EVALUATION OF NUTRITIONAL PREFERENCES OF SCHOOL-AGE CHILDREN AND PARENTS ATTITUDES TOWARDS CHILD NUTRITION: A CROSS-SECTIONAL STUDY

Objective: This study aimed to examine the nutrition of school-age children and the influence of their parents. Method: The study involved 259 school-age children aged 9-12 and their volunteering parents from a province in Türkiye. A questionnaire was administered to the children questioning sociodemographic data and basic nutritional information, anthropometric measurements were taken, and the Parent Mealtime Action Scale was applied to their parents. The obtained data were analyzed in SPSS 26 program. Results: It was found that the snack consumption status of children was related to the income status of the family's daily fruit and vegetable consumption (p<0.01). It has been found that animal fat restricted diet is associated with growth status in children (p<0.01). It has been determined that the children's eating situation is related to the persistent behavior of parents (p<0.05). It has been found that children who do not consume chips at all are also fed restricted animal fats in their daily diet. It was determined that bagel/cereal consumption was also excessive in children in whom rewarding was applied excessively (p<0.05). Conclusion: As a result, it was determined that school-age children's own preferences in food choices, as well as the parent's behavior and educational status, and the family's income level also have a significant impact. It is thought that it will be beneficial to provide nutrition education to parents and children in order to develop the right eating habits in school-age children and to increase the level of nutrition knowledge.


INTRODUCTION
Healthy nutrition; Although it has a separate importance for every age, it is very important for school-age children to ensure growth and development and maintain life in a 3 healthy way (Saavedra & Prentice, 2023;Orkun Erkılıç et al., 2024).The school age period covers the period between the ages of 5-15.It is seen that academic accumulation of knowledge takes place during this period when the individual grows and develops physically and mentally (Abrams, 2021;Karaağaoğlu & Şanlıer, 2020).In addition, it is a period in which behavioral and psychosocial changes are experienced due to the fact that it also covers the transition process to adolescence.During this transition process, gender-related differentiations also occur in growth and development.It can be a process that helps to correct nutritional problems that occur in infancy.For this reason, adequate and balanced nutrition during school age is of critical importance for maintaining health during adulthood, as well as ensuring growth and development (Saavedra & Prentice, 2023;O'Brien et al., 2021).
The nutritional needs of children vary according to body weight, age, gender, basal metabolism, physical activity and disease status.Adequate and balanced nutrition is important to ensure the ideal body composition.Although school age is one of the most important periods in which eating habits are acquired throughout life, many factors affect these habits.Among these factors, the child's food choice, the family's food choice, the family's socioeconomic status and educational level, role modeling in the family's food consumption process, friends and social media are effective (Scaglioni et al., 2018;Kucharczuk et al., 2022).Children's wrong eating habits can lead to weakness, obesity, eating disorders, dental caries, vitamin and mineral deficiencies and related diseases.In addition, it can also cause conditions such as a decrease in cognitive capacity, distraction and a decrease in school achievement (Srivastava et al., 2012).
Since school-aged children spend most of the day separated from their parents, it can be seen that they are prone to skipping meals and unhealthy foods such as fast food.When the literature is examined, it is seen that the socioeconomic status of the family creates nutritional differences in children (Victora et al., 2021;Hemmingsson, 2018).Parents' approaches to nutrition have a great influence on the nutritional status of children, as they are the first to create nutrition education and awareness (Bayhan et al., 2022).By monitoring the child's nutrition, families can prevent the child's access to unhealthy foods and increase the healthy food preference (Özdemir, 2018).In addition, the adoption of a repressive, restrictive or overly controlling attitude by parents in the nutrition of children negatively affects the development of the child's body weight and healthy eating behaviors (Francis et al., 2001).
Since this study is a determinant of nutrition and health status in adulthood, it has been planned to evaluate the nutritional status of childhood and the nutritional impact of the parent.

SAMPLE SELECTION AND DATA COLLECTION
The current study covers school-age children and parents living in Bayburt province who are between the ages of 9-12.Since there was no similar study, the sample size of the study was calculated using the G*Power 3.1.9.7 analysis program; It was determined as 252 with a 25% effect size, 5% margin of error and 95% power.School visits were made to 259 school-aged children, and research data were collected by inviting their parents to the school and interviewing them face-to-face.The children participating in the study and their parents were informed verbally and in writing before the survey on a voluntary basis and their permissions were obtained.A questionnaire questioning sociodemographic data and basic nutritional information was applied to 259 children participating in the study, and a Parent Mealtime Action Scale was applied to their parents.

