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Original research article, determinants of junk food consumption among adolescents in pokhara valley, nepal.

• 1 Faculty of Health Science, School of Health and Allied Sciences, Pokhara University, Kaski, Nepal
• 2 Independent Public Health Researcher, Kathmandu, Nepal
• 3 Department of Healthcare Management, National Open College, Pokhara University, Kaski, Nepal

Background: Junk food consumption and its consequences has become a major public health concern globally because of its deteriorating health consequences and surging prevalence. Though its adverse health consequences are widely prevalent in all age groups, children and adolescents are more at risk. It may lead to obesity and act as a risk factor for different non-communicable diseases (NCD's) like heart diseases, cardiovascular disease, cancer, hypertension, diabetes, etc. This study was carried out to explore the junk food consumption and its associated factors among adolescent students.

Methods: A cross-sectional study was conducted among 538 adolescent students of Kaski district, Nepal. We used a stratified proportionate sampling technique to recruit the participants. A self-administered questionnaire was used for data collection. Descriptive and bivariate statistical analysis was performed. The odds ratio was computed to test the association.

Results: The study found that more than half of the participants (60.30%) consumed junk foods over the last 30 days, more prevalent among public school participants (65.1%) followed by participants of private school (56.3%). More than half of the participants consumed salty snacks (58.7%) followed by sweets (57.5%). The time of consumption was found to be higher together with friends (83.9%). Similarly, it was consumed more while the participants were on a trip (70.1%). Consumption of junk foods was significantly associated with public school (OR: 1.44, CI = 1.01–2.06), single family (OR: 1.46, CI = 1.01–2.10), living with parents (OR: 1.64, CI = 1.03–2.63), while on travel (OR: 1.99, CI = 1.33–2.98), while reading (OR: 2.01, CI = 1.16–3.47), at home (OR: 2.20, CI = 1.53–3.16), at school (OR: 2.86, CI = 1.98–4.12), friends' influence (OR: 2.01, CI = 1.37–2.94), and junk food availability at home (OR: 1.92, CI = 1.33–2.76).

Conclusion: Consumption of junk foods among adolescent students was remarkably high in both public school and private school adolescents. Regardless of adequate knowledge on harmful consequences of junk foods, school-going adolescents are consuming junk foods due to its easy availability and ready-to-use packaging. The government of Nepal should strictly standardize and regulate advertising policies and extravagant health claims advertised by junk food manufacturers. An appropriate intervention targeted to adolescents to improve food behaviors is recommended.

Introduction

Junk foods are defined as foods that are readily available, usually inexpensive, and having less nutrient value. These foods contain more calories, more salt, have a higher content of saturated fat, and contain less iron, calcium, and dietary fiber. Common junk foods include fast food, carbonated drinks, chips, desserts, chocolates, etc. ( 1 ).

Globally, junk foods are popular stuff, and consumption is increasing constantly. Traditional foods have been nearly replaced by food items that can be found in a state of ready to eat, in canned form, and preserved for a longtime ( 2 ). The consumption of such foods has peaked in developed countries; however, there is an increasing trend in the developing countries of the world ( 3 ). In South Asian countries, there is a clear rising trend of such junk food consumption ( 4 , 5 ). Despite established evidence of the negative impacts of junk foods on the human body, the consumption of junk foods is popular among youngsters. Such consumption may lead to a high prevalence of obesity, diabetes mellitus, hypertension, and coronary heart disease ( 6 ).

It is estimated that 16 million (1.0%) disability-adjusted life years (DALYs) lost and 1.7 million (2.8%) of worldwide mortality have been attributed to inadequate consumption of vegetables and fruits ( 7 ). Despite the socioeconomic condition of the family, junk food consumption has been emerging worldwide due to quick consumption, ready to eat, inexpensive, and of good taste. Such foods have been found prepared using low-quality ingredients such as refined grains, added sugar, and fats, despite nutritious ingredients ( 8 ). Fast foods have high sodium salt, which is often used as a preservative to make the foods more flavorful and satisfying. Such foods attract more people especially children and adolescents ( 9 ).

Increased junk food consumption among all age groups and more common to young adults is an emerging public health challenge with global prevalence of around 70%. Rapidly changing dietary practices and an increasing sedentary lifestyle predispose to obesity-related non-communicable diseases, including insulin resistance diabetes, neurodegeneration, and psychological changes, stroke, headache/precipitation of migraine, the metabolic syndrome, adult-onset diabetes, non-insulin-dependent diabetes, coronary artery diseases, polycystic ovarian syndrome, non-alcoholic fatty liver disease, cancers, and autoimmune disorders and site-specific neoplasms, both in children and in adults. Recent data show that obesity-related non-communicable diseases are increasing in many developing countries with cross-sectional and secular trends of childhood obesity globally and more prevalent to developing countries ( 10 , 11 ).

