PHI Centre for public health, 29 November 73, 1200 Tetovo, Macedonia 2

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1 Original scientific paper UDC 613.2: ( ) 2013 NUTRITIONAL STATUS, DIET AND MALNUTRITION ASSESSMENT, AND EARLY DETECTION OF HEALTH RISKS FROM CHRONICAL NON-CONTAGIOUS DISEASES AT PRESCHOOL AND SCHOOL CHILDREN Ilija Ilijoski 1, Anastasika Poposka 2, Dijana Jovanoska 3* 1 PHI Centre for public health, 29 November 73, 1200 Tetovo, Macedonia 2 Faculty of Medicine, University Ss. Cyril and Methodius, Vodnjanska bb, 1000 Skopje, Macedonia 3 PHI Centre for public health, 29 November 73, 1200 Tetovo, Macedonia * diki_jovanoska@yahoo.com Abstract Objective of this research was to show and compare the nutritional status, nutrition of the children s population of preschool and school age, following and preventing cases of malnutrition, fattening risk and overweight body mass in this group, and early detection of signs for possible health risks from appearance of chronicle non-contagious diseases cases. On particular representative sample of children from the region covered by PHI Centre for Public Health Tetovo, anthropological examinations are made. The research is a result of the systematic planned gathering, analysis, and interpretation of the data collected from the national program for public health in the region covered by PHI Centre for Public Health Tetovo for period of Applied methodology was in accordance with the methodology delivered by the Institute for Public Health of Republic of Macedonia, and according to the World Health Organization - WHO recommended standards for growth and development from These anthropological examinations (anthropological measurements) were conducted of 531 children from five school and one preschool institution (kindergarten). The given results from the estimation of nutritional status in correlation with the growth and development in the period of childhood and adolescence are in agreement with the analyzed parameters: mark on the growth in relation to the age of children, nutrition status and mark on the nutrition. Anthropological measurements indicate that nutritional status of examinees is in the framework of the recommended standards. Anthropological measurements have shown that body height of examinees (regarding the complete example) is in accordance with age standards. In the biggest percentage of children is detected normal nutrition and average muscle mass, while in one part of the examined population is detected deviation of these values where we can notice malnutrition and fattening from different degree. There is not considerable difference between the sexes and age groups of the examinees, disruption in growth and development are not detected. Key words: Diet, nutrition, Malnutrition, Risk of chronicle non-contagious diseases. 1. Introduction Diet is one of the most important factors for protection and development of the human health, starting from the mother s pregnancy, nursing, children and adolescent life period which are characterized by the intensive human growth and development [2, and 4]. Pursuant to the definition of the World Health Organization - WHO, the proper diet is diet which satisfies the energetic and building needs of the organism and could enable input of protection substances necessary for its hormonal growth, development and protection [1]. Diet and nutrition are very important factors in good health promotion and sustaining during the whole life. Their role as chronicle diseases determinants is well known and because of that they have important place in the prevention activities [1]. Food is the unique source of energy in the human organism. Energy is required for all life functions which our organism conducts. Balanced diet enables good health and successful handling of diseases. When we consume food which gives us energy, and which is not 24

