Beslenme Dostu Okul Programının Çocukların Beslenme Bilgi Düzeyleri ve Akdeniz Diyet Kalitelerine Etkisi

Öz

Amaç: Okullar, çocuklara erişim sağlama konusunda evrensel bir ortam oluştururlar ve beslenmeyle ilgili yetersizliklerle mücadelede büyük avantaj sağlarlar. Türkiye’de 2010 yılında “Okullarda Obezite ile Mücadelede Yeterli ve Dengeli Beslenme ve Düzenli Fiziksel Aktivite Alışkanlığının Kazandırılması” başlığı altında “Beslenme Dostu Okullar Programı” hayata geçirilmiştir. Bu çalışmanın amacı, beslenme dostu okul programının çocukların beslenme bilgi düzeyleri ve Akdeniz diyet kalitelerine etkisini değerlendirmektir. Yöntem: Çalışmaya üçü beslenme dostu okul programında yer alan ve dördü beslenme dostu okul programında yer almayan toplam yedi özel okul dahil edilmiştir. Çalışmanın örneklemi her grupta 250 öğrenci olacak şekilde toplam 500 öğrenci olarak belirlenmiştir. Bu kapsamda öğrencilere genel bilgiler, beslenme bilgi düzeyleri, Akdeniz Diyet Kaliteleri (KIDMED) ve antropometrik ölçümleri içeren anket formu uygulanmıştır. Bulgular: Beslenme dostu olan ve olmayan okullarda okuyan öğrencilerin Beden Kütle İndeksi (BKİ) sınıflandırmaları ve beslenme bilgi düzeyleri arasındaki fark anlamlı değildir (p>0,05). Ancak öğrencilerin Akdeniz diyet kaliteleri (KIDMED) arasındaki fark anlamlıdır (p<0,05). Çalışmada öğrencilerin beslenme bilgi düzeyleri ile Akdeniz diyet kaliteleri arasında beslenme dostu okul programı, sınıf, yaş, ebeveynlerin eğitim düzeyleri ve annelerin çalışma durumları ayrı ayrı modele dahil edildiğinde pozitif yönlü anlamlı ilişki olduğu görülmüştür (p<0,05). Sonuç: Beslenme dostu okul kriterlerinin geliştirilmesi, beslenme dostu okullara yapılan denetimlerin arttırılması, beslenme dostu olmayan okulların teşvik edilmesi, okullarda beslenmeyle ilgili aktivitelerin (beslenme kulübü vb.) ve derslerin arttırılması yönünde politikalar geliştirilmelidir. Beslenme dostu okul programının doğru yöntemlerle geliştirilerek yaygınlaştırılması beslenme bozukluklarını önlemede avantaj sağlayacaktır.

Anahtar Kelimeler

• Beslenme dostu okul
• beslenme bilgi düzeyi
• akdeniz diyet kalitesi

The Effect of Nutri̇ti̇on-Friendly Schools Program on Children's Nutrition Knowledge Levels and Mediterranean Diet Quality

Öz

Aim: Schools create a universal environment for providing access to children and are a great advantage in tackling nutritional deficiencies. In Turkey, the “Nutrition-Friendly Schools Program” was launched in 2010 under the title of “Adequate and Balanced Nutrition and Regular Physical Activity Habits in the Fight Against Obesity in Schools”.The aim of this study is to evaluate the effect of a nutrition-friendly schools program on children's nutritional knowledge and Mediterranean diet quality. Method: A total of seven schools, three of which are in the nutrition-friendly schools program and four of which are not in the nutrition-friendly schools program, were included in the study. The sample of the study was determined as 500 students in total, with 250 students in each group. In this context, a questionnaire including general information, nutritional knowledge levels, KIDMED and anthropometric measurements was applied to the students. Results: The difference between BMI classifications and nutritional knowledge levels of students studying in nutrition-friendly and non-nutrition-friendly schools is not significant (p>0.05). However, the difference between the Mediterranean diet quality (KIDMED) of the students studying at schools that are nutrition-friendly and those that are not, is significant (p<0.05). When multiple linear regression analysis was performed in the study, it was observed that there was a positive significant relationship between the nutritional knowledge levels of the students and the Mediterranean diet quality when the nutrition-friendly schools program, class, age, education levels of the parents and the working status of the mothers were included in the model separately (p<0.05). Conclusion: As a result, policies should be developed to develop criteria for nutrition-friendly schools, to increase inspections of nutrition-friendly schools, to encourage non-nutrition-friendly schools, to increase nutrition-related activities (nutrition clubs, etc.) and lessons in schools. Developing and disseminating the nutrition-friendly schools program with the right methods will provide an advantage in preventing nutritional disorders.

