Document Type : Research Article (s)

Authors

1 Department of Nutrition and Dietetics, Faculty of Health Sciences, Kırklareli University, Kırklareli, Turkey

2 Department of Nutrition and Dietetics, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey

Abstract

Background: Unhealthy dietary behaviors are suggested among the factors leading to obesity in adolescents. Adolescents tend to consume unhealthy food at school. However, whether these habits differ by gender is not known. The present study aimed to evaluate gender differences in adolescents’ dietary behaviors at school and to determine the relationship between these behaviors and abdominal obesity by gender.
Methods: This cross-sectional study was conducted on 1020 fifth-eighth grader students (502 boys and 518 girls) in Kırklareli, Turkey, between November 2019 and December 2019. Dietary behaviors and anthropometric measurements were obtained. Descriptive statistics were shown as numbers and percentages. Chi-Square test was used to compare the classified data. Statistical significance was evaluated at P<0.05.
Results: Among these students, 40.8% of the boys and 22.0% of the girls had abdominal obesity (P<0.001). The daily breakfast consumption of the boys was higher than that of the girls (P=0.038). Snack consumption in school was higher in the girls (P=0.002). Moreover, carrying a lunchbox to school (P<0.001) and shopping from the school canteen (P=0.042) were more frequent in the girls. Between meals, the consumption of bagel/pastry (P=0.031), plain mineral water/light beverages (P=0.037), and carbonated beverages (P<0.001) was higher in the boys. Meanwhile nuts (P=0.022) and fruit/fresh fruit juice consumption was higher in the girls (P<0.001). The girls preferred biscuits/cakes (P=0.032) and candy (P=0.001), whereas the boys preferred sandwiches (P=0.008) at a higher rate when shopping at the canteen. Consumption of the three main meals was lower in the boys with obesity (P=0.008). Daily breakfast consumption was lower in the girls with obesity (P=0.015).
Conclusions: This study suggested that girls tend to consume unhealthy foods in the canteen and boys tend to consume unhealthy beverages between meals. Furthermore, skipping meals was found to contribute to obesity in adolescents.

