Original Paper

Ann Nutr Metab 2007;51:454–460 Received: August 8, 2006

Accepted: April 28, 2007
DOI: 10.1159/000111166
Published online: November 20, 2007

Dietary Habits of School Children:

Representative Survey in Metropolitan
Elementary Schools – Part Two
Lajos Biró Andrea Regöly-Mérei Katalin Nagy Szabolcs Péter Györgyi Arató
Csaba Szabó Éva Martos Magda Antal
National Institute of Food Safety and Nutrition, Budapest, Hungary

Key Words Introduction

Hungarian primary school children ⴢ Eating habits ⴢ
Nutrient intake ⴢ Food frequency Obesity is a global epidemiological problem both in
adult and young populations [1–3] which causes disabil-
ity as well as death [4]. Besides the genetic component of
Abstract obesity, the mean characteristic is the excess energy input
Background/Aims: The aim of this study was to investigate over output. Namely evidence suggests that dietary and
the eating habits and the nutrient intake of 11- to 14-year-old activity patterns strongly affect the weight appearance of
school children as part of a representative nutrition and human beings. However, it is not only the excessive
health survey in primary schools in Budapest. Methods: A amount of daily energy intake with unbalanced nutrient
food frequency questionnaire of 875 school children, aged structure that can be blamed for unfavorable effects, but
from 11 to 14 (449 boys and 426 girls), was recorded and eval- also nutritional deficiencies can affect a child’s physical,
uated. Energy and nutrient intake of 235 children (124 boys mental and behavioral development at all stages of growth
and 111 girls) was calculated in parallel by 3-day dietary re- [5]. That is why it is so important to assess children’s nu-
cord. Results: The average energy intake (MJ) was appropri- tritional status early in their school age.
ate (boys: 10.40 8 1.89; girls: 9.18 8 1.50); protein and fat Comprehensive nutrition and health epidemiological
intake was somewhat higher than the Hungarian recom- studies have been completed in Hungary related both to
mended dietary allowances. Sodium intake was alarmingly university students [6] and secondary school children [7],
high. The intake of calcium and vitamin D was inadequate. but our knowledge about primary school children’s nu-
The intakes of zinc, chromium, retinol, folate for both gen- tritional habits is still incomplete. This study aimed to
ders, and iron in the case of girls were insufficient. The daily investigate the eating habits and the nutrient intake of 11-
consumption of milk and dairy products was deficient, that to 14-year-old school children.
of vegetables and fresh fruits was rather low, while the fre-
quency of consumption of sugar-sweetened beverages,
chips, sticks and fast foods was high. Conclusions: Nutrition Subjects and Methods
intervention programs should be launched among Hungar- The study was a part of the representative nutrition and health
ian school children. Copyright © 2007 S. Karger AG, Basel survey in 18 primary schools of Budapest, in the first semester of
the school year 2005/2006. It was conducted under an authoriza-