2 balanced, in correlation with insufficient physical activity, it becomes easy to increase body weight which leads to unhealthy state called fattening. On the other hand, if we don t take in enough energy which is required for the organism, than there will be a loss of body weight, and which results with other unhealthy state named as malnutrition [1, and 4]. This energetic imbalance in combination with unhealthy diet and unhealthy lifestyle easily brings human organism to exposure to chronicle non-contagious diseases [3, and 4]. Burden from the chronicle non-contagious diseases is increasing rapidly worldwide, and for sure is one of the global problems from which no one is spared, and hence cardiovascular, brain and cancer diseases, diabetes, etc. are in constant rise. Food is beneficial and easy can be harmful too. Only the food which contains necessary nutritive and protective materials can provide normal growth and development, good health and high working ability in the further life period [4, and 7]. Insufficient quality food leads to deficit of biological materials, like essential amino acids, vitamins and minerals, which can result in health disorders, disorders on psychological and physical development and become factor for chronicle non-contiguous diseases development [4]. It should be known that medicine is not only a pill. We can freely say that the greatest contribution on good general health have healthy food and healthy way of life. The proper diet needs to be appropriate to the sex, age, and physical activity [4]. Having all of this at mind and we perform this research on the representative children population group. The overall aim was to get insights in the: growth process, development and nutritional status of this group of examinees, and to detect malnutrition, risk of fattening and overweight body mass among children od preschool and school age. One of the goals was to detect signs for possible health risks and appearance of chronicle non-contagious diseases in the future, and possibility for their timely prevention. 2. Material and Methods Anthropometrical examination on particular representative sample of children from the region covered by PHI Center for Public Health Tetovo are conducted in accordance with the methodology delivered to the Institute for Public Health of Republic of Macedonia, pursuant to the recommended standards for growth and development of the World Health Organization (WHO) [6]. These examination contain anthropometrical indices and indicators. Anthropometrical indices are combination of anthropometrical parameters unnecessary for interpretation of the anthropometry. For example, only body mass does not have importance if it is not compared with the height and age. Because of that we determined body mass index BMI (weight in kg/height in m 2 ) or weight in relation with height, using reference data. When examining children, often are used the following three anthropometrical indices: 1. z-score percentage or percent of media. Z-score is score for standard deviations which mean deviations of values of one anthropometrical parameter for the individual from medium value for reference population, divided with standard deviation for reference population. They are used for comparison of individual children or group of children with reference population [6]. 2. Anthropometrical indicators. They are narrowly connected with the use of indices. These are indicators are derived from indices, and broadly used as indicator for the status of the community is the percentage of children who are under the level of weight for the appropriate age. 3. Height and weight appropriate for the age [6]. These measurements were used for estimation of nutritional status of each child individually and population group. During 2013 were conducted anthropological measurements of 531 children from five school institutions. These children belonged to different age groups - first and fifth grade in elementary schools, first year in secondary education, and children in preschool institution (kinder garden), or more precisely: 103 preschool children (4-5 age) children from kinder garden Youth Tetovo 175 school children from first grade from Primary School (PS) Goce Delchev Tetovo, PS 7 Mart v. Chelopek, PS Naim Frasheri Tetovo. 175 school children from fifth grade from the primary school PS Goce Delchev, PS Bratstvo Midjeni and PS Naim Frasheri all from Tetovo. 88 school children from first year high school Djoce Stojchevski Tetovo. Results from all examined parameters were processed by the software developed on the methodology and standards provided by reference of the World Health Organization (WHO). 3. Results and Discussion 3.1 Results Height index and nutritional status (BMI) in preschool children Among examined population of 103 children from preschool age of (4 to 5 years old) we detected that for this age: 1 or 0.9% have inadequate height; 3 or 2.9% have small height; 96 or 93.2% have good height; 25

3 3 or 2.9 % have bigger height and None or 0% haven t very big height for their age. We didn t noticed any significant difference between the sexes (Table 1 and Figure 1). When speaking about nutritional status of children within this group we established that in total: there is no malnutrition of 3 rd and 2 nd degree and only 2.9% of children were diagnosed with malnutrition from 1 st degree; 70 examined children or 67.9% have good nutrition status; 19 or 18.4 % are detected with fattening of 1 st degree (light degree of fattening); 11 children or 10.7% are detected with fattening of 2 nd degree of fattening (moderate degree of and fattening) and none of the children are detected with fattening of 3 rd degree fattening or heavy degree of fattening (Table 2, and Figure 2) Height index and nutritional status (BMI) in school children from first grade Among examined population of 175 school children (6 years old) from above mentioned schools we detected that for this age (Table 3, Figure 3): None or 0% have inadequate height; 6 or 3.4% have small height; 147 or 43% have good height; 16 or 9.14% have bigger height and 6 or 3.4% have very big height for their age. When speaking about nutritional status of children within this group we established that in total: malnutrition of 3 rd degree is not noticed among any of the examined children; malnutrition of 2 nd degree is noticed among 6 children or 3.4%; malnutrition from 1 st degree Figure 1. Distribution of height index for age among preschool children Figure 2. Nutritional status (BMI) for age of preschool children Table 1. Distribution of height index for age among preschool children State/ z score Males Females Total (%) Inadequate height for age 1 / 1 (1.0%) Small height for age (2.9%) Good height for age (93.2%) Bigger height for age 3 / 3 (2.9%) Big height for age / / / Total (100%) Table 2. Nutritional status (BMI) for age of preschool children Malnutrition from 2 nd degree / / / Malnutrition from 1 st degree 3 / 3/2.9% Good nutrition /67.9% Fattening from 1 st degree /18.4% Fattening from 2 nd degree /10.7% Total

