The proportion of differently processed foods in the diet of Croatian school-aged children and its impact on daily energy and nutrient intake

In countries around the world, a dietary shift is observed in which the consumption of highly processed foods increases over unprocessed or minimally processed foods. The objective of this study was to observe the proportion of processed foods in the diet of school-aged children and to assess how this relates to sex, weight status and school meal consumption. The aim was to assess the impact of processed foods on overall diet quality in terms of ultra-processed foods contribution to total daily energy intake. Dietary intake was observed from dietary records for three non-consecutive days of 168 children (50.6% boys) aged 8.3 ± 0.5 years. All foods and beverages were classified into four groups according to NOVA food classification system. The contribution of each NOVA food group to total daily energy intake was calculated and the mean nutrient intake of children divided into terciles according to total daily energy intake from ultra-processed foods was compared. Anthropometric measurements were performed according to standard protocols, while sex and age z-scores were obtained using AnthroPlus software. Results show that unprocessed or minimally processed foods (38.1% kcal) and ultra-processed foods (38.1% kcal) had the highest proportion of dietary intake. There was no difference in NOVA food groups intake by sex or weight status, while number of school meals may contribute to the intake of processed culinary ingredients. Children who had higher energy intake from ultra-processed foods had lower intake of animal proteins (p=0.009), polyunsaturated fatty acids (p=0.014), vitamin A (p=0.027) and most minerals, but higher intake of carbohydrates (p=0.014) and copper (p=0.014) compared to children with lower energy intake from ultra-processed foods. In conclusion, school-aged children had equal share of energy from unprocessed or minimally processed foods and from ultra-processed foods. Higher share of energy from ultra-process foods may contribute to poor overall nutrition