Dietary Characteristics of Hong Kong Young Children: Implications for Nutrition Education

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1 HK J Peditr (new series) 2006;11: Dietry Chrcteristics of Hong Kong Young Children: Implictions for Nutrition Eduction LL HUI, EAS NELSON Abstrct Key words Objectives: To exmine the dietry pttern of Hong Kong young children nd its impliction for nutrition eduction. Methods: Dietry ptterns of 316 children ged 6-7-yers (121 overweight, 130 middle-weight nd 65 low-weight children), were ssessed by stndrdised questionnire nd 3-dy dietry record. Results: Mcronutrient composition (crbohydrtes: 53%; proteins: 16% nd fts: 31%) ws similr in the three weight groups nd in line with recommendtions. Our subjects minly consumed proteins from niml sources. Seventy-nine percent of the subjects reported routine sncking during school breks nd ft from sncks (22%) ws higher thn tht reported in 1993 (15%). An indequte vegetble (84 g/dy) intke ws observed. Absence of vegetbles during lunch ws reported by 22% of subjects nd this ws ssocited with eting out. Conclusion: Further nutrition eduction in young children in Hong Kong should focus on helthy choices of sncks, blncing niml nd plnt sources of proteins nd dequte consumption of vegetbles nd fruits. The need for helthy school lunch nd snck progrmmes should be emphsised. Children; Diet; Nutrition; Overweight Introduction The importnce of blnced diet for young children is obvious in terms of promoting helth nd optiml growth. However promotion of helthy eting is not esy in modern society where children re confronted with bundnt, often unhelthy, food choices. Nutrition-relted problems mong 7-yer-old children reported in 1993 Hong Kong nutritionl nd growth survey included high serum cholesterol levels nd high protein consumption. 1 In Hong Kong the prevlence of childhood overweight 1 nd type II dibetes 2 is on the increse. Strtegies to tckle these trends will include nutritionl wreness progrmmes to encourge Deprtment of Peditrics, The Chinese University of Hong Kong, Prince of Wles Hospitl, Shtin, N.T., Hong Kong, Chin LL HUI EAS NELSON Correspondence to: Dr EAS NELSON Received October 21, 2005 MPhil MBChB, MD, FHKCPed helthy eting hbits from young ge. Development of such progrmmes requires knowledge of current nutritionl problems nd flwed dietry hbits. In 2000, cse-control study ws undertken to identify risk fctors for childhood overweight nd obesity in Hong Kong Chinese children ged 6-7 yers old. 3 We now report descriptive informtion on the dietry hbits nd ptterns of this study smple. Methods Subjects Subjects prticipting in cse-control study to identify risk fctors of childhood overweight were recruited from primry-one students (ge 6-7 yers) who were ttending one of 12 Student Helth Service Centres of the Deprtment of Helth for their nnul body check during the period Februry 2000 to My We developed Body Mss Index (BMI, weight in kg/height 2 in m 2 ) cutoffs from previous 1993 cross-sectionl Hong Kong growth survey dt. 4 These cutoffs identified the 8% of children who were clssified s overweight in this previous study, s well s the 10% of children in the middle weight group nd the 8%

2 256 Dietry Chrcteristics of HK Young Children with the lowest weights. In this wy, three groups of subjects were identified nd recruited: n overweight group ( 92nd centile for BMI); middle-weight group (45th-55th centile for BMI); nd low-weight group ( 8th centile for BMI). The BMIs of the 6-7 yers old students were clculted from their weight (to the nerest 0.1 kg) nd height (to the nerest 0.1 cm) mesured by nursing stff t the Student Helth Service Centres. We did not intend to recruit rndom smple for this study but insted three distinct weight groups. Dt Collection Ech prticipnt ws visited t home where fce-tofce interview ws crried out to collect informtion on demogrphic dt, lifestyle chrcteristics nd dietry prctice. Food intkes of children were exmined using 3-dy dietry recording method. Nmes, serving sizes, cooking methods nd the brnd nmes of ll foods consumed over three dys (two weekdys nd one weekend) were recorded on set of stndrd recording sheets which were posted prior to the home interview. During the home visits the completed 3-dy dietry record sheets were collected by the interviewer. Dt on the record sheets were checked nd ny vgue informtion ws clrified with the fmilies or the children using coloured food pictures nd simple utensils, such s tblespoons, tespoons nd glsses. Assessment of Food nd Nutrient Intke Food dt from the 3-dy dietry record ws computer entered using the professionl edition of the SERVE Nutritionl Mngement System for windows (M & H Willims Pty Ltd). 