Obesity and overweight has increased many fold in Asia, and it is becoming more alarming in recent years. Countries of the World Health Organization (WHO) South East Asia Region are facing an epidemic of diseases associated with obesity such as diabetes and cardiovascular disease (CVD). Various studies had shown a rising prevalence of obesity among children due to their risky behaviors and dietary patterns ( 12 ).

Despite facts known among adolescents in Nepal, there is a gap to explore food consumption patterns and association with obesity. Since adolescents account for a quarter of the country's population, there should be special strategies to think about their current nutritional status ( 13 ). A recent study from Kaski district depicts 8.1% prevalence of overweight and obesity among adolescents ( 14 ). Another study conducted in the Kaski district of Nepal shows that the obesity prevalence among adolescents is 3.3% ( 15 ). Risky behaviors such as unusual time of sleeping, tobacco and substance abuse, watching television for a longer time, consuming low dietary foods and fruits, along with insufficient physical activities are found to be more prevalent in the Kaski district, which are leading to more risk of deviating health condition of adolescents ( 16 – 18 ). About six among 10 deaths are found to be caused by NCD in Nepal; among them, nearly a quarter of these have been caused by cardiovascular diseases ( 19 ). So, we are in a better position to think about food habits among adolescents to prevent further complications.

There is limited evidence to identify the magnitude of the junk food prevalence and factors promoting its consumption. We explored the status of junk food consumption and its associated factor among the adolescents in the Kaski district of Nepal. Findings of this study are expected to be a primary step toward planning multipronged strategies to address the growing health hazard and protecting children and adolescents from the long-term ill health effects of junk foods. The study results will have policy implications for adolescents to plan, prevent, and control junk foods, obesity, and other health complications.

Study Design

An analytical cross-sectional study was conducted among selected school-aged adolescents in the Kaski district of Nepal from July 2017 to December 2017.

Study Areas

The study was conducted in 54 private and 47 public schools of Pokhara metropolitan (formerly Lekhnath municipality), Kaski district, Nepal. Kaski district is one of the largest cities of Gandaki Province, which comprises a total of 492,098 population, which is 1.86% of the national estimated population. The district has 46.3% adolescents, and it ranks third on literacy rate (82.38) and Human Development Index (0.576) with a poverty gap of 0.79 in the district ( 20 ).

Study Population

This study recruited school-going adolescents studying in grades 11 and 12 of selected schools in Pokhara metropolitan. The students of school having only girl's cohort or boy's cohort, physically challenged, and visually impaired students were excluded from this study.

Sample Size Estimation

Sample size was calculated by using the following formula: sample size ( n ) = Z 2 pq/d 2 [Z = 1.96 for 95% confidence interval, P = proportion of population with certain characteristic, q = proportion of population without certain characteristic, and d = allowable error (0.05 for 5%)].

Thus, sample size was computed to be 274 and after adjusting the non-response rate to 5%, the sample size was 290. Since the study included participants of both public and private schools at a ratio of 5:6, therefore, by adjusting the proportion ratio of 5:6, the sample size for public schools was 245 and private school was 290. Therefore, the final sample size of this study was 245 + 290 = 535 (Sample size calculation described in the Table 1 ).

Table 1 . Sample size calculation table.

Sampling Technique

A stratified proportionate sampling method was used to select participants. We designed a disaggregated sampling frame for public and private secondary schools of Kaski district, and the required proportion (5:6) was taken from the type of schools and the required participants from them Sampling technique is described in the diagram ( Figure 1 ).

Figure 1 . Flow diagram of sampling technique.

Data Collection Method

The data were collected using the standard self-administered questionnaire among the adolescent students during their school day, and a 30-min time was allocated to complete the questionnaire. Written informed consent was taken from the teacher on behalf of the participants, and the teacher was informed about the student's volunteer participation before the consent grant on behalf of the student. The purpose of the study, confidentiality of their answer, and there is nothing like right or wrong were briefed before data collection. Seven-day dietary recall methods were used to report their recent week dietary pattern. The data were collected from October 29 to November 8, 2017 in Pokhara metropolitan of Kaski district.

Data Collection Tool

A self-administered questionnaire was used for data collection. The questionnaire was pretested and validated before the final data collection. Extensive literature review was done, and a tool was developed reviewing similar literature, which reports the factors that accelerate junk food consumption. The tool was initially developed in English version and translated into Nepali. The linguistic validation and context validation was checked and recommended by nutrition experts and academic professors prior to pretesting.

Independent Variables

The independent variables are age, sex, parents' education, living status, family type, parents' occupation, advertisement, convenience, peer influence, availability of junk food, and knowledge about the health effect of junk food consumption.

Dependent Variable

The dependent variable is junk food consumption.

Operational Definitions

Adolescent student.

Students of grade 11 and grade 12 who are not older than 19 years of age.

