1 in 4 Palestinian children goes without breakfast

The authors studies a representative sample of 2000 students (aged 9-11 years [young children] and 14-16 years [adolescents]) from the target population living in different districts in the West Bank and Gaza Strip, oPt. Weight and height were measured, and haemoglobin concentration was measured to assess the degree of iron-deficiency anaemia. Information about knowledge, attitudes, and practices was mainly gathered during verbal interviews with young children, and by use of a self-administered questionnaire (written) for adolescents.

6% of 1883 children who were assessed were stunted (8% of 930 boys vs 3% of 950 girls), less than 1% had wasting, 2% were underweight, 11% were anaemic (7% of boys vs 14% of girls), and 15% were overweight and obese (11% of boys vs 20% of girls; overall, 11% were overweight, and 4% were obese). 26% of children did not eat breakfast (the main indicator of healthy eating habits)—32% of 1082 adolescents versus 18% of 801 young children. Lack of appetite was the main reason for adolescents skipping breakfast, whereas in young children the reason was waking up late. Young children scored 47% in tests of nutrition knowledge, 86% in tests of attitudes, and 46% in tests of practices, whereas adolescents scored 50%, 70%, and 23%, respectively. Around three-quarters of young children showed a willingness to change their behaviours and accept advice about healthy eating habits, compared with around one in three adolescents.

The authors say higher anaemia in girls could be due to menstruation not compensated for with a good diet, while more boys could be stunted due to late onset of puberty or poor health since early childhood. They say: "Undernutrition, and high proportions of overweight and obesity might be attributable to children's poor eating habits and consumption of unhealthy food and snacks. Undernutrition and overweight represent the double burden of malnutrition in the oPt."

They conclude: "Young children had poor knowledge about nutrition compared with adolescents; however, adolescents were worse in terms of their practices, which could be related to a peer effect. Despite the health benefits of breakfast, it is the meal that is most often skipped, resulting in short-term hunger that affects children's concentration and performance at school. Comprehensive and effective school nutrition programmes that are targeted at all age groups, with special attention to adolescents and girls, are needed because the data for overweight and iron-deficiency anaemia are alarming."

Provided by Lancet