EATING HABITS OF CHILDREN IN NORTH MACEDONIA: RESULTS FROM THE FIFTH ROUND OF THE CHILDHOOD OBESITY SURVEILLANCE INITIATIVE (COSI)
Keywords:eating habits, children, obesity, surveillance, health, noncommunicable diseases
In Europe, 29% of boys and 27% of girls aged seven to nine were overweight and 12% of boys and 9% of girls obese. Eating habits are important for understanding the obesity problem. The aim of this paper was to describe the eating behaviors of second grade children in North Macedonia (MKD).
A total of 3246 children were selected for data collection. Measurements of height and weight, as well as data for the eating habits was collected. Frequency of consumption of fruits, vegetables, soft drinks, savory snacks, and sweet snacks as well as breakfast consumption was used to create eating habits score.
There were significantly more obese boys while more girls were overweight. Obesity was more prevalent in urban areas of the country. Majority of children practiced neither “healthy” nor “less healthy” nutrition behavior. Children whose parents has tertiary education had significantly lower score comparing to those whose parents have secondary or lower education. Dietary habits had not a significant impact on BMI. 75% of girls and 78% of boys had breakfast every day. 40% of children daily consumed fruit and 37% consumed vegetables. Consumption of soft drinks was significantly higher in boys.
Eating habits of children may shed light on root causes for obesity in MKD. There is much room for improvement in the intake of fruit and vegetables. Consumption of snacks and particularly soft drinks should be reduced. National obesity surveillance program that collects data and present evidence to policy makers is crucial and should be supported.
World Health Organization. Noncommunicable diseases. Key facts. [Internet]. Geneva: WHO; 2018 [Cited 7 April 2021]. Available from:
World Health Organization. The WHO Global Monitoring Framework on noncommunicable diseases. Progress towards achieving the targets for the WHO European Region. Background paper for the WHO European Meeting of National NCD Directors and Programme Managers. Moscow: WHO; 2017.
NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 2017; 390(10113):2627–2642.
World Health Organization. WHO European Childhood Obesity Surveillance Initiative: Report of the Fourth Round of Data Collection (2015–2017); Geneva: WHO; 2020.
Spiroski I, Mikik V, Miloradovska N, Veljanovski, M, Shaqiri J, Petrova A et al. Changes in weight status of 7-year-old children in Macedonia between 2010 and 2019. Arch Pub Health 2021; 13(1):1-9.
World Health Organization. Increasing Fruit and Vegetable Consumption to Reduce the Risk of Noncommunicable Diseases. Geneva: WHO; 2014.
World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva: WHO; 2015.
European Commission. Commission regulation (EU) 2019/649 of 24 April 2019 amending Annex III to Regulation (EC) No 1925/2006 of the European Parliament and of the Council as regards trans fat, other than trans fat naturally occurring in fat of animal origin. Brussels: Official Journal of the European Union L 110; 2019.
Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: A systematic review and meta-analysis. Am J Clin Nutr 2013; 98:1084–1102.
Dietary guidelines for the population of the Republic of Macedonia [Internet]. Skopje: Institute of Public Health of the Republic of Macedonia; 2014 [cited 10 April 2021]. Available from: http://iph.mk/wp-content/uploads/2014/11/nasoki_ishrana-2014.pdf . (In Macedonian.)
Wijnhoven TM, van Raaij J, Breda J. WHO European Childhood Obesity Surveillance Initiative. Implementation of Round 1 (2007/2008) and Round 2 (2009/2010). Copenhagen: WHO Regional Office for Europe; 2014.
Ministry of Health. National Annual Program for Public Health. [Internet]. Skopje: MoH; 2020 [cited 11 April 2021]. Available from: http://zdravstvo.gov.mk/wp-content/uploads/2019/02/9.2019-programi-2019-javno-zdravje.pdf .
World Health Organization. Childhood Obesity Surveillance Initiative (COSI). Protocol. Copenhagen: WHO; 2017.
World Health Organization. Childhood Obesity Surveillance Initiative (COSI). Data collection procedures 2018-2019. Copenhagen: WHO; 2018.
Wijnhoven TM, van Raaij JM, Spinelli A, Rito AI, Hovengen R, Kunesova M et al. WHO European Childhood Obesity Surveillance Initiative 2008: Weight, height and body mass index in 6-9-year-old children. Pediatr Obes 2013; 8:79–97.
World Health Organization. Growth reference data for 5–19 years. Geneva: WHO; 2007 [cited 12 May 2021]. Available from: https://www.who.int/tools/growth-reference-data-for-5to19-years .
World Health Organization. Childhood Obesity Surveillance Initiative (COSI). Report on the fourth round of data collection, 2015–2017. Copenhagen: WHO; 2021.
Simovska JV, Jakimoska JR. Nutrition Status and Health Behaviour among School-Aged Children and Young Adolescents in Republic of Macedonia. Nutri Food Sci Int J 2016; 1(4):555567.
Kjosevska E. Health behavior in school-aged children in the Republic of Macedonia. Evrodijalog 2015; 20:111-20. European Food Safety Authority. EU Menu external scientific reports. [Internet]. Parma: EFSA; 2019 [cited 11 May 2021]. Available from:https://efsa.onlinelibrary.wiley.com/doi/toc/10.1002/(ISSN)18314732.scientificreports
Johnson JA, Johnson AM. Urban-Rural Differences in Childhood and Adolescent Obesity in the United States: A Systematic Review and Meta-Analysis. Child Obes 2015; 11(3):233-41.
Chirita-Emandi A, Barbu CG, Cinteza EE, Chesaru B, Gafencu M, Mocanu V et al. Overweight and Underweight Prevalence Trends in Children from Romania - Pooled Analysis of Cross-Sectional Studies between 2006 and 2015.
Erdei G, Bakacs M, Nagy B, Kaposvari C, Mak E, Nagy E et al. Substantial variation across geographic regions in the obesity prevalence among 6–8 years old Hungarian children (COSI Hungary 2016). BMC Public Health 2018; 18: 611.
Wolnicka K, Jarosz M, Jaczewska-Schuetz J, Taraszewska AM. Differences in the prevalence of overweight, obesity and underweight among children from primary schools in rural and urban areas. Ann Agric Environ Med 2016; 23(2): 341-344.
NCD Risk Factor Collaboration (NCD-RisC). Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature 2019; 569:260–264.
Fernández-Alvira J, Mouratidou T, Bammann K, Hebestreit A, Barba G, Sieri S et al. Parental education and frequency of food consumption in European children: The IDEFICS study. Public Health Nutr 2013; 16(3):487-498.
Williams J, Buoncristiano M, Nardone P, Rito AI, Spinelli A, Hejgaard T et al. A Snapshot of European Children’s Eating Habits: Results from the Fourth Round of the WHO European Childhood Obesity Surveillance Initiative (COSI). Nutrients 2020; 12:2481.
Dereń K, Weghuber D, Caroli M, Koletzko B, Thivel D, Frelut M-L et al. Consumption of Sugar-Sweetened Beverages in Paediatric Age: A Position Paper of the European Academy of Paediatrics and the European Childhood Obesity Group. Ann Nutr Metab 2019; 74:296–302.
Laverty AA, Magee L, Monteiro CA, Saxena S, Millett C. Sugar and artificially sweetened beverage consumption and adiposity changes: national longitudinal study. Int J Behav Nutr Phys Act 2015; 12(1):137–146.
Wang M, Yu M, Fang L, Hu RY. Association between sugar-sweetened beverages and type 2 diabetes: A meta-analysis. J Diabetes Investig 2015; 6(3):360–366.