Anahtar Kelimeler

• Nutrition Friendly School
• Nutrition Knowledge Level
• Mediterranean Diet Quality

Kaynakça

1. World Health Organisation (WHO). Nutrition-Friendly Schools Initiative (NFSI) www.who.int/nutrition/topics/NFSI_Briefing_presentation.pdf.2022. Erişim tarihi: 11 Ekim 2022.
2. World Health Organisation (WHO). Nutrition- Friendly Schools Initiative (NFSI): a school-based program to address the double burden of malnutrition [Internet]. Geneva: Department of Nutrition for Health and Development; 2001. Available from: http://www.who.int/ nutrition/topics/NFSI_Briefing_presentation.pdf.2006. Erişim tarihi: 11 Ekim 2022.
3. Elkhouri Edde C, Delisle H, Dabone C, Batal M. Impact of the nutrition-friendly school initiative: analysis of anthropometric and biochemical data among school-aged children in Ouagadougou. Global Health Promotion. 2019;27(2):1757975918789350.
4. Delisle H, Agueh V, Fayomi B. Partnership research on nutrition transition and chronic diseases in West Africa-trends, outcomes and impacts. BMC international health and human rights. 2019;11(2):Q10.
5. World Health Organisation (WHO). file:///Users/macbook/Downloads/9789241514620-eng.pdf. 2018. Erişim tarihi: 09 Ekim 2022.
6. Abdollahi M, Amini M, Kianfar H, et al. Qualitative study on nutritional knowledge of primary-school children and mothers in Tehran. East Mediterr Heal J. 2008;14:82-9.
7. Hwenda L. Addressing diet related risk factors for non-communicable diseases. Globe Heal Gove. 2013.
8. Serra-Majem L, Ribas L. Paises mediteraneos, dietas mediterraneas y political de nutricion. Rev. Esp. Nutr. Comunitaria. 1995;1(4):187-191.