4 is detected among 17 children or 9.7%; good nutrition is noticed among 119 children or 68%; fattening of 1 st degree is noticed among 24 examinees or 13.7 %; fattening from 2 nd degree is noticed among 9 examinees or 5.1 %, and none of the children are detected with fattening of 3 rd degree fattening or heavy degree of fattening (Table 4, Figure 4) Height index and nutritional status (BMI) in school children from fifth grade Among examined population of 175 school children (11 years old) from above mentioned schools we detected that for this age (Table 5, Figure 5): 1 or 1% have inadequate height; 11 or 6.3% have small height; 144 or 82.3% have good height; 13 or 7.4% have bigger height and 7 or 4% have very big height for their age. When speaking about nutritional status of children within this group we established that in total: there is no malnutrition of 3 rd and 2 nd degree and only 6 children or 3.4% were diagnosed with malnutrition from 1 st degree; 139 examined children or 79.5% have good nutrition status; 21 or 12% are detected with fattening of 1 st degree (light degree of fattening); 9 children or 5.14% are detected with fattening of 2 nd degree of fattening (moderate degree of and fattening) and none of the children are detected with fattening of 3 rd degree fattening or heavy degree of fattening (Table 6, and Figure 6). Figure 3. Distribution of height index for age among children from 1st grade Figure 4. Nutritional status (BMI) for age for school children from first grade Table 3. Distribution of height index for age among children from 1 st grade State/z score Males Females Total (%) Inadequate height for age / / / Small height for age (3.4%) Good height for age (84%) Bigger height for age (9.14%) Big height for age (3.4%) Table 4. Nutritional status (BMI) for age among school children from first grade Malnutrition from 2 nd degree (3.4%) Malnutrition from 1 st degree (9.7%) Good nutrition (68%) Fattening from 1 st degree (13.7%) Fattening from 2 nd degree (5.1%) 27

5 Figure 5. Distribution of height index for age among children from 5th grade Figure 6. Nutritional status (BMI) for age of school children in 5th grade Table 5. Distribution of height index for age among children from 5 th grade State/z score Males Females Total (%) Inadequate height for age 1 / 1 Small height for age (6.3%) Good height for age (82.3%) Bigger height for age (7.4%) Big height for age (4%) Table 6. Nutritional status (BMI) for age for school children from fifth grade Malnutrition from 2 nd degree / / / Malnutrition from 1 st degree (3.4%) Good nutrition (79.5%) Fattening from 1 st degree (12%) Fattening from 2 nd degree (5.14%) Height index and nutritional status (BMI) in children from first year secondary education Among examined population of 88 school children (15 years old) we detected that for this age (Table 7, and Figure 7): 1 or 1.1% have inadequate height; 9 or 10.2% have small height; 76 or 86.4% have good height; 2 or 2.3% have bigger height and None or 0% have very big height for their age. Regarding nutritional status of children within this group we established that in total: malnutrition of 3 rd and 2 nd degree is not noticed among any of the examined children; malnutrition 1 st degree is noticed among 12 children or 13.7%; good nutrition is noticed among 64 children or 72.7%; fattening of 1 st degree is noticed among 11 examinees or 12.5 %; fattening from 2 nd degree is noticed in 1 case or 1.1 %, and none of the children are detected with fattening of 3 rd degree (Table 8, Figure 8). 3.2 Discussion Burden from the chronicle non-contagious diseases as well as fattening outbreak among the young population is increasing rapidly in world frameworks and certainly becomes one global problem from which no one is spared, neither developed countries nor developing countries [1]. Starting from this realization and the fact that this is global trend and it is supported by the results of many studies, we made this research on 28

