Food sources of energy and nutrients in Finnish girls and boys 6–8 years of age – the PANIC study

ORIGINAL ARTICLE

Food sources of energy and nutrients in Finnish girls and boys 6–8 years of age – the PANIC study

Aino-Maija Eloranta1*, Taisa Venäläinen1,2, Sonja Soininen1,3,4, Henna Jalkanen1, Sanna Kiiskinen1, Ursula Schwab2,5, Timo A. Lakka1,6,7 and Virpi Lindi1

1Department of Physiology, Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland; 2Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland; 3Social and Health Center, City of Varkaus, Finland; 4Institute of Dentistry, School of Medicine, University of Eastern Finland, Kuopio, Finland; 5Department of Internal Medicine, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, Finland; 6Kuopio Research Institute of Exercise Medicine, Kuopio, Finland; 7Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland

Abstract

Background: Data on food sources of nutrients are needed to improve strategies to enhance nutrient intake among girls and boys in Western countries.

Objective: To identify major food sources of energy, energy nutrients, dietary fibre, and micronutrients, and to study gender differences in these food sources among children.

Design: We assessed food consumption and nutrient intake using 4-day food records in a population sample of Finnish girls (n=213) and boys (n=217) aged 6–8 years from the Physical Activity and Nutrition in Children Study. We calculated the percentual contribution of 55 food groups for energy and nutrient intake using the population proportion method.

Results: Low-fibre grain products, skimmed milk, and high-fibre bread provided almost 23% of total energy intake. Skimmed milk was the top source of protein (18% of total intake), vitamin D (32%), potassium (20%), calcium (39%), magnesium (17%), and zinc (16%). Vegetable oils (15%) and high-fat vegetable oil–based spreads (14%) were the top sources of polyunsaturated fat. High-fibre bread was the top source of fibre (27%) and iron (12%). Non-root vegetables were the top source of folate (14%) and vitamin C (22%). Sugar-sweetened beverages provided 21% of sucrose intake. Pork was a more important source of protein and sausage was a more important source of total fat and monounsaturated fat in boys than in girls. Vegetable oils provided a higher proportion of unsaturated fat and vitamin E among boys, whereas high-fat vegetable oil–based spreads provided a higher proportion of these nutrients among girls.

Conclusion: Commonly recommended foods, such as skimmed milk, high-fibre grain products, vegetables, vegetable oil, and vegetable oil–based spreads, were important sources of several nutrients, whereas sugar-sweetened beverages provided the majority of sucrose intake among children. This knowledge can be used in improving health among children by dietary interventions, nutrition education, and health policy decision making.

Keywords: food sources; energy; nutrients; vitamins; minerals; children; gender differences

Citation: Food & Nutrition Research 2016, 60: 32444 - http://dx.doi.org/10.3402/fnr.v60.32444

Copyright: © 2016 Aino-Maija Eloranta et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

Received: 31 May 2016; Revised: 16 August 2016; Accepted: 16 August 2016; Published: 30 September 2016

Competing interests and funding: The authors declare that there is no conflict of interest.

*Correspondence to: Aino-Maija Eloranta, Department of Physiology, Institute of Biomedicine, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland, Email: aino-maija.eloranta@uef.fi

 

Children in Western countries fail to meet recommendations for many nutrients that are important for their health, growth, and development (1). For example, the intakes of saturated fat (SFA), sucrose, and salt are higher and the intakes of vitamin D, iron, and dietary fibre as well as unsaturated-to-saturated fatty acid ratio are lower than recommended among children in many Western countries, including Finland (2, 3).

Health promotion messages and nutrition counselling can be made more concrete and easier to adopt if they are based on food consumption rather than nutrient intake. Therefore, recent dietary guidelines, for example in Nordic countries, emphasise healthy dietary choices at food rather than nutrient level (4, 5). Consequently, it is important to have precise data on food sources of nutrients to better design strategies to enhance diet quality in different age groups.

There are few studies on the food sources of nutrients in children and most of them have reported the sources of only one or few nutrients (69). Milk products have been found to be among the main sources of energy, protein, and SFA among children in Europe (6, 8, 10) and the USA (1113). Sugar-sweetened beverages have also been observed to be a major source of energy and refined carbohydrates among US children (13, 14). In a Swedish study, girls obtained more sucrose from sweets and chocolate, whereas boys received more sucrose from sugar-sweetened beverages (8). With the exception of the Swedish study (8), there are limited data on differences in the food sources of nutrients among girls and boys (11).

To provide detailed information on food sources of nutrients for health promotion and dietary counselling to correct the observed shortcomings in nutrient intake among children, we investigated the main food sources of energy, energy nutrients, dietary fibre, vitamins, and minerals among Finnish children 6–8 years of age. We also studied the gender differences in food sources of energy and these nutrients.

Methods

Study population

The present analyses are based on the baseline data of the Physical Activity and Nutrition in Children (PANIC) study, which is an ongoing physical activity and dietary intervention study in a population sample of primary school children from the city of Kuopio, Finland. We invited 736 children 6–8 years of age who were registered for the first grade in 16 primary schools, selected out of all 26 primary schools of Kuopio, in 2007–2009. We received the contact information of the children’s principal custodians from the city of Kuopio and sent them the invitation letters by mail. Of 736 invited children, 512 (70%) participated in the baseline examinations that were conducted in 2007–2009. The participants did not differ in sex distribution, age, or body mass index standard deviation score (BMI-SDS) from all children who started first grade in primary schools of Kuopio in 2007–2009 based on available school health examination data. Complete dietary data were available for 430 children (213 girls and 217 boys) who were included in the analyses. These children did not differ in sex distribution, age, or BMI-SDS from those 82 children who had incomplete data and were excluded. The PANIC study protocol was approved by the research ethics committee of the Hospital District of Northern Savo. All participating children and their parents gave informed written consent.

