Jemds.

com Original Research Article

JUNK FOOD CONSUMPTION AND LIFESTYLE PATTERN AMONG UNDERNOURISHED CHILDREN IN

JAMMU REGION
Pallavi Sharma1, Ashu Jamwal2, Sunil Dutt Sharma3, Rattan Singh Manhas4, Ghanshyam Saini5, Tarundeep Kour6

1Registrar, Department of Paediatrics, GMC, Jammu, Jammu and Kashmir, India.

2Assocaite Professor, Department of Paediatrics, GMC, Jammu, Jammu and Kashmir, India.
3Associate Professor, Department of Paediatrics, GMC, Jammu, Jammu and Kashmir, India.
4Senior Consultant, Department of Paediatrics, J & K Health Services, Jammu and Kashmir, India.
5Professor, Department of Paediatrics, GMC, Jammu, Jammu and Kashmir, India.
6Dental Officer, DEIC, Department of Paediatrics, GMC, Jammu, Jammu and Kashmir, India.

ABSTRACT
BACKGROUND
Changing lifestyles and easy availability both have led to increased consumption of junk food amongst all age groups. Such foods
and beverages have low nutrient density, provide empty calories and have minimal amount of vitamins and minerals and their
regular consumption can adversely affect our health. The association of junk food with obesity and cardiovascular risk factors has
been well established, but less has been talked about its association with undernutrition.
Aims and Objectives- Current study was designed to assess the junk food consumption and lifestyle pattern among the
underweight children.

MATERIALS AND METHODS

It is a prospective hospital-based study. Children aged 5-18 years, presenting to Paediatric OPD of a Medical College Hospital were
screened for weight, height and BMI. Those with a BMI for age less than -2SD as per WHO BMI charts were included in the study.
They were evaluated for dietary intake including junk food consumption, lifestyle pattern especially physical activity and screen
time as per a predesigned proforma. The co-infections with which they presented were also evaluated. The height, weight and BMI
of the parents were also recorded.

RESULTS
Out of the 203 study subjects, 58% were from urban areas while 42% belonged to rural area. Majority of the children belonged to
the middle class with 49.2% being from upper middle class and 39.2% from lower middle class. Fast food consumption was
reported as more than 4 times per week by 48.80 %, 2-4 times/week by 43.20%, at least once a week by 6.40%. 62.4 % of children
reported daily intake of sweetened beverages with 44.8% reporting intake of more than one per day. 27.6% of the children
reported having sweetened beverages at least 2 to 4 times in a week. Skipping of breakfast was common among school going
children and observed 2-4 times/week in 49.20%, and >4 times/week by 6.0%. About 57.60% children had purchased the school
lunch 2-4 times/week from canteen, 13.60% >4/week and 10.80% at least once a week. In the study subjects, approximately 52%
of children spent more than the recommended 2 hrs./day on screen, 32.4% spent 1-2 hrs. on screen. About 75% of the children
met the WHO recommendations for physical activity (i.e. moderate to vigorous physical activity of at least 60 minutes/day).

CONCLUSION
Cheap processed junk food has adversely affected the health of ordinary people. Such foods contain empty calories and hardly any
vitamins, minerals or proteins and may be an important contributor to under nutrition in both upper and lower middle class where
non-nutritive processed food and sugary beverages have replaced the traditional nutritious food. Both urban and rural population
have fallen prey to this malady.

KEY WORDS
Junk Food, Underweight, BMI.
HOW TO CITE THIS ARTICLE: Sharma P, Jamwal A, Sharma SD, et al. Junk food consumption and lifestyle pattern among
undernourished children in Jammu region. J. Evolution Med. Dent. Sci. 2018;7(50):5373-5377, DOI: 10.14260/jemds/2018/1189
BACKGROUND Foods such as chips, Kurkure, soft drinks, juices, ice
Junk foods are foods or beverages that have low nutrient creams, chocolates and snacks, classified as junk foods are
density, provide calories primarily through fats or added quite popular among children. Such foods are deficient in
sugars and have minimal amounts of vitamins and minerals. iron, calcium and other trace elements, and their sodium
‘Financial or Other Competing Interest’: None. content is very high. Some may contain chemicals, artificial
Submission 22-10-2018, Peer Review 23-11-2018, colours, flavours and preservatives which are bad for
Acceptance 29-11-2018, Published 10-12-2018.
Corresponding Author: health.(1) Regular and consistent consumption of such foods
Dr. Ashu Jamwal, over a long period of time may be deleterious to health.
Ram Niwas, 356-A, Ready availability, low cost, commercial marketing strategies
Gandhinagar, Jammu-180004, and peer pressure makes junk food popular with children.
Jammu and Kashmir, India.
E-mail: [email protected]
High fat and sugary taste being addictive attract the children
DOI: 10.14260/jemds/2018/1189 to junk food over healthy food.(2, 3)

