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British Journal of Medicine & Medical Research
14(10): 1-9, 2016, Article no.BJMMR.24970
ISSN: 2231-0614, NLM ID: 101570965
SCIENCEDOMAIN international
www.sciencedomain.org
The Relationship between TV Viewing and Food
Intake and BMI in Preschool Children
Naser Kalantari
1
, Saeid Doaei
2*
, Hanieh Malmir
3
, Atefeh Aminifard
4
and Maryam Gholamalizadeh
5
1
Department of Community Nutrition, National Nutrition and Food Technology Research Institute,
Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences,
Tehran, Iran.
2
Students` Research Committee, National Nutrition and Food Technology Research Institute,
Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences,
Tehran, Iran.
3
Faculty of Nutrition Sciences, Tehran University of Medical Sciences, Tehran, Iran.
4
Food Sciences and Industry, Khouzestan Sciences and Research Branch, Islamic Azad University,
Khouzestan, Iran.
5
Research Center of Natural Product Safety and Medicinal Plants, North Khorasan University of
Medical Sciences, Bojnurd, Iran.
Authors’ contributions
This work was carried out in collaboration between all authors. Authors NK and SD designed the
study and wrote the protocol. Authors AA and MG wrote the first draft of the manuscript. Author HM
managed the literature searches and analyses of the study. All authors read and approved the final
manuscript.
Article Information
DOI: 10.9734/BJMMR/2016/24970
Editor(s):
(1) Toru Watanabe, Department of Pediatrics, Niigata City General Hospital, Japan.
Reviewers:
(1) Anonymous, Canada.
(2)
Danielle Cristina Guimarães da Silva, Universidade Federal de Viçosa, Viçosa, Brazil.
Complete Peer review History:
http://sciencedomain.org/review-history/13887
Received 10
th
February 2016
Accepted 14
th
March 2016
Published 28
th
March 2016
ABSTRACT
Background:
Considerable attention is currently being paid to childhood nutrition. Mass media,
particularly television (TV), is believed to largely contribute to eating habits and Body mass index
(BMI). This study was carried out to identify the relation between tendency towards TV viewing and
its influence on children with food intake and BMI in pre-school kids.
Original Research Article
Kalantari et al.; BJMMR, 14(10): 1-9, 2016; Article no.BJMMR.24970
2
Methodology:
The survey was conducted using a cross-sectional design, in which 114 children
aged 2-6 yrs from 11 selected nursery schools were included. Regarding data collection related to
TV viewing rate and influence rate of TV viewing from parents' viewpoint, a valid and reliable
questionnaire was used. To collect data about children's diets intake, a food frequency
questionnaire (FFQ) was applied. Face-to-face meetings and interviews with the parents were
held. Height and weights of children were measured using a measuring tape and a digital weight
scale. Data were analyzed using Pearson correlation coefficient and analysis of variance (ANOVA)
statistical tests by SPSS software.
Results: It turned out that consumption rate of some food groups including meats & alternatives
(p=0.008), sugars (p=0.013) and snacks & desserts (p=0.011) were higher in children who spend
more time watching TV. In addition, Intake of cereals and breads appeared to be higher in children
with strong desire for TV food ads (p=0.019). It was also revealed that influence rate of TV viewing
and fats intake were positively correlated (p=0.017). No significant relationship was revealed
between TV viewing rate and BMI in children
Conclusion: It can be concluded that tendency of preschool children to TV is positively related
with some food groups intake and consumption of low nutritional-value foods.
Keywords: Television viewing; body mass index; dietary intake; children.