Assessments

We assessed food consumption and nutrient intake by food records administered by the parents on 4 predefined consecutive days that included either consecutive 2 weekdays and 2 weekend days (99.5%) or consecutive 3 weekdays and 1 weekend day (0.5%). A clinical nutritionist instructed the parents to record all food and drinks consumed by their child at home, at school, in afternoon care, and elsewhere outside home using household or other measures, such as tablespoons, decilitres, and centimetres, in person at the first study visit. The parents were instructed to report the recipes of mixed dishes and the brands and the contents of food products. A clinical nutritionist reviewed the food records with the parents at the second study visit and completed the records using a picture booklet of portion sizes (15). Moreover, a clinical nutritionist asked the catering company about the details of food and drinks, such as menus, cooking fat, and spread on bread, served at schools and in afternoon care. All prepared foods and mixed dishes were disaggregated into ingredients according to the recipes used. We analysed food consumption and nutrient intake using The Micro Nutrica® dietary analysis software, version 2.5 (The Social Insurance Institution of Finland), that uses Finnish and international data on the nutrient compositions of foods (16). A clinical nutritionist also updated the software by adding new food items and products with their precise nutrient content received from the producers. Vitamin and mineral supplements were not included in these analyses. Food records that contained <4 days, contained inconsecutive days, did not include weekdays and weekend days, or lacked essential information for dietary analysis even after the review were excluded from the analyses. We estimate that 26% of girls and 24% of boys may have underreported their total energy intake in the food records when comparing it with energy expenditure estimated by basal metabolic rate and using the cut-offs for underreporting suggested by Torun et al. (17).

Foods consumed were divided into 55 food groups each of which included foods of similar nutrient composition and type of consumption (Table 1). We divided bread, breakfast cereals, and grain products into six food groups based on their fibre content. Bread, breakfast cereals, and grain products with at least 5% of fibre were considered high-fibre products. Meat products were divided into seven groups and fish was separated from shellfish and fish products. Fats and fat products were divided into five groups based on the amount and the quality of fat. Milk, sour milk products, and cheese were divided into six groups based on their fat content. Milk and sour milk products with <1% of fat were considered low-fat products. Cheese was defined low-fat cheese if it contained no more than 17% of fat. Ice creams and puddings were included in the same group. Sweetened beverages were divided into artificially sweetened and sugar-sweetened beverages. Energy drinks formed one group.


