Urban and rural differences in frequency of fruit, vegetable, and soft drink consumption among 6–9-year-old children from 19 countries from the WHO European region

Heinen M.M. Bel-Serrat S. Kelleher C.C. Buoncristiano M. Spinelli A. Nardone P. Milanović S.M. Rito A.I. Bosi A.T.B. Gutiérrrez-González E. Pudule I. Abdrakhmanova S. Abdurrahmonova Z. Brinduse L.A. Cucu A. Duleva V. Fijałkowska A. Gualtieri A. Hejgaard T. Hyska J. Kujundžić E. Petrauskiene A. Sacchini E. Shengelia L. Tanrygulyyeva M. Usupova Z. Bergh I.H. Weghuber D. Taxová Braunerová R. Kunešová M. SantAngelo V.F. Nurk E. Ostojic S.M. Spiroski I. Tichá Ľ. Rutter H. Williams J. Boymatova K. Rakovac I. Weber M.W. Breda J.
November 2021 John Wiley and Sons Inc

Obesity Reviews
2021 #22 Issue S6

In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban–rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6–9 years from 19 countries participating in the fourth round (2015–2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Childrens parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30–80% and 30–90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1–2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.

children , fruit , rural , soft drinks , urban , vegetables

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National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
Croatian Institute of Public Health, Zagreb, Croatia
School of Medicine, University of Zagreb, Zagreb, Croatia
WHO/Europe Collaborating Center for Nutrition and Childhood Obesity - Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
Medical Faculty, Department of Public Health, Hacettepe University, Ankara, Turkey
Spanish Agency for Food Safety and Nutrition, Ministry of Consumer Affairs, Madrid, Spain
Department of Research and Health Statistics, Centre for Disease and Prevention Control, Riga, Latvia
Department of Science and Professional Development, National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Almaty, Kazakhstan
Kazakhstan School of Public Health, Kazakhstans Medical University, Almaty, Kazakhstan
Republican Centre for Nutrition, Ministry of Health and Social Protection of Population, Duschanbe, Tajikistan
Faculty of Medicine, Department of Public Health and Management, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
National Centre of Health Promotion and Health Evaluation, National Institute of Public Health, Bucharest, Romania
Faculty of Midwifery and Nursing, Discipline of Public Health and Health Management, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
Department Food and Nutrition, National Centre of Public Health and Analyses, Sofia, Bulgaria
Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
Health Authority, Ministry of Health, San Marino, San Marino
Health Promotion and Inequality, Danish Health Authority, Copenhagen, Denmark
Nutrition and Food Safety Sector, Institute of Public Health, Tirana, Albania
Center for Health Ecology, Institute of Public Health, Podgorica, Montenegro
Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
Maternal, Child and Reproductive Health, National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
Scientific Research Institute of Maternal and Child Health, Ashgabat, Turkmenistan
Republican Center for Health Promotion and Mass Communication, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
Department of Health and Inequality, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
Primary Child Health Unit, Primary Health Care, Floriana, Malta
Department of Nutrition Research, National Institute for Health Development, Tallinn, Estonia
Biomedical Sciences Department, Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
Institute of Public Health, Skopje, North Macedonia
Faculty of Medicine, SS. Cyril and Methodius University, Skopje, North Macedonia
Childrens Hospital National Institute of Childrens Diseases, Medical Faculty, Comenius University, Bratislava, Slovakia
Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
Division of Noncommunicable Diseases and Promoting Health Through the Life-Course, WHO Country Office for Tajikistan, Dushanbe, Tajikistan
World Health Organization (WHO) Child and Adolescent Health and Development, WHO Regional Office for Europe, Copenhagen, Denmark

National Nutrition Surveillance Centre
College of Health and Agricultural Sciences
World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases
National Centre for Disease Prevention and Health Promotion
Croatian Institute of Public Health
School of Medicine
WHO/Europe Collaborating Center for Nutrition and Childhood Obesity - Food and Nutrition Department
Medical Faculty
Spanish Agency for Food Safety and Nutrition
Department of Research and Health Statistics
Department of Science and Professional Development
Kazakhstan School of Public Health
Republican Centre for Nutrition
Faculty of Medicine
National Centre of Health Promotion and Health Evaluation
Faculty of Midwifery and Nursing
Department Food and Nutrition
Department of Cardiology
Health Authority
Health Promotion and Inequality
Nutrition and Food Safety Sector
Center for Health Ecology
Department of Preventive Medicine
Maternal
Scientific Research Institute of Maternal and Child Health
Republican Center for Health Promotion and Mass Communication
Department of Health and Inequality
Department of Pediatrics
Obesity Management Centre
Primary Child Health Unit
Department of Nutrition Research
Biomedical Sciences Department
Institute of Public Health
Faculty of Medicine
Childrens Hospital National Institute of Childrens Diseases
Department of Social and Policy Sciences
Division of Noncommunicable Diseases and Promoting Health Through the Life-Course
World Health Organization (WHO) Child and Adolescent Health and Development

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