1. INTRODUCTION
Childhood is considered to be the most important
period of life in which the main character qualities
of individuals are formed and from which lots of
fixed habits and behaviors such as eating habits
in adulthood are descended [1,2]. In fact,
provided that children are educated proper eating
habits, they will have healthier diets and less risk
of weight-related chronic disorders such as
obesity, diabetes, high blood pressure, metabolic
syndrome, as well as cardio-vascular diseases in
adulthood [3,4]. Additionally, increased body
weight in childhood is regarded as a strong
predictive factor for adulthood obesity [5]. Eating
habits development begins at the age of 2-3 yrs
and will be fixed at 12 [6]. Several environmental
factors such as family, friends, nursery and
primary schools, and mass media can be
addressed as influential causes for eating habits
and behaviors [7,8]. Television is the most
popular mass media in Iran. Based on some
previous studies, Iranian children aged 5-10 yrs,
on average, watch 4 h/9 min of TV, which is
considered to be much higher than screen-time
exposure recommended by World Health
Organization (WHO) [9]. The amount of TV
viewing has increased over the last decades,
paving the way for the prevalence of childhood
obesity [10]. Moreover, it is believed that much
TV viewing result in reduced physical activity,
increased non-nutritious and energy-dense food
consumption, increased sense of starvation, and
low-quality diet intake [11-13]. A TV in the child's
bedroom is an even stronger marker of increased
risk of being overweight [14]. There are 20-30
commercials on TV per hour, so a child whose
mean TV watching is 4 hours, may be exposed
to 80-120, 900, and 45000 of them daily, weekly,
and annually respectively of them [7]. At the time
of TV programs for children and adolescents,
these TV ads mainly focus on junk foods and
snacks such as potato chips, sugar-contained
beverage and juices, chocolate, fast food like
sausages, hamburger and pizza, fat-rich food
and pickles leading to adverse eating habits in
them [15].
According to statistics released by WHO, 7.6% of
children in the world suffer from obesity and
overweight [16]. In addition, based on figures
reported by Iranian ministry of health, 4-7%
children in rural areas and 15-20% in urban
areas gain excess weight in the country [17] and
fatness is estimated to have doubled over the
last decade [18]. With regard to the impact of
obesity and overweight on children physical and
mental health and wellbeing and relevant
consequences such as anxiety, educational
failure, depression, low self-confidence, some
cardio-vascular diseases and cancers, it is
required to administer some preventive
strategies like eating habits modification. Surveys
conducted in the country have focused largely on
investigating a relation between TV viewing with
diet pattern and body weight of children.
However, no study has been carried out to
investigate the association between TV program
contents and influence rate of TV viewing with
food groups intake and body mass index (BMI).
The present study is to investigate the
association of influence rate of TV viewing from
parents' viewpoint and TV viewing rate as well as
Kalantari et al.; BJMMR, 14(10): 1-9, 2016; Article no.BJMMR.24970
3
TV program contents on diet intake and BMI in
children aged 2-6 yrs coming from some nursery
school in Tehran.
2. MATERIALS AND METHODS
The survey was conducted using a cross-
sectional design in the summer of 2014.
Employing cluster random sampling technique,
114 children aged 2-6 yrs from 11 selected
nursery schools in Tehran were selected by
cluster randomized sampling. In a briefing
meeting, the school principals were explained
about the purpose and the advantages of survey
before the study began. In six of the nursery
schools, face-to-face meetings and interviews
with the parents were held to fill in food
frequency questionnaire (FFQ). In these
meetings, some other questionnaires including
general information and TV viewing were filled
out by parents and they signed an informed
consent. In five schools, face-to-face interview
was not conducted, so the questionnaires were
presented to the parents and returned through
the school principals. Then, through phone
interviews with parents, the FFQ were
completed.
Height was measured using a measuring tape
established on the wall, whose values recorded
to the nearest 0.5 cm. Weight was measured
with light wearing garments by a digital weight
scale (BF66 Beurer-Germany) to the nearest 100
gr. To gather the data related to child birth
weight, child's age, mother's age and height,
mother's employment, parents' literacy,
accommodation status as well as family's
income, the general information questionnaire
was employed. Regarding data collection
referring TV viewing rate and influence rate of TV
viewing from parents' viewpoint, a questionnaire
which had been already approved in terms of
validation and reliability was used. In order to
estimate the validity, a content and structure
assessment was applied and also a test-retest
method and kappa correlation coefficient was
used to assess the reliability [19]. The
questionnaire consisted of 11 questions, focusing
on the influence rate of TV viewing from parents'
viewpoint and TV viewing rate. All subtests were
measured with rating scale approach using Likert
Scale, ranging from Very "Low" to Very "Much".
The rate below score 3, score 3 and above score
3 are considered low, medium and high
respectively, in terms of influence rate of TV
viewing from parents' viewpoint and TV viewing
rate. To collect data related to children's diets, a
food frequency questionnaire (FFQ) which had
already been developed and validated in Iran
was used [20].
