). Rocz Panstw Zakl Hig. 2003;54:417–25.PubMedGoogle Scholar
  5. Kucharska A, Sińska B, Dobrowolska E. Ocena jakości żywienia i stanu odżywienia dzieci w wybranym przedszkolu miejskim i wiejskim, in Polish (Evaluation of feeding quality and nutritional status of children in selected kindergartens in town and country). In: Bartnikowska E, Brzozowska A, Gromadzka-Ostrowska J, Narojek L, Rosołowska-Huszcz D, editors. Fizjologiczne uwarunkowania postępowania dietetycznego, in Polish (Physiological determinants of dietary approach). Warszawa: Wydawnictwo SGGW; 2004. p. 599–603.Google Scholar
  6. Orkusz A, Włodarczyk A. Ocena żywienia dzieci w przedszkolu na podstawie dekadowych jadłospisów, in Polish (Assessment of preschool children’s decade menus). Nauki Inżynierskie Technol Eng Sci Technol. 2014;1:72–81.Google Scholar
  7. Klemarczyk W, Strucińska M, Weker H, Więch M. Ocena sposobu żywienia dzieci w przedszkolu wegetariańskim, in Polish (Assessment of preschool vegetarian menus). Pediatr Współcz. 2005;7:243–6.Google Scholar
  8. Czech A, Kęska A. Zawartość składników pokarmowych w racjach przedszkolnych w okresie wiosennym i jesiennym, in Polish (Nutrient content in the meals offered in pre-school canteen in spring and autumn period). Żyw Człow. 2007;34:567–71.Google Scholar
  9. Czech A, Kęska A. Zawartość składników pokarmowych w zimowych i letnich posiłkach przedszkolnych, in Polish (Content of nutrients in winter and summer pre-school meals). Żyw Człow. 2007;34:572–7.Google Scholar
  10. Kozioł-Kozakowska A, Schlegel-Zawadzka M. Jakościowa ocena jadłospisów przedszkolnych w regionie Krakowa, in Polish (Qualitative estimation of the kindergarden menus in the Kraków region). Żyw Człow. 2007;34:133–8.Google Scholar
  11. Chalcarz W, Merkiel S, Wegner M. Ocena jadłospisów przedszkolnych. Część II. Witaminy i składniki mineralne, in Polish (Assessment of preschool menus. Part 2. Vitamins and minerals). Med Środow. 2009;12:81–4.Google Scholar
  12. Kowieska A, Biel W, Chalaba A. Jakościowa ocena żywienia dzieci w wieku przedszkolnym na podstawie jadłospisów, in Polish (Qualitative assessment of nutrition in children under age preschool menus). Żyw Człow. 2009;36:179–84.Google Scholar
  13. Merkiel S, Chalcarz W, Wegner M. Ocena jadłospisów przedszkolnych. Część I. Energia i makroskładniki, in Polish (Assessment of preschool menus. Part 1. Energy and macronutrients). Med Środow. 2009;12:75–80.Google Scholar
  14. Dymkowska-Malesa M, Skibniewska KA. Udział posiłków przedszkolnych w pokryciu zapotrzebowania na podstawowe składniki odżywcze i energię, in Polish (Meals served at nursery schools and their share in meeting the recommended daily demand for nutrients and energy). Bromat Chem Toksykol. 2011;44:374–9.Google Scholar
  15. Górnicka M, Frąckiewicz J, Trela I. Zawartość wybranych witamin w racjach pokarmowych przedszkoli na terenie Warszawy i okolic, in Polish (Content of selected vitamins in pre-school menus in Warsaw and the vicinity). Rocz Panstw Zakl Hig. 2011;62:205–8.PubMedGoogle Scholar
  16. Frąckiewicz J, Ring-Andrzejczuk K, Gronowska-Senger A. Zawartość energii i wybranych składników w racjach pokarmowych przedszkoli z rejonu warszawskiego, in Polish (Energy and selected nutrients content in pre-school menus in Warsaw and the vicinity). Rocz Panstw Zakl Hig. 2011;62:181–5.PubMedGoogle Scholar
  17. Leszczyńska T, Sikora E, Kręcina K, Pysz K. Udział posiłków przedszkolnych w całkowitym pokryciu zapotrzebowania na energię i składniki odżywcze na przykładzie wybranej stołówki, in Polish (Meals served in nursery schools and their share in meeting the recommended daily demand for energy and nutrients exemplified by one selected canteen). ŻYWNOŚĆ Nauka Technologia Jakość. 2007;55:327–34.Google Scholar