Junk food includes instant noodles, biscuits, cookies, chip lays, chocolates, cake, ice cream, chow mien, Mo: Mo, samosa, soft drinks, Coke, Pepsi, Fanta, burgers, pizza, canned foods, fried potatoes, meat products, etc.

Junk Food Consumption

A student consumes at least one item of junk food for 3 days or more within the last 7 days.

Frequency of Consumption

It is the time that is more than 15 days in a month and more than 4 days in a week.

It is the time that is 5–15 days in a month and 2–4 days in a week.

It is the time that is <5 days in a month and <2 days in a week.

Place of Consumption

It is the place such as home, school, friend's home, etc., where the individual adolescent student consumes any type of junk food.

Living Situation

An adolescent's current living status with parents, relatives, friends, in a hostel, alone, or in any other condition.

Peer Influence

Peer influence is the perceived impact of peer groups, their encouragement, involvement, facilitation, and role modeling for other friends.

Participants who answered the right option among the given three questions in the questionnaire that were classified as adequate knowledge regarding the harmful effects of junk foods and others who did not answer right among the three were classified as inadequate knowledge.

Validity and Reliability

The study tool was reviewed by the researcher and nutrition expert to maintain the validity and reliability of the data collection. Pretesting was done among the 50 students of Pokhara valley, and all the required revision based on pretesting was done on the data collection tool. Pretesting samples were excluded in the final enumeration. Based on the findings of pre-testing, necessary modification on the tool was done prior to data collection. The test of normality was done for those nonparametric distributions, and the median values were computed and presented in the Results section.

Data Management and Analysis

Data were entered in Epi-data and imported into SPSS version 22. A descriptive and interferential analysis of data was performed. Odds ratio (OR) with a value greater than 1.00 is considered as significant. Similarly, chi-square testing was done. Those variables having a p-value less than 0.05 mentioned for risk ratio (RR). Thus, the computed RR yield odds ratio (OR) at 95% confidence interval and 5% level of significance.

Information about the demographic characteristics of the participants is presented in Table 2 . More than half (63%, 339/538) of the participants were in the late adolescent age (17–19 years) followed by the middle adolescent aged group. The minimum and maximum age of the participants was 14 and 19 years. The median age of the participants was 17 years with an interquartile range of 2 years. More than half (52.0%, 280/538) of the participants were female. More than half (64.1%) of the participants were from the nuclear family and lived with parents (83.8%, 345/538). Almost all participants' fathers (95.5%, 515/538) and mothers (92.6%, 498/538) had formal education. The respondents' fathers (78.4%, 421/538) and mothers (92.7%, 499/538) both had informal employment status at the data collection time.

Table 2 . Sociodemographic characteristics of participants ( n = 538).

Table 3 shows the status of junk food consumption by school type. More than half of the participants of the public school consumed junk food (65.1%, 153/235), and the same was found among private school participants (56.3%, 161/286). Among the total participants, 60.30% (314/521) were junk food consumers as they consumed junk foods for four or more days last week. The remaining (39.7%, 207/521) were non-consumers that means they consumed junk foods for four or more days last week. Thus, higher junk food consumption status in public schools than in private schools was observed (65.1%, 153/235, 56.3%, 161/286, respectively).

Table 3 . Status of junk food consumption ( n = 521).

Table 4 reveals the frequency and varieties of junk food consumption over the last month of data collection. Salty snacks were consumed by 59.8% (143/239) of participants from public school and 57.7% (165/286) from the private school. Similarly, sweet-related junk food consumption status, it was almost equal in both public and private schools (56.1%, 134/239 and 58.7%, 168/286, respectively).

Table 4 . Average consumption of type of junk food in last month ( n = 525).

The sweetened beverage was more prevalent at private school (50.3%, 144/286) compared with the public (42.3%, 101/239); the same result was found in fast food consumption status as well (44.1%, 126/286 and 31.8%, 76/239). More than three quarters of the participants from the public school (86%, 197/239) had a practice of consuming junk food with friends; however, participants from private schools (78.3%, 224/286) consumed the foods during travel time.

Occasional food consumption was found more in private school participants. However, they had more practice of taking junk food while they were being alone or while they were with their parents (60.5%, 173/286 and 40.6%, 116/286, respectively). This study also found that participants from public schools had more junk food consumption (15.7%, 37/239) at the time of reading, which was slightly less in participants from public schools (14.0%, 40/286). Consumption during the trip (75.5%, 216/286), at home (59.8%, 171/286), and with friends was more predominant with private school than with public school participants, while more proportion of public school participants had higher junk food consumption rate at a restaurant (64.9 %, 150/239) and at a school (61.3 %, 144/239).