The questionnaire contained 168 food
ingredients, and consumption of each was
reported daily, weekly and monthly. These
ingredients are classified into 17 food groups
including whole cereal grains, processed cereal
grains, pulses, meats, dairy products,
vegetables, fruits, nuts & kernels, hydrogenated
fats, oils, sugars, honey & jams, beverages,
snacks & desserts, tea & coffee and pickles. In
the study, food items were allocated to 9 food
groups including cereals & breads, meats &
alternatives, dairy products, fruits, vegetables,
simple sugars, snacks & desserts, fats and
beverages. Feeding guide published in a book
entitled "Krause
’
s Food and the Nutrition
Care Process" was applied as the reference
for appropriate consumption of each food
group [21]. Data were analyzed using Pearson
correlation coefficient and analysis of variance
(ANOVA) statistical tests by SPSS (version 21)
and the level of significance was set at
p≤0.05.
3. RESULTS
The findings obtained from demographic data
and social characteristics showed that children
age was between 2.3 and 6.9 yrs. Most of the
mothers were housewives, married and had
academic education at the time of conducting
survey and their BMI were higher than the
normal. None of them smoked cigarette. Most of
the families participating in the survey came from
middle-class and affluent backgrounds. The
general characteristics of children and their
families are shown in Table 1. To determine the
values related to influence rate of TV viewing
from parents' viewpoint, mean scores of each
sub-test was calculated. Table 2 suggests that
TV viewing rate and influence rate of TV viewing
from parents' viewpoint turned out high and
medium respectively.
In addition, the average rate of TV viewing in
children was estimated to be 2 h/47 m (+ 1 h/35
m) and the most popular programs were kids'
series and cartoons (n=111), TV ads (n=62),
films and TV series (n=55). Moreover, it
appeared that intake of vegetable group was
lower than recommended rate (3 units/d) in half
of the children (Table 3). It also points out that
fruits, meats and dairy products were consumed
about 25% less than recommended rates.
Kalantari et al.; BJMMR, 14(10): 1-9, 2016; Article no.BJMMR.24970
4
(2 units/d for fruits and meats and 3 units/d for
dairy products). However, fats and simple
sugars, snacks & desserts and beverages intake
turned out to be 50%, 50%, 25% and 25% higher
than the permitted level. Relationship between
children TV viewing rate and influence rate of TV
viewing from parents' viewpoint with intake of
food groups and BMI was analyzed using
Pearson correlation and analysis of variance
(ANOVA) adjusted for all potential confounders
(Parent’s occupation, education levels, BMI,
income, marriage and their consent to child TV
viewing). The results are displayed in Tables 4
and 5.
Table 1. General characteristics and social factors related to children and their families
Variable Count
(percent) Variable Count
(percent) Variable Mean
±standard
deviation
Mother's educational
status Family's income Child's age
(year) 4.39±1.01
Lower than diploma 6(5.3) Less than 10
million Rials 2(17.5) Birth weight
(kg) 3.29±0.39
Diploma 34(29.8) Between 1 and 2
million Rials 67(58.8) Child's BMI 1.77±15.37
Higher than diploma 74(64.9) Over 2 million
Rials 27(23.7) Mother's age 32.28±5.96
Father's
educational
status
Child gender
Mother's
weight 66.46±10.37
Lower than diploma 9(7.9) Girls 71(63.3) Mother's
height 161.97±6.05
Diploma 30(29.8) Boys 43(37/3) Mother's BMI 25.48±3.99
Higher than diploma 75(65.8) Mother's marital
status
Mother's employment
status Married 114(100)
Housewife 84(73.7) Single parent 0(0)
Employee 30(26.3)
Table 2. Rate and tendency of children towards different TV programs