Table 1.  Contents and median intakes (interquartile range) of the food groups in girls and boys
Food groups Contents All children (n=430), median (interquartile range) Girls (n=213), median (interquartile range) Boys (n=217), median (interquartile range)
High-fibre bread Rye bread, crisp bread, wholegrain bread (fibre ≥5%) 37.5 (22.5, 59.0) 36.5 (21.1, 58.9) 37.5 (22.5, 59.0)
Low-fibre bread White bread, white rolls (fibre <5%) 22.0 (7.5, 40.1) 22.3 (7.5, 37.5) 21.7 (7.5, 45.0)
High-fibre breakfast cereals Mueslis, breakfast cereals (fibre ≥5%) 0.0 (0.0, 3.8) 0.0 (0.0, 3.8) 0.0 (0.0, 4.1)
Low-fibre breakfast cereals Breakfast cereals (fibre <5%) 0.0 (0.0, 7.5) 0.0 (0.0, 7.5) 0.0 (0.0, 6.6)
High-fibre grain products Wholegrain pasta, rice, oatmeal (fibre ≥5%) 9.6 (0.0, 24.1) 9.4 (0.0, 23.5) 10.5 (0.0, 24.9)
Low-fibre grain products White pasta, rice, flours (fibre <5%) 70.7 (45.0, 104.7) 71.8 (46.2, 100.4) 69.1 (42.6, 108.5)
Sweet pastry Biscuits, cookies, cakes, pastries 0.0 (0.0, 6.8) 0.0 (0.0, 6.6) 0.0 (0.0, 7.1)
Potato Potatoes 70.7 (44.7, 101.2) 68.3 (43.6, 100.4) 75.0 (48.3, 101.9)
Root vegetables Carrot, beetroot, turnip 14.9 (3.8, 30.2) 16.9 (5.3, 31.6) 12.5 (1.7, 28.2)
Non-root vegetables Green leafy vegetables, cabbages, cucumber, peppers, tomatoes, onions 68.3 (40.0, 103.9) 68.3 (43.1, 103.9) 68.3 (39.0, 104.8)
Legume and nut Peas, beans, nuts, almonds, seeds 0.0 (0.0, 2.4) 0.0 (0.0, 2.2) 0.0 (0.0, 2.5)
Mushroom Mushrooms 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Vegetable products Ready-made vegetable products 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Fruit Fruit and fruit purées 73.8 (33.6, 121.1) 75.8 (40.5, 126.8) 70.0 (27.5, 117.7)
Berry Berries and berry purées 9.0 (0.0, 25.4) 9.9 (0.0, 28.2) 8.3 (0.0, 23.4)
Jam Jams, marmalades 0.9 (0.0, 7.7) 1.6 (0.0, 8.0) 0.0 (0.0, 7.4)
Pork Pork 29.5 (15.7, 46.8) 27.8 (13.8, 42.6) 32.6 (16.7, 56.5)**
Beef Beef 13.5 (0.0, 29.0) 12.0 (0.0, 27.9) 14.5 (0.0, 30.5)
Sausage Frankfurter, balkan, salami, ham sausage 15.0 (3.5, 31.8) 11.8 (0.0, 25.3) 18.0 (6.9, 34.6)**
Poultry Chicken, turkey 10.3 (0.0, 24.5) 10.3 (0.0, 22.9) 10.0 (0.0, 27.2)
Game Hare, moose, willow grouse 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Lamb and other meat Lamb, horse, reindeer 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Organ meats Liver, kidney, tongue 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Fish Fresh fish 0.0 (0.0, 18.5) 0.0 (0.0, 17.1) 0.0 (0.0, 23.9)
Shellfish Shellfish 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Fish products Salted fish, smoked fish, canned fish, roe paste 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Egg Eggs 10.0 (5.7, 19.1) 9.8 (5.8, 18.6) 10.9 (5.6, 19.6)
High-fat vegetable oil–based spreads Vegetable oil–based spreads (fat 60–80%)a 5.0 (1.3, 10.3) 5.0 (1.5, 10.6) 4.5 (1.3, 9.9)
Low-fat vegetable oil–based spreads Low-fat vegetable oil–based spreads (fat <60%)a 0.0 (0.0, 5.3) 0.0 (0.0, 5.0) 0.0 (0.0, 6.1)
Vegetable oil Vegetable oils, vegetable oil–based salad dressings 2.9 (1.2, 5.5) 2.5 (1.1, 5.0) 3.1 (1.2, 6.3)
Butter and butter-based spreads Butter, butter-based spreads 3.0 (0.9, 7.9) 2.9 (1.0, 6.9) 3.1 (0.8, 10.1)
Shortenings and other added fats Shortenings, lard, coconut fat 5.1 (2.7, 8.5) 5.1 (2.7, 8.6) 5.2 (2.7, 8.6)
Skimmed milk Milk,a organic milk (fat <1%) 371.7 (88.8, 602.8) 356.4 (91.4, 587.5) 421.2 (87.5, 633.8)
Fat-containing milk Milk,a organic milk, farm milk (fat ≥1%) 95.8 (33.1, 264.4) 93.4 (31.2, 253.7) 102.6 (36.6, 301.7)
Low-fat sour milk products Yoghurts, sour milk (fat <1%) 0.0 (0.0, 9.9) 0.0 (0.0, 13.3) 0.0 (0.0, 8.9)
Sour milk products Yoghurts, sour milk (fat ≥1%) 66.9 (25.0, 125.0) 65.0 (25.0, 114.4) 75.0 (25.0, 142.6)
Low-fat cheese Cheese, cottage cheese, processed cheese, fromage frais (fat ≤17%) 2.5 (0.0, 10.0) 4.2 (0.0, 12.0) 0.6 (0.0, 9.0)*
Cheese Cheese, processed cheese, blue cheese, fromage frais (fat >17%) 4.2 (0.0, 10.1) 3.8 (0.0, 9.3) 5.0 (0.0, 11.2)
Ice cream and pudding Ice creams, puddings 17.5 (0.0, 37.9) 16.3 (0.0, 40.9) 18.8 (0.0, 37.5)
Cream and other dairy products Cream, sour cream, double cream, soya-, rice-, and oat-based milks and creams 10.6 (2.9, 20.0) 11.2 (3.8, 19.9) 10.4 (1.6, 20.2)
Coffee Coffee 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Tea Tea 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Artificially sweetened beverage Carbonated and non-carbonated artificially sweetened beverages 0.0 (0.0, 50.0) 0.0 (0.0, 0.0) 0.0 (0.0, 56.7)
Sugar-sweetened beverage Carbonated and non-carbonated sugar-sweetened beverages 100.0 (43.4, 200.3) 87.5 (42.5, 200.0) 125.0 (50.0, 225.0)
Fruit juice Natural fruit juices 1.4 (0.0, 50.0) 1.5 (0.0, 50.0) 0.8 (0.0, 50.0)
Energy drink Energy drinks 0.0 (0.0, 0.0) 0.0 (0.0, 0.0) 0.0 (0.0, 0.0)
Water and other drinks Water, mineral water, sport drink, mulled wine, berry fool 187.2 (108.2, 319.8) 163.4 (90.1, 277.8) 206.0 (121.6, 350.0)**
Sugar and honey Table sugar, baking sugar, honey, syrup 7.7 (4.2, 13.3) 7.7 (4.1, 13.3) 7.4 (4.4, 13.3)
Candy Sweets, chewing gums 12.5 (2.0, 31.1) 12.0 (2.0, 26.8) 15.0 (0.0, 37.5)
Chocolate and hot chocolate powder Chocolate, hot chocolate powder 5.3 (0.2, 14.1) 5.0 (0.5, 12.5) 6.0 (0.0, 16.2)
Ready meal Hamburgers, pizzas, nuggets 0.0 (0.0, 10.0) 0.0 (0.0, 5.6) 0.0 (0.0, 15.0)
Salt Recipe and table salt 2.2 (1.8, 2.8) 2.1 (1.7, 2.6) 2.4 (1.9, 3.0)***
Condiments and sauces Ketchup, mustard, soy sauce, chilli sauce, barbeque sauce 3.9 (0.4, 12.0) 4.0 (0.5, 13.0) 3.8 (0.3, 11.1)
Salty snacks Popcorn, potato crisps, nachos, crackers, tacos 0.0 (0.0, 3.8) 0.0 (0.0, 3.8) 0.0 (0.0, 3.9)
aFortified with vitamin D.
*p<0.05 for difference between girls and boys. **p<0.01 for difference between girls and boys. ***p<0.001 for difference between girls and boys.

Statistical methods

Data were analysed using the SPSS for Windows software, Version 21.0 (IBM Corp. IBM SPSS Statistics for Windows, Armonk, NY). We compared differences in food consumption between genders by the Mann–Whitney U-test. The differences between genders with p-value <0.05 were considered statistically significant. We calculated the contribution of each food group to the intakes of total energy, energy nutrients, dietary fibre, and selected vitamins and minerals using the population proportion method as defined by Krebs-Smith et al. (18). The percentage contribution of each food group to the intakes of total energy, energy nutrients, dietary fibre, and selected vitamins and minerals was estimated by summing the amount of a particular nutrient from the particular food group for all children and dividing this value by the sum of the nutrient from all foods for all children. The food sources of nutrients were ranked and top 10 sources were reported for all children, and for girls and boys separately.

Results

The medians (interquartile ranges) of the consumption of food groups in girls and boys are presented in Table 1. Boys consumed more pork, sausage, water and other drinks, and salt and less low-fat cheese than girls.