9. Serra-Majem L, Ribas L, Garcia A, Pérez-Rodrigo C, Aranceta J. Nutrient adequacy and Mediterranean Diet in Spanish school children and adolescents. European Journal Of Clinical Nutrition. 2003;57(1):35.
10. Serra-Majem L, Ribas L, Ngo J, Ortega Rm, Garcia A, Pérez-Rodrigo C, Aranceta J. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutrition. 2004;7(7):931-935.
11. Zhang J, Hebert JR, Muldoon MF. Dietary fat intake is associated with psychosocial and cognitive functioning of school- aged children in the United States. The Journal of Nutrition. 2005;135(8):1967-1973.
12. Falkingham M, Abdelhamid A, Curtis P, Faiiweather-Taii S, Dye L, Hooper L. The effects of oral iron supplementation on cognition in older children and adults: a systematic review and meta-analysis. Nutrition Journal. 2010;9(1):4.
13. Baym CL, Khan NA, Monti JM, et al. Dietary lipids are differentially associated with hippocampal-dependent relational memory in prepubescent children. The American Journal of Clinical Nutrition. 2014;99(5):1026-1032.
14. Jiao J, Li Q, Chu J, Zeng W, Yang M, Zhu S. Effect of n? 3 PUFA supplementation on cognitive function throughout the life span from infancy to old age: a systematic review and meta-analysis of randomized controlled trials. The American Journal of Clinical Nutrition. 2014;100(6):1422-1436.
15. Fuhr JE, Barclay KH. The Importance of appropriate nutrition and nutrition education. Young Children. 1998;53(1):74-80.
16. Milli Eğitim Bakanlığı (MEB) https://okulsagligi.meb.gov.tr/meb_iys_dosyalar /2018_12/21163335_Beslenen_Dostu_Okul_Kriterleri.pdf . 2018. Erişim tarihi: 09 Ekim 2022.
17. Milli Eğitim Bakanlığı https://kecioren.meb.gov.tr/www/ozel-ogretim-kurumlari-ilkokullari/icerik/2241.2021. Erişim tarihi: 10 Ekim 2022.
18. Sağlık Bakanlığı https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-hareketli-hayatdb/okulsagligi/beslenme_dostu/Beslenme_Dostu_Okullar_AB_Ile_Baslayan_Iller.pdf.2018. Erişim tarihi: 13 Ekim 2022.
19. Kalaycioglu O, Akhanli SE. The importance and basic principles of power analysis in health research: Practical examples on medical studies. Turkish Journal of Public Health. 2020;18(1):103-112.
20. Uzsen H. Okul Çağı Çocuklarının Beslenme Alışkanlıklarının Değerlendirilmesi ve Oyunla Beslenme Eğitiminin Beslenme Alışkanlıklarına Etkisi. [Yüksek lisans tezi]. Ege Üniversitesi, İzmir, 2016.
21. Şahingöz SA, Özgen L, Yalçın E. Akdeniz Diyet Kalitesi Ölçeğinin (Mediterranean Diet Quality-KIDMED) geçerlik ve güvenirlik çalışması. In Proceedings Book of 5th International Eurasian Congress on Natural Nutrition, Healthy Life & Sport, 2019;1078-1088. Malatya Turgut Ozal University Scientific Publication.
22. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. 1988;177:3-8. Champaign, IL: Human kinetics books.
23. World Health Organisation (WHO) Source: WHO. Training Course on Child Growth Assessment. Interpreting Growth Indicators. Geneva: WHO. 2008.
24. Erbay Ş, Beydoğan H. Eğitimcilerin eğitim araştırmalarına yönelik tutumları. Ahi Evran Üniversitesi Kırşehir Eğitim Fakültesi Dergisi. 2017;18(3):246-260.
25. Manios Y, Kafatos A. Health and nutrition education in elementary schools: changes in health knowledge, nutrient intakes and physical activity over a six year period. Public Health Nutrition. 1999;2(3a):445-448.
26. Pirouznia M. The influence of nutrition knowledge on eating behavior. The role of grade level. Nutrition Food Science. 2001;31:62-66.
27. Powers AR, Struempler BJ, Guarino A, Parmer SM. Effects of a nutrition education program on the dietary behavior and nutrition knowledge of secondgrade and third-grade students. Journal of School Health: 2007;75:129-133.
28. Serra-Majem L, Garci´A-Closas R, Ribas L, Pe´Rez-Rodrigo C, Aranceta J. Food patterns of Spanish schoolchildren and adolescents: The enKid Study. Public Health Nutrition. 2001;4:1433-8.
29. Serra-Majem L, Roman B, Estruch R. Scientific evidence of interventions using the Mediterranean Diet. A systematic review. Nutrition Reviews. 2006;64:P27-P47.
30. Barclay L. Mediterranean diet may protect against childhood asthma-like symptoms and rhinitis. medscape. Available from:http://cme.medscape.com/viewarticle/ 554819.2008.
31. Benetou V, Trichopoulou A, Orfanos P, et al. Greek EPIC cohort. Conformity to traditional Mediterranean diet and cancer incidence. the Greek EPIC cohort. British Journal of Cancer. 2008;99:191-195.
32. Martínez-Gonzalez MA, De La Fuente-Arrillage C, Nunez-Cortoba LM, et al. Adherence to the Mediterranean diet and risk of developing diabetes. Prospective cohort study. British Medical Journal. 2008;336:1348-1351.
33. Muñoz MA, FíTo M, Marrugat J, Covas Mİ, Schröder H. Adrehence to the Mediterranean diet is associated with better mental and physical health. British Journal of Nutrition. 2009;15:1-7.