5 A Hong Kong food composition tble bsed on food tbles from Britin, Chin, Tiwn, nd US 1 ws specilly incorported into the SERVE progrm for ssessing the energy intke, mcronutrient intke nd food intke over the 3 dys. Sttisticl Method Simple logistic regression ws used to ssess the difference of energy nd mcronutrient intke of overweight nd middle-weight children with overweight s the dependent vrible. The differences mong groups were ssessed by chi-squre tests (for ctegoricl vribles) nd ANOVA (for continuous vribles). All the sttisticl nlyses were done by SPSS, the Sttisticl Pckge for Socil Sciences (SPSS for Windows, versions 10.1 nd 11.0; SPSS Inc., Chicgo, United Sttes). This study ws pproved by the Ethics Committee of The Chinese University of Hong Kong nd written informed consent ws obtined from the prents of ll subjects. Results The men ge of the subjects ws 6.7±0.3 yers. The men BMI for the overweight (n=121), middle-weight (130) nd low-weight (65) groups were 20.5±2.1 kg/m 2, 15.0± 0.2 kg/m 2 nd 12.8±0.3 kg/m 2 respectively. There ws no significnt difference in the BMI between mle nd femle subjects in ech weight group. Ninety-eight point five percent of the children in the overweight group met the interntionl cut-off for overweight (equivlent to 25 kg/ m 2 in dults) derived by Cole et l. 6 All but one of the children in the low weight group ws within Hong Kong norml weight rnge (80-120% medin weight-for-height). Dietry Prctice Min mels: The usul frequency of hving three mels nd sncks in-between mels ws reported by the prents/ cregivers. Thirteen percent of our subjects "skipped brekfst", which ws defined s hving brekfst (nything tht contined energy) less thn three times week. There ws no significnt difference found mong different weight groups. Twenty-two percent of children were seldom or never provided with vegetbles during lunch while 99% of the prents climed tht vegetbles were lwys vilble t dinner. Absence of vegetbles during lunch ws ssocited with eting out for lunch three times or more per week. Fruits were vilble dily for 93.3% of subjects. Prents/cregivers were sked to pick the most preferred nd most disliked food group of the children from seven ctegories: cerel; fish; met; vegetbles; fruits; milk products & eggs; nd dessert. Met (30%) ws the most preferred food nd vegetbles (27%) were the most disliked. Sncking: Seventy-nine percent of subjects reported tht they lwys hd food during school breks nd 87% of them brought their snck from home. Eighty-two percent reported some restriction on sncking in terms of sncking time, type of snck nd mount of snck. Frequency of eting sncks while wtching television ws evluted. Eting brekfst, lunch or dinner while wtching television ws not counted s snck. Eighty-five percent of subjects seldom or never requested snck while wtching television nd 83% sid unhelthy junk foods (i.e. foods with high ft or high sugr content) were seldom or never given t this time. Eting out: Eting out ws defined s lmost ll food served during mel ws prepred or bought from outside stores. Tke wy mels bought from resturnts nd hving school lunch boxes were therefore counted s eting out. Results showed tht 6.7%, 27%, 2% of brekfst, lunch

3 Hui nd Nelson 257 nd dinner mels were eten out 3 times/week or more respectively. Chinese-style resturnts nd Western-style fst food resturnts were the most frequently visited venues with respectively 36% nd 26% of fmilies visiting one or more times per week. Nutritionl Supplements: Respectively 67%, 88% nd 86% of overweight, middle-weight nd low-weight children hd ever been given nutritionl supplements. Significntly fewer overweight children were ever given supplements (p<0.0001). Among fish oil, vitmin C, multi-vitmins nd clcium, fish oil ws the most populr supplement. Sixtynine percent hd ever been given fish oil, nd 44% of the children strted tking these supplements before three yers of ge nd 41% hd received the fish oil supplements for more thn one yer. Food nd Nutrient Intke Energy & Mcronutrients intke: Averge energy intke ws generlly higher in boys thn girls (Tble 1). The overweight group hd higher totl energy intke but the lowest energy intke per kg of weight. Percentge energy from crbohydrte, protein nd ft were on verge 53%, 16% nd 31% respectively. Twelve percent of the overweight children hd n energy intke greter thn tht recommended (1850 kcl/dy for children ged 5-7 with medin weight 20.5 kg). 