  18. Barbarska O, Zegan M, Czerwonogrodzka-Senczyna A, Michota-Katulska E. Jakościowa i ilościowa ocena jadłospisów przedszkoli publicznych i prywatnych, in Polish (Qualitative and quantitative evaluation of menus of public and private preschools). Żyw Człow. 2012;39:176–90.Google Scholar
  19. Doak CM, Hamelinck V, Vossenaar M, Panday B, Soto-Méndez MJ, Campos Ponce M, et al. Evaluating food menus from daycare centers in Guatemala City: descriptive and analytical approaches. Nutrition. 2012;28:879–85.View ArticlePubMedGoogle Scholar
  20. Hyżyk AK, Gunia I. Nutritional supply of vitamins in the selected group of kindergarten children. Nauka Przyr Technol. 2012;6:64.Google Scholar
  21. Benjamin Neelon SE, Reyes-Morales H, Haines J, Gillman MW, Taveras EM. Nutritional quality of foods and beverages on child-care centre menus in Mexico. Public Health Nutr. 2013;16:2014–22.View ArticlePubMedGoogle Scholar
  22. Dymkowska-Malesa M, Szparaga A. Ocena spożycia wybranych witamin i składników mineralnych w przedszkolnych racjach pokarmowych dzieci z terenu Koszalina, in Polish (Evaluation of intake of selected vitamins and minerals in the diets of preschool children from Koszalin). Nowa Pediatr. 2013;17:106–10.Google Scholar
  23. Maalouf J, Evers SC, Griffin M, Lyn R. Assessment of mealtime environments and nutrition practices in child care centers in Georgia. Child Obes. 2013;9:437–45.PubMedGoogle Scholar
  24. Frampton AM, Sisson SB, Horm D, Campbell JE, Lora K, Ladner JL. What’s for lunch? An analysis of lunch menus in 83 urban and rural Oklahoma child-care centers providing all-day care to preschool children. J Acad Nutr Diet. 2014;114:1367–74.View ArticlePubMedGoogle Scholar
  25. Turner-McGrievy GM, Hales SB, Baum AC. Transitioning to new child-care nutrition policies: nutrient content of preschool menus differs by presence of vegetarian main entrée. J Acad Nutr Diet. 2014;114:117–23.View ArticlePubMedGoogle Scholar
  26. Fleischhacker S, Cason KL, Achterberg C. “You had peas today?”: a pilot study comparing a head start child-care center’s menu with the actual food served. J Am Diet Assoc. 2006;106:277–80.View ArticlePubMedGoogle Scholar
  27. Benjamin Neelon SE, Copeland KA, Ball SC, Bradley L, Ward DS. Comparison of menus to actual foods and beverages served in North Carolina child-care centers. J Am Diet Assoc. 2010;110:1890–95.View ArticlePubMedPubMed CentralGoogle Scholar
  28. Erinosho TO, Ball SC, Hanson PP, Vaughn AE, Ward DS. Assessing foods offered to children at child-care centers using the Healthy Eating Index-2005. J Acad Nutr Diet. 2013;113:1084–9.View ArticlePubMedPubMed CentralGoogle Scholar
  29. Padget A, Briley ME. Dietary intakes at child-care centers in Central Texas fail to meet food guide pyramid recommendations. J Am Diet Assoc. 2005;105:790–3.View ArticlePubMedGoogle Scholar
  30. Ball SC, Benjamin SE, Ward DS. Dietary intakes in North Carolina child-care centers: are children meeting current recommendations? J Am Diet Assoc. 2008;108:718–21.View ArticlePubMedGoogle Scholar
  31. Sadowska J, Krzymuska A. Ocena uzupełniania przedszkolnej racji pokarmowej przez rodziców u dzieci w wieku przedszkolnym, in Polish (The estimation of complementation of the nursery school food rations by parents of pre-school children). Bromat Chem Toksykol. 2010;43:203–11.Google Scholar
  32. Erinosho T, Dixon LB, Young C, Brotman LM, Hayman LL. Nutrition practices and children’s dietary intakes at 40 child-care centers in New York City. J Am Diet Assoc. 2011;111:1391–7.View ArticlePubMedGoogle Scholar
  33. Sepp H, Lennernäs M, Pettersson R, Abrahamsson L. Children’s nutrient intake at preschool and at home. Acta Paediatr. 2001;90:483–91.View ArticlePubMedGoogle Scholar
