How are children in Singapore eating?

In a study of 777 children from the GUSTO cohort, it was found that approximately 56 percent had healthful diets. While the results are encouraging, there are still many kids here who could afford to eat more healthily. A better understanding of the factors impacting childhood diets could prove helpful with improving how children in Singapore eat.

Child eating healthily

Childhood obesity in Singapore is on the rise. According to figures from the Ministry of Health (MOH), the proportion of overweight children in our mainstream schools, aged 6 to 18 years, increased from 11 percent in 2013 to 13 percent in 2017. Research has shown that obesity tends to track over the life course, which puts an overweight child at increased risk of type 2 diabetes, elevated blood pressure and cardiovascular disease in adulthood.

With diet being a major influencing factor in childhood obesity, researchers from the National University of Singapore and the Singapore Institute for Clinical Sciences looked into the dietary patterns of 777 five-year-old children – the preschool period is crucial in influencing the long-term diet preferences of children – from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort to better understand local diets and the intricacies that influence what preschoolers in Singapore eat.

What young kids are being fed
Approximately two-thirds of the children had their parents as their primary caregivers with more than half of parents reporting that they read food labels when making food purchases. Through the use of a quantitative food frequency questionnaire administered to caregivers of the GUSTO children, researchers identified two mutually exclusive clusters: “Healthy” and “Unhealthy”. The dietary pattern of the “Healthy” cluster (56.1 percent) was characterised by higher intakes of fruits, vegetables and fish, while the “Unhealthy” cluster (43.9 percent) had higher intakes of white bread, processed meat, ice cream and sweets. At five years of age, 18.3 percent of the children were overweight.

The study also found differences in nutrient intakes between clusters. The higher levels of dietary fibre, vitamin A and beta-carotene intakes in the “Healthy” diet were consistent with a higher intake of fruits and vegetables, while the “Unhealthy” cluster had higher levels of total energy carbohydrates, as well as lower levels of healthier fats such as monounsaturated fatty acids and polyunsaturated fatty acids, which are in line with the higher intakes of refined and processed food in this cluster.

An interesting finding was that the choice of protein sources differed between the clusters – the protein sources of children in the “Healthy” cluster were mainly from fish, non-fried poultry, tofu and non-fried red meat. These food items were consumed less often by children in the “Unhealthy” cluster.

Influences of a child’s diet
Besides gaining insight into the types of food children in Singapore were eating, researchers also discovered associations between the children’s diets, ethnicity and maternal education levels.

Children of Indian and Malay ethnicities (as compared to Chinese kids) had higher odds of being assigned to the “Unhealthy” cluster. This finding was consistent with the Singapore National Nutrition Survey of adults in 2010, where adults belonging to the Malay ethnic group tended to have lower intakes of fruits and vegetables.

A lower maternal education level (secondary-level or below) was also associated with twice the odds of children being assigned to the “Unhealthy” cluster – this may be related to how mothers perceive the importance of diet for the health of children or due to the differing abilities of mothers to access health-related information. However, the author of the paper highlights that this finding must be interpreted with caution, as it may be possible that social desirability bias affected the responses.

Helping little ones eat better
By understanding the dietary patterns of preschool children here and the factors influencing what kids in Singapore eat, policymakers here may be better informed when developing health promotion programmes aimed at improving the diets of Asian children.

(Excerpts taken from the published paper Dietary patterns of 5-year-old children and their correlates: findings from a multi-ethnic Asian cohort)