© 2007 S. Karger AG, Basel Lajos Biró, MD

0250–6807/07/0515–0454$23.50/0 National Institute of Food Safety and Nutrition, Department of Nutrition and Health
Fax +41 61 306 12 34 Gyáli street 3/A
E-Mail [email protected] Accessible online at: HR–1097 Budapest (Hungary)
www.karger.com www.karger.com/anm Tel. +36 1 476 6479, Fax +36 1 215 1545, E-Mail [email protected]
tion of the Regional Medical-Ethics Committee, in compliance take was far below the recommendation, only 798 mg for
with international [8] and national [9] regulations. boys and 696 mg for girls. Magnesium and copper intakes
Dietary intake data of the 11- to 14-year-old students were ob-
tained from a 3-day food-record diary kept for 2 non-consecutive were adequate in both genders; zinc and iron intakes were
working days and Sunday [10]. The diary was filled in by the help somewhat lower for girls. Intake of phosphorus was above
of parents, later on a qualified dietician interviewed all partici- and chrome intake was below the recommended value.
pants specifying the food items data. Energy and nutrient intake The intake of retinol equivalent for both genders was
was calculated using specially developed software, called Nutri- a bit lower than required, while vitamin D consumption
Comp [11]. To check the subjects for misreporting about food in-
take, the ratio of calculated energy intake (EI) and estimated bas- was definitely low. Intake of vitamin E, of the members
al metabolic rate (BMR) [12] was used; records with an EI:BMR of the vitamin B group and of vitamin C was fairly good,
ratio !1.1 or 12.7 were excluded from further analysis due to the while that of folate was lower.
high probability of under- and over-reporting of dietary intake,
respectively [13]. Excess and Insufficient Intake of Energy
At the same time, food frequency questionnaires (FFQ) [14]
adapted and used earlier in Hungary [15] were also completed in and Nutrients
the presence of skilled dieticians. Data were maintained in a Mi- The prevalence of students with energy or nutrient in-
crosoft Access application, and the statistical evaluation was car- takes 1130% (excess) or !70% (insufficient) of current
ried out using SPSS 11.0 for Windows. Data are presented as recommendations was examined (table 3). The sodium
means, standard deviations and percentages. intake of all children was enormously high. Excessive in-
take of protein, fat, cholesterol, copper, phosphorus, vita-
mins B6, B12, C and E was observable in a high percentage
Results of the children in both genders. Vitamin D was insuffi-
cient for every student. The intake of carbohydrate, po-
Energy and Nutrient Intake tassium, zinc, vitamin groups B (except of B6 and B12) and
28.4% out of the 900 school children, aged between 11 C was found insufficient in 10–25% of children, while the
and 14 (boys: 459, girls: 441), involved in the survey, filled percentage of insufficient intake of fiber, calcium and fo-
in 3-day dietary records. After a verification of the ques- late in both genders, and that of iron among girls was
tionnaires, the information resulting from 124 boys and much higher.
111 girls was evaluated.
Mean daily energy and nutrient intake of children is Frequency of Food Consumption of Different
detailed in table 1. The total average daily energy intakes Food Groups
(10.40 MJ/day for boys; 9.18 MJ/day for girls) were appro- All of the students filled in the 29-item FFQ, records
priate compared to the recommended [16] values adjust- of 449 boys and 426 girls could be evaluated. The fre-
ed for age and gender. In both genders, the protein intake quency categories of consumption were as follows: more
related to body weight was much higher than the recom- than once per day, 4–7 times per week, 1–3 times per
mended value. Fat consumption as percentage of energy week, 1–3 times per month and rarely or never. Hardly
(en%) was around 35 both for boys and girls. Energy from more than half of the children consumed milk on a dai-
saturated (SFA), monosaturated (MUFA), and polyunsat- ly basis, although the same proportion for dairy prod-
urated fatty acids (PUFA) were fairly close (10.9, 10.8, 8.2 ucts was somewhat better. The frequency of meat and
for boys; 10.6, 10.2, 8.6 en% for girls, respectively) to the poultry consumption was similar in both genders with
recommended values, and PUFA/SFA ratio was good, but the maximum of 1–3 times per week, while cold meats
the n–6/n–3 fatty acid ratio was rather high. Boys’ cho- were consumed more than once a day. Fish was not char-
lesterol intake was far above the recommended value. Al- acteristic in children’s diet, as most students had fish
cohol consumption was practically not found among the 1–3 times a month or less frequently. Students preferred
children involved in this study. margarine to butter on their bread. The daily consump-
tion of fresh vegetable and fruit was 43.7 and 73.4% for
Mineral and Vitamin Intake boys and 51.4 and 82.9% for girls, respectively. The dai-
Mean daily mineral and vitamin intake of children is ly consumption of brown bread was around 45% both in
detailed in table 2. The sodium intake was quite high, boys and girls, nevertheless the consumption of sugared
both in boys and girls, while potassium intake did not refreshments, and of chips and sticks was rather high.
reach the recommended value, resulting in a rather unfa- Nearly 14% of the school-aged boys and 10% of girls
vorable sodium/potassium ratio. The daily calcium in- drink coffee daily.

Dietary Habits of Hungarian School Ann Nutr Metab 2007;51:454–460 455

Children
 Table 1. Mean daily energy and nutrient intake of children

Boys (n = 124) Girls (n = 111)

mean SD HRDA mean SD HRDA

Energy, kJ 10,404 1,891.9 11,300 9,175 1,495.2 10,000

kcal 2,489 452.6 2,700 2,195 357.7 2,400
Protein, g 89.7 18.92 75.4 15.25
en% 14.6 2.01 12–14 13.9 1.86 12–14
g/kg bw 1.99 0.59 1.0 1.73 0.60 1.0
Fat, g 96.9 24.11 83.3 18.85
en% 35.0 4.94 30 34.3 5.18 30
SFA en% 10.9 2.12 10 10.6 2.17 10
MUFA en% 10.8 2.11 12 10.2 2.14 12
PUFA en% 8.2 2.09 8 8.6 2.04 8
n–6/n–3 fatty acid 24.3 9.10 5 25.7 8.38 5
PUFA/SFA 0.79 0.28 0.8 0.83 0.23 0.8
Cholesterol, mg 347.3 115.92 ≤250 291.8 95.96 ≤250
Carbohydrate, g 311.2 64.98 282.2 54.88
en% 50.3 5.58 55–60 51.7 5.42 55–60
Added sugar, en% 11.9 5.62 ≤10 12.5 5.90 ≤10
Fiber 20.8 5.89 20–25 20.1 6.72 20–25

HRDA = Hungarian recommended daily allowance; en = energy; bw = body weight.

Table 2. Mean daily mineral and vitamin intake of children

Boys (n = 124) Girls (n = 111)

mean SD HRDA mean SD HRDA

Sodium, mg 5,343 1,507.5 2,000a 4,839 1,910.1 2,000a

Potassium, mg 2,781 712.2 3,100 2,506 707.2 3,100
Na/K ratio 1.98 0.53 1–1.2 1.99 0.58 1–1.2
Calcium, mg 798.3 287.67 1,000 695.9 237.89 1,000
Magnesium, mg 362.7 84.34 350 324.4 88.75 350
Iron, mg 11.3 2.79 10 10.0 2.85 12
Copper, mg 0.97 0.31 0.8 0.88 0.30 0.8
Zinc, mg 8.62 2.38 9 7.21 1.89 9
Phosphorus, mg 1,136.6 252.80 775 987.6 221.20 775
Chromium, ␮g 70.7 27.17 120 62.5 24.60 120
Retinol equivalent, mg 0.62 0.40 1.00 0.59 0.41 0.80
Vitamin E, mg 14.14 5.04 11 13.26 3.57 11
Vitamin D, ␮g 2.49 1.13 10 2.19 0.98 10
Vitamin B1, mg 1.03 0.30 1.0 0.89 0.31 0.9
Vitamin B2, mg 1.37 0.41 1.4 1.15 0.35 1.2
Vitamin B6, mg 1.76 0.53 1.0 1.56 0.45 1.0
Niacin equivalent, mg 30.80 7.84 15 26.32 5.87 14
Pantothenic acid, mg 3.50 1.23 4 3.00 1.00 4
Biotin, ␮g 26.21 7.66 – 23.69 7.93 –
Vitamin B12, ␮g 3.17 2.47 2.0 2.24 1.11 2.0
Folate, ␮g 150.6 58.10 180 140.3 64.77 180
Vitamin C, mg 99.3 78.86 50 94.3 69.93 50

HRDA = Hungarian recommended daily allowance. a Suggested maximum intake.

456 Ann Nutr Metab 2007;51:454–460 Biró/Regöly-Mérei/Nagy/Péter/Arató/

Szabó/Martos/Antal
 Table 3. Percentage of students with excess or insufficient intake of energy and/or selected nutrients

Intake in boys, % (n = 124) Intake in girls, % (n = 111)

insufficient normal excessive insufficient normal excessive

Energy 5.6 88.7 5.6 11.7 88.3 –

Protein 1.6 79.8 18.5 11.7 82.9 5.4
Fat 3.2 69.4 27.4 7.2 78.4 14.4
Carbohydrate 20.2 79.0 0.8 21.6 77.5 0.9
Cholesterol 4.0 62.1 33.9 14.4 64.0 21.6
Fiber 30.6 65.3 4.0 39.6 54.1 6.3
Sodium – – 100 – 2.7 97.3
Potassium 16.1 78.2 5.6 32.4 64.0 3.6
Calcium 39.5 54.0 6.5 51.4 48.6 –
Magnesium 7.3 81.5 11.3 17.1 73.9 9.0
Iron 10.5 71.8 17.7 27.9 63.1 9.0
Copper 4.0 64.5 31.5 8.1 69.4 22.5
Zinc 16.1 71.0 12.9 36.0 62.2 1.8
Phosphorus 0.8 32.3 66.9 – 56.8 43.2
Vitamin B1 10.5 66.1 23.4 23.4 63.1 13.5
Vitamin B2 12.9 70.2 16.9 20.7 70.3 9.0
Vitamin B6 – 21.0 79.0 1.8 27.9 70.3
Vitamin B12 8.1 40.3 51.6 24.3 46.8 28.8
Folate 36.3 36.3 27.4 48.6 41.4 9.9
Vitamin C 16.1 25.8 58.1 17.1 27.0 55.9
Vitamin D 100 – – 100 – –
Vitamin E 6.5 50.8 42.7 6.3 60.4 33.3

Insufficient intake: <70% of Hungarian recommended daily allowance (HRDA); excessive intake: >130% of
HRDA.