  34. Kunachowicz H, Nadolna I, Przygoda B, Iwanow K. Tabele składu i wartości odżywczej żywności, in Polish (Tables of food composition and nutritional value). Warszawa: Wydawnictwo Lekarskie PZWL; 2005.Google Scholar
  35. Merkiel S. Dietary intake in 6-year-old children from southern Poland: part 1 – energy and macronutrient intakes. BMC Pediatr. 2014;14:197.View ArticlePubMedPubMed CentralGoogle Scholar
  36. Merkiel S, Chalcarz W. Challenges of dietary intake assessment in preschool children – conclusions from a dietary intervention study on Polish preschoolers. New Med (Wars). 2014;18:47–51.Google Scholar
  37. Helrich K, editor. Official Methods of Analysis of the Association of Official Analytical Chemists. Virginia: the Association of Official Analytical Chemists; 1990.Google Scholar
  38. World Health Organization. Diet, nutrition and the prevention of chronic diseases. Report of a Joint WHO/FAO Expert Consultation. WHO Technical Report Series no. 916. Geneva: World Health Organization; 2003.Google Scholar
  39. Jarosz M, editor. Normy żywienia dla populacji polskiej – nowelizacja, in Polish (Dietary reference intakes for the Polish population – amendment). Warszawa: Instytut Żywności i Żywienia; 2012.Google Scholar
  40. Food and Nutrition Board of the Institute of Medicine. Dietary Reference Intakes for calcium and vitamin D. Washington DC: the National Academies Press; 2011.Google Scholar
  41. Food and Nutrition Board of the Institute of Medicine. Dietary Reference Intakes for vitamin a, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium and zinc. Washington DC: the National Academies Press; 2001.Google Scholar
  42. Krawczyński M. Żywienie we wczesnym dzieciństwie i wieku przedszkolnym, in Polish (Nutrition in early childhood and preschool age). In: Krawczyński M, editor. Żywienie dzieci w zdrowiu i chorobie, in Polish (Child nutrition in health and disease). Kraków: Wydawnictwo Help-Med; 2008. p. 97–100.Google Scholar
  43. Scienfitic Committee on Food, Scientific Panel of Dietetic Products, Nutrition and Allergies. Tolerable upper intake levels for vitamins and minerals. Brussels: European Food Safety Authority (EFSA); 2006.Google Scholar
  44. Food and Nutrition Board of the Institute of Medicine. Dietary Reference Intakes for calcium, phosphorus, magnesium, vitamin D and fluoride. Washington DC: the National Academies Press; 1997.Google Scholar
  45. Food and Nutrition Board of the Institute of Medicine. Dietary Reference Intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, panthotenic acid, biotin and choline. Washington DC: the National Academies Press; 1998.Google Scholar
  46. Food and Nutrition Board of the Institute of Medicine. Dietary Reference Intakes for vitamin C, vitamin E, selenium and carotenoids. Washington DC: the National Academies Press; 2000.Google Scholar
  47. Merkiel S, Chalcarz W. The relationship between physical fitness, urine iodine status, and body-mass index in 6- to 7-year-old Polish children. Int J Sport Nutr Exerc Metab. 2011;21:318–27.PubMedGoogle Scholar
  48. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11. 2002;246:1–190.PubMedGoogle Scholar
  49. Barlow SE, the Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120:S164–92.View ArticlePubMedGoogle Scholar
  50. Huybrechts I, De Henauw S. Energy and nutrient intakes by pre-school children in Flanders-Belgium. Br J Nutr. 2007;98:600–10.View ArticlePubMedGoogle Scholar
  51. Food and Nutrition Board of the Institute of Medicine. Dietary Reference Intakes. Applications in dietary assessment. Washington DC: the National Academies Press; 2003.Google Scholar
  52. Merkiel S, Chalcarz W. Selected indices of health status in preschool children from Piła and their families as a risk factor of diet-related diseases. Rocz Panstw Zakl Hig. 2015;66:159–65.PubMedGoogle Scholar