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Jemds.com Original Research Article
Junk food has displaced more traditional diets and is now Sex Underweight
available in every neighbourhood. Biscuits, savoury snack Males 91 (44.82%)
packets and the likes, costing between five and ten rupees Females 112 (51.17%)
have replaced many meals for a large chunk of population Table 1. Association between Sex Distribution and BMI of
across rural and urban India. These children also consumed Study Subjects (n=203)
less of fresh fruits and vegetables and had less of milk
Age Distribution (Years) Underweight BMI < -2 SD
intake.(4)
5-9 yrs. 59 (29%)
An increased consumption of junk food has been reported
10-14 yrs. 55 (27%)
among school aged children as these are widely available in >15 yrs. 89 (43.8%)
and outside the schools, through variety of outlets. Sale of Table 2. Association between Age Distribution and BMI of
junk food in these outlets often competes with more Study Subjects (n=203)
nutritious school lunch schemes.(5)
India is fast becoming the diabetes and heart disease Family Status Number of Patients Percentage
capital of the world. The association of junk food with obesity Upper class 8 4.0%
and cardiovascular risk factors is well established. At the Upper middle 100 49.20%
same time India leads the world in terms of underweight Lower middle 80 39.2%
Lower class 15 7.6%
people with almost half the nation’s under-five being
Table 3. Demographic Characteristics of Study Subjects
underweight.(6,7) Undernutrition is closely associated with
(n=203)
communicable diseases like tuberculosis, malaria, pneumonia
and diarrhoea.(8,9) Population Number of Patients Percentage
The present study attempts to identify four risk factors Rural 85 42%
for eating behaviour i.e. fast food intake, sweetened Urban 118 58%
beverages intake, skipping of breakfast and purchased lunch Table 4
amongst the underweight children.

MATERIALS AND METHODS

All children 5-18 yrs. of age attending Paediatrics Department
OPD of Shri Maharaja Gulab Singh Hospital (SMGS-H), Jammu
every Thursday over a period of one month were screened,
their height and weight recorded, and BMI calculated. The
underweight children, i.e. those with BMI less than -2SD for
age and sex as per WHO BMI charts were included in the
study.(10) Their parents were explained the purpose of study
and informed consent was taken. Sociodemographic details
and history of present illness was taken, and a complete
clinical examination was done focusing on the detection of co-
morbid conditions. Each patient’s dietary quality, eating
behaviour, screen time and physical activity were evaluated
as per the designed Performa. The height and weight of
parents were also recorded, and BMI was calculated. Figure 1
The data was analysed using computer software
Microsoft Excel and SPSS version 12.0 for windows.

RESULTS
 800 children aged 5-18 yrs., who visited the outpatient
patient wing of the Department of Paediatrics a, SMGS
hospital were screened by BMI. Of them 203 satisfied
the inclusion criteria and were thus included in the
study.
 The study group comprised of 112(55.17%) females
and 91(44.82%) males. (Table-1)
 59(29%) children were between 5- 9 yr of age,
55(27%) between 10-11 yrs. and 89(43.8%) were more
than 15 years of age. (Table -2)
 88.4 % of the children belonged to the middle class
with 49.2% being from upper middle class and 39.2%
from lower middle class as per Modified Kuppuswamy
Scale. (Table -3)
 58% were from urban areas while 42% belong to rural Figure 2
area. (Table -4)