Variable Count
(percent) Variable Count
(percent) Variable Standard
deviation±
mean
TV viewing rate Children's popular
programs (third
choice
TV viewing rate
from parents'
viewpoint
3.29±0.66
Less than 2 hours 42(36.8) Films
and TV series
32(28.1) Influence rate of
TV viewing
(parents'
viewpoint)
2.64±0.49
More than 2 hours 72(63.2)
TV ads
10(8.8)
Children's popular
programs
(First choice)
Science programs
6(5.3)
Kids' series and
cartoons 109(95.6) Cd and DVD
cartoon 4(3.5)
TV ads 5(4.4) kids' series and
cartoons 1(0.9)
Children's popular
programs
(second choice)
Unanswered
58(50.9)
TV ads
50(43.9)
Films
and TV series
23(20.2)
Science programs 8(7)
Cd and DVD cartoon 1(0.9)
Unanswered 32(28.1)
Kalantari et al.; BJMMR, 14(10): 1-9, 2016; Article no.BJMMR.24970
5
Table 3. Children's intake of different food groups
Intake of different food groups
N (%)
Intake of different food groups
N (%)
Fats
Bread and cereals
Less than 3 unit/d 64(56.1) Less than required rate(3unit/d) 40(35.1)
More or equal to 3 unit/d 50(43.9) More or equal to 3 unit/d 74(64.9)
Sugars
Dairy products
Less than 2 unit/d 46(40.4) Less than required rate(3unit/d) 21(18.4)
More or equal 2 unit/d 68(59.6) More or equal to 3 unit/d 93(81.6)
Snacks & Desserts
Meats
Less than 2 unit/d 75(65.8) Less than 2unit/d 28(24.6)
More or equal to 2 unit/d 39(34.2) More or equal to 2 unit/d 86(75.4)
Beverages
Vegetables
Less than 1 unit/w 76(65.8) Less than 3unit/d 49(43)
More or equal to 1 unit/w 38(33.3) More or equal to 3 unit/d 65(57)
Fruits
Less 2unit/d 22(19.3)
More or equal to 2 unit/d 92(80.7)
Table 4. Association of children food intake and BMI with tendency towards different TV programs using analysis of variance (ANOVA)
BMI
Beverages
Fats
Snacks &
Desserts
Sugars
Vegetables
Fruits
Dairy
products
Meats
Cereals
0.972 0.247 0.242 1.570 0.279 0.275 0.548 1.315 0.074
0.607
Interested in cartoon 1.074 1.165 2.025 0.445 1.039 0.095 0.076 1.659 0.527 0.129 Interested in films and
TV series 0/002* 0.589 0.017 1.599 0.070 0.120 0.627 0.397 0.370 5.630* Interested in TV ads
0.02 0.005 0.089 0.152 0.256 1.347 0.355 0.358 0.488 2.076 Interested in to sport
programs 1.386 0.334 0.360 0.141 0.013 0.003 0.787 0.266 1.312 0.738 Interested in Science
programs
P<0.05; *p<0.01**
Table 5. Relationship between food intake and BMI with TV viewing rate and influence rate of TV viewing (parents' viewpoint) using Pearson correlation coefficient
Cereals
Meats
Dairy products
Fruits
Vegetables
Sugars
Snacks &
desserts
Fats
Beverages
BMI
TV viewing rate 0.127
0.246 ̽ ̽
0.036
-
0.159
0.084 0.233 ̽
0.221 ̽
0.153
0.118
0.012
Influence rate of TV viewing
(parents' viewpoint) 0.04
-
0.036
0.102
0.14
0.111
0.035
0.101
0.225 ̽
0.007
0.009
p<0.01** ; P<0.05*
Kalantari et al.; BJMMR, 14(10): 1-9, 2016; Article no.BJMMR.24970
6
The results showed that TV viewing rate in boys
was higher than girls (2.9±1.58 Vs 2.71±0.59),
but girls were influenced by TV viewing more
than boys (2.71±0.49 Vs 2.54±0.49) from
parents' viewpoint. Higher TV viewing rate in
children resulted in higher consumption of meats
(p=0.008), sugars (p=0.013) and snacks &
desserts (p=0.011). In addition, Intake of cereals
and breads appeared to be higher in children
with strong desire for TV food ads (p=0.019).
Regarding influence rate of TV viewing from
parents' viewpoint, children who were more likely
to be affected, showed higher intake of fats
(p=0.017). However, no significant relationship
was revealed between TV viewing rate and BMI
in children (p=0.09). Finally, desire for TV
advertising appeared to be positively correlated
with BMI (p=0.021). Gender was not found to be
a factor of significant impact on findings using
ANOVA.