34. Panagiotakos DB, Dimakopolou K, Katsouyanni K, et al. On behalf of the AIRGENE study group. Mediterranean diet and inflammatory response in myocardial infarction survivors. International Journal of Epidemiology. 2009;38:856-866.
35. Bassett R, Chapman GE, Beagan BL. Autonomy and control: The construction of adolescent food choice. Appetite. 2008;50:325-332.
36. Shahsanai A, Farajzadegan Z, Sichani ZH, Heidari K, Omidi R. Assessment of the relationship between nutritional knowledge and anthropometric indices in Isfahan children and adolescent. Advanced Biomedical Research. 2018;7:110.
37. Di Cesare M, Sori? M, Bovet P, et al. The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Medicine. 2019;17(1):1-20.
38. Han JC, Lawlor DA, Kimm SY. Childhood obesity. The Lancet. 2010;375(9727):1737-1748.
39. Türkiye'de Okul Çağı (6-10 Yaş Grubu) Çocukların Büyümesinin İzlenmesi (TOÇBİ) Projesi 2009. T.C. Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü, Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi Beslenme ve Diyetetik Anabilim Dalı, Sağlık Bakanlığı Milli Eğitim Bakanlığı Yayın No: 834, Ankara, 2011. https://hsgm.saglik.gov.tr/depo/birimler/sagliklibeslenmehareketlihayatdb/Yayinlar/kitaplar/diger-kitaplar/tocbi-kitap.pdf. Erişim tarihi: 20 Ekim 2022.
40. COSI-TUR. Turkey childhood (primary school 2nd grade students) obesity research, Ankara. 2016. https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-hareketli-hayat-db/Yayinlar/ingilizceyayinlar/Turkey_Childhoodages_78_Obesity_Surveillance_Initiavite_Cosi-Tur_2013_Key_Findings.pdf. Erişim tarihi: 18 Ekim 2022.
41. Filiz B. İstanbul İlinde Bir İlkokulda Obez Olan ve Olmayan 5-7 Yaş Arası Okul Çağı Çocuklarında Besin Alımını Etkileyen Faktörler. [Yüksek lisans tezi]. Haliç Üniversitesi, İstanbul, 2015.
42. Lloyd JJ, Wyatt KM, Creanor S. Behavioral and weight status outcomes from an exploratory trial of the Healthy Lifestyles Program (HeLP): a novel school-based obesity prevention programme. BMJ open. 2012;2(3):e000390.
43. Akman M, Tuzun S, Ünalan PC. Healthy nutrition and physical activity status in adolescents. Nobel Medicus Journal. 2012;8(1):24-29.
44. Özcan BA, Uslu B, Ercan A. Comparison of nutrition knowledge levels of children given direct or indirect nutrition education. Journal of Nutrition and Diet. 2019;1-10.
45. Merrotsy A, Mccarthy Al, Flack J, Lacey S, Coppinger T. Project Spraoi: dietary intake, nutritional knowledge, cardiorespiratory fitness and health markers of Irish primary school children. International Journal of Child Health and Nutrition, 2018;7(2):63-73.
46. Alay F. Okul Çağı Çocuklarına Verilen Beslenme Eğitimi Programının Beslenme Alışkanlıkları, Besin Tüketim Sıklıkları ve Beslenme Bilgisi Üzerine Etkisinin Değerlendirilmesi. [Yüksek lisans tezi]. Selçuk Üniversitesi, Konya, 2019.
47. Avan M. Mardin İli Kızıltepe İlçesi Merkez İlköğretim Okullarında Okuyan 6. 7. ve 8. Sınıf Öğrencilerinin Beslenmesi Üzerine Bir Araştırma. [Yüksek lisans tezi]. Selçuk Üniversitesi, Konya, 2006.
48. Aktaş N. Gaziantep İl Merkezindeki İlköğretim 2. Sınıf Öğrencilerinin Okul Kantininden Besin Seçimlerinin ve Annelerinin Besin Güvenliği Bilgi Düzeylerinin Belirlenmesi. Yüksek lisans tezi, Selçuk Üniversitesi, Konya, 2010.
49. Sanlıer N, Kılıç E. Comparison of nutritional habits of three generations of women. Kastamonu Journal of Education. 2007;15(1):31-44.
50. Sahingoz SA, Dogan L. The implementation and evaluation of a nutrition education program about Mediterranean diet for adolescents. Progress in Nutrition. 2019;21(2):316-326.
51. Kabaran S, Gezer C. Determination of obesity with Mediterranean diet compliance in children and adolescents in the Turkish Republic of Northern Cyprus. Turkish Journal of Pediatrics. 2013;7(1):11-20.
52. Bawaked RA, Gomez SF, Homs C, et al. Association of eating behaviors, lifestyle, and maternal education with adherence to the Mediterranean diet in Spanish children. Appetite. 2018;130(1):279-285.
53. Roccaldo R, Censi L, D'addezio L, et al. Adherence to the Mediterranean diet in Italian school children (The ZOOM8 Study). International Journal of Food Sciences and Nutrition. 2014;65(5):621- 628.
54. Rito Ai, Dinis A, Rascôa C, et al. Mediterranean Diet Index (KIDMED) adherence, socioeconomic determinants, and nutritional status of portuguese children: the eat mediterranean program. Portuguese Journal of Public Health. 2018;36(3):122-130.
55. Tehrani AN, Farhadnejad H, Salehpour A, Beyzai B, Hekmatdoost A, Rashidkhani B. The association between nutritional knowledge and adherence to a Mediterranean dietary pattern in Iranian female adolescents. International Journal of Adolescent Medicine and Health. 2019;33(4):20180188.
56. Beydoun MA, Wang Y. Do nutrition knowledge and beliefs modify the association of socio-economic factors and diet quality among US adults? Preventive medicine. 2008;46(2):145-153.