Evolving Trends in Eating Habits of Children

Fetal Programming is a theory that focuses on the importance of the uterine environment during a critical period of the first 1,000 days from conception to the second birthday. Insults or changes in this time can lead to a permanent change in the structure or function of physiology and metabolism in later life.¹ This research gave rise to the developmental origins of health and disease hypothesis, in that environmental stressors, such as suboptimal nutrition, induce metabolic changes in utero and programme a higher risk of later chronic disease. Infant and child nutrition in utero, but also in infancy and childhood, may affect long-term health. Malnutrition is intergenerational in nature; poor nutrition starts in utero among women with poor nutritional status, and extends throughout the life course, affecting future generations. In low- and middle-income countries, low-birth-weight babies are nearly two to five times more likely to be underweight, stunted, or wasted during childhood.¹ This child will grow into a malnourished adolescent, then an adult, and if female, finally a malnourished pregnant woman, perpetuating the intergenerational cycle of malnutrition. As a result, it is critical to act early to ensure the best possible start in life.² In infancy, this may include adequate care for low-birth-weight infants, adequate breastfeeding, vitamin A supplementation, adequate immunization, minimized exposure to poverty, minimized vertical transmission of infections, and avoidance of environmental hazards. In early childhood, early nutritional intervention should include adequate complementary feeding, growth monitoring, management of wasting, and supplementation of iron, vitamin A, iodine and zinc, Additionally, other interventions include adequate immunization, minimizing exposure to poverty, avoidance of environmental hazards, and maximizing positive caregiver interactions and social and cognitive stimulation.

During the COVID-19 pandemic, enforced changes in social patterns meant that children spent more time away from structured school settings and isolated from support systems outside the home. As a result, many children may have experienced increased stress, irregular mealtimes, less access to nutritious foods, increased screen time, and decreased physical activity. A study conducted during this time discovered significant increases in BMI rates, with those already affected by overweight or obesity and younger school-aged children experiencing the greatest increases in BMI .³ Additionally, families and households who were already predisposed to socio-economic and health inequalities may have experienced additional disruptions to income, food security, and other social determinants of health. In recent years, there has been an increase in multiple forms of food insecurity including physical availability and financial access.⁴ According to the most recent Food Foundation⁵ survey, one in every four households with children (25.8%) experienced food insecurity, affecting an estimated 4 million children in the United Kingdom. This was the highest level of food insecurity since the start of the pandemic. The pandemic has had a catastrophic impact on the most disadvantaged and vulnerable groups in the United Kingdom, and the issue of household food insecurity is far from resolved. Exacerbating the problem of food insecurity is the increasing global food prices. This has huge implications for food security and health, particularly in developing countries, such as Africa and Asia, where cereals contribute as much as 70% of energy intake. The rising food prices have contributed to food insecurity in many low-income countries, which already had increased food insecurity in response to the pandemic, adverse weather events, and conflict. 

There is a need for an intergenerational approach with cross-discipline collaboration to impact the underlying determinants of malnutrition including poverty, maternal health, education, and household food security. 

References 

1 Guyatt H, Muiruri F, Mburu P, Robins A. Prevalence and predictors of underweight and stunting among children under 2 years of age in Eastern Kenya. Public Health Nutr. 2020 Jun;23(9):1599–608. 

2 Actions EN. Mainstreaming nutrition through the life-course. Geneva: World Health Organization, 2019. 

3 Lange SJ, Kompaniyets L, Freedman DS, Kraus EM, Porter R, Blanck HM, et al. Longitudinal trends in body mass index before and during the COVID-19 pandemic among persons aged 2–19 years – United States, 2018–2020. MMWR Morb Mortal Wkly Rep. 2021 Sep 9;70(37):1278. 

4 Ntenda PA. Association of low birth weight with undernutrition in preschool-aged children in Malawi. Nutr J. 2019 Dec;18(1):1–5. 

5 Food Foundation. New data show 4 million children in households affected by food insecurity; 2023. Available from: https://foodfoundation.org.uk/publication/ new-data-show-4-million-children-households-affected-food-insecurity