Keywords

1. Rouse H, Goudie A, Rettiganti M, Leath K, Riser Q, Thompson J. Prevalence, patterns, and predictors: A statewide longitudinal study of childhood obesity. J Sch Health. 2019;89(4):237-245. doi: 10.1111/josh.12741. PubMed PMID: 30740717. ## 2. Winpenny EM, van Sluijs EMF, White M, Klepp K-I, Wold B, Lien N. Changes in diet through adolescence and early adulthood: longitudinal trajectories and association with key life transitions. Int J Behav Nutr Phys Act. 2018;15(1):86. doi: 10.1186/s12966-018-0719-8. PubMed PMID: 30200990; PubMed Central PMCID: PMC6131755. ## 3. Kansra AR, Lakkunarajah S, Jay MS. Childhood and Adolescent Obesity: A Review. Front Pediatr. 2020;8:581461. doi: 10.3389/fped.2020.581461. PubMed PMID: 33511092; PubMed Central PMCID: PMC7835259. ## 4. Ortega A, Bejarano CM, Cushing CC, Staggs VS, Papa AE, Steel C, et al. Differences in adolescent activity and dietary behaviors across home, school, and other locations warrant location-specific intervention approaches. Int J Behav Nutr Phys Act. 2020;17(1):123. doi: 10.1186/s12966-020-01027-1. PubMed PMID: 32993715; PubMed Central PMCID: PMC7526379. ## 5. Sarsour A, Turban M, Al Wahaidi A, Abed Y, Alkahlout H. Does gender influence food intake and physical activity pattern among Palestinian adolescents in the Gaza Strip? East Mediterr Health J. 2019;25(10):722-727. doi: 10.26719/emhj.19.073. PubMed PMID: 31774138. ## 6. Otsuka Y, Kaneita Y, Itani O, Jike M, Osaki Y, Higuchi S, et al. Gender differences in dietary behaviors among Japanese adolescents. Prev Med Rep. 2020;20:101203. doi: 10.1016/j.pmedr.2020.101203. PubMed PMID: 32995146; PubMed Central PMCID: PMC7509230. ## 7. Zalewska M, Maciorkowska E. Selected nutritional habits of teenagers associated with overweight and obesity. PeerJ. 2017;5:e3681. doi: 10.7717/peerj.3681. PubMed PMID: 28951812; PubMed Central PMCID: PMC5611898. ## 8. Freedman DS, Kahn HS, Mei Z, Grummer-Strawn LM, Dietz WH, Srinivasan SR, et al. Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr. 2007;86(1):33-40. doi: 10.1093/ajcn/86.1.33. PubMed PMID: 17616760. ## 9. Abreu S, Santos R, Moreira C, Santos PC, Vale S, Soares‐Miranda L, et al. Relationship of milk intake and physical activity to abdominal obesity among adolescents. Pediatr Obes. 2014;9(1):71-80. doi: 10.1111/j.2047-6310.2012.00130.x. PubMed PMID: 23325606. ## 10. Mogre V, Nyaba R, Aleyira S, Sam NB. Demographic, dietary and physical activity predictors of general and abdominal obesity among university students: a cross-sectional study. Springerplus. 2015;4:226. doi: 10.1186/s40064-015-0999-2. PubMed PMID: 26140255. PubMed Central PMCID: PMC4480231. ## 11. Deshmukh-Taskar P, Nicklas TA, Radcliffe JD, O'Neil CE, Liu Y. The relationship of breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome in young adults. The National Health and Nutrition Examination Survey (NHANES): 1999–2006. Public Health Nutr. 2013;16(11):2073-82. doi: 10.1017/S1368980012004296. PubMed PMID: 23031568. ## 12. Rathi N, Riddell L, Worsley A. Food consumption patterns of adolescents aged 14–16 years in Kolkata, India. Nutr J. 2017;16(1):50. doi: 10.1186/s12937-017-0272-3. PubMed PMID: 28836982; PubMed Central PMCID: PMC5571590. ## 13. World Health Organization. Growth Reference Data for 5-19 years; 2007. Available from: https://www.who.int/tools/growth-reference-data-for-5to19-years/indicators/bmi-for-age. ## 14. World Health Organization. Waist circumference and waist-hip ratio: report of a WHO expert consultation, Geneva, 8-11 December 2008; 2011. Available from: https://www.who.int/publications/i/item/9789241501491. ## 15. McCarthy HD, Ashwell M. A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message–‘keep your waist circumference to less than half your height’. Int J Obes. 2006;30(6):988-92. doi: 10.1038/sj.ijo.0803226. PubMed PMID: 16432546. ## 16. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005;56(5):303-7. doi: 10.1080/09637480500195066. PubMed PMID: 16236591. ## 17. Al-Sheyab NA, Alomari MA, Hayajneh AA, Shah S. Attitudes and perceived barriers toward healthy lifestyle behaviors in Jordanian adolescents: a developing country perspective. Adolesc Health Med Ther. 2019;10:39-47. doi: 10.2147/AHMT.S181001. PubMed PMID: 30992686; PubMed Central PMCID: PMC6445189. ## 18. Macwana JI, Mehta KG, Baxi RK. Predictors of overweight and obesity among school going adolescents of Vadodara city in Western India. Int J Adolesc Med Health. 2017;29(3):/j/ijamh.2017.29.issue-3/ijamh-2015-0078/ijamh-2015-0078.xml. doi: 10.1515/ijamh-2015-0078. PubMed PMID: 26812764. ## 19. Agustina R, Nadiya K, Andini EA, Setianingsih AA, Sadariskar AA, Prafiantini E, et al. Associations of meal patterning, dietary quality and diversity with anemia and overweight-obesity among Indonesian school-going adolescent girls in West Java. PLoS One. 2020;15(4):e0231519. doi: 10.1371/journal.pone.0231519. PubMed PMID: 32324775; PubMed Central PMCID: PMC7179884. ## 20. Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, Swinburn BA, et al. Child and adolescent obesity: part of a bigger picture. Lancet. 2015;385(9986):2510-20. doi: 10.1016/S0140-6736(14)61746-3. PubMed PMID: 25703114; PubMed Central PMCID: PMC4594797. ## 21. Castro JAC, Nunes HEG, Silva DAS. Prevalence of abdominal obesity in adolescents: association between sociodemographic factors and lifestyle. Rev Paul Pediatr. 2016;34(3):343-51. doi: 10.1016/j.rpped.2016.01.003. PubMed PMID: 26993748; PubMed Central PMCID: PMC5178121. ## 22. Grammatikopoulou M, Poulimeneas D, Gounitsioti I, Gerothanasi K, Tsigga M, Kiranas E, et al. Prevalence of simple and abdominal obesity in Greek adolescents: the ADONUT study. Clin Obes. 2014;4(6):303-8. doi: 10.1111/cob.12070. PubMed PMID: 25826159. ## 23. Esmaili H, Bahreynian M, Qorbani M, Motlagh ME, Ardalan G, Heshmat R, et al. Prevalence of general and abdominal obesity in a nationally representative sample of Iranian children and adolescents: the CASPIAN-IV study. Iran J Pediatr. 2015;25(3):e401. doi: 10.5812/ijp.25(3)2015.401. PubMed PMID: 26199707; PubMed Central PMCID: PMC4505989. ## 24. Çam HH, Top FÜ. Overweight, obesity, weight-related behaviors, and health-related quality of life among high-school students in Turkey. Eat Weight Disord. 2019;25(5):1295-1302. doi: 10.1007/s40519-019-00762-0. PubMed PMID: 31463887. ## 25. Gökler ME, Buğrııl N, Metintaş S, Kalyoncu C. Adolescent obesity and associated cardiovascular risk factors of rural and urban life (Eskisehir, Turkey). Cent Eur J Public Health. 2015;23(1):20-5. doi: 10.21101/cejph.a3958. PubMed PMID: 26036094. ## 26. Ercan S, Dallar YB, Önen S, Engiz Ö. Prevalence of obesity and associated risk factors among adolescents in Ankara, Turkey. J Clin Res Pediatr Endocrinol. 2012;4(4):204-7. doi: 10.4274/jcrpe.714. PubMed PMID: 23149433; PubMed Central PMCID: PMC3537287. ## 27. Birch L, Savage JS, Ventura A. Influences on the development of children's eating behaviours: from infancy to adolescence. Can J Diet Pract Res. 2007;68(1):s1-s56. PubMed PMID: 19430591; PubMed Central PMCID: PMC2678872. ## 28. Farvid MS, Chen WY, Michels KB, Cho E, Willett WC, Eliassen AH. Fruit and vegetable consumption in adolescence and early adulthood and risk of breast cancer: population based cohort study. BMJ. 2016;353:i2343. doi: 10.1136/bmj.i2343. PubMed PMID: 27170029; PubMed Central PMCID: PMC5068921. ## 29. Wawrzyniak A, Myszkowska-Ryciak J, Harton A, Lange E, Laskowski W, Hamulka J, et al. Dissatisfaction with Body Weight among Polish Adolescents Is Related to Unhealthy Dietary Behaviors. Nutrients. 2020;12(9):2658. doi: 10.3390/nu12092658. PubMed PMID: 32878216; PubMed Central PMCID: PMC7551787. ## 30. Bartkowicz J, Mironiuk K. Assessment of selected nutritional behaviours among college adolescents from Pomerania province. Rocz Panstw Zakl Hig. 2018;69(4):387-395. doi: 10.32394/rpzh.2018.0045. PubMed PMID: 30525330. ## 31. Okeyo AP, Seekoe E, de Villiers A, Faber M, Nel JH, Steyn NP. Dietary Practices and Adolescent Obesity in Secondary School Learners at Disadvantaged Schools in South Africa: Urban–Rural and Gender Differences. Int J Environ Res Public Health. 2020;17(16):5864. doi: 10.3390/ijerph17165864. PubMed PMID: 32823510; PubMed Central PMCID: PMC7460370. ## 32. Lee JY, Ban D, Kim H, Kim SY, Kim JM, Shin IS, et al. Sociodemographic and clinical factors associated with breakfast skipping among high school students. Nutr Diet. 2021;78(4):442-448. doi: 10.1111/1747-0080.12642. PubMed PMID: 33047479. ## 33. Som N, Mukhopadhyay S. Body weight and body shape concerns and related behaviours among Indian urban adolescent girls. Public Health Nutr. 2015;18(6):1075-83. doi: 10.1017/S1368980014001451. PubMed PMID: 25079706. ## 34. Rocha LL, Gratão LHA, do Carmo AS, Costa ABP, de Freitas Cunha C, de Oliveira TRPR, et al. School Type, Eating Habits, and Screen Time are Associated With Ultra-Processed Food Consumption Among Brazilian Adolescents. J Acad Nutr Diet. 2021;121(6):1136-1142. doi: 10.1016/j.jand.2020.12.010. PubMed PMID: 33516640. ## 35. Gage R, Girling-Butcher M, Joe E, Smith M, Ni Mhurchu C, McKerchar C, et al. The Frequency and Context of Snacking among Children: An Objective Analysis Using Wearable Cameras. Nutrients. 2020;13(1):103. doi: 10.3390/nu13010103. PubMed PMID: 33396846; PubMed Central PMCID: PMC7824478. ## 36. Makansi N, Allison P, Awad M, Bedos C. Fruit and vegetable intake among Emirati adolescents: a mixed methods study. East Mediterr Health J. 2018;24(7):653-663. doi: 10.26719/2018.24.7.653. PubMed PMID: 30215475. ## 37. Gaylis JB, Levy SS, Kviatkovsky S, DeHamer R, Hong MY. Relationships between physical activity, food choices, gender and BMI in Southern Californian teenagers. Int J Adolesc Med Health. 2017;31(5):/j/ijamh.2019.31.issue-5/ijamh-2017-0067/ijamh-2017-0067.xml. doi: 10.1515/ijamh-2017-0067. PubMed PMID: 29168958. ## 38. Jodkowska M, Oblacińska A, Tabak I, Radiukiewicz K. Differences in dietary patterns between overweight and normal-weight adolescents. Med Wieku Rozwoj. 2011;15(3):266-73. PubMed PMID: 22006481. ## 39. Garcia-Continente X, Allué N, Pérez-Giménez A, Ariza C, Sánchez-Martínez F, López M, et al. Eating habits, sedentary behaviours and overweight and obesity among adolescents in Barcelona (Spain). An Pediatr (Barc). 2015;83(1):3-10. doi: 10.1016/j.anpedi.2014.07.006. PubMed PMID: 25475904. ## 40. Garden EM, Pallan M, Clarke J, Griffin T, Hurley K, Lancashire E, et al. Relationship between primary school healthy eating and physical activity promoting environments and children’s dietary intake, physical activity and weight status: a longitudinal study in the West Midlands, UK. BMJ Open. 2020;10(12):e040833. doi: 10.1136/bmjopen-2020-040833. PubMed PMID: 33371029; PubMed Central PMCID: PMC7757477. ## 41. Gearan EC, Monzella K, Jennings L, Fox MK. Differences in Diet Quality between School Lunch Participants and Nonparticipants in the United States by Income and Race. Nutrients. 2020;12(12):3891. doi: 10.3390/nu12123891. PubMed PMID: 33352695; PubMed Central PMCID: PMC7765856. ## 42. Albayrak S, Ergün A. The Effect of a School-Based Nutritional Program on the Anthropometric Measurements, Blood Test Results and Eating Habits of Adolescents. Clinical and Experimental Health Sciences. 2018;8(3):217-23. doi: 10.5152/clinexphealthsci.2018.720. ## 43. Knight KB, Cole JW, Dodd LM, Oakley CB. Eating good and moving like we should: a consideration for registered dietitians in schools. Int J School Health. 2017;4(2):e43043. doi: 10.17795/intjsh-43043. ##