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Feeding Characteristics of Study Subjects (Table -5) Among the parents of study subjects 70.80% of mothers
 62.4 % of children reported daily intake of sweetened are obese, 17.20% are overweight, 7.60% are extreme obese
beverages with 44.8% reporting intake of more than one and 4.40% are having normal BMI, whereas 75.20% of
per day. 27.6% of the children reported having fathers are obese, 15.20% are overweight, 6.0 % are extreme
sweetened beverages at least 2 to 4 times in a week. obese and 3.60% are normal. Hence degree of under nutrition
 Skipping of breakfast was observed >4 times/week by did not correlate with parenteral nutrition (Table-7)
6.0%., 2-4 times/week in 49.20%, at least once a week
by 22.70%. BMI (kg/m2) Mother Father
 13.60% of children purchased school lunch from canteen Frequency (%) Frequency (%)
more than 4 times/week, 57.60% children did it 2-4 Underweight (<18.5) 0 0.00 0 0.00
Normal (18.5-24.9) 10 4.90 7 3.40
times/week and 10.80% at least once a week.
Overweight
 Fast food consumption was more than 4 times per week 35 17.20 31 15.20
(25.0-29.0)
by 48.80 %, 2-4 times/week by 43.20%, at least once a
Obese (30.0-40.0) 143 70.40 152 74.80
week by 6.40% and <1/week by 1.60%. Extreme obese (>40.0) 15 7.38 12 6.00
Table 7. BMI of Parents of the Study Subjects (n= 203)
Characteristics No. of Patients Percentage
Sweetened Beverages DISCUSSION
<1 week 7 3.60% The prevalence of moderate and severe underweight is
1/week 13 6.40% highest in South Asia; one in 5 girls aged 5-19 years and
2-4 times/ week 56 27.60% nearly one third of their male peers are underweight.
1/day 36 17.60% Physical growth is a key indicator of child health. (11)
>1/day 91 44.80% In the present study of 203 underweight children aged 5-
Breakfast Skipped 18 years, 58% were from urban and 42 % from rural areas.
<1/week 45 22.10% Majority belonged to the middle class with 49.2% belonging
to the upper middle class and 39.2 % belonging to the lower
1/week 46 22.70%
middle class. Intake of fast food and sweetened beverages
2-4/week 100 49.20%
was common in all age groups. Skipping breakfast and
>4/week 12 6.0%
purchasing school lunch was a commonly observed
behaviour.
Purchased School Lunch Gupta A et al in their study of children in the age groups
<1 week 36 18% 12-18 years from Govt Schools in the rural areas of Himachal
1/week 22 10.80% Pradesh found high prevalence (36%) of consumption of junk
2-4/week 117 57.60% food. They found that most popular junk food item was chips
>4/week 28 13.60% (71%) followed by chocolate (14%) bakery products (13%),
Fast Food Consumed soft drinks (7%) and sugar sweetened beverages (5%). They
<1/week 3 1.60% also observed that junk food was consumed mainly as snacks
1/week 13 6.40% from shops outside the school. (12)
Kaur M et al in their study screened 2636 children aged
2-4/week 87 43.20%
between 4 and 15 years from rural schools and reported that
>4/week 100 48.80%
fast food prevalence was high among all age groups and both
Table 5
the genders and nearly 60% of these consumed fast food on a
daily basis. All the children had inclination for fast food and
 In the study subjects approximately 52% of children 25% skipped meals for fast food.(4)
spent more than the recommended 2 hrs./day on screen, Most of the western countries and few schools in India
32.4% spent 1-2 hrs. on screen. have banned the sale of junk food in school cafeteria. In
 About 75% of the children met the WHO United Kingdom and many European countries, all
recommendations for physical activity (i.e. moderate to commercial activities in primary school are restricted as per
vigorous physical activity of at least 60 minutes/day). the directive of Union Of European Beverages Association
 Children attended the hospital with acute illnesses, like (UNESDA).(13) However, there is lack of stringent law and
gastroenteritis (30%), worm infestation (21%), anaemia regulation pertaining to fast food sale in Indian schools.
(18%), upper respiratory tract infection (16%), urinary In the present study these underweight children had
tract infection (12%) and acute hepatitis (3%). reported to the paediatric outpatient department with
various ailments like acute gastroenteritis (30%), worm
Characteristics No. of Patients Percentage infestation (21%), anaemia (18%), upper respiratory tract
TV – viewing/day infection (16%), urinary tract infection (12%), acute hepatitis
<1 hr 20 10% (3%). Childhood underweight is becoming increasingly
1-2 hrs 66 32.4% important contributor to adolescent undernutrition and
2-4 hrs 106 52% diseases, both deficiency as well as infections. Children who
are undernourished are at increased risk of various infectious
>4 hrs 11 5.60%
diseases due to weak immune system. The increased intake of
Table 6. Recreational Characteristics of Study Subjects
fast food predisposes children to infections due to poor

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hygiene during preparation, storage and handling of junk marketing and advertising of junk food in and around school
food.(9, 14) premises may also be helpful in reducing the consumption of
Reicheit Ac & Rank MM have also highlighted the negative junk food among school aged children.
impact of junk foods on cognition and behaviour during
adolescence. They further proposed that poor dietary choices CONCLUSION
may derail the normal adolescent maturational process, Fast foods have become an important part of dietary menu
which can predispose individuals to dysregulated eating and for most children. There is a high prevalence of food
impulsive behaviour.(15) consumption amongst the underweight children belonging to
Jalambo MO et al in their study of female adolescents aged the upper- and middle-class families in both urban and rural
15-19 years reported significant association between iron areas. Individual counselling for children and their families
deficiency anaemia and dietary habits like skipping breakfast on healthy eating habits, restricting junk food and replacing it
and the amount of junk food consumed and cognitive with available, affordable traditional food is the need of the
impairment.(16) hour.
Burrows et al in their review of literature reported that
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