7 The men sturted ft, monounsturted ft, polyunsturted ft, cholesterol intkes nd P/S rtio (polyunsturted ft intke : sturted ft intke) were not different mong the weight-groups nor between the different sexes (Tble 2). The rnge of cholesterol intke ws wide Tble 1 Energy nd mcronutrient intke mong the three weight groups. Dily energy intke Energy intke per kg weight Averge intke (g) (kcl) (kcl) Crbohydrte Protein Ft Overweight group Boys n= ±300 51±12 209±47 66±17 55±15 Girls n= ±301 50±12 190±44 56±16 53±13 Middle-weight group Boys n= ±263 71±13 202±37 61±17 51±14 Girls n= ±256 72±12 194±40 60±16 49±13 Low-weight group Boys n= ±246 79±13 203±40 59±16 50±12 Girls n= ±272 82±18 186±38 57±14 49±14 Averge Boys 1518±281 64±17 203±40 63±17 52±14 Girls 1435±276 67±19 190±40 59±16 50±13 All 1475±281 65±18 197±40 61±16 51±14 Rnge Tble 2 Ft intke mong the three weight groups Dily ft intke (g/d) P/S rtio Dily cholesterol intke (g/d) Sturted ft Mono-unsturted ft Poly-unsturted ft Overweight group Boys n=63 18±5.9 20±5.2 11± ± ±103 Girls n=58 18±5.4 19±5.3 10± ± ±114 Middle-weight group Boys n=64 18±6.0 18± ± ± ±118 Girls n=66 16±5.0 18± ± ± ±111 Low-weight group Boys n=24 17±5.2 19± ± ± ±82 Girls n=41 17±6.4 17± ± ± ±100 Averge 17±5.7 18± ± ± ±108 Rnge

4 258 Dietry Chrcteristics of HK Young Children nd 35% of children hd cholesterol intkes over 300 mg/d. The proportion of energy from different mels ws similr for the mcronutrient distribution. The mjority of the energy nd mcronutrients intkes were from the lunch (29%) nd dinner (31%). Energy intke outside the three min mels, i.e. sncking, during morning, fternoon nd evening contributed respectively 4.5%, 13.4% nd 4.1% of the totl energy intke. Sncking contributed 22±10% of the totl energy intke which is more thn tht from brekfst (18%). Ninety-five percent of subjects consumed t lest one fternoon snck within the three dys of diet recording. Food consumption: Cerel foods provided the gretest mount of energy (bout 43%) in ll three weight-groups (Tble 3). Met nd poultry provided the second gretest mount of energy (18% in overweight group nd 15% in both middle-weight nd low-weight groups). Beverges (6%), dessert (4-5%) nd confectionry (1-3%) provided bout 12-14% of dily energy intke. The verge vegetble nd fruit consumption were 84 g/dy nd 97 g/dy respectively. Met nd poultry provided the gretest proportion of both ft (32%) nd protein (39%) in diets (dt not shown in the tble). Added ft, minly spreding nd cooking oil provided the second gretest proportion of ft (17%) while fish nd sefood ws the second most importnt source of protein (14%). Milk nd milk products provided the third lrgest proportion of both ft (12%) nd protein (10%). The verge energy contribution from beverges nd milk ws respectively 8.8%, 10% nd 11% for the overweight, middle-weight nd low-weight groups. According to the consumption frequency, on verge, ech child t the ge of 6-7 hd 408 ml of sugry drinks nd 0.8 cn of soft drinks (355 ml) per week. Among those who hd milk during the 3-dy dietry recording, 92% of them hd full crem milk nd the rest hd skimmed milk. Fortythree percent hd t lest one glss (250 ml) of full crem milk every dy during the three-dy dietry record. Comprison With 1993 Growth nd Nutrition Study Age, men weight, height nd BMI of the subjects in the middle-weight group of this present study were comprble with the 7-yer-old smple of the 1993 Hong Kong growth nd nutrition study (Tble 4). The bsolute dily energy intke ws lower in boys but similr in girls in this study when compring with the 1993 dt. However when djusted for weight, our subjects hd lower energy intke for both sexes. Ft intke ws similr for both sexes while protein intke ws 16 g lower in boys nd 10 g lower in girls in the present study. Proportion of energy consumed from sncks incresed in this study while tht from brekfst decresed. Sturted ft intke ws higher while the P/S rtio ws lower in this present study. The mjor source of ft ws met nd poultry in both studies. Discussion We previously identified high energy consumption s risk fctor for overweight in this study popultion. 