  53. Merkiel S, Chalcarz W, Mielczarek D. Błędy w spożyciu energii z makroskładników czynnikiem sprzyjającym rozwojowi chorób dietozależnych w grupie dzieci przedszkolnych z Turku, in Polish (Inadequate energy intake from macronutrients favours the development of diet-related diseases in preschool children from Turek). In: Gromadzka-Ostrowska J, editor. Fizjologiczne uwarunkowania postępowania dietetycznego, in Polish (Physiological determinants of dietary approach). Warszawa: Oficyna Wydawniczo-Poligraficzna ADAM; 2014. p. 226–43.Google Scholar
  54. Fisher JO, Johnson RK, Lindquist C, Birch LL, Goran MI. Influence of body composition on the accuracy of reported energy intake in children. Obes Res. 2000;8:597–603.View ArticlePubMedGoogle Scholar
  55. Alexy U, Sichert-Hellert W, Kersting M, Schultze-Pawlitschko V. Pattern of long-term fat intake and BMI during childhood and adolescence—results of the DONALD Study. Int J Obes. 2004;28:1203–9.View ArticleGoogle Scholar
  56. Waling MU, Larsson CL. Energy intake of Swedish overweight and obese children is underestimated using a diet history interview. J Nutr. 2009;139:522–7.View ArticlePubMedGoogle Scholar
  57. Ruottinen S, Karjalainen S, Pienihäkkinen K, Lagström H, Niinikoski H, Salminen M. Sucrose intake since infancy and dental health in 10-year-old children. Caries Res. 2004;38:142–8.View ArticlePubMedGoogle Scholar
  58. Ruottinen S, Rönnemaa T, Niinikoski H, Lagström H, Saarinen M, Pahkala K, et al. Carbohydrate intake, serum lipids and apolipoprotein E phenotype show association in children. Acta Paediatr. 2009;98:1667–73.View ArticlePubMedGoogle Scholar
  59. Institute for Health Metrics and Evaluation: Global Burden of Disease (GBD) Arrow Diagram. http://www.healthmetricsandevaluation.org/gbd/visualizations/gbd-arrow-diagram. Accessed 11 June 2015.
  60. Erkkilä A, de Mello VDF, Risérus U, Laaksonen DE. Dietary fatty acids and cardiovascular disease: an epidemiological approach. Prog Lipid Res. 2008;47:172–87.View ArticlePubMedGoogle Scholar
  61. Bryan J, Osendarp S, Hughes D, Calvaresi E, Baghurst K, van Klinken JW. Nutrients for cognitive development in school-aged children. Nutr Rev. 2004;62:295–306.View ArticlePubMedGoogle Scholar
  62. Brauchla M, McCabe GP, Miller KB, Kranz S. The effect of high fiber snacks on digestive function and diet quality in a sample of school-age children. Nutr J. 2013;12:153.View ArticlePubMedPubMed CentralGoogle Scholar
  63. Ötles S, Ozgoz S. Health effects of dietary fiber. Acta Sci Pol Technol Aliment. 2014;13:191–202.View ArticlePubMedGoogle Scholar
  64. Stewart ML, Schroeder NM. Dietary treatments for childhood constipation: efficacy of dietary fiber and whole grains. Nutr Rev. 2013;71:98–109.View ArticlePubMedGoogle Scholar
  65. Piernas C, Barquera S, Popkin BM. Current patterns of water and beverage consumption among Mexican children and adolescents aged 1–18 years: analysis of the Mexican National Health and Nutrition Survey 2012. Public Health Nutr. 2014;17:2166–75.View ArticlePubMedGoogle Scholar
  66. Senterre C, Dramaix M, Thiébaut I. Fluid intake survey among schoolchildren in Belgium. BMC Public Health. 2014;14:651.View ArticlePubMedPubMed CentralGoogle Scholar
  67. Popkin BM, D'Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010;68:439–58.View ArticlePubMedPubMed CentralGoogle Scholar
  68. Love C. The role of diet in the prevention of osteoporosis. J Orthop Nursing. 2002;6:101–10.View ArticleGoogle Scholar
  69. Norman PE, Powell JT. Vitamin D and cardiovascular disease. Circ Res. 2014;114:379–93.View ArticlePubMedGoogle Scholar
  70. Xuan Y, Zhao H, Liu JM. Vitamin D and type 2 diabetes mellitus. J Diabetes. 2013;5:261–7.View ArticlePubMedGoogle Scholar