Food sources of energy, energy nutrients, and dietary fibre

Several food groups contributed almost similarly to the intake of energy, the two main sources being low-fibre grain products and skimmed milk in girls and boys (Table 2). Skimmed milk was the main source of protein in girls and boys, followed by fat-containing milk in girls and pork in boys. The main source of total fat was high-fat vegetable oil–based spreads, followed by shortenings and other added fats among girls and sausage among boys. The top two sources of SFA were cream and other dairy products and fat-containing milk in girls and fat-containing milk and butter and butter-based spreads in boys. The main source of monounsaturated fatty acids (MUFA) was high-fat vegetable oil–based spreads in girls and boys, followed by shortenings and other added fats among girls and by sausage among boys. The main source of polyunsaturated fatty acids (PUFA) was high-fat vegetable oil–based spreads followed by vegetable oil in girls and vegetable oil followed by high-fat vegetable oil–based spreads in boys. Low-fibre grain products were the major source of carbohydrates, followed by skimmed milk in girls and boys. Sugar-sweetened beverages and sugar and honey were the major sources of sucrose in both girls and boys. High-fibre bread was the major source of dietary fibre, followed by fruit and low-fibre grain products in girls and boys.


Table 2.  Dietary sources of energy, energy nutrients, and dietary fibre in all children, girls, and boys
All (n=430) Girls (n=213) Boys (n=217)
Ranka Food group % of intake % of intake % of intake
Energy
1 Low-fibre grain products 9.4 9.5 9.4
2 Skimmed milk 7.6 7.5 7.7
3 High-fibre bread 5.5 5.7 5.4
4 Fat-containing milk 5.4 5.4 5.3
5 Sour milk products 4.5 4.3 4.6
6 Candy 4.4 4.3 4.6
7 Low-fibre bread 4.0 4.0 4.0
8 Pork 3.7 3.4 3.9
9 Sugar-sweetened beverage 3.3 3.2 3.4
10 Potato 3.3 3.3 3.2
Protein
1 Skimmed milk 18.3 18.2 18.4
2 Pork 9.2 8.7 9.7
3 Fat-containing milk 9.2 9.4 9.0
4 Low-fibre grain products 6.5 6.6 6.4
5 Beef 5.8 5.9 5.7
6 High-fibre bread 5.0 5.1 4.8
7 Poultry 4.6 4.8 4.4
8 Sour milk products 4.3 4.2 4.3
9 Sausage 3.7 3.1 4.2
10 Low-fibre bread 3.6 3.6 3.6
Total fat
1 High-fat vegetable oil–based spreads 9.1 10.0 8.4
2 Shortenings and other added fats 8.1 8.6 7.7
3 Sausage 7.2 6.2 8.0
4 Pork 6.9 6.5 7.2
5 Butter and butter-based spreads 6.6 6.3 6.8
6 Vegetable oil 6.5 6.2 6.8
7 Fat-containing milk 5.4 5.3 5.4
8 Cream and other dairy products 5.3 5.8 4.8
9 Chocolate and hot chocolate powder 5.0 4.6 5.3
10 Ice cream and pudding 4.8 5.3 4.4
Saturated fatty acids
1 Fat-containing milk 8.8 8.7 8.9
2 Cream and other dairy products 8.3 9.2 7.5
3 Butter and butter-based spreads 7.9 7.7 8.1
4 Shortenings and other added fats 7.9 8.3 7.5
5 Ice cream and pudding 7.2 7.9 6.6
6 Chocolate and hot chocolate powder 7.0 6.5 7.4
7 Sausage 6.8 5.8 7.6
8 High-fat vegetable oil–based spreads 6.6 7.3 6.0
9 Pork 6.2 5.9 6.5
10 Cheese 6.2 5.5 6.8
Monounsaturated fatty acids
1 Vegetable oil–based spreads 12.2 13.4 11.2
2 Sausage 9.6 8.3 10.7
3 Vegetable oil 9.3 8.9 9.6
4 Pork 9.0 8.4 9.4
5 Shortenings and other added fats 8.5 9.0 8.1
6 Butter and butter-based spreads 5.3 5.0 5.7
7 Chocolate and hot chocolate powder 4.8 4.4 5.0
8 Cream and other dairy products 4.0 4.3 3.8
9 Ice cream and pudding 3.5 3.8 3.2
10 Fat-containing milk 3.2 3.2 3.3
Polyunsaturated fatty acids
1 Vegetable oil 15.0 14.1 15.8
2 High-fat vegetable oil–based spreads 13.8 14.8 12.9
3 Shortenings and other added fats 11.0 11.9 10.2
4 Sausage 5.9 5.1 6.6
5 Pork 5.9 5.5 6.2
6 Low-fat vegetable oil–based spreads 5.5 4.9 6.0
7 Salty snacks 5.5 5.7 5.2
8 Low-fibre grain products 4.2 4.2 4.1
9 High-fibre bread 3.4 3.5 3.3
10 Butter and butter-based spreads 3.2 2.8 3.5
Carbohydrates
1 Low-fibre grain products 14.8 14.8 14.8
2 Skimmed milk 8.5 8.3 8.7
3 Candy 8.3 7.9 8.7
4 High-fibre bread 8.0 8.2 7.9
5 Sugar-sweetened beverage 6.1 5.9 6.2
6 Low-fibre bread 5.7 5.6 5.7
7 Potato 5.5 5.6 5.4
8 Sour milk products 5.2 4.9 5.4
9 Fruit 5.0 5.5 4.5
10 Sugar and honey 4.5 4.7 4.3
Sucrose
1 Sugar-sweetened beverage 21.2 20.5 21.7
2 Sugar and honey 17.5 18.4 16.6
3 Sour milk products 14.5 13.6 15.3
4 Candy 9.7 9.2 10.1
5 Chocolate and hot chocolate powder 8.0 7.4 8.5
6 Ice cream and pudding 6.4 6.8 6.0
7 Fruit 6.2 6.8 5.6
8 Sweet pastry 2.4 2.2 2.6
9 Fruit juice 2.4 2.1 2.6
10 Low-fibre breakfast cereals 2.0 2.2 1.9
Dietary fibre
1 High-fibre bread 27.1 27.1 27.2
2 Fruit 11.7 12.4 11.0
3 Low-fibre grain products 10.9 10.7 11.0
4 High-fibre grain products 8.3 7.7 8.7
5 Potato 8.1 8.1 8.1
6 Low-fibre bread 7.5 7.1 7.8
7 Non-root vegetables 6.0 6.3 5.6
8 Berry 3.6 3.7 3.5
9 Root vegetables 3.3 3.7 3.0
10 High-fibre breakfast cereals 2.0 1.8 2.2
aRank for all children.

