O. Kushnir ¹, T. Grachova ¹, N. Fundiur ¹, O. Zhukovskyi ¹, O. Iftoda ¹, V. Seleznova ^1,2, T. Kolodnitska ^1,2

¹ Department of Hygiene and Ecology, Higher State Educational Institution of Ukraine “Bukovinian State Medical University”, Chernivtsi, Ukraine,

² L.I. Medved’s "Research Center of Preventive Toxicology, Food and Chemical Safety, Ministry of Health, Ukraine" (State Enterprise), Kyiv, Ukraine

ABSTRACT. One of the most important reasons of the health status deterioration among the child population is the infraction of the diet structure and the decrease of its Quality. The purpose of the research is to study and analyze the Quantitative and Qualitative composition of the daily dietary intakes of preschool children attending children's educational establishments, followed by a hygienic assessment of their balance with the main nutrients. The dietary intake balance has been assessed by comparing the received data with state normative documents and international recommendations. Analysis of the daily children’s diets at 9 preschool institutions of Chernivtsi showed that their food was various, the order and intervals between meals were kept, as well as the seQuence of taking dishes and distribution of energy value. An insufficient content of products was in the diets, which are sources of animal protein (meat and meat products, fish products, eggs, milk and dairy products, cheeses), fats of vegetable origin (vegetable oils, seeds, nuts), fiber (rye bread, vegetables and fruits). The ratio of proteins, fats and carbohydrates at any preschool institutions did not correspond to the recommended 1:1:4 due to reducing the fat Quota and exceeding the Quota of carbohydrates in daily rations. The inadeQuate content of animal proteins, vegetable fats, polyunsaturated fatty acids of the ω-З family and fiber on the background of excess simple carbohydrates have been established. The obtained results and conclusions formed the basis for the development of recommendations for correction of actual nutrition of children of preschool age attending children's educational institutions in Chernivtsi.

Key Words: health of the children's population, daily intake of children, nutrition standards, dietary balance, nutrients.

Introduction. Under contemporary socio-economic conditions in Ukraine, the structure of food baskets is deteriorating. Therefore, organization of a full-value nutrition in pre-school educational institutions is an important factor that determines a balanced physical development of children and an optimal functioning of all their organs and systems and promotes adaptation to adverse environmental factors that affect the overall health of paediatric population [1, 2].

The foundation of physical and mental health is laid in the pre-school age. The younger the child, the greater the importance of age-appropriate balanced nutrition for his/her health and further development is. Improper metabolic habits in childhood are considered to be related to the so-called “metabolic programming”, a phenomenon of increased risk for obesity, atherosclerosis, hypertension and type 2 diabetes mellitus in adolescence and adulthood [3, 4]. Nutrition-related health problems in pre-school children suggest that the highest prevalence is typical for the diseases caused by nutrient imbalance. Scientific evidence confirms a close relationship between such diseases and the excessive caloric intake of simple carbohydrates and animal fats and insufficient supply of polyunsaturated fatty acids, dietary fibre, etc. [5, 6].

Given the importance of rational nutrition in preschool age and its influence on further development and health preservation, an important area of current research includes the studies of balance of dietary rations for children attending pre-school educational institutions.

The aim of the study is to investigate and to analyse the balance of dietary rations for pre-school children attending pre-school educational institutions (PEI) in the city of Chernivtsi.

Materials and methods. Evaluation of organized nutrition of children 4 to 6 years of age attending 9 PEIs in Chernivtsi was performed using a calculation method. After seasonal copying of data covering 10 days from menu production records, the average amount of products per one child per day was calculated and the obtained data were compared with the recommended data [7]. The content of basic nutrients in foods was assessed with dedicated software custom-developed by the authors based on the reference tables by I.M. Skurykhin [8]. The qualitative and the quantitative assessment of children’s nutrition was performed by comparing the data obtained against national regulatory documents [7, 9] and international recommendations [10, 11].

Results and discussion. The nutrition of pre-school children in PEIs of Chernivtsi was organized in groups, i.e. healthy children within one group were receiving identical three-meals-daily nutrition with the same bulk and chemical composition. Analysing the data from menu production records, it should be noted that children’s nutrition was diversified, with appropriate number of meals per day and with correct intervals between meals. The sequence of serving foods and the distribution of dietary energy values between meals were also appropriate.

The dietary rations of children were notable for use of greater (by 45%) amounts of wheat bread and absence of rye bread. The actual amounts of cereals, legumes and pasta exceeded the recommended values by 37.8% and amounts of confectionery exceeded recommended values by 13.3% (see Table 1).