PARENT MEALTIME ACTION SCALE (PMAS)
The Parent Mealtime Action Scale (PMAS) consisting of 31 statements, the validity and reliability of which were studied by Arslan and Erol (2014), was applied to the parents participating in the study.The answers are rated as 1-never 2-sometimes 3-always.As a result of the item total score analysis of the scale, item-sub-dimension total score correlations of the scale items were found to be between 0.56 and 0.84 (p<0.001).Cronbach's Alpha values of the sub-dimensions of the scale were found to be: snack amounts 0.75, positive persuasion 0.57, daily fruit and vegetable options 0.60, reward use 0.64, insistence on eating 0.72, snack model 0.63, special meals sub-0.41,reduction of animal fats 0.54, multiple meal options 0.55.
Cronbach's Alpha values of the scale's sub-dimensions were found in the current study; snack amounts were 0.740, positive persuasion was 0.559, daily fruit and vegetable options were 0.657, reward use was 0.629, insistence on eating was 0.727, snack model was 0.639, special meals were 0.290, reduction of animal fats was 0.517, multiple meal options were 0.593.Special dishes were not included in the analyses because the Alpha coefficient of the lower dimension was less than 0.40.

ANTHROPOMETRIC MEASUREMENTS
Height measurement was taken from all the children included in the study to take anthropometric measurements, body weight was measured on Tanita BC-418, Tokyo, JAPAN device and body mass index calculation was performed.Weight measurement was taken with thin clothes, bare feet, in the morning when hungry and after defecation.

ETHICAL CONSIDERATION
Scientific and universal principles were followed in this study.The study was conducted in accordance with the Declaration of Helsinki.This study was approved by the Bayburt University ethics committee (Date:25.11.2022/Decision no:262/12).Verbal/written informed consent was obtained from the students' parents/guardians.Before the data were collected by the researchers, the students were informed about the study and their verbal/written consent was obtained.Volunteers were included in the study.6

RESULTS AND DISCUSSION
The average age of the children participating in the study was 10.71±0.94(min: 9, max: 12), the average age of the parents was 39.24±5.70 (min: 28, max: 70).In the study, the average score of the "Snack Quantities" sub-dimension of the PMAS was 2.29±0.56, the average score of the "Positive Persuasion" sub-dimension was 2.34±0.43, the average score of the "Daily Fruit and Vegetable Options" sub-dimension was 2.34±0.41, the average score of the "Reward Use" sub-dimension was 1.74±0.39,the average score of the "Insist on Eating" sub-dimension was 1.64±0.56,the average score of the "Snack Model" sub-dimension was 1.61±0.41,the average score of the "Animal The average score of the "Reducing Fats" sub-size was found to be 1.99±0.52,and the average score of the "More than One Meal Option" sub-size was found to be 2.05±0.40(not shown in the table ).
Table 1 shows the comparison of some characteristics of children and parents with the scale sub-dimension score averages.A significant difference was found between the "Snack Amounts" sub-dimension score averages of the scale and the gender of the children (p<0.05).
The average score of the "Snack Amounts" sub-dimension is higher in females than in males.
A significant difference was found between the children's "Snack Amounts" and "Daily Fruit and Vegetable Options" sub-dimension score averages and class levels (p<0.01).As a result of the posthoc analysis conducted in terms of the grade level variable of children, it was found that the average score of the "Snack Amounts" sub-dimension was higher for children attending the fourth grade than for children attending the sixth grade.It was found that the average score of the "Daily Fruit and Vegetable Options" sub-dimension was higher for children attending the fourth grade than for children attending the fifth and sixth grades.A significant difference was found between the "Snack Amounts" sub-dimension score averages and the variable of which child is the oldest child of the family (p<0.05).It has been determined that children who consume more snacks are usually the first child in the family.This situation suggests that families may not have yet gained experience in nutrition for their first children.
Hormones are biological molecules involved in physiological processes (Bayraktar, 2020).The secretion of growth hormone in the body is affected by lipids (Inzaghi et al., 2022).
In addition, oxidative stress is the imbalance of free radicals and antioxidants in the body (Bayraktar & Tekçe, 2018).Stress has negative effects on the immune system, growth development, and chronic diseases (Bayraktar et al., 2020).In a study, it was determined that eating a high-fat diet can disrupt the synthesis of growth hormone through the activation of endoplasmic reticulum stress and reduce its circulating levels (Gong et al., 2021).In the current 7 study, it was found that children who restrict animal fat more had a higher height length (p<0.01).This may be due to the fact that the essential fatty acids, which are important for growth and development, are less present in animal fats.
In this study, a significant difference was found between the "Daily Fruit and Vegetable Options" sub-dimension score averages of the scale and income status (p<0.01,Table 1).It has been found that children of families with higher income levels consume more vegetables and fruits.In another study, it was also stated that the income status of families is effective in choosing healthy foods for children (Arduzlar Kağan et al., 2019).In today's conditions, the economic situation of families can significantly affect the eating habits of family members.
It is known that the educational status of parents is effective on child nutrition.In one study, it is reported that the mother's education level has a significantly greater impact on the nutrition of elementary and secondary school children than the father's education (Alderman & Headey, 2017).In this study, a significant difference was found between the "Snack Amounts" and "Decrement of Animal Fats" sub-dimension score averages and the educational status of the mother (p<0.05,p<0.01, respectively).It was determined that the averages of the "Snack Amounts" sub-dimension scores were higher for children with a university degree in maternal and paternal educational status than for children with a primary school education and the averages of the "Reduction of Animal Fats" sub-dimension scores were higher for children with a university degree in maternal and paternal educational status than for other children.In addition, the "Snack Model" sub-size score averages were found to be higher in working mothers than in non-working ones (p<0.05).Mothers may have preferred the snack model more because they work.As a matter of fact, both working and taking on big responsibilities as a mother can be quite tiring.There was no statistically significant difference between the subdimension score averages of the scale and the child's body weight and the parent variables participating in the study (p>0.05,Table 1).e Games-Howell 1>3; f Games-Howell 5>2; g Scheffe 5>1, 5>2, 5>4; h Gabriel 5>2 Table 2 shows the comparison of children's nutritional characteristics with the scale subdimension score averages.The "Insist on Eating" and "Multiple Meal Options" sub-dimension score averages were found to be higher in those who insisted that the child finish the meal on the plate than in those who did not (p<0.05).A significant difference was determined between the average score of the children's "Daily Fruit and Vegetable Choices" sub-dimension and the frequency of meat/chicken/fish consumption (p<0.05).It has been found that children's "Daily Fruit and Vegetable Choices" sub-dimension score averages are higher for children who 10 consume meat/chicken/fish 5 times a week and more than children who consume meat/chicken/fish 3-4 times a week.A significant difference was found between the children's "Daily Fruit and Vegetable Choices" sub-size score averages and the frequency of chips consumption (p<0.01).A significant difference was determined between the average scores of the children's "Decrement of Animal Fats" sub-dimension and the frequency of chips consumption (p<0.05).It has been found that the average scores of the "Daily Fruit and Vegetable Options" sub-dimension are higher for children who consume chips every day than for those who consume them 3-4 times a week.It has been found that the average scores of the "Reduction of Animal Fats" sub-dimension are higher for children who do not consume chips at all than for children who consume them 3-4 times a week.It may be considered that children who do not consume chips are more selective in their dietary fat preferences.According to Andaya et al. (2011) in the study, it was determined that children who ate three main meals with their families at least 4 days a week consumed chips 5 or more times a week.It has been found that children who have breakfast with their families at least 4 times a week are more likely to consume fruits and vegetables.
Parents can follow an attitude that encourages the development of correct feeding behavior in children at mealtimes and ensures child autonomy (Hubbs-Tait et al., 2008;Patrick et al., 2005).Oppressive, restrictive, rewarding, overly controlling and authoritarian parenting can lead to the formation of negative eating habits (Podlesak et al., 2017;Wardle et al., 2005).
In this study, a significant difference was found between the "Reward Use" sub-dimension score averages of children and pretzel/bagel consumption frequencies (p<0.05).It has been found that the "Reward Use" sub-dimension score averages of children who consume pretzel/bagel every day are higher than children who do not consume them at all.This situation suggests that rewarding in children leads to making more carbohydrate-containing food preferences.There was no statistically significant difference between the other sub-dimension score averages of the scale and the nutrient consumption frequency variables (p>0.05,Table 2).
The findings of the study conducted to evaluate the nutritional status of childhood and the influence of parents on nutrition have been tried to be discussed in the light of the literature.
However, there are a limited number of studies on this topic in the literature.13