Table 5 Depicts junk food consumption by some characteristics related to practice. Out of 522 participants, 39.3% (205/522) spent 0.85–2.5 US$ on junk foods followed by <0.85 US$ (27.8 %, 145/522), about 19.5% (102/522) spent 2.5 to 4$ and more than 4$ were expended by 13.4% (70/522) of the respondents. Junk food consumption by a family member was found to be 31.3% (163/522). A family member of private school participants had slightly more consumption (33.2%) than public school participants (28.9%). Nearly half of the participants (49.2%) consume junk food as an alternative to breakfast. Out of 522 participants, 38.9% (203/522) wanted to the junk food consumption. Similarly, out of 538 participants, 9.7% (52/538) mostly went outside of the home for dinner and had use of any item of junk food category.

Table 5 . Distribution of weekly expenditure on junk foods, consumption accompanying fruits and vegetables among the participants.

Furthermore, out of 538 participants, more than one third (34.0%, 183/538) of the participants had a practice of consuming fruits and vegetables three to four times a week. More than one fourth (25.5%, 137/538) of them consumed fruits and vegetables seven or more times, and one among five (21.9%, 118/538) consumed five to six times in a week. Only 18.6% (100/538) of them consumed fruits and vegetables one to two times a week.

Table 6 illustrates the knowledge level of junk food consumption and its consequences. Out of 538 participants, only 33.50% (180/538) had adequate knowledge regarding the harmful health effects of junk foods, and among them, more numbers were from private schools (37.5%, 109/291). Similarly, 66.5% (358/538) had inadequate knowledge of junk foods and its harmful effects. Among them, nearly three quarters (71.3%, 176/247) were from public school compared with private school.

Table 6 . Knowledge on harmful health effects.

We compared the OR for the different sociodemographic, behavioral, and individual-level variables with junk food consumption ( Table 7 ). It was found that participants of public school were 1.44 times more likely to consume junk foods. Similarly, children from a single family were 1.46 times, and those living with parents were 1.64 times more likely to consume junk foods. Time of consumption was explored and found, while on travel, 1.99 times, while reading 2.016, and while being alone, adolescents were 2.144 times likely to eat junk foods.

Table 7 . Relationship of different sociodemographic, individual, and behavioral factors with junk food consumption.

Home and schools were more commonly observed places for junk foods with OR of 2.20 and 2.86, respectively. Among the sources of information, peer pressure was found to be more influencing, and they were likely to consume 2.01 while being with friends. Similarly, we also explored family member's roles. Those who reported the availability of junk foods at home were 1.92 times more likely to consume junk food.

In this study from Pokhara, we found that more participants were late adolescents, female, living in a nuclear family, and mostly living with parents. A higher number of fathers had received formal education than mothers and had a similar trend in employment status. Adolescents studying in public schools were consuming more junk foods than those in private schools. Salty snacks, sweets, sweetened beverages, and fast foods were frequently consumed junk foods. The time of consumption, traveling, special occasion, places of consumption, and weekly expenditure were explored in this study. We found that adolescents were also interested to avoid junk foods in their meals. More frequent (7+ times/week) consumption of fruits and vegetables was reported from private school participants. Inadequate knowledge of junk food and its long-term public health impact was found more common to participants from public school (71.3%,176/247) and private school participants (62 %,182/291), which suggests that more than half of the respondents had inadequate knowledge on junk food; thus, appropriate interventions need to be done to reduce consumption of such foods.

Consumption of junk foods and its association with different sociodemographic variables has been evaluated in our study; furthermore, published evidence supports that the dietary pattern and socioeconomic characteristics are associated ( 21 , 25 , 26 ). Similarly, consumption is also governed by availability and distance to junk food outlets ( 27 , 28 ). The distance to the grocery store and fast food outlet is also found to be associated with skipping breakfast and free lunch at school and irregular eating habits ( 29 ). Furthermore, good taste, advertisement, easy availability of fast foods, and marketing are also found to be associated ( 30 , 31 ). Other factors for growing fast food availability are increased earning, urbanization, busier lifestyle, fast service, assurance of food safety, and brands in China ( 32 ). Our study is of different nature, and we did not explore these factors; however, these might have definite impacts on the behaviors of the food of adolescents. One of such studies stated that there is no relationship with the proximity of restaurant and the body mass index (BMI) ( 33 ). Consumption of junk foods has been reported as risk factors for obesity and overweight among adolescents ( 34 ). More factors at the individual, social levels have a promotive role in fast food consumption in Teheran among adolescents ( 35 ). Advertisements and bored with family foods have been associated with fast food consumption ( 36 ). Our study shows similarities with the current research findings though we did not explore the BMI status and its factors for them.

Furthermore, adolescents living with parents are consuming junk foods more than others. Similarly, another research from the United States of America (USA) shows that those living with parents and in rented apartments have less frequent meals, poor dietary intake, and little home food availability compared with those living on campus ( 37 ). Moreover, another study from the USA shows that the food intake increased with increasing age and color of participants ( 38 ); however, we did not assess any role of ethnicity in this study, though our study population had a later adolescent aged population. In our study, we found that adolescents are more likely to consume junk food at home, schools, restaurants, and on a trip. Another study reveals that those taking lunch in the school canteen, hotels, and bakers are more likely to consume junk foods; parental influence on eating habits, eating dinner out, and consumption of vegetables and fruits have been found associated with junk food consumption ( 39 ). These factors reported from different studies were similar to our findings.