Food sources of vitamins

Skimmed milk and fat-containing milk were the most important sources of vitamin D, followed by high-fat vegetable oil–based spreads among girls and by fish among boys (Table 3). The main source of vitamin E was high-fat vegetable oil–based spreads followed by vegetable oil in girls and vegetable oil followed by high-fat vegetable oil–based spreads in boys. The main sources of folate were non-root vegetables and potato in girls and boys. Non-root vegetables were the main source of vitamin C, followed by sugar-sweetened beverages among girls and boys.


Table 3.  Dietary sources of selected vitamins in all children, girls, and boys
All (n=430) Girls (n=213) Boys (n=217)
Ranka Food group % of intake % of intake % of intake
Vitamin D
1 Skimmed milkb 31.9 32.0 31.8
2 Fat-containing milkb 16.1 16.7 15.6
3 High-fat vegetable oil–based spreadsb 11.1 12.2 10.1
4 Fish 9.7 8.4 10.8
5 Low-fat vegetable oil–based spreadsb 6.5 6.0 6.9
6 Shortenings and other added fats 6.3 6.7 6.0
7 Fish products 3.0 2.8 3.1
8 Egg 2.9 3.1 2.7
9 Pork 2.5 2.4 2.6
10 Butter and butter-based spreads 1.5 1.3 1.7
Vitamin E
1 Vegetable oil 14.1 13.1 15.1
2 High-fat vegetable oil-based spreads 12.8 13.5 12.2
3 Non-root vegetables 5.4 5.8 5.0
4 High-fibre bread 5.2 5.4 5.1
5 Low-fat vegetable oil–based spreads 5.1 4.4 5.6
6 Shortenings and other added fats 4.4 4.4 4.4
7 Fruit 4.1 4.6 3.7
8 Low-fibre bread 3.9 4.0 3.8
9 Egg 3.8 3.9 3.6
10 Butter and butter-based spreads 3.1 2.7 3.4
Folate
1 Non-root vegetables 13.5 14.4 12.7
2 Potato 11.5 11.5 11.5
3 Skimmed milk 9.3 8.9 9.7
4 Sour milk products 6.5 6.2 6.8
5 High-fibre bread 6.0 6.2 5.8
6 Fruit 5.8 6.3 5.3
7 Fat-containing milk 4.5 4.4 4.6
8 Low-fibre grain products 3.9 3.7 4.0
9 Low-fibre bread 3.8 3.6 4.0
10 Egg 3.3 3.3 3.3
Vitamin C
1 Non-root vegetables 22.3 23.1 21.4
2 Sugar-sweetened beverage 18.4 17.3 19.5
3 Fruit 14.4 15.9 12.9
4 Fruit juice 13.6 12.6 14.5
5 Berry 10.5 10.3 10.7
6 Potato 7.2 7.0 7.3
7 Skimmed milk 4.9 4.6 5.2
8 Fat-containing milk 2.4 2.3 2.5
9 Root vegetables 2.0 2.1 2.0
10 Sour milk products 0.9 0.8 1.0
aRank for all children. bFortified with vitamin D.

Food sources of minerals

Sodium was mainly obtained from salt among girls and boys (Table 4). The main source of potassium was skimmed milk, followed by potato in girls and fat-containing milk in boys. Skimmed milk and fat-containing milk provided the majority of calcium intake in girls and boys. High-fibre bread was the main source of iron, followed by low-fibre grain products in girls and boys. The main sources of magnesium were skimmed milk and high-fibre bread in girls and boys. Similarly, skimmed milk was the main source of zinc, followed by high-fibre bread among girls and boys.