CONCLUSION
Adequate and balanced nutrition in school-age children; in addition to ensuring growth and development, it also forms the basis of health in adulthood.During this period, many factors affect the child's eating habits other than his own food choice.One of the most important among these is the attitude of parents in the process of child nutrition.In addition to the income level and educational status of parents, children's mealtime behaviors affect the nutritional status of children.Restrictive, persistent and authoritarian attitudes of parents can lead to more food selectivity in children.Instead, children can better manage their food-selective behavior when parents approach their children as an exemplary model and by including the child himself in the feeding process.In addition, the organization of nutrition education programs for children and their parents can contribute to the development of healthy eating habits in children.

2. 5
STATISTICAL ANALYSIS OF THE DATA SPSS 26 (Statistical Package for the Social Sciences) program was used for the evaluation of the data.Whether the data are distributed normally or not was evaluated by the Skewness and Kurtosis coefficients being in the range (-1) -(+1)(Hair et al., 2013).For descriptive statistics, number, percentage, mean and standard deviation (±) values for continuous variables were used.Parametric tests were applied because the data were normally distributed.Independent sample t-test and One-Way ANOVA test were used to compare the descriptive characteristics and nutritional characteristics of the children and the scale scores.Tukey HSD, Gabriel and Scheffe analyses were used to determine which group caused the difference in more than two groups where the group variances were equal; Games-Howell posthoc analyses were used to determine which group caused the difference in more than two groups where the group variances were not equal.Statistical significance levels were accepted as p<0.001 and p<0.05.Evaluation of Nutritional Preferences of School-Age Children and Parents Attitudes Towards Child Nutrition: A Cross-Sectional Study ___________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.8 | p.1-15 | e08208 | 2024.

Table 1
Comparison of some characteristics of children and parents with the scale sub-dimension score averages

Table 2
Evaluation of Nutritional Preferences of School-Age Children and Parents Attitudes Towards Child Nutrition: A Cross-Sectional Study Comparison of children's nutritional characteristics with the scale sub-dimension score averages ____________________________________________________________________________________________________________________ Rev. Gest.Soc.Ambient.| Miami | v.18.n.8 | p.1-15 | e08208 | 2024.11