4. DISCUSSION
The findings of this study suggest that there is an
association between TV viewing and influence
rate of TV viewing with food intake and in
children. Examination of the children diets
indicated that consumption of vegetables (43%),
fruits (19.3%), meats (24.6%), dairy products
(18.4%) and cereals (35.1%) were less than the
relevant recommended levels and Intake of
cereals and breads appeared to be higher in
children with strong desire for TV food ads. In
other studies, there were less reports about
lower intake of vegetables, fruits and cereals and
more reports about lower intake of dairy products
and meats than recommended values. Further,
intake of fats, sugars, snacks & desserts and
beverages were 43.2%, 59.6%, 34.2% and
33.3% respectively, exceeding the relevant
permitted levels [22,23]. According to the study
conducted by Millar et al. [23]. It was revealed
that children, on average, receive higher amount
of these foods than permitted levels. It also
suggests that as children get older, they receive
more fat-rich food and less sweetened food. It is
in correspondence with the study by Towers
et al. [24]. Also, introducing kids and cartoons,
advertising as well as films and TV series as the
most popular TV programs for children, was
similar to findings of a study about how children
and adolescents use media by Sepasgar [25].
Further, time increase in TV viewing contributed
to higher intake of meats (mostly in form of the
alternatives like sausages, hamburger, pizza),
sugars and snacks & desserts groups, which was
confirmed by some studies [26,27]. A positive
relation between the variables was reported by
wake et al. [28] and several other studies [29-31].
The difference between the results can be due to
the difference in the age range of children
studied, because in the other studies, children
over 6 years old were taken into consideration. It
appeared that enthusiasm for different TV
programs can affect food intake in children. As
mentioned before, there is a relation between
interest in watching TV advertising and increase
in cereals intake. In addition, meats intake in
children interested in TV advertising was higher
than uninterested ones (2.31±3.61 Vs
2.02±3.36), but it was not statistically significant
(p=0.544) and as sausages, hamburgers and
pizza are classified in meat group, this relation is
significant. Ka et al reported that watching TV
advertising can lead to 6% increase in meats
consumption [32]. Mean fruits intake in children
interested in TV scientific programs appeared to
be higher compared with uninterested ones
(4.48±4.06 Vs 1.62±3.51), but not statistically
significant (p=0.377). However, an inverse
relationship between fruits intake with TV viewing
was reported by Matheson et al. [33]. The
difference can be caused by the contents of
scientific programs. Moreover, the results
suggest that snacks & desserts intake was
positively affected by desire for films and TV
series viewing (1.39±2.01 Vs 2.07±1.79), but the
relation was not significant (p=0.506), which is
similar to the results of other studies. It is also
achieved from the findings that influence rate of
TV viewing and fats intake were positively
correlated (p=0.017), which is confirmed by
previous studies [34].
Further, in current study, desire for TV
advertising and BMI in children were related
together (p=0.021), which is consistent with other
studies (12-14). No relationship was found
between TV viewing time and BMI and this
corresponds to the result reported by Shannon
et al. [35].
5. LIMITATIONS
The findings of this study are based on cross-
sectional data, and a important avenue for future
research will be to replicate these studies with
causal structures using longitudinal data.
6. CONCLUSION
It can be concluded that tendency of preschool
children to TV is positively related with some
Kalantari et al.; BJMMR, 14(10): 1-9, 2016; Article no.BJMMR.24970
7
food groups intake and consumption of low
nutritional-value foods. Also, curbing screen-time
exposure, particularly advertising, can be taken
into consideration as an approach to improve
eating habits and to alleviate the prevalence of
overweight and obesity in children.
CONSENT
All authors declare that written informed consent
was obtained from the subjects for publication of
this paper.
ETHICAL APPROVAL
All authors hereby declare that all experiments
have been examined and approved by the
appropriate ethics committee and have therefore
been performed in accordance with the ethical
standards laid down in the 1964 Declaration of
Helsinki.
ACKNOWLEDGEMENTS
This work was supported by the Student’s
Research Committee of Shahid Beheshti
University of Medical Sciences, Iran (grant
number 5588).
COMPETING INTERESTS
Authors have declared that no competing
interests exist.
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