3 However their mcronutrient composition ws not different from tht of the norml weight group. From the 3-dy dietry record, the distribution of energy from crbohydrtes (53%), proteins (16%) nd fts (31%) ws similr mong the three weight groups nd ttined the gols proposed by the Food nd Environmentl Hygiene Deprtment of the Hong Kong SAR government 8 which re bsed on recommendtions from World Helth Orgniztion nd Food nd Agriculture Orgniztion. Percentge energy from ft ws lower thn those of Minlnd Chin [35% in 1992], 9 Jpn [33% in 1994] 10 nd the US [35% in 1994] 11 but similr to tht of the sevenyer-old smple in the 1993 Hong Kong study [29%]. 1 Both the ctul sturted ft intke nd the poly-unsturted ft were higher in our subjects compred with the 1993 dt. However prt of the difference might be due to the difference in ftty cids intke ssessment methods (1993: chemicl nlyses, present study: deduced from food composition tbles). The 1993 study showed tht the children hd high cholesterol levels prompting the recommendtion tht sturted ft consumption in Hong Kong children be reduced. 12 Although the cholesterol levels of our subjects re not known, it is estimted tht 35% of them consumed more thn 300 mg of cholesterol on dy. Promoting helthy food choice to void over-consumption of cholesterol mong young children would seem desirble. The mount of protein consumed in the young children in this study ws twice the lowest sfe protein intke recommendtion from the U.S. 7 This finding is consistent with previous report of reltively high protein consumption in Hong Kong children compred with Austrlin dt. 1 Our dt lso suggested tht the children minly consumed proteins from niml sources. Plnt sources of protein supplies fiber, vitmins nd minerls nd therefore it is good to blnce the consumption of plnt nd niml sources of proteins mong Hong Kong young children. When choosing niml proteins, children should be dvised to choose those with less sturted ft.

5 Hui nd Nelson 259 Tble 3 Percentge energy contributed by food groups Dily intke Overweight group Middle-weight group Low-weight group Cerel n=316 Amount (g) 436± ± ±95 Kcl (%energy) 707±193 (42%) 695±154 (44%) 653±163 (43%) Vegetbles n=311 Amount (g) 89±68 83±60 78±42 Kcl (%energy) 48±47 (2.9%) 43±41 (2.7%) 39±37 (2.5%) Fruits n=235 Amount (g) 112±79 99±74 81±49 Kcl (%energy) 61±45 (3.7%) 58±45 (3.7%) 46±27 (3.0%) Met n=314 Amount (g) 120±51 100±45 91±38 Kcl (%energy) 296±126 (18%) 245±117 (15%) 233±99 (15%) Fish n=295 Amount (g) 48±34 48±31 49±31 Kcl (%energy) 66±49 (4.0%) 63±41 (4.0%) 62±41 (4.0%) Milk/Milk pdt n=234 Amount (g) 142± ± ±132 Kcl (%energy) 108±89 (6.5%) 112±89 (7.1%) 136±88 (8.9%) Eggs n=258 Amount (g) 31±19 29±18 25±14 Kcl (%energy) 65±41 (3.9%) 63±42 (4.0%) 51±31 (3.3%) Lentils/Bens n=208 Amount (g) 26±25 29±29 26±23 Kcl (%energy) 27±29 (1.6%) 36±49 (2.3%) 26±25 (1.7%) Beverges n=275 Amount (g) 184± ± ±115 Kcl (%energy) 97±73 (5.8%) 100±68 (6.3%) 93±54 (6.1%) Dessert n=146 Amount (g) 52±35 53±37 51±39 Kcl (%energy) 67±40 (4.0%) 79±44 (5.0%) 69±44 (4.5%) Confectionry n=119 Amount (g) 9.6±10 7.2±9.4 13±18 Kcl (%energy) 38±56 (2.3%) 18±28 (1.1%) 48±94 (3.1%) Added ft n=315 Amount (g) 10±5 8.5± ±3.0 Kcl (%energy) 86±42 (5.2%) 74±29 (4.7%) 75±24.0 (4.9%) Cerel includes grins, products mde from flours or food with mjority content mde from crbohydrte rich ingredient; Vegetbles includes ll vegetbles nd mushrooms, but excluded pickled vegetbles; Fruits includes fresh fruit juice, fresh, tinned nd dried fruits; Met includes pork, beef, lmb, poultry nd offl from these nimls; Fish includes ll fish nd sefood; Milk & Milk products include milk, cheese, yoghurts nd other byproduct of milk; Eggs includes eggs of different vrieties; Lentils & Bens include ben curd, dried nd fresh bens; Beverges include ll diluted fruit juice, sweeten drinks, soft drinks but exclude milk; Dessert includes Chinese sweet soup, crem cke, ice-crem...etc; Confectionry includes chocoltes nd sweets; Added ft includes cooking oil nd spreding.