Furthermore, another research also highlighted the parental role in reducing the consumption of snacks high in solid oils, fats, and added sugars (SOFAS) ( 22 ). Our study demonstrated quite an interesting finding that adolescents living with parents also consumed more junk foods. However, friends were an important influencer to consume junk foods than parents. There are recommendations that the computation of fast foods have multiple factors including societal and individual level ( 35 ). Our study reported having similar elements in urban context of Pokhara, Nepal.

Increased fast food consumption is significantly associated with age, sex, family income, and residence ( 40 ). We also found an association with family types, family behaviors, and availability of foods. Since we conducted a study in urban settings, therefore, we are unable to comment on the difference on the basis of study settings, either urban or rural strata for food consumption. Another study from Pokhara shows that 75% of adolescents had good knowledge ( 15 ). However, in our study findings, 66.5% only had inadequate knowledge about junk foods. The varying proportion can be the used for the cutoff to define knowledge level. Furthermore, we only computed odds ratio without limiting other influencers. So, identification of the strongest influencer can be another scope of work. A study conducted on the general population in Singapore shows that regular fast-food consumers are those who are younger, belong to higher-income groups, and with middle-level education ( 41 ). Among the adolescents, there are various concerns related to foods and body images, dieting, education about foods, control of parents, educational level of mothers, and eating with family ( 42 ). In the present study also, we found positive association with some of these tested variables. In-depth exploring of these factors can be another sphere for the study.

Outcome of our study provides detailed understanding not only on knowledge, prevalence, and practice, influence of social media, peers, and family for junk food consumption among participants but also the reasons and influencing factors for participants to consume junk foods regardless of their knowledge on harmful effects and complications of junk food consumption. Similarly, this research work also provides a comparative insight information on junk food consumption pattern in public and private schools, which will be a supportive evidence for further policy implication.

Despite of these, our study is only limited to explore factors for junk food consumption among adolescents. We only relied on information given by them on the self-administered questionnaire. Therefore, we are unable to comment on the impact of these factors on their nutritional status due to lack of ABC parameters. These figures might have information bias, recall bias, copying other responses, and negligence to respond. We only recruited classes 11 and 12; therefore, junk food consumption status and other predictive factors of the other early adolescents might be missing. The economic status of the participants was not measured, although we supposed that it as an important factor. Junk food consumption is one of the growing concerns of the policymakers to safeguard public health globally. Therefore, we would like to recommend further study exploring ABC parameters of nutrition, their relationship with junk foods, frequency, lesser bias, and using the comprehensive technique of data collection.

Various cross-sectional studies have been conducted to assess the determinants of junk food and knowledge and practice of junk food consumption in different settings of Nepal and other low- and middle-income countries (LMICs), but our attempt to figure out public school and private school participants' junk food consumption status would be a further pathway to conduct comparative studies on similar topic to assess the health impact of junk foods among those who consume it and who do not consume it. Furthermore, comprehensive longitudinal studies will be a future direction to assess the growth and development of children and adults having junk food consumption practice.

Strategic risk communication to minimize junk food consumption should be prioritized, and interventions should be incorporated into national nutritional strategies. Behavior-change communication strategies should be tailored to targeted school children and general populations in order to address Nepal's food transition and long-term impact. We recommend further longitudinal research to assess epidemiological impact of junk foods, growth, and development of children and adolescents who had the history of regular junk food consumption.

Conclusions

Our study findings reveal an increasing junk food consumption among school going-adolescents, which may contribute to poor growth outcomes. Consumption during travel time, restaurants, home, and school were found to be more common. Family and peer roles were also found to be more influencing for junk food accompanying the participants increased consumption. Interestingly, media exposure played a promotive role in junk food promotion, and among these, friend's influence is most influential.

Consumption of junk food among adolescent students was remarkably high in both public school and private school adolescents. Regardless of adequate knowledge on harmful consequences of junk foods, school-going adolescents are consuming junk food due to its easy availability and ready-to-use packaging. The government of Nepal should strictly standardize and regulate advertising policies and extravagant health claims advertised by junk food manufacturers. An appropriate intervention incorporated with national nutrition policies targeted to adolescents for improved food behaviors is recommended.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by Pokhara University Institutional Review Committee(Ref # 28/074/75). Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.

Author Contributions

SSB, KT, and LDB are principal investigators of this study, responsible for conceptualization, design, methodology application, data curation, data analysis, software application, writing an original draft, reviewing and editing, and overall supervision of the research. SSD and SW are responsible for the concept and design of the study, interpretation of the results, and preparation of the manuscript. LDB is responsible for conceptualization, design, methodology application, data collection, data curation, and analysis. All authors read and approved the final manuscript.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

Our heartfelt thanks to all the participants who participated in this study. We are thankful to Pokhara University, Faculty of Health Science, School of Health and Allied Sciences. Special thanks to all the public and private schools of Pokhara Metropolitan and Private and Boarding School's Organization (PABSON) Kaski branch for their immense support.

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Keywords: adolescents, food preferences, junk food consumption, nutrient, non-communicable disease

Citation: Bohara SS, Thapa K, Bhatt LD, Dhami SS and Wagle S (2021) Determinants of Junk Food Consumption Among Adolescents in Pokhara Valley, Nepal. Front. Nutr. 8:644650. doi: 10.3389/fnut.2021.644650

Received: 21 December 2020; Accepted: 24 February 2021; Published: 08 April 2021.

Reviewed by:

Copyright © 2021 Bohara, Thapa, Bhatt, Dhami and Wagle. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Laxman Datt Bhatt, laxmanbhattbph@gmail.com

† These authors have contributed equally to this work and share first authorship

Frontiers for Young Minds

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The Impacts of Junk Food on Health

Energy-dense, nutrient-poor foods, otherwise known as junk foods, have never been more accessible and available. Young people are bombarded with unhealthy junk-food choices daily, and this can lead to life-long dietary habits that are difficult to undo. In this article, we explore the scientific evidence behind both the short-term and long-term impacts of junk food consumption on our health.

Introduction

The world is currently facing an obesity epidemic, which puts people at risk for chronic diseases like heart disease and diabetes. Junk food can contribute to obesity and yet it is becoming a part of our everyday lives because of our fast-paced lifestyles. Life can be jam-packed when you are juggling school, sport, and hanging with friends and family! Junk food companies make food convenient, tasty, and affordable, so it has largely replaced preparing and eating healthy homemade meals. Junk foods include foods like burgers, fried chicken, and pizza from fast-food restaurants, as well as packaged foods like chips, biscuits, and ice-cream, sugar-sweetened beverages like soda, fatty meats like bacon, sugary cereals, and frozen ready meals like lasagne. These are typically highly processed foods , meaning several steps were involved in making the food, with a focus on making them tasty and thus easy to overeat. Unfortunately, junk foods provide lots of calories and energy, but little of the vital nutrients our bodies need to grow and be healthy, like proteins, vitamins, minerals, and fiber. Australian teenagers aged 14–18 years get more than 40% of their daily energy from these types of foods, which is concerning [ 1 ]. Junk foods are also known as discretionary foods , which means they are “not needed to meet nutrient requirements and do not belong to the five food groups” [ 2 ]. According to the dietary guidelines of Australian and many other countries, these five food groups are grains and cereals, vegetables and legumes, fruits, dairy and dairy alternatives, and meat and meat alternatives.

Young people are often the targets of sneaky advertising tactics by junk food companies, which show our heroes and icons promoting junk foods. In Australia, cricket, one of our favorite sports, is sponsored by a big fast-food brand. Elite athletes like cricket players are not fuelling their bodies with fried chicken, burgers, and fries! A study showed that adolescents aged 12–17 years view over 14.4 million food advertisements in a single year on popular websites, with cakes, cookies, and ice cream being the most frequently advertised products [ 3 ]. Another study examining YouTube videos popular amongst children reported that 38% of all ads involved a food or beverage and 56% of those food ads were for junk foods [ 4 ].

What Happens to Our Bodies Shortly After We Eat Junk Foods?

Food is made up of three major nutrients: carbohydrates, proteins, and fats. There are also vitamins and minerals in food that support good health, growth, and development. Getting the proper nutrition is very important during our teenage years. However, when we eat junk foods, we are consuming high amounts of carbohydrates, proteins, and fats, which are quickly absorbed by the body.

Let us take the example of eating a hamburger. A burger typically contains carbohydrates from the bun, proteins and fats from the beef patty, and fats from the cheese and sauce. On average, a burger from a fast-food chain contains 36–40% of your daily energy needs and this does not account for any chips or drinks consumed with it ( Figure 1 ). This is a large amount of food for the body to digest—not good if you are about to hit the cricket pitch!

• Figure 1 - The nutritional composition of a popular burger from a famous fast-food restaurant, detailing the average quantity per serving and per 100 g.
• The carbohydrates of a burger are mainly from the bun, while the protein comes from the beef patty. Large amounts of fat come from the cheese and sauce. Based on the Australian dietary guidelines, just one burger can be 36% of the recommended daily energy intake for teenage boys aged 12–15 years and 40% of the recommendations for teenage girls 12–15 years.

A few hours to a few days after eating rich, heavy foods such as a burger, unpleasant symptoms like tiredness, poor sleep, and even hunger can result ( Figure 2 ). Rather than providing an energy boost, junk foods can lead to a lack of energy. For a short time, sugar (a type of carbohydrate) makes people feel energized, happy, and upbeat as it is used by the body for energy. However, refined sugar , which is the type of sugar commonly found in junk foods, leads to a quick drop in blood sugar levels because it is digested quickly by the body. This can lead tiredness and cravings [ 5 ].

• Figure 2 - The short- and long-term impacts of junk food consumption.
• In the short-term, junk foods can make you feel tired, bloated, and unable to concentrate. Long-term, junk foods can lead to tooth decay and poor bowel habits. Junk foods can also lead to obesity and associated diseases such as heart disease. When junk foods are regularly consumed over long periods of time, the damages and complications to health are increasingly costly.

Fiber is a good carbohydrate commonly found in vegetables, fruits, barley, legumes, nuts, and seeds—foods from the five food groups. Fiber not only keeps the digestive system healthy, but also slows the stomach’s emptying process, keeping us feeling full for longer. Junk foods tend to lack fiber, so when we eat them, we notice decreasing energy and increasing hunger sooner.

Foods such as walnuts, berries, tuna, and green veggies can boost concentration levels. This is particularly important for young minds who are doing lots of schoolwork. These foods are what most elite athletes are eating! On the other hand, eating junk foods can lead to poor concentration. Eating junk foods can lead to swelling in the part of the brain that has a major role in memory. A study performed in humans showed that eating an unhealthy breakfast high in fat and sugar for 4 days in a row caused disruptions to the learning and memory parts of the brain [ 6 ].

Long-Term Impacts of Junk Foods

If we eat mostly junk foods over many weeks, months, or years, there can be several long-term impacts on health ( Figure 2 ). For example, high saturated fat intake is strongly linked with high levels of bad cholesterol in the blood, which can be a sign of heart disease. Respected research studies found that young people who eat only small amounts of saturated fat have lower total cholesterol levels [ 7 ].

Frequent consumption of junk foods can also increase the risk of diseases such as hypertension and stroke. Hypertension is also known as high blood pressure and a stroke is damage to the brain from reduced blood supply, which prevents the brain from receiving the oxygen and nutrients it needs to survive. Hypertension and stroke can occur because of the high amounts of cholesterol and salt in junk foods.

Furthermore, junk foods can trigger the “happy hormone,” dopamine , to be released in the brain, making us feel good when we eat these foods. This can lead us to wanting more junk food to get that same happy feeling again [ 8 ]. Other long-term effects of eating too much junk food include tooth decay and constipation. Soft drinks, for instance, can cause tooth decay due to high amounts of sugar and acid that can wear down the protective tooth enamel. Junk foods are typically low in fiber too, which has negative consequences for gut health in the long term. Fiber forms the bulk of our poop and without it, it can be hard to poop!

Tips for Being Healthy

One way to figure out whether a food is a junk food is to think about how processed it is. When we think of foods in their whole and original forms, like a fresh tomato, a grain of rice, or milk squeezed from a cow, we can then start to imagine how many steps are involved to transform that whole food into something that is ready-to-eat, tasty, convenient, and has a long shelf life.

For teenagers 13–14 years old, the recommended daily energy intake is 8,200–9,900 kJ/day or 1,960 kcal-2,370 kcal/day for boys and 7,400–8,200 kJ/day or 1,770–1,960 kcal for girls, according to the Australian dietary guidelines. Of course, the more physically active you are, the higher your energy needs. Remember that junk foods are okay to eat occasionally, but they should not make up more than 10% of your daily energy intake. In a day, this may be a simple treat such as a small muffin or a few squares of chocolate. On a weekly basis, this might mean no more than two fast-food meals per week. The remaining 90% of food eaten should be from the five food groups.

In conclusion, we know that junk foods are tasty, affordable, and convenient. This makes it hard to limit the amount of junk food we eat. However, if junk foods become a staple of our diets, there can be negative impacts on our health. We should aim for high-fiber foods such as whole grains, vegetables, and fruits; meals that have moderate amounts of sugar and salt; and calcium-rich and iron-rich foods. Healthy foods help to build strong bodies and brains. Limiting junk food intake can happen on an individual level, based on our food choices, or through government policies and health-promotion strategies. We need governments to stop junk food companies from advertising to young people, and we need their help to replace junk food restaurants with more healthy options. Researchers can focus on education and health promotion around healthy food options and can work with young people to develop solutions. If we all work together, we can help young people across the world to make food choices that will improve their short and long-term health.

Obesity : ↑ A disorder where too much body fat increases the risk of health problems.

Processed Food : ↑ A raw agricultural food that has undergone processes to be washed, ground, cleaned and/or cooked further.

Discretionary Food : ↑ Foods and drinks not necessary to provide the nutrients the body needs but that may add variety to a person’s diet (according to the Australian dietary guidelines).

Refined Sugar : ↑ Sugar that has been processed from raw sources such as sugar cane, sugar beets or corn.

Saturated Fat : ↑ A type of fat commonly eaten from animal sources such as beef, chicken and pork, which typically promotes the production of “bad” cholesterol in the body.

Dopamine : ↑ A hormone that is released when the brain is expecting a reward and is associated with activities that generate pleasure, such as eating or shopping.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

[1] ↑ Australian Bureau of Statistics. 2013. 4324.0.55.002 - Microdata: Australian Health Survey: Nutrition and Physical Activity, 2011-12 . Australian Bureau of Statistics. Available online at: http://bit.ly/2jkRRZO (accessed December 13, 2019).

[2] ↑ National Health and Medical Research Council. 2013. Australian Dietary Guidelines Summary . Canberra, ACT: National Health and Medical Research Council.

[3] ↑ Potvin Kent, M., and Pauzé, E. 2018. The frequency and healthfulness of food and beverages advertised on adolescents’ preferred web sites in Canada. J. Adolesc. Health. 63:102–7. doi: 10.1016/j.jadohealth.2018.01.007

[4] ↑ Tan, L., Ng, S. H., Omar, A., and Karupaiah, T. 2018. What’s on YouTube? A case study on food and beverage advertising in videos targeted at children on social media. Child Obes. 14:280–90. doi: 10.1089/chi.2018.0037

[5] ↑ Gómez-Pinilla, F. 2008. Brain foods: the effects of nutrients on brain function. Nat. Rev. Neurosci. 9, 568–78. doi: 10.1038/nrn2421

[6] ↑ Attuquayefio, T., Stevenson, R. J., Oaten, M. J., and Francis, H. M. 2017. A four-day western-style dietary intervention causes reductions in hippocampal-dependent learning and memory and interoceptive sensitivity. PLoS ONE . 12:e0172645. doi: 10.1371/journal.pone.0172645

[7] ↑ Te Morenga, L., and Montez, J. 2017. Health effects of saturated and trans-fatty acid intake in children and adolescents: systematic review and meta-analysis. PLoS ONE. 12:e0186672. doi: 10.1371/journal.pone.0186672

[8] ↑ Reichelt, A. C. 2016. Adolescent maturational transitions in the prefrontal cortex and dopamine signaling as a risk factor for the development of obesity and high fat/high sugar diet induced cognitive deficits. Front. Behav. Neurosci. 10. doi: 10.3389/fnbeh.2016.00189

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Junk food-induced obesity- a growing threat to youngsters during the pandemic

Introduction.

Obesity has been declared an epidemic that does not discriminate based on age, gender, or ethnicity and thus needs urgent containment and management. Since the third wave of COVID-19 is expected to affect children the most, these children and adolescents should be more cautious while having junk foods, during covid situations due to the compromise of Immunity in the individuals and further exacerbating the organ damage.

Methodology

A PAN India survey organized by the Centre for Science and Environment (CSE) among 13,274 children between the ages 9–14 years reported that 93% of the children ate packed food and 68% consumed packaged sweetened beverages more than once a week, and 53% ate these products at least once in a day. Almost 25% of the School going children take ultra-processed food with high levels of sugar, salt, fat, such as pizza and burgers, from fast food outlets more than once a week. Children and adolescents who consume more junk food or addicted to such consumption might be even more vulnerable during the third wave, which will significantly affect the younger category.

There is an urgent need to spread awareness among children and young adults about these adverse effects of junk food. There is no better time than now to build a supportive environment nurturing children and young adults in society and promising good health.

1. Introduction

Obesity has been declared as epidemic that does not discriminate based on age, gender, or ethnicity and thus needs urgent containment and management. Cardiovascular complications are a global threat with the rapid increase in the prevalence of obesity; by 2025, it is expected to reachupto 18% in men and 21% in women by forbidding heavy burden upon individuals, societies, and health care systems. Heart attack survivors with excess fat around their waist are at increased risk of another cardiac arrest, according to the journal of the European Society of Cardiology (Mohammadi H et al., 2020).

In the modern era, obesity is linked with various factors enhancing the production of cortisol, such as Food consumption with a high glycaemic index, chronic stress, and change in sleep patterns ( Knutson et al., 2010 ; Cohen and Janicki-Deverts, 2012 ). The burden of non-communicable disease has become a major threat globally, attributing to physical inactivity, unhealthy dietary habits, unhealthy lifestyle, and smoking. It is also observed that food with high levels of fat content is preferred to non-fat food by people ( Visschers and Siegrist, 2010 ). Based on the reports, more than one-third of the adults eat junk food several times a week ( Bauer et al., 2009 ). Studies have proven that Junk food tends to cause obesity (central adiposity), a primary concern of heart diseases and other non-communicable diseases ( Rouhani et al., 2012 ; Musaiger, 2014 ). Poor nutrition could result in reduced Immunity, susceptibility to several oral and systemic diseases, impaