1 ORIGINAL ARTICLES / Prace oryginalne Gastroenterologia Polska 2011, 18 (4): ISSN Copyright 2011 Cornetis, Evaluation of diets of young people aged from rural areas in K arpatian province in terms of diet-related disease risk in adulthood Ocena sposobu żywienia młodzieży w wieku lat z terenów wiejskich województwa podkarpackiego w aspekcie zagrożenia chorobami żywieniowozależnymi w wieku dorosłym Diana Wolańska Outpatient Clinic of the Diet-Related Disease and Metabolic Disease National Food and Nurition Institute, Warsaw, Poland Address for correspondence: Mgr Diana Wolańska Poradnia Chorób Żywieniowozależnych z Poradnią Chorób Metabolicznych Instytutu Żywności i Żywienia ul. Powsińska 61/63, Warszawa, Poland phone: (+48 22) ; Abstract Introduction: The proper eating habits are the essential elements of recommended prohealthy lifestyle. Establishing healthy eating habits in childhood and adolescence is essential to young people s dental and general health in the future. Both nutritional deficiency and excess may lead to dietrelated diseases which impair the population health condition. Aim of the study: The aim of this study was the evaluation of dietary habits in regard to dietary recommendations in the adolescents, aged living in the rural region of south-eastern Poland. Material and methods: The examinations were performer on 110 youth, aged from 13 to 15 years, living in the region of south-eastern Poland (in the municipality Bukowsko).The research tool was an anonymous questionnaire that included information about the number of meals during the day, data pertaining to meal frequency, size, contents and composition. Data obtained with 24-hour questionnaire method were calculated with computer program Dieta 2.0 and compared with dietary recommendations for young people aged Results: Our results show many dietary errors, such as long breaks between meals and irregularity of daily meals. Consumption of min. 4 meals per day on weekdays and holidays was declared by 41% and 64% of the patients, respectively. It is alarming that the intake of milk and dairy products remains insufficient milk consumed only 42% of the young people. Fermented milk beverages rarely were considered in the diet daily yogurt or kefir chose only 23% and 6%, respectively. The results indicate that adolescents consume too little vegetables and fruits. Very worrying in terms of risk of developing diet-related diseases was excessive consumption of fruit juices and sweet beverages, which are daily consumed 68% and 32% respondents. We noticed an increasing tendency to snacking between main meals, especially sweets and crisps. We observed a high prevalence of children with nutritional deficiencies. We found also deficiencies of vitamins most children did not meet recommendations for vitamins D and C as well as folate. Intake of mineral components was very low, especially calcium, iron, magnesium, zinc and copper. Significant excess of dietary intake of sodium was found in all respondents. Conclusions: Nutrition study group of young people aged years deviate from the principles of healthy nutrition. Perpetuate the existing incorrect dietary behavior may result in the continuation of their adulthood, and consequently adversely affect the normal development and health in present and future. The study demonstrated that there are significant deviations from the optimal recommendations for the intake of nutrients in adolescents. Results suggest a potential need for nutrition education for youth of secondary schools. (Gastroenterol. Pol., 2011, Vol. 18, No. 4, p ) Key words: nutritional behavior, food consumption, children and teenagers, nutrition dependent diseases Streszczenie Wprowadzenie: W rozwoju somatycznym dziecka okres dojrzewania jest jednym z najbardziej dynamicznych, co wiąże się z zwiększonymi potrzebami żywieniowymi. Tylko prawidłowo zbilansowana dieta dostarcza odpowiedniej ilości składników pokarmowych oraz witamin i składników mineralnych, będących podstawą prawidłowego wzrostu i dojrzewania. Nieprawidłowe żywienie w tym okresie może być przyczyną wielu chorób żywieniowozależnych zarówno w okresie młodzieńczym, jak i zwiększać ryzyko ich wystąpienia w wieku późniejszym. Cel: Celem pracy była ocena sposobu żywienia młodzieży w wieku lat zamieszkałej w regionie wiejskim w odniesieniu do zaleceń żywieniowych. Materiał i metody: Badaną grupę stanowiła młodzież (n=110) w wieku lat zamieszkała na terenie powiatu sanockiego, gminy Bukowsko. Dane o sposobie żywienia zebrano za pomocą autorskiego kwestionariusza ankiety oraz wywiadu 24-godzinnego, na podstawie którego oszacowano całodzienną rację pokarmową (CRP) i obliczono jej wartość odżywczą przy użyciu programu kompu- 141
2 Wolańska D. Ocena sposobu żywienia młodzieży w wieku lat z terenów wiejskich... Gastroenterol. Pol., 2011, 18 (4), terowego Dietetyk 2. Wartość odżywczą CRP porównano z normami dla młodzieży w wieku lat, opracowanymi w Instytucie Żywności i Żywienia. Wyniki: Sposób żywienia badanej młodzieży w wieku lat wykazał wiele nieprawidłowości. Dotyczyły one m.in. niewłaściwej częstości spożywania posiłków. Tylko 39% uczniów w dni powszednie i wowano zbyt mały udział mleka i produktów mlecznych w CRP. Codziennie po mleko sięgało jedynie 42% młodzieży, natomiast jogurty czy kefiry wybierało tylko 23% i 6% respondentów. Kolejnymi nieprawidłowościami była zbyt niska podaż warzyw i owoców oraz nadmierne spożycie napojów owocowych oraz słodkich napojów gazowanych, które codziennie pijało odpowiednio 68% i 32% badanych. Między posiłkami uczniowie najczęściej podjadali słodycze i chipsy. Dzienne racje pokarmowe młodzieży nie zapewniały pokrycia zapotrzebowania na większość składników odżywczych, zwłaszcza witamin (D, C i kwasu foliowego) i składników mineralnych (wapń, żelazo, magnez, cynk i miedź). Wnioski: 1. Sposób żywienia badanej grupy młodzieży w wieku lat był nieprawidłowy w zakresie regularności spożycia posiłków oraz częstości spożycia warzyw, owoców oraz produktów mlecznych. 2. Całodzienne racje pokarmowe młodzieży nie zapewniały pokrycia zapotrzebowania na większość składników odżywczych, zwłaszcza witamin (D, C) i składników mineralnych, takich jak wapń, magnez, cynk, żelazo. 3. Istnieje potrzeba edukacji żywieniowej wśród badanej grupy młodzieży w celu skorygowania nieprawidłowych zachowań żywieniowych. Słowa kluczowe: zachowania żywieniowe, spożycie żywności, dzieci i młodzież, choroby żywieniowozależne 142 Introduction During the somatic development of a person, the adolescence is one of the most dynamic periods in terms of physical, psychological and social progress. Multiple changes, taking place in teenagers bodies, are strictly combined with increased nutritional needs. Together with puberty and growth of the body increases the demand for energy and essential nutrients. Therefore it is extremely important to feed the children and youth in accordance with their current stage of development. Nutritional and health behavior patters that are carried on into adulthood are formed during adolescence. The determining factor of these patterns is usually the life-style of the family, however social conditions, school, peers and media also play an important role. The nutritional factors in 20-40% are responsible for obesity. Strengthening of the incorrect nutritional behaviors, especially in teenagers with genetic predispositions, largely increases the risk of obesity in adulthood . Hence, rational nutrition is one of the basic determinants of the child s correct development, especially during puberty, as well as affecting the psycho-social behavior and health in adulthood. Incorrect nutrition, concerning both deficiency and excess of particular food types and nutritients, as well as consumption of poor health quality foods, may lead to development of many conditions in puberty or increase their risk at later age. The most common diseases caused by incorrect nutrition are overweight, obesity and caries among teenagers, as well as osteoporosis, diabetes and atherosclerosis in adulthood. Nevertheless, all of above have their roots in incorrect nutrition during adolescences and puberty. Aim of the study The aim of our study was evaluation of the dietary habits of teenagers, aged years, living in the rural region of south-eastern Poland in regard to dietary recommendations. Materials and methods The study included teenagers (n=110), aged years, living in the Bukowsko community and surrounding villages: Tokarnia, Karlików, Wolica, Wola Piotrowa. All subjects were residents of rural area and attended junior high-school in Bukowsko (Publiczne Gimnazjum w Bukowsku). In the study an anonymous questionnaire was used, filled by the students with permission of parents and school board (school principal). The family history was collected through an anonymous questionnaire that included information about: parents education, socio-economic conditions, the number of meals partaken during the day, preferences and frequency of specific meals, as well as all-diet record of the last 24 hours. The acquired data was used to evaluate the dietary habits of the teenagers and the 24-hour questionnaire concerning the partaken products and meals helped to establish daily food rations and their nutritional values were calculated with computer program Dieta 2.0. The results were compared with dietary recommendations of the Institute of Food and Nutrition (Instytut Żywności i Żywienia), provided for young people aged years . The nutritional status was evaluated by anthropometric parameters (weight and height) from the growth charts. Basing on the obtained data the body mass index (BMI) was calculated: BMI (kg/m 2 )=weight (kg)/height (m 2 ), that was later on interpreted using percentiles grinds of the Institute of Mother and Child (Instytut Matki i Dziecka), taking into account the sex and age of the patients. The criteria of evaluation of the nutritional status in accordance with recommendations of the Institute of Mother and Child were utilized . Results The characteristics of the evaluated group We evaluated 110 persons, aged years, living in the Bukowsko community. Among examined teenagers, there were 47 boys (43%) and 63 girls (57%), where each age group
3 Gastroenterol. Pol., 2011, 18 (4), Wolańska D. Evaluation of diets of young people aged from rural areas... constituted 1/3 of the respondents: 34% 13 years olds, 32% 14 years olds and 34% 15 years olds. The children came from whole families, where the parents education was at the level of vocational 44% of mothers and 62% of fathers, and secondary 35% of mothers and 26% of fathers. Majority of the parents were both professionally active (39%), while in 30% of families professionally active was only father and in 13% only mother. Parents of 21% of the evaluated students were unemployed and their income came from farm-management. Approximately half of the teenagers came from large families with 6 or more members. The smallest family was one that comprised of 3 members only 1 of the evaluated persons (tab. I). The evaluation of the nutritional status During the interpretation of the BMI in accordance with the percentiles grinds 16% of the examined teenagers showed the characteristics of shortage of body weight, while overweight were 18%, among which 6% were obese. Self-evaluation of figure In the self-evaluation of their figures, 55% of the students found it to be correct accordingly to the reality, 15% too slim and 3% definitely too slim. In turn, 15% of the students found their figures to be a bit too fat and 3% definitely too fat. Girls more often found themselves as fat than boys (40% vs 6%). Moreover, the group who found themselves to be definitely too fat comprised only of 15 years old girls. Diets and other actions in order to loose weight undertook 13% of the teenagers and 11% did not administer diets, despite willing to loose weight. Evaluation of the dietary habits The questionnaires results concerning the regularity of meals showed that 39% of the students partake 4-5 meals a day during the week days and 62% during the weekend. Majority (55%) of the examined teenagers stated that they partake 3 meals a day. Everyday 78% of them ate breakfast, while lunch (2nd breakfast) was eaten by every second child (53%). Dinner at home ate almost each of the evaluated children (93%), while 39% of them partook also afternoon tea and majority (79%) had supper as well. While the preferred snacks were sweets (61%) and other high-calorie products such as crisps (35%), only 27% of the respondents chose fruits and just 2 persons reached for vegetables. The data concerning the frequency of the partake of particular groups of products showed, that fruits and vegetables were eaten daily or almost daily by 61% and 81% of the teenagers, respectively. The girls more often than boys ate the fruits (87% vs 72%) and vegetables (75% vs 43%). In daily nutrient ration (DNR) wheat bread was more common than the rye bread 84% and 14%, respectively. The daily consumption of diary products declared 72% of the examined teenagers: 42% used milk everyday and only 1/3 yogurts. In the everyday diet cheese was eaten by 57%, while the cottage cheese by 20%. While, meat was consumed by more than half (53%) of the respondents daily and at least once a week by 35%, fish was eaten mainly once a week by 53% of evaluated and 1/4 of them did not include fish into their diet or ate it less frequently than once a week. The preferred drinks consumed daily were: tea (85%), fruit drinks (68%) and mineral water (52%). Caffeine coffee was drunk everyday by 15% of the teenagers and 35% drank it at least weekly. The nutritional value of the average daily nutrient ration The mean of the nutritional values of the DNR of boys and girls were 1720±434 kcal and 2288±673 kcal, respectively. In their diet, girls averagely supplied 56.9±18.2 g of proteins, 65.9±23.3 g of fats and 239.8±69.7 g of carbohydrates, while boys 78.6±25 g of proteins, 91.3±29.8 g of fats and 307.5±101 g of carbohydrates. The average content of the basic nutrients, vitamins and minerals was shown in table II. In the analyzed diets, the contents of calcium and phosphorus were: in girls 579±263 mg and 912±275 mg and in boys 677±381.5 mg and 1215±429 mg, respectively. The quantity of some of the microcomponents and fat-soluble vitamins in the diet amounted: iron 9.9±5.8 mg and 13.2±6.6 mg; vitamin A 1019±1913 μq and 731.5±519.7 μq; vitamin D 2.3±3.14 μq and 3.0±4.0 μq; in girls and boys respectively. The amount of vitamin C in DNR was 50.2±36.8 mg in girls and 39.9±26.2 mg in boys. Discussion The occurrence of the shortage of body weight, as well as overweight and obesity, especially with unsuitable dietary habits, pose an important problem, particularly among the TABLE I: Characteristics of the evaluated group Sex Persons (n) %n Girls 63 63% Boys 47 43% Age 13 years 38 34% 14 years 34 32% 15 lyears 38 34% Parents education Basic 15 7% Vocational % Secondary 67 30% Higher 22 10% Parents occupational situation Both working 38 34% One working 47 43% Farm-management 23 21% Both unemployed 2 2% Amount of children in family 1 1 1% % % 4 and more 51 46% 143
4 Wolańska D. Ocena sposobu żywienia młodzieży w wieku lat z terenów wiejskich... Gastroenterol. Pol., 2011, 18 (4), adolescents, which may lead even to incorrect development. Our studies presented improper body weight in 34% of the evaluated teenagers, among which 18% showed excessive body weight. According to HSBC studies conducted in Poland in 2010, overweight was recognized in 10.6% of teenagers aged years and obesity in 10.3% . In Warsaw population of teens aged years, the overweight was stated in 18% of boys and 11% of girls, while obesity in 2.8% and 3.4%, respectively . The results of the our study concerning nutritional status are comparable with the results of other authors. Nevertheless, the expanding problem of excessive body weight among teenagers is noticeable, what constitutes an important risk factor of nutrition dependent diseases. Perception of own body shape by young people is valid aspect in context of impaired nutritional risk. Interesting seems to be the fact, that more of the examined teenagers found their bodies too fat or definitely too fat than the results of the evaluation of nutritional status showed (27% vs 18%). This group was constituted mostly girls who independently undertook efforts to reduce their body mass, often using starvation or unbalanced diets, that increase the risks of incorrect development or forming eating disorders in the future. Equally disturbing in the report from HSBC study are results showing TABLE II: Average daily energy and nutrients intake of examined teenagers Energy and nutrients Grils Boys Mean value SD Mean value SD Energetic value kcal Energetic value kj Total protein g Total fats g Cholesterol mg Total carbohydrates g Dietary fibre g Vitamin vit. A uq vit. D uq Thiamin mg Riboflavin mg Pyridoxine mg Cobalamin uq Folate uq 139± Vit. C mg 50.2± Minerals Sodium mg Potassium mg Calcium mg Phosphorus mg Magnesium mg Iron mg Zinc mg that almost every young person is interested in their appearances and more than half would like to change something about their body . Every fifth teenager find themselves to be too skinny (mostly boys), a every third too fat (mostly girls). 20% of teenage girls has applied slimming diet, which often were incorrectly selected and administered, posing a serious threat for health. These results confirm how important is the nutrition education, what could lead not only to improved knowledge about nutrition, but also rise awareness of children and teenagers that if and when they want to reduce their body mass, rather than do it on their own, they should ask for help from qualified medical personnel, such as nutritionist. Dietary habits of the examined teenagers aged years showed many incorrectness, concerning, among others, improper frequency of meals, especially during week days. According to nutrition recommendations, 4-5 meals a day during the weekends ate 62% of the respondents, while during week days only 39%. Irregularity of the meals was noticeable in case of breakfast and lunch, which were either skipped or eaten only sometimes (at least once a week, though) by 22% and 46% of the evaluated teenagers. Similar abnormalities were observed by other authors [4, 6-11]. Boniecka et al. noticed that breakfast was eaten by majority of children aged 7-9 years, but only by 70% of older students (junior-high school) . The analysis conducted by HSBC, showed that only 63% of respondents aged and 56% aged accounted breakfast in their daily food ration . Irregular meals contribute to daily snacking up to 89% of the teenagers, what was also noted by other authors [9, 11, 12]. Our study showed that, while the most frequent snacks were sweets and crisps, 61% and 35% respectively, only every third of the respondents snacked on fruits. Snacking on products with potentially adverse health impacts, which are sources of simple sugars and saturated fatty acids, may contribute to an earlier occurrence of diseases arising from the defective nutrition. Continuation of this kind of nutritional behaviors may adversely influence not only the child s development during puberty, but also negatively affect their health in adulthood. While regular meals, together with intervals no longer than 3-4 hours, allow to maintain a steady blood glucose levels and prevent the development of overweight, obesity and other diet-related diseases, such as diabetes mellitus type 2 and atherosclerosis, too long intervals between meals may also impair mood and increase irritability, what often leads to conflicts in school and at home . In our study, we noticed too small percentage of milk and dairy products in daily food rations, especially milk-fermented beverages. Although almost every fourth teenager gave up drinking milk and milk-fermented beverages, more than 50% of them preferred cheese over cottage cheese (20%). Other authors stated comparable frequency of consumption of the diary products, where their daily intake was declared by 28-50% of the respondents [14-18]. Flaczyk et al., Waszkowiak et al. and Szczęsna et al. showed that the most common were: cheese, fruit yogurts and ice-cream [19-21]. Never or less frequently than once a week milk-fermented beverages were chosen by majority of the patients ( kefir 70% and maślanka 83%) what was confirmed by the results of Jeżewska-Zychowicz et
5 Gastroenterol. Pol., 2011, 18 (4), Wolańska D. Evaluation of diets of young people aged from rural areas... al. and Topolska et el. [6, 22]. Moreover, teenagers from rural area chose kefir more often than those from bigger cities. Too low intake of diary products, including calcium, may lead to progress of obesity, hypertension and earlier development of osteoporosis in adulthood. Diet with high content of calcium, while reducing lipogenesis also intensifies processes of lipolysis and thermogenesis, which prevent increase of the fat tissue and weight gain [22-24]. Many studies indicate that only calcium from diary products has this kind of property, what is connected with the occurrence in only these products of other biologically active compounds, such as angiotensinconverting enzyme inhibitor, which influences the metabolism of adipocytes of the fat tissue [25, 26]. Consumption of diary products with reduced fat content may be one of the elements of prevention of obesity and metabolic syndrome. Another important incorrectness was too rare daily consumption of fruits and vegetables 81% and 61% of the students, respectively, as well as other low-proceeded cereal products, particularly rye bread (daily eaten by only 14% of the examined). Other authors showed more favorable results, where daily consumption of fruits was declared by 16% up to 72% of examined and vegetables 15% up to 66% [4, 7, 9, 11, 27]. The frequency of fish intake in the evaluated group of teenagers diverges significantly from dietary recommendations. Disturbing is the fact that every fourth teenager did not eat fish at all or did less frequently than once a week, what was also stated by other authors [10, 11, 14]. They showed that as much as 10-30% resigns from fish consumption and 40-63% included it in their diet only once a week. Due to the fact, that fish are very good source of essential polyunsaturated fatty acids, as well as iodine, phosphorus, selenium and vitamin D, these results are particularly worrying in terms of preventing cardiovascular and thyroid diseases. In terms of risks of overweight and obesity, bothering is the frequent consumption of sweets and sweetened drinks. Our study showed that sweets and sodas were daily partook by 61% and 68% of the respondents, respectively. Oblacińska et al., while comparing the dietary behaviors of obese teenagers and those with proper weight, showed that CocaCola and other sodas were drank significantly more often on weekly basis by the control group (40% vs 28%) . 9% of the obese and almost as much (7%) of the control group never drank sweetened drinks. Sodas are not recommended in children s and teenagers nutrition, due to being primarily the source of simple sugars as well as containing aromatic substances, dyes, acids and other preservatives. Large consumption of such beverages may be an important risk factor for many diseases, including obesity, diabetes mellitus type 2, gastroesophageal reflux and caries, what is connected with big content of the simple sugars as well as their high acidity in cases of gastro-esophageal reflux and caries [13, 28]. The analysis of daily nutrient ration of teenagers compared with the nutrition recommendations showed that diets did not fulfill the needs for most of the nutritional components. The diets did not provide sufficient amount of energy: in case of girls, it was 680 kcal less than recommended 2400 kcal and in case of boys 712 kcal too little (from 3000 kcal). Boys diet contained 35% too much of proteins, while the diet of both sexes included only about 80% of recommended amount of fats. Girls diet comprised too little fiber, amounting 16.6±5.4 g, with the recommended 20 to 40 g per day. DNR were also insufficient in essential for development minerals such as calcium, magnesium, iron and zinc, as well as vitamins D and C. Augustyniak et al. presented different results and the similarities concerned only the deficiency of energy, fiber (in girls), niacin, calcium, magnesium and copper . The differences were noticed in fulfillment of requirement for proteins, fat, group B vitamins, vitamin C, iron and zinc. Moreover, Augustyniak et al. stated deficiencies of vitamin A in girls and its excess in boys, unlike in our study . Jeżewska-Zychowicz et al. and Czeczelewski et al. got similar results [6, 30]. Food rations of the examined teenagers included deficient amounts of calcium, iron and copper, but excessive amounts of sodium, potassium and phosphorus. Magnesium and zinc comprised the difference in the authors studies. Evaluation of nutritious food ration, done by Rożnowski et al., was very similar to our study and results . The similarities included deficiency of energy, calcium, iron, zinc, and excess carbohydrates, group B vitamins, sodium, potassium and phosphorus. On the other hand, the differences were shown in deficiency of consumed proteins and excess of consumed fats and vitamin C, comparing to the recommendations. It should be noticed, that our study as well as other authors observed significant nutrient deficiencies in the nutritional value of DNR, that are highly important during intense developmental changes of the body associated with puberty. Nutrient deficiencies are caused mainly by irregular meals, lack of their diversity and other mistakes in nutrition, such as inappropriate selection of quality products in the daily food rations. Continuation of the incorrect nutritional behaviors and permanent deficiencies of nutrients in the diet may lead not only to disturbances during puberty, but also increase the risk of development of nutrition dependent diseases. References 1. Otyłość u polskich nastolatków: epidemiologia, st yl życia, samopoczucie. (red.) A. Obla cińska, M. Jodkowska. Instytut Matki i Dziecka, Warszawa, Normy żywienia człowieka. Podstawy prewencji otyłości i pr zewlekłych chorób niezakaźnych. (red.) M. Jarosz, B. Bułhak-Jachymczyk. PZWL, Warszawa, Jodkowska M., Woynarowska B., Oblacińska A.: Test przesiewowy do w ykrywania zaburzeń w r ozwoju fizycznym u dzieci i młodzież y w wieku szk olnym. Instytut Matki i Dziecka, Warszawa, Wyniki badań HBSC Rapor t techniczny. (red.) J. Mazur, A. Małkowska-Szkutnik. Instytut Matki i Dziecka, Warszawa, Chabros E., Charzewska J., Wajszczak B., Rogalska-Niedźwiedź M., Chwojnowska Z., Fabiszewska J.: Częstość występowania nadwagi i ot yłości u młodzież y warszawskiej w wieku pokwitania. [w:] Otyłość epidemią XXI wieku. (red.) J. Charzewska, P. Bergman, K. Kaczanowski, H. Piechaczek. Akademia Wychowania Fizycznego, Warszawa, 2006, Jeżewska-Zychowicz M., Łyszkowska D.: Ocena wybranych zachowań żywieniowych młodzieży w wieku lat i ich uw arunkowania na przykładzie środowiska miejskiego. Żywienie Człow. Metabol., 2003, 30, Sygit K., Sygit M., Talerczyk M., Talerczyk M., Zienkiewicz P., Owoc A.: Znaczenie znajomości zachowań zdrowotnych młodzieży wiejskiej dla popr awy stanu zdr owia. Zdrow. Publiczne, 2003, 113, Babicz-Zielińska E., Schlegel-Zawadzka M., Wądołowska L., Przysławski J., Czarnocińska J.: Wpływ miejsca zamieszkania na pr eferencje i spo życie żywności. Bromatol. Chem. Toksykol., 2004, 37, suppl. 3-4,
6 Wolańska D. Ocena sposobu żywienia młodzieży w wieku lat z terenów wiejskich... Gastroenterol. Pol., 2011, 18 (4), Gacek M., Fiedor M.: Charakterystyka sposobu odż ywiania się młodzież y w wieku lat. Rocz. Państw. Zakł. Hig., 2005, 56, Piórecka B., Jagielski P., Wójcik K., Żwirska J., Schlegel-Zawadzka M.: Zachowania żywieniowe młodzieży gimnazjalnej w Małopolsc e. Żywienie Człow. Metabol., 2007, 34, Boniecka I., Michota-Kotulska E., Ukleja A., Czerwonogrodzka A., Kowalczyk E., Szczygłowska A.: Zachowania żywieniowe wybranej grupy dzieci w wieku szk olnym w aspekcie zagrożenia otyłością. Przegl. Lek., 2009, 66, Cisek M., Martko H., Schlegel-Zawadzka M.: Ocena sposobu ż ywienia uczniów w Zubrzycy Górnej. Żywienie Człow. Metabol., 2007, 34, Zasady prawidłowego żywienia dzieci i młodzież y oraz wskazówki dotyczące zdrowego stylu życia. (red.) M. Jarosz. Instytut Żywności i Żywienia, Warszawa, Cieślik E., Filipiak-Florkiewicz A., Topolska K.: Częstotliwość spożycia wybranych grup produktów spożywczych oraz stan odżywienia młodzieży gimnazjalnej. Żywienie Człow. Metabol., 2007, 34, Czeczelewski J., Huk-Wieliczuk E., Michalska A., Raczyńska B., Raczyński G.: Ocena sposobu żywienia dzieci ze śr odowiska wiejskiego i miejsk iego z ter enu południowego Podlasia. Żywienie Człow. Metabol., 2001, 28, suppl. 2, Kołłajtis-Dołowy A., Pietruszka B., Waszczeniuk-Uliczka M., Chmara-Pawlińska R.: Wybrane zachowania żywieniowe młodzieży gimnazjalnej z Warszawy. Żywienie Człow. Metabol., 2003, 30, Perek M., Krzeczkowska B., Twarduś K.: Zachowania żywieniowe młodzieży w ok resie dojrzewania. Ann. Univ. Mariae Curie-Sklodowska (Med.), 2003, 58, suppl. 13, Szczepaniak B., Górecka D., Flaczyk E.: Zachowania żywieniowe młodzieży z wybranych regionów kraju w zak resie spożycia mleka i pr oduktów mlecznych. Żywienie Człow. Metabol., 2003, 30, Flaczyk E., Górecka D., Szczepanik B., Spisacka B.: Preferencje i częstość spo życia mleka i jego przetworów wśród młodzieży szkół ponadpodstawowych w K oninie. Żywienie Człow. Metabol., 2003, 30, Waszkowiak L., Szymańska A., Szymandera-Buszka K.: Wpływ czynników demograficznych na spożycie przetworów mlecznych wśród młodych kobiet studiujących i pracujących. Żywienie Człow. Metabol., 2007, 34, Szczęsna T., Waszkowiak K., Krawiecka B.: Wpływ wieku, miejsca zamieszkania oraz wykształcenia na pr eferencje i częstotliw ość spożycia produktów mlecznych wśród młodzieży szkolnej z r ejonu Wielkopolski i K ujaw. Żywienie Człow. Metabol., 2005, 32, suppl., Topolska K., Cieślik E., Bodzioch A., Grzych-Tuleja E.: Preferencje młodzieży gimnazjalnej z terenu województwa małopolskiego w zakresie spożycia mleka i produktów mlecznych. Żywność Nauka Technologia Jakość, 2010, 69, Pereira M.A., Jacobs D.R., Van Horn L., Slattery M.L., Kartashov A.I., Ludwig D.S.: Dairy consumption, obesity and the insulin r esistance syndrome in y oung adults: the CARDIA study. JAMA, 2002, 287, Van Loan M.: The role of dairy foods and dietar y calcium in weight management. J. Am. Coll. Nutr., 2009, 28, suppl. 1, 120S-129S. 25. Zemel M.B.: Regulation of adiposity and obesity risk risk b y dietary calcium: mechanisms and implications. J. Am. Coll. Nutr., 2002, 21, 146S-151S. 26. Zemel M.B.: The role of dairy foods in w eight management. J. Am. Coll. Nutr., 2005, 24, suppl. 6, 537S-546S. 27. Kołłajtis-Dołowy A., Kosińska M., Boniecka I.: Częstotliwość i ilość spo życia wybranych produktów spożywczych w grupie letnich dzieci z ter enu Grójca. Żywienie Człow. Metabol., 2007, 34, Jarosz M., Rychlik E.: Napoje słodzone gazowane i ich z wiązek z powstawaniem chorób dietozależnych. Stand. Med., 2007, 4, Augustyniak U., Brzozowska A.: Sposób żywienia młodzieży w P olsce na podstawie piśmiennictwa z ostatnich 10 lat ( ). Rocz. Państw. Zakł. Hig., 2002, 53, Czeczlewski J., Huk-Wieliczuk E., Michalska A.: Ocena sposobu ż ywienia dzieci ze środowiska wiejskiego i miejsk iego z ter enu południowego Podlasia. Żywienie Człow. Metabol., 2001, 28, suppl., Rożnowski J., Cymek L., Czerny W., Czaja R.: Evaluation and comparison of diets of year old children inhabiting villages and small towns of Podkarpacie. Pol. J. Environ. Stud., 2006, 15, Received: Revised: Accepted: Conflict of interests: none declared Wydawnictwo Medyczne Cornetis Sp. z o.o. Polskie Towarzystwo Gastroenterologii oraz Redakcja GASTROENTEROLOGII POLSKIEJ ogłaszają Konkurs o nagrodę prof. dr. hab. dr. h.c. Zbigniewa Knapika za najlepsze prace opublikowane w Gastroenterologii Polskiej w danym roczniku. Celem konkursu jest wyłonienie spośród artykułów zamieszczonych na łamach Gastroenterologii Polskiej w danym roczniku najlepszej pracy oryginalnej, poglądowej i kazuistycznej.