Discussion value of total energy intake of 11- to 14-year-old children

was comparable to that of 12-year-old Greek children
Nutrition-related diseases such as obesity with associ- (9.82 8 1.84 vs. 8.37 8 3.06 MJ); on the other hand, there
ated illnesses, cardiovascular diseases, diabetes mellitus were noticeable differences in the energy percentages
and some kinds of tumors are among the leading causes from fat and the structure of fatty acids. Daily intake of
of death [17, 18]. Nutritional habits are rooted in the early fat was high (42.0 en%), saturated fat consumption was
childhood, and can affect physical and mental develop- elevated (15.6 en%), while polyunsaturated fat intake fell
ment [5], academic performance [19, 20] as well as health short (4.8 en%) for Greek students [21], suggesting that
status not only in childhood [21] but throughout the whole values of Hungarian school children appear to be more
lifetime [4], making it so important to get an adequate favorable. Inadequate dietary fat structure could be dis-
quantity and quality of food, especially in childhood. advantageous in spite of a low level of daily total fat in-
The mean daily energy intake of both boys and girls take, as is manifested in the Isfahan Healthy Heart Pro-
was appropriate in average, but in total the proportion of gram. Although the percentage of total fat intake was
children with insufficient and excessive energy intake only 21.2 en% in Iranian school children, dyslipidemia
was 8.5 and 3.0%, respectively. The most important fac- was shown with a significant linear association between
tors leading to obesity are excessive daily energy intake adolescents’ lipid values and the frequency of intake of
and low level of physical activity, however from the point fast foods, cheese puffs, potato chips and the highly prev-
of view of heart diseases the ratio of macronutrients and alent consumption of fatty lamb meats [22].
structure of dietary fat are crucial as well. Considering It is important to mention the unsatisfactory ratio of
other studies about the school-children population, our n–6/n–3 fatty acids – in spite of the nearly adequate

Dietary Habits of Hungarian School Ann Nutr Metab 2007;51:454–460 457

Children
Table 4. Frequency of consumption of various food groups (boys: n = 449; girls: n = 426)

More than once 4–7 times 1–3 times 1–3 times Rarely or never, %
per day, % per week, % per week, % per month, %
boys girls boys girls boys girls boys girls boys girls

Milk 31.8 29.8 26.5 21.6 27.2 29.1 5.1 8.5 9.4 11.0
Dairy products 33.4 40.8 32.1 27.9 25.6 23.2 4.7 4.5 4.3 3.5
Eggs 4.8 4.2 15.6 16.0 41.2 38.4 22.6 23.5 15.8 17.9
Meat 8.5 4.1 17.7 19.8 39.4 27.0 18.6 27.0 15.9 22.2
Poultry 7.0 5.3 25.0 26.4 36.6 31.5 20.0 24.0 11.4 12.8
Cold meats 41.0 36.4 32.0 34.4 17.8 19.6 4.7 5.7 4.5 3.8
Fish/sardines 2.0 1.9 8.6 4.3 11.6 14.7 33.3 21.5 44.4 57.5
Butter 28.0 24.6 19.4 19.3 16.9 16.2 14.0 13.1 21.7 26.7
Grease 38.5 39.3 19.1 22.2 14.3 11.1 8.8 9.9 19.4 17.6
Vegetable dish 3.9 2.9 15.9 13.8 33.1 36.2 27.7 28.8 19.5 18.3
Fresh vegetables 16.3 22.1 27.4 29.3 30.6 27.6 16.1 14.6 9.5 6.5
Fresh fruit 41.2 55.9 32.2 27.0 15.8 11.1 6.5 3.6 4.3 2.4
Dried fruit 2.7 2.6 7.4 7.7 11.2 12.0 23.5 22.1 55.3 55.6
Bottled, canned fruit 7.7 6.8 18.8 15.7 26.5 27.3 28.1 28.5 19.0 21.7
Potatoes 7.5 7.6 28.9 29.9 41.2 42.7 18.9 17.3 3.4 2.6
Pulses 2.7 1.6 9.0 8.0 26.9 23.1 44.6 48.0 16.7 19.3
Rice 4.0 4.5 19.1 19.0 37.2 40.5 32.7 26.8 7.0 9.2
Noodles 5.2 7.4 24.5 23.4 34.0 35.3 28.8 29.4 7.5 4.5
Cakes 16.7 12.5 28.6 30.8 34.8 32.2 14.6 19.0 5.3 5.5
Sweets 21.7 23.3 29.1 28.0 30.2 29.2 13.9 12.8 5.1 6.7
Refreshments 44.2 42.7 21.7 21.1 17.2 18.5 10.8 9.5 6.1 8.3
Juice 37.9 45.7 27.1 22.0 20.2 16.0 7.2 9.3 7.6 6.9
White bread 67.3 65.3 24.4 22.6 4.7 8.3 1.8 1.9 1.8 1.9
Brown bread 22.6 26.9 22.1 20.4 17.6 15.1 16.5 17.3 21.2 20.4
Chips, sticks 11.4 11.8 20.9 18.9 29.4 26.7 24.2 29.7 14.1 13.0
Hamburger, hot dog 6.8 3.5 11.5 8.5 21.6 19.1 40.3 41.1 19.8 27.7
Cola-like beverages 16.9 9.3 16.0 13.1 20.9 19.3 22.7 28.1 23.6 30.2
Mineral water 44.7 53.0 21.8 15.2 14.4 11.6 7.0 7.4 12.1 12.8
Coffee 3.3 2.4 10.2 6.9 9.8 7.8 16.5 14.0 60.1 69.0

PUFA/SFA ratio – which should be 5:1 (or at least 10:1) The data gained from the FFQ provide useful infor-
according to the current recommendations [23]. Accord- mation about the consumption of different food groups,
ing to our results a significant percentage of school-aged peculiar to a person’s general, longer-time habits. The
children had an excessive intake of protein, fat, phospho- younger children are, the more carefully the self-reported
rus and in the case of boys, cholesterol. We found an data must be evaluated, because children do not have
alarmingly high intake of sodium, but it is a well-known such a well-developed ‘sense of conscious nutrition’ yet.
characteristic of Hungarian diet in all age groups [6, 7, Hardly more than half of the children in the present study
15]. consumed milk and dairy products on a daily basis. Ac-
The mean daily calcium intake was rather low, as the cording to the new food-based dietary guidelines (FBDG)
study showed approximately 40% of boys and 51% of the the consumption of that food group should be two or
girls had a lower calcium intake than 700 mg/day. Con- more servings a day (equivalent to at least 500 g milk), to
sidering the findings that 56% of the children had an ex- prevent later osteoporosis effectively. The health-pro-
cessive phosphorus intake, and that neither of them had moting effect of diets rich in fresh vegetables and fruits is
adequate vitamin D intake, the picture concerning the well known. Hungarian FBDG suggest a 400- to 500-
proper bone growth is more exasperating than in our ear- gram daily intake from that food group, but in spite of a
lier study [24]. favorable upward tendency (including fruit juices), chil-

458 Ann Nutr Metab 2007;51:454–460 Biró/Regöly-Mérei/Nagy/Péter/Arató/

Szabó/Martos/Antal
dren’s vegetable and fruit consumption is much lower and collective determinants of healthy eating in children
than that value. Unfortunately the consumption of sugar- and youth [26], a fact which can enforce the necessity of
sweetened beverages, chips and sticks as well as fast foods further research work in this direction. Nowadays it is
shows a high frequency among the school children. obvious that the main activities in this field must aim at
the primary prevention of young children. Experiences
Study Limitations gained and evidence collected are available about the top-
The results of this survey represent only the 11- to 14- ic, identifying research priorities, areas for action and
year-old primary school-children of the capital, which is making opportunities for program development of ‘best
obviously not characteristic for the smaller towns and the practice’ recommendations that will reduce obesity and
rural areas of Hungary. chronic disease risk in children and youths [27]. A school-
based intervention can positively influence children’s di-
etary habits, suggesting that population-based approach-
Conclusion es for reducing cardiovascular risk factors in children are
feasible and effective [28]. Hungarian experts have start-
There is a general consensus that the welfare of both ed changing the dietary habits of school children by mod-
the young generation and adult population requires ef- ifying the scale of foodstuffs available in school canteens
fective health promotion initiatives. Such projects must as a first step.
be based on correct, evidence-based results of nutrition
and lifestyle research. However, methods of measuring
food intake are not standardized across Europe, so there Acknowledgement
are uncertainties over the true nutrient intakes of chil-
The technical background for this study was provided by
dren and adolescents. This may make comparisons be-
Nestlé Hungária Ltd.
tween countries difficult and inaccurate [25]. There are
also gaps in our knowledge concerning true individual

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