6 Figure 7. Distribution of height index for age among the students from first year secondary education Figure 8. Nutritional status (BMI) for age for students from first year secondary education Table 7. Distribution of height index for age among the students from first year secondary education State/z score Males Females Total (%) Inadequate height for age 1 / 1 (1.1%) Small height for age (10.2%) Good height for age (86.4%) Bigger height for age 2 / 2 (2.3%) Big height for age / / / Total (100%) Table 8. Nutritional status (BMI) for age for students from first year secondary education Malnutrition from 2 nd degree / / / Malnutrition from 1 st degree (13.7%) Good nutrition (72.7%) Fattening from 1 st degree (12.5%) Fattening from 2 nd degree 1 / 1 (1.1%) Total (100%) representative group of examinees of children population, with only one aim, to have insight in the growth process, development and nutritional status for age, fattening risk with all the risks and consequences among children and school population among us. The results from anthropometrical research of height index in relation to age, has shown that examined population of preschool children from kindergarten and school children from 6 to 15 years is in the framework of recommended standards [6]. Biggest percent of examined children have good height for their age. Insufficient, small, and bigger height for age is also noticed, but in insignificant number of children. The results related to the anthropometrical research of nutritional status (BMI) for age, has shown that examined population of preschool and school children from 6 to 15 years, in the highest percent is in the framework of recommended standards. Good nutrition status is noticed among biggest part of examined children. Most concerns raise is the fact that among these children are noticed malnutrition from first and second degree and rather increased number of children with fattening from first and second degree. However fattening from third degree is not determined. It is noticeable that we found increased number of children with increased body mass and fattening from different degree. This trend of children population fattening is certainly a result of irregular and excessive diet, irregularly schedule meals and irregular caloric input of high energetic food rich with saturated fats, salt and sugar, insufficient physical activity, defects 29

7 in the metabolism and fast and dynamic life which is reflected from parents to children. We can freely say that this is a global trend as in many developed countries, where children are exposed on permanent and aggressive marketing and input of high energetic food rich with sugar, salt and fats. The number of children population who has particular degree of malnutrition and small height for their particular age is present. This for sure is a result of lower socio-economical standard, deficient caloric input, metabolic and malnutrition defects among that children population. Misbalanced caloric input, and metabolic defects also could be reasons for inadequate growth for children s age. Although the number of these children is very low, we think that is necessary to perform additional and coordinated research oriented toward the reasons for this deviation, because it leads to future health risks of chronicle non-contagious diseases development. From results of these anthropometrical researches can be concluded that there is not substantial difference between the sexes and age groups, and the biggest number of children are in the framework of the recommended standards, or to be exact, there is no deviation from World Health Organization (WHO) recommended standards for growth and development [2]. 4. Conclusions - Height index in relation to age for examined population in all groups is within the framework of recommended standards. Biggest percent of examined children have good height for their age. Insufficient, small, and bigger height for age is also noticed, but in insignificant number. - The biggest part of examined population of preschool children from kindergarten and school children from 6 to 15 years have good nutrition status which is in the framework of recommended standards. - Most concerns raise the fact that among all groups there are increased numbers of children with fattening from first and second degree. This is direct result from: irregular and excessive diet, irregularly scheduled meals and irregular caloric input of high energetic food rich with saturated fats, salt and sugar, insufficient physical activity, defects in the metabolism and fast and dynamic life which is reflected from parents to children. This is a global trend as in many developed countries, where children are exposed on permanent and aggressive marketing and input of high energetic food rich with sugar, salt and fats. - We noticed malnutrition from first and second degree. This is a result of lower socio-economical standard, deficient and misbalanced caloric input, and metabolic and malnutrition defects. This is a reason for inadequate growth for children s age. Although the number of these children is very low, we think that is necessary to perform additional and coordinated research oriented toward the reasons for this deviation, because it leads to future health risks of chronicle non-contagious diseases development. - Also it is necessary to involve in this nutritional issues more professionals from preventive medicine and health authorities, to develop broad strategies and activities [5] that will promote ideas for healthy diet and healthy way of life. 5. References [1] World Health Organization. (2003). Food, nutrition, and prevention of chronic diseases: report of a joint expert advisory group. WHO/FAO, Geneva, Switzerland. [2] PHI Republic Health Institute. (2008). Healthy diet for primary school children (in Macedonian). In: Global research on adolescent health, Republic Health Institute, Skopje, Macedonia. [3] World Health Organization. (2003). Globalization, nutrition, and non-communicable diseases. WHO, Geneva, Switzerland. [4] Stikova E. (2006). Health Ecology (in Macedonian). University Ss Cyril and Methodius, Skopje, Macedonia, pp [5] Cvetanova N., Malinska P. (1998). Health education (in Macedonian). Macedonian Treasury, Skopje, Macedonia, pp [6] Azis Polozhani (2006). Nutritive antrophometry (in Macedonian). Republic Health Institute, Skopje, Macedonia. [7] Simich B. (1998). Medical Dietetics. Nauka, Belgrade, Serbia. 30