6 260 Dietry Chrcteristics of HK Young Children Tble 4 Comprison of the nutrient intke with 1993 growth nd nutrition study Middle-weight group of Present study Men ge 6.63±0.3 7 Number of subjects Boys Girls Men weight/kg Boys 21±1.6 20±3.3 Girls 20±1.5 19±3.2 Men height/cm Boys 118± ±4.4 Girls 116± ±4.7 Men BMI Boys 15±0.2 15±1.9 Girls 15±0.2 15±1.7 Energy intke (kcl) Boys 1494± ±379 Girls 1443± ±331 Energy intke per unit weight (kcl/kg) Boys 71±13 84±18 Girls 72±12 76±20 Crbohydrte intke Boys 202±37 239±63 Girls 194±37 195±53 Protein intke (g) Boys 61±17 76±21 Girls 60±16 69±21 Protein intke per unit weight (g/kg) Boys 2.9± ±1.1 Girls 3.0± ±1.3 Ft intke (g) Boys 51±14 52±38 Girls 49±13 44±16 P/S rtio 0.55± yer-old subjects in 1993 nutrition study b Mjor source of ft Met nd poultry Met nd poultry b Distribution of ft intke in mels Brekfst, lunch, dinner, snck 19%, 27%, 32%, 22% 25%, 30%, 30%, 15% b Ftty cids intke (g) Sturted ft 17±5.5 14±4.4 Mono-unsturted ft 18±5.1 19±5.1 Poly-unsturted ft 9.5± ±2.0 Sources from reference no. 1, mens were tken from dt of 7 yers old for comprison by using 3-dy dietry record. b Sources from reference no. 12, dietry study on subset of 20 seven-yer old children in the 1993 growth nd nutrition study by using chemicl nlyses on duplicted mels.

7 Hui nd Nelson 261 Energy contributed from beverges nd milk ws reported s 20% mong US children ged 6-11 yers, 11 which ws lmost double the percentge clculted from this study. The smller energy contribution from beverges mong our subjects ws desirble nd this could be due to their younger ge nd culturl difference. We did not record mount of wter consumed mong our subjects therefore how much of their fluid needs were provided by cloriefree beverges could not be deduced. Limiting energy contributed from sweetened beverges nd using wter to fulfill fluid needs should be encourged in ll children, especilly for those suffer from obesity. The verge dily intke of vegetbles nd fruits clculted from the 3-dy dietry record ws less thn the equivlent of, respectively, tomto nd n pple of smll size. The mount of fruits consumed per dy mong our subjects pproches the suggested dily consumption mount recommended by the Hospitl Authority dietetic informtion centre. 13 However consumption of vegetbles ws indequte when compred with the recommendtion ( g/dy). 13 Mesures to increse the dily consumption of fruits nd vegetbles in this ge group re wrrnted. Our dt suggested tht vegetbles nd fruits re widely vilble in most households but tht their vilbility decreses if children frequently et out for lunch, including hving school lunch. The incresing number of full-dy schools in the Hong Kong eduction system emphsises the need to estblish school lunch policy. In view of the fct tht the lunch contributes 30% of totl energy intke in our subjects, school lunches should provide food choices tht contin blnce of nutrients nd dequte mounts of fruits nd vegetbles. About 80% of our subjects hd fternoon sncks four times or more per week. Our study highlights the importnce of emphsising helthy snck food choices, s opposed to the high-energy sncks tht re commonly vilble to children. It should lso be noted tht the percentge of ft intke from sncks hs incresed from 15% in the 1993 study to 22% in the present study. Therefore, providing helthy sncks in the right portions is n importnt prt of chieving blnced diet in young children. Seventy-nine percent of our subjects lwys hd snck during school breks, suggesting tht primry schools cn lso ply n importnt role in promoting helthy sncking through eduction progrms nd by incresing the vilbility of helthy sncks sold t resonble prices. Different from other studies, 14 most children in our study did not request sncks nor hve sncks while wtching television. According to prents, most children re so focused on the television progrmmes tht they do not bother to et. Although sncking while wtching television does not pper to be problem in this ge group, it would still pproprite to limit television wtching in fvour of more physicl pursuits. Some limittions need to be considered when interpreting our findings. The selected group of children do not represent spectrum of weight sttus but insted three distinct weight groups on the spectrum. Lck of rndom popultion smple might ffect generlistion of our findings. Dietry intkes vry dy-by-dy nd thus the dietry informtion clculted from the 3-dy dietry records might not be representtive of usul nutrient intke of the subjects. Underreporting, especilly for overweight children of unhelthy or "bd" foods might lso underestimte the ctul intke. It should lso be recognised tht the dietry hbits of the children might hve chnged s result of their weight sttus so tht the current diet my not reflect the child's diet tken when the child ws becoming overweight. Primry schools ply potentilly importnt role in nutrition eduction nd in fcilitting helthy eting prctices mong young children in Hong Kong. Ares to be trgeted include the provision of helthy snck choices nd ensuring the dequte intke of vegetbles nd fruits. Blncing niml nd plnt sources of proteins nd promoting pproprite cholesterol consumption should be encourged. However, modertion nd vriety, rther thn food restriction, should be dvocted mong both norml weight nd overweight children nd their fmilies. Acknowledgements We thnk Dr. L.Y. Tse, Dr. G. Tong nd the doctors nd nurses in the Student Helth Service Centres, Deprtment of Helth for their help in recruiting the subjects for this study. References 1. Leung SS, Chn SM, Lui S, Lee WT, Dvies DP. Growth nd nutrition of Hong Kong children ged 0-7 yers. J Peditr Child Helth 2000;36: Cockrm CS. Dibetes mellitus: perspective from the Asi- Pcific region. Dibetes Res Clin Prct 2000;50 Suppl 2: S Hui LL, Nelson EA, Yu LM, Li AM, Fok TF. Risk fctors for childhood overweight in 6- to 7-y-old Hong Kong children. Int J Obes Relt Metb Disord 2003;27: Leung SS, Lu JT, Tse LY, Oppenheimer SJ. Weight-for-ge

8 262 Dietry Chrcteristics of HK Young Children nd weight-for-height references for Hong Kong children from birth to 18 yers. J Peditr Child Helth 1996;32: Monro JA, Willims M. Concurrent mngement of postprndil glycemi nd nutrient intke using glycemic glucose equivlents, food composition dt nd computerssisted mel design. Asi Pc J Clin Nutr 2000; 9: Cole TJ, Bellizzi MC, Flegl KM, Dietz WH. Estblishing stndrd definition for child overweight nd obesity worldwide: interntionl survey. BMJ 2000;320: World Helth Orgniztion. World Helth Orgniztion Technicl Report Series 724: Energy nd Protein Requirements. Genev, World Helth Orgniztion, Nutrients Definition nd Function. nmenu_energy.shtml (2006). Food nd Environmentl Hygiene Deprtment. Hong Kong SAR Government. 9. Chunming C. Ft intke nd nutritionl sttus of children in Chin. Am J Clin Nutr 2000;72(5 Suppl):1368S-1372S. 10. Murt M. Seculr trends in growth nd chnges in eting ptterns of Jpnese children. Am J Clin Nutr 2000;72(5 Suppl): 1379S-1383S. 11. Troino RP, Briefel RR, Crroll MD, Bilostosky K. Energy nd ft intkes of children nd dolescents in the united sttes: dt from the ntionl helth nd nutrition exmintion surveys. Am J Clin Nutr 2000;72(5 Suppl):1343S-1353S. 12. Leung SS. Nutrition of Hong Kong Chinese Children. HK J Peditr (new series) 1993;10: Blnce Diet. (in Chinese) html (2004). Hospitl Authority Dietetic Informtion Centre. Accessed 3 July Coon KA, Goldberg J, Rogers BL, Tucker KL. Reltionships between use of television during mels nd children's food consumption ptterns. Peditrics 2001;107:E7.

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