Table 1

Actual and recommended amounts of food products in rations of children 4-6 years of age in PEIs (grams per day per 1 child)

 * smetana – special Ukrainian variety of thick sour cream

** salo – cured pork fatback with usually no meat, a Ukrainian specialty

At the same time, dietary rations were found to contain smaller amounts of alimentary sources of complete proteins, animal and vegetable fats and dietary fibre. Thus, the levels of meat and meat products were below recommended values by 30%, the levels of fish products were below recommended values by 24.4%, the levels of eggs were lower by 40 %, the amounts of milk and dairy products were lower by 18.8%, the amounts of cottage cheese (processed) and hard cheese were lower by 33.3% and 40%, respectively. Average daily amount of butter in rations of all PEIs met recommended values and the amounts of oil was 22.2% lower.

Potato content in dietary rations was 21.6% lower than required and the content of other vegetables was 1.3% lower than required. Most of the vegetables (potatoes, beets, carrots, squash and onions) were served to children cooked, which reduced their nutritional and biological value. Fresh vegetables in the diet were mostly represented by cabbage. At the same time, there were significant deficits of fresh fruit (by 75%) and dried fruit (by 50%).

Analysis of dietary rations by the content of the main nutrients has shown that total protein content was 12.58 ± 1.88% of daily energy value (in recommended level of 15%). The percentage of animal proteins in the diet relative to total protein was 46.8 ± 2.18%, which was lower than recommended (60%).

The energy value of rations in a three-meals-daily regimen was 1486.98 ± 102.38 kcal, which provided 81.6–93% of the recommended daily caloric intake (1700 kcal).

Dietary fats contributed to 25.53 ± 2.35% of total caloric value of the ration, while the recommended fraction was 30%. The level of vegetable fats across all PEIs was 16.6 ± 0.32%, which was below recommended level (i.e. 20% of total dietary fat).

The quantitative content of monounsaturated fatty acids provided for 13.6 ± 0.82 of the ration’s energy value, which was slightly above recommended (10%); the content of polyunsaturated fatty acids (PUFAs) provided for 5.0 ± 0.08% of the ration’s energy value, which was twice as low as recommended (Table 2). The content of w-6 PUFAs was 8.1 ± 0.14 g; this provided for 4.9 ± 0.08% of the ration’s energy value, which did meet international recommendations. The content of w-3 PUFAs (0.25 ± 0.003 g) did not provide the required 1-2% of the ration’s energy value (0.15 ± 0.001%). In none of the PEIs did the w-6:w-3 ratio meet the recommended 5:1 to 10:1 and fluctuated from 29:1 to 36:1.

Table 2

Daily values of PUFAs in dietary rations of children in PEIs

*= significantly different from the recommended norms

Fig. Seasonal differences in daily PUFA content in the rations of children in PEIs of Chernivtsi (g/day)

Analysis of seasonal differences in daily PUFA content had shown (see Figure) that it was the lowest in summer. The highest values of w-6 PUFAs in the rations were documented in winter (8.84±0.4 g) and the highest values of w-3 PUFAs were documented in autumn (0.34±0.03 g).

Analysis of the carbohydrate component in dietary rations had shown total carbohydrate content in PEI rations to be 61.89 ± 2.38% of the daily ration’s energy value, which was above the recommended 55%. The percentage of simple carbohydrates in the ration (relative to total carbohydrates) was 41.0 ± 2.8%, i.e. more than twice the recommended levels.

Fibre content in the rations of PEIs was 4.94 ± 0.45 g, which was more than three times lower than the daily consumption rates recommended by international scholars. Analysis of seasonal differences in daily fibre content had shown that the lowest values across all PEIs were documented in spring (4.71 ± 0.49 g). During summer and autumn, the levels of fibre were gradually increasing (4.95 ± 0.69 g and 5.01 ± 0.64 g, respectively) up to the highest level in winter (5.11 ± 0.64 g).

None of the PEIs met the recommended 1:1:4 ratio of protein: fat: carbohydrate (weight-wise) due to disproportionately reduced fats and increased carbohydrates in daily rations.

In our opinion, the main reasons for imbalanced dietary rations of children in terms of basic nutrients include the following:

• The dietary rations contained reduced amounts of dietary sources of animal proteins and fats (meat and meat products, fish products, eggs, milk and dairy products and cheeses) in a setting of predominance of cereals and legumes;
• Insufficient amounts of sea fish and PUFA-rich oils;
• Increased consumption of high-calorie foods rich in simple carbohydrates but poor in fibre (white bread, pasta and confectionery) as opposed to lack of rye bread and deficiencies of vegetables and fruits as the main source of dietary fibre.

The proteins are the principal building material for the cells and tissues in the body; they are responsible for transport of haemoglobin, lipids, carbohydrates and vitamins; in addition, they are constituents of hormones and enzymes and take part in haematopoiesis. The deficit of animal proteins (principal sources of essential amino acids required by the child’s body) may cause developmental delays, anaemia and reduced immunological responses [3, 12].

Adequate levels of dietary fat meet the energy expenditures of the body, support the high intensity of plastic processes and regulate fluid metabolism. Deficit of fats has adverse metabolic effects and created prerequisites for deficiencies of fat-soluble vitamins and reduced host resistance to adverse environmental factors. PUFAs are precursors of glycolipids, phospholipids and eicosanoids (prostaglandins, leukotrienes and thromboxanes), which, together with the enzymes related to metabolism of these compounds, form a complex regulating matrix to support intracellular homeostasis. Unsaturated fatty acids are structural components of cell membranes and regulate the expression of genes, which affect the metabolism of lipids, carbohydrates and proteins as well as cell growth and differentiation. Since essential PUFAs of ω-3 and ω-6 families compete for the same synthesizing enzymes, their imbalanced content in a child’s diet causes dysregulation of metabolic effects of derivatives of both families. Such dysregulation adversely affects physical development, morbidity and academic performance of children and contributes to gradual development of metabolic disorders. Inadequate w-6:w-3 PUFA ratio in a setting of prolonged dietary deficits of essential α-linolenic acid results in impaired synthesis of derivatives of this acid. This may be manifested as growth retardation, changes in blood lipid profiles, reduced visual acuity and various types of neurological and cognitive disorders. Deficits of w-3 PUFAs increases the risk of cardiovascular disease, allergies, depression, chronic inflammation in the joints and internal organs, hyperactivity and the associated low learning ability in children [13, 14].

Carbohydrates provide for basic energy needs of the child’s body, participate in metabolic processes, maintain acid-base balance and play an important role in the functioning of central nervous system. Dietary fibre prevents intestinal absorption of toxic and carcinogenic substances and promotes normal intestinal flora, thereby increasing host resistance to adverse environmental factors. Excessive consumption of simple carbohydrates in a setting of insufficient fibre intake by the child contributes to constipation, diverticulosis, intestinal dysbiosis and produces metabolic problems creating preconditions for obesity, type 2 diabetes mellitus and diseases of the biliary tract [6, 12].

Thus, unbalanced diet is one of the risk factors of functional abnormalities in children’s health, which may cause somatic disease later in life.

In order to improve actual nutrition of pre-school children attending the aforementioned PEIs in Chernivtsi, the following can be recommended:

• Increase the consumption of meat and meat-based products
• Increase the consumption of milk and dairy products (yogurts, kefir, fermented baked milk), various types of cheese and eggs
• Increase the consumption of vegetable fats (by adding flax oil, pumpkin oil and soybean oil, walnuts and pumpkin seeds to freshly prepared porridges and salads) and sea fish from cold seas (cod, humpback salmon, mackerel, etc.)
• Limit the consumption of fried products and confectionery, since margarine and heat-treated fats contain trans-isomers of fatty acids that adversely affect PUFA metabolism
• In winter and in spring, additionally enrich the diet with w-3 PUFA from cod liver oil (selection of oral supplements must be performed by health personnel of PEI taking into account the age group of children at 0.8% of caloric content of the ration) [15]
• Enrich the rations with rye bread and bread with bran while reducing the wheat bread
• Increase the consumption of buckwheat and oat cereals while reducing the fraction of pasta and confectionery
• Increase the fraction of fresh raw fruits and vegetables in the ration
• Conduct health education events to address potential knowledge deficits in the parents of children concerning the significance of essential nutrients in the child’s diet and alimentary sources of such nutrients.

Conclusions

1. The analysis of daily rations of pre-school age children in PEIs of Chernivtsi had shown that children’s nutrition was diversified, with appropriate number of meals per day and with correct intervals between meals. The sequence of serving foods and the distribution of dietary energy values between meals were also appropriate.
2. Dietary rations of children were observed to contain reduced amounts of dietary sources of animal proteins and fats, especially polyunsaturated fatty acids of the ω-3 family and increased amounts of high-calorie foods rich in simple carbohydrates in a setting of deficient sources of dietary fibre.
3. Dietary rations of children were imbalanced in terms of the following parameters: ratio of proteins, fats and carbohydrates and their qualitative content relative to the ration’s energy value; animal proteins; vegetable fats; the content and ratio of polyunsaturated fatty acids of ω-6 and ω-3 families and the content of simple carbohydrates and fibre.
4. The results obtained in this study have become the basis for development of guidelines for improvement of actual nutrition of children attending PEIs in the city of Chernivtsi, Ukraine.

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