  71. Walentowicz-Sadłecka M, Sadłecki P, Walentowicz P, Grabiec M. The role of vitamin D in the carcinogenesis of breast and ovarian cancer. Ginekol Pol. 2013;84:305–8.PubMedGoogle Scholar
  72. Ishihara J, Iso H, Inoue M, Iwasaki M, Okada K, Kita Y. Intake of folate, vitamin B6 and vitamin B12 and the risk of CHD: the Japan Public Health Center-Based Prospective Study Cohort I. J Am Coll Nutr. 2008;27:127–36.View ArticlePubMedGoogle Scholar
  73. Swart KMA, van Schoor NM, Lips P. Vitamin B12, folic acid, and bone. Curr Osteoporos Rep. 2013;11:213–8.View ArticlePubMedGoogle Scholar
  74. Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: scientific review. JAMA 2002;287:3116–26. Erratum in JAMA 2002;288:1720.Google Scholar
  75. Samuelson G. Folic acid: a key vitamin in nutrition. Scand J Nutr. 2003;47:3.View ArticleGoogle Scholar
  76. Morris MS. The role of B vitamins in preventing and treating cognitive impairment and decline. Adv Nutr. 2012;3:801–12.View ArticlePubMedPubMed CentralGoogle Scholar
  77. Bhupathiraju SN, Tucker KL. Coronary heart disease prevention: nutrients, foods, and dietary patterns. Clin Chim Acta. 2011;412:1493–514.View ArticlePubMedGoogle Scholar
  78. MacKay D, Hathcock J, Guarneri E. Niacin: chemical forms, bioavailability, and health effects. Nutr Rev. 2012;70:357–66.View ArticlePubMedGoogle Scholar
  79. Zhu K, Prince RL. Calcium and bone. Clin Biochem. 2012;45:936–42.View ArticlePubMedGoogle Scholar
  80. Huncharek M, Muscat J, Kupelnick B. Impact of dairy products and dietary calcium on bone-mineral content in children: Results of a meta-analysis. Bone. 2008;43:312–21.View ArticlePubMedGoogle Scholar
  81. Koliaki C, Katsilambros N. Dietary sodium, potassium, and alcohol: key players in the pathophysiology, prevention, and treatment of human hypertension. Nutr Rev. 2013;71:402–11.View ArticlePubMedGoogle Scholar
  82. Weaver CM. Potassium and health. Adv Nutr. 2013;4:368S–77S.View ArticlePubMedPubMed CentralGoogle Scholar
  83. Atkinson SA, Ward WE. Clinical nutrition: 2. The role of nutrition in the prevention and treatment of adult osteoporosis. CMAJ. 2001;165:1511–4.PubMedPubMed CentralGoogle Scholar
  84. Rosanoff A, Weaver CM, Rude RK. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutr Rev. 2012;70:153–64.View ArticlePubMedGoogle Scholar
  85. Hunnicutt J, He K, Xun P. Dietary iron intake and body iron stores are associated with risk of coronary heart disease in a meta-analysis of prospective cohort studies. J Nutr. 2014;144:359–66.View ArticlePubMedPubMed CentralGoogle Scholar
  86. Uauy R, Dangour AD. Nutrition in brain development and aging: role of essential fatty acids. Nutr Rev. 2006;64:S24–33.View ArticlePubMedGoogle Scholar
  87. Glynn L, Emmett P, Rogers I. Food and nutrient intakes of a population sample of 7-year-old children in the south-west of England in 1999–2000—what difference does gender make? J Hum Nutr Diet. 2005;18:7–19.View ArticlePubMedGoogle Scholar
  88. Manios Y. Design and descriptive results of the “Growth, Exercise and Nutrition Epidemiological Study In preSchoolers”: The GENESIS Study. BMC Public Health. 2006;6:32.View ArticlePubMedPubMed CentralGoogle Scholar
  89. Merkiel S, Chalcarz W. Dietary intake in 6-year-old children from southern Poland: part 2—vitamin and mineral intakes. BMC Pediatr. 2014;14:310.View ArticlePubMedPubMed CentralGoogle Scholar
  90. Grajeta H, Biernat J. Ocena wartości żywieniowej tłuszczów zawartych w posiłkach przedszkolnych w aspekcie profilaktyki miażdżycy, in Polish (Nutritional value of fat in nursery school meals and atherosclerosis prevention). Bromat Chem Toksykol. 2002;35:195–201. Abstract available at: http://yadda.icm.edu.pl/yadda/element/bwmeta1.element.agro-article-d7ce7533-4e2a-4e6f-a9e6-7658ced0eb93.Google Scholar

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