Table 4.  Dietary sources of selected minerals in all children, girls, and boys
All (n=430) Girls (n=213) Boys (n=217)
Ranka Food group % of intake % of intake % of intake
Sodium
1 Salt 37.8 37.9 37.7
2 High-fibre bread 8.2 8.6 7.9
3 Skimmed milk 6.9 6.9 6.9
4 Sausage 6.6 5.8 7.3
5 Low-fibre bread 4.8 4.8 4.8
6 Pork 4.1 3.7 4.4
7 Fat-containing milk 3.2 3.3 3.1
8 Condiments and sauces 3.2 3.4 3.0
9 Ready meal 2.1 1.9 2.2
10 Low-fibre breakfast cereals 1.8 1.9 1.7
Potassium
1 Skimmed milk 20.4 19.9 20.9
2 Potato 9.7 9.9 9.5
3 Fat-containing milk 9.7 9.7 9.6
4 Non-root vegetables 6.9 7.3 6.6
5 Fruit 6.3 6.8 5.8
6 Sour milk products 5.4 5.1 5.6
7 High-fibre bread 5.0 5.0 5.0
8 Sugar-sweetened beverages 2.9 2.8 3.0
9 Low-fibre grain products 2.8 2.8 2.8
10 Pork 2.8 2.6 3.0
Calcium
1 Skimmed milk 38.9 38.6 39.2
2 Fat-containing milk 19.5 19.9 19.2
3 Sour milk products 8.6 8.3 8.8
4 Cheese 5.3 4.6 5.9
5 Low-fat cheese 4.8 5.3 4.4
6 Ice cream and pudding 2.5 2.7 2.4
7 Chocolate and hot chocolate powder 1.9 1.7 2.0
8 Low-fat sour milk products 1.9 1.9 1.8
9 Candy 1.6 1.5 1.6
10 Non-root vegetables 1.5 1.6 1.4
Iron
1 High-fibre bread 12.4 12.7 12.0
2 Low-fibre grain products 9.3 9.4 9.2
3 Potato 6.2 6.3 6.0
4 Low-fibre bread 5.9 5.8 6.0
5 High-fibre grain products 5.9 5.7 6.1
6 Pork 5.4 5.1 5.6
7 Beef 4.2 4.3 4.2
8 Egg 3.7 3.9 3.6
9 Candy 3.7 3.5 3.9
10 Non-root vegetables 3.6 3.9 3.4
Magnesium
1 Skimmed milk 16.7 16.4 17.1
2 High-fibre bread 11.7 11.9 11.6
3 Fat-containing milk 7.7 7.8 7.7
4 Potato 6.6 6.6 6.5
5 Fruit 5.0 5.4 4.6
6 Low-fibre grain products 4.8 4.9 4.7
7 High-fibre grain products 4.6 4.4 4.7
8 Low-fibre bread 4.3 4.2 4.4
9 Non-root vegetables 4.2 4.5 4.0
10 Sour milk products 3.9 3.7 4.1
Zinc
1 Skimmed milk 16.2 16.1 16.3
2 High-fibre bread 9.8 10.1 9.5
3 Pork 9.0 8.6 9.4
4 Fat-containing milk 7.8 8.0 7.7
5 Beef 7.4 7.6 7.3
6 Low-fibre grain products 4.9 5.0 4.7
7 Low-fibre bread 4.0 3.9 4.0
8 Sour milk products 3.8 3.7 3.9
9 High-fibre grain products 3.8 3.7 4.0
10 Sausage 3.4 2.9 3.9
aRank for all children.

Discussion

Our study in a population sample of girls and boys 6–8 years of age provides new information on the top food sources of energy, energy nutrients, dietary fibre, and several vitamins and minerals among primary school children. Previous studies have mainly focused on the sources of one or few nutrients (9, 1921), and only few studies have compared the food sources of nutrients among girls and boys (8, 11).

Milk products have been observed to be among the main sources of energy, protein, and SFA among children in Western countries (6, 8, 1013). However, most of the previous studies have not analysed the contribution of milk products of different fat contents to the intake of nutrients. We found that skimmed milk was among the top sources of energy, protein, carbohydrates, vitamin D, folate, potassium, calcium, magnesium, and zinc. Fat-containing milk provided a lower proportion of all these nutrients than skimmed milk. This finding is due to the higher consumption of skimmed milk than fat-containing milk in the present study sample that is in line with the results of previous studies in Finnish children (1, 22). However, we observed that fat-containing milk was the highest source of SFA among children. Since milk is commonly consumed in large quantities among children, the consumption of fat-containing milk easily leads to an excessive intake of SFA. Because milk is an important source of several nutrients among children, sufficient intake of these nutrients from other sources should be assured among children who do not drink milk regularly.

Bread has been reported to provide 20–45% of the intake of dietary fibre among Finnish children (6) and European adolescents (23). We found that high-fibre bread was among the top sources not only for dietary fibre but also for iron, magnesium, and zinc. However, low-fibre grain products were the top source of energy and carbohydrates among children. These findings are explained by a higher density of dietary fibre and minerals but a lower consumption of high-fibre grain products than those of low-fibre grain products. Enhancing the use of high-fibre grain products at the expense of low-fibre grain products could be effective in improving the intake of several nutrients among children.

Previous studies have reported that sugar-sweetened beverages provide a considerable amount of energy and refined carbohydrates among children (8, 13, 14). In line with those findings, sugar-sweetened beverages were the top source of sucrose in children in this study, providing one-fifth of total sucrose intake. They were also the ninth most common source of energy and the fifth most common source of carbohydrates. The reduction in the consumption of sugar-sweetened beverages among children would markedly decrease their total intake of sucrose, which is currently higher than recommended (1, 24). Moreover, we found that sugar and honey provided almost 18% of the total sucrose intake in children. In this study, the food group of sugar and honey included all sugar used at home in baking, cooking, and as table sugar, and the dietary analysis software was unable to analyse sugar from recipes and sugar as such separately. This led to overestimation of sugar and honey as a source of sucrose at the expense of other food groups and needs to be acknowledged when comparing the dietary sources of sucrose in this study with those of other studies.

Previous studies have shown that the daily intake of vitamin D from food is around 6 µg in Finland (2426) and even lower in the most Western countries (2, 3, 27). Products fortified with vitamin D have been reported to be major food sources of vitamin D in children across Europe and USA (10, 2628). Whereas products fortified with vitamin D are available to a lesser extent in many other countries, in Finland most of the liquid dairy products and vegetable oil-based spreads have been fortified with vitamin D since 2003. In line with this, we found that the top sources of vitamin D among children were skimmed milk, fat-containing milk, and high-fat vegetable oil–based spreads that together contributed more than a half of the total intake of vitamin D. The level of fortification was increased in 2010, after the data collection of this study, in both liquid dairy products and fat spreads. Therefore, we suggest that the fortified products are even more abundant sources of vitamin D in Finnish children at the moment. Moreover, because skimmed milk was among the top sources of several vitamins and minerals, and high-fat vegetable oil–based spreads were among the top sources of MUFA, PUFA, and vitamin E, these products are not only good sources of vitamin D but also important sources of other nutrients among children.

Potato was among the top 10 sources of energy, carbohydrates, dietary fibre, folate, vitamin C, potassium, iron, and magnesium in our study sample. Although potato is not particularly rich in these nutrients (16, 29), high consumption of potato in Finland makes it as a good source of several nutrients. On the contrary, although the consumption of vegetables and fruit was relatively low among children in this study, they contributed markedly to the intakes of dietary fibre, vitamin E, folate, and vitamin C and to a lesser extent to the intakes of several minerals. This is due to the high density of these nutrients in vegetables and fruit (29).

Fish and fish products were among the top 10 sources of vitamin D in our study. However, fish did not markedly contribute to the intakes of any other nutrients, although it is high in protein and several minerals, such as calcium and potassium, and some fish species provide a considerable amount of PUFA (29). This finding is explained by the low consumption of fish among children in our study, which is in line with a previous report among Finnish children (1, 24).

In one previous study, meat provided more total and SFA in boys than in girls among 15-year-old adolescents, but the differences between genders were smaller among 9-year-old children (8). We also found that meat and sausages covered a slightly higher proportion of the intake of protein, fat, and sodium in boys than in girls. Moreover, vegetable oils provided a higher proportion of PUFA and vitamin E among boys, whereas high-fat vegetable oil–based spreads provided a higher proportion of these nutrients among girls. However, the rankings of most sources of nutrients did not differ between girls and boys. One explanation for the minor differences between girls and boys can be that our study sample consisted of primary school children who are provided a free-of-charge school meal every school day which may equalise food consumption between genders at this age. In addition, most of the gender differences in the sources of nutrients may not appear before adulthood (30).

A major strength of this study is the large population-based sample of Finnish primary school children. Another strength is that food consumption and nutrient intake were assessed by 4-day food records that were reviewed by a clinical nutritionist together with the family at return and analysed using a carefully updated nutrition database. A limitation of this study is that the grouping of food items was based on the judgement of a clinical nutritionist which could have had an influence on the rankings. If no detailed information was available, standard recipes were used for foods prepared at home, which could have led to either underestimation or overestimation of the intake of certain nutrients at an individual level. However, at group level this might have a minor effect only.

This study provides comprehensive data on the main food sources of nutrients among primary school girls and boys. Foods that are commonly recommended to be included in a healthy diet, such as skimmed milk, high-fibre grain products, vegetables, vegetable oil, and vegetable oil-based spreads, had a major contribution to the intake of several health-promoting nutrients, whereas sugar-sweetened beverages provided the majority of sucrose intake. This knowledge can be used in improving health among children by dietary interventions, nutrition education, and health policy decision making.

Acknowledgements

We are grateful to all voluntary subjects and their families participating in the PANIC study. We are also gratefully indebted to the research team for the skilful contribution in performing the study. The PANIC study was financially supported by grants from the Ministry of Social Affairs and Health of Finland, the Ministry of Education and Culture of Finland, the Finnish Innovation Fund Sitra, the Social Insurance Institution of Finland, the Finnish Cultural Foundation, the Juho Vainio Foundation, the Foundation for Paediatric Research, the Paavo Nurmi Foundation, the Paulo Foundation, the Diabetes Research Foundation, state research funding from the Research Committee of the Kuopio University Hospital Catchment Area, Kuopio University Hospital EVO funding, and the city of Kuopio.

References

  1. Eloranta A, Lindi V, Schwab U, Kiiskinen S, Kalinkin M, Lakka HM, et al. Dietary factors and their associations with socioeconomic background in Finnish girls and boys 6–8 years of age: the PANIC study. Eur J Clin Nutr 2011; 65: 1211–18. PubMed Abstract | Publisher Full Text
  2. Lambert J, Agostoni C, Elmadfa I, Hulshof K, Krause E, Livingstone B, et al. Dietary intake and nutritional status of children and adolescents in Europe. Br J Nutr 2004; 92: S147–211. PubMed Abstract | Publisher Full Text
  3. Elmadfa I, Meyer AL, Nowak V, Hasenegger V, Putz P, Verstraeten R, et al. European Nutrition and Health Report 2009. Ann Nutr Metab 2009; 55: 1–40. PubMed Abstract | Publisher Full Text
  4. Nordic Council of Ministers (2014). Nordic nutrition recommendations, integrating nutrition and physical activity. Copenhagen, Denmark: Nordic Council of Ministers.
  5. National Nutrition Council (2014). Finnish nutrition recommendations. Helsinki, Finland: National Nutrition Council. (in Finnish)
  6. Kyttälä P, Ovaskainen M, Kronberg-Kippilä C, Erkkola M, Tapanainen H, Tuokkola J, et al. The diet of Finnish preschoolers. Helsinki, Finland: Publications of the National Public Health Institute; 2008. (in Finnish)
  7. Erkkola M, Kronberg-Kippilä C, Kyttälä P, Lehtisalo J, Reinivuo H, Tapanainen H, et al. Sucrose in the diet of 3-year-old Finnish children: sources, determinants and impact on food and nutrient intake. Br J Nutr 2009; 28: 1209–17. PubMed Abstract | Publisher Full Text
  8. Patterson E, Wärnberg J, Kearney J, Sjöström M. Sources of saturated fat and sucrose in the diets of Swedish children and adolescents in the European Youth Heart Study: strategies for improving intakes. Public Health Nutr 2010; 13: 1955–64. PubMed Abstract | Publisher Full Text
  9. Cribb VL, Northstone K, Hopkins D, Emmett PM. Sources of vitamin A in the diets of pre-school children in the Avon longitudinal study of parents and children (ALSPAC). Nutrients 2013; 13: 1609–21. PubMed Abstract | PubMed Central Full Text | Publisher Full Text
  10. Royo-Bordonada MA, Gorgojo L, de Oya M, Garcés C, Rodríguez-Artalejo F, Rubio R, et al. Food sources of nutrients in the diet of Spanish children: the four provinces study. Br J Nutr 2003; 89: 105–14. PubMed Abstract | Publisher Full Text
  11. Subar AF, Krebs-Smith SM, Cook A, Kahle LL. Dietary sources of nutrients among US children, 1989–1991. Pediatrics 1998; 102: 913–23. PubMed Abstract | Publisher Full Text
  12. Stroehla BC, Malcoe LH, Velie EM. Dietary sources of nutrients among rural native Americans and white children. J Am Diet Assoc 2005; 105: 1908–16. PubMed Abstract | Publisher Full Text
  13. Keast DR, Fulgoni VL, Nicklas TA, O’Neil CE. Food sources of energy and nutrients among children in the United States: National health and nutrition examination survey 2003–2006. Nutrients 2013; 5: 283–301. PubMed Abstract | PubMed Central Full Text | Publisher Full Text
  14. Reedy J, Krebs-Smith SM. Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. J Am Diet Assoc 2010; 110: 1477–84. PubMed Abstract | PubMed Central Full Text | Publisher Full Text
  15. Paturi M, Nieminen R, Reinivuo H, Ovaskainen ML, editors. Picture book of food portion sizes. Helsinki, Finland: Publications of the National Public Health Institute; 2006.
  16. Rastas M, Seppänen R, Knuts LR, Hakala P, Karttila V. Nutrient composition of foods. Helsinki, Finland: Publications of the Social Insurance Institution; 1997.
  17. Torun B, Davies PS, Livingstone MB, Paolisso M, Sackett R, Spurr GB. Energy requirements and dietary energy recommendations for children and adolescents 1 to 18 years old. Eur J Clin Nutr 1996; 50: S37–81. PubMed Abstract
  18. Krebs-Smith SM, Kott PS, Guenther PM. Mean proportion and population proportion: two answers to the same question? J Am Diet Assoc 1989; 89: 671–6. PubMed Abstract
  19. Slining MM, Mathias KC, Popkin BM. Trends in food and beverage sources among US children and adolescents: 1989–2010. J Acad Nutr Diet 2013; 113: 1683–94. PubMed Abstract | PubMed Central Full Text | Publisher Full Text
  20. Vandevijvere S, Michels N, Verstraete S, Ferrari M, Leclercq C, Cuenca-García M, et al. Intake and dietary sources of haem and non-haem iron among European adolescents and their association with iron status and different lifestyle and socio-economic factors. Eur J Clin Nutr 2013; 67: 765–72. PubMed Abstract | Publisher Full Text
  21. Campbell KJ, Hendrie G, Nowson C, Grimes CA, Riley M, Lioret S, et al. Sources and correlates of sodium consumption in the first 2 years of life. J Acad Nutr Diet 2014; 114: 1525–32. PubMed Abstract | Publisher Full Text
  22. Mäki P, Hakulinen-Viitanen T, Kaikkonen R, Koponen P, Ovaskainen ML, Sippola R, et al. Child health – results of the LATE-study of growth, development, health, health behavior and growth environment. Helsinki, Finland: National Institute for Health and Welfare; 2010.
  23. Lin Y, Huybrechts I, Vereecken C, Mouratidou T, Valtueña J, Kersting M, et al. Dietary fiber intake and its association with indicators of adiposity and serum biomarkers in European adolescents: the HELENA study. Eur J Nutr 2015; 54: 771–82. PubMed Abstract | Publisher Full Text
  24. Kyttälä P, Erkkola M, Kronberg-Kippilä, Tapanainen H, Veijola R, Simell O, et al. Food consumption and nutrient intake in Finnish 1–6-year-old children. Public Health Nutr 2010; 13: 947–56. PubMed Abstract | Publisher Full Text
  25. Hoppu U, Lehtisalo J, Tapanainen H, Pietinen P. Dietary habits and nutrient intake of Finnish adolescents. Public Health Nutr 2010; 13: 965–72. PubMed Abstract | Publisher Full Text
  26. Soininen S, Eloranta AM, Lindi V, Venäläinen T, Zaproudina N, Mahonen A, et al. Determinants of serum 25-hydroxyvitamin D concentration in Finnish children: the Physical Activity and Nutrition in Children (PANIC) study. Br J Nutr 2016; 115(6): 1080–92. PubMed Abstract | Publisher Full Text
  27. Black LJ, Walton J, Flynn A, Kiely M. Adequacy of vitamin D intakes in children and teenagers from the base diet, fortified foods and supplements. Public Health Nutr 2014; 17: 721–31. PubMed Abstract | Publisher Full Text
  28. Berner LA, Keast DR, Bailey RL, Dwyer JT. Fortified foods are major contributors to nutrient intakes in diets of US children and adolescents. J Acad Nutr Diet 2014; 114: 1009–22. PubMed Abstract | Publisher Full Text
  29. Fineli, Finnish food composition database. Helsinki, Finland: National Institute for Health and Welfare, Nutrition Unit. Release 16. Available from: http://www.fineli.fi [cited 18 May 2015].
  30. Helldán A, Raulio S, Kosola M, Tapanainen H, Ovaskainen ML, Virtanen S. The National FINDIET 2012 Survey. Helsinki, Finland: National Institute for Health and Welfare; 2013. (in Finnish)

Footnote

These authors contributed equally to this work.

About The Authors

Aino-Maija Eloranta
University of Eastern Finland
Finland

Institute of Biomedicine

Taisa Venäläinen
University of Eastern Finland
Finland

Institute of Biomedicine /
Institute of Public Health and Clinical Nutrition

Sonja Soininen
University of Eastern Finland / City of Varkaus
Finland

Institute of Biomedicine /
Institute of Dentistry /
Social and Health Center, City of Varkaus

Henna Jalkanen
University of Eastern Finland
Finland

Institute of Biomedicine

Sanna Kiiskinen
University of Eastern Finland
Finland

Institute of Biomedicine

Ursula Schwab
University of Eastern Finland / Kuopio University Hospital
Finland

Institute of Public Health and Clinical Nutrition /
Institute of Clinical Medicine

Timo A. Lakka
University of Eastern Finland / Kuopio Research Institute of Exercise Medicine / Kuopio University Hospital
Finland

Institute of Biomedicine /
Department of Clinical Physiology and Nuclear Medicine

Virpi Lindi
University of Eastern Finland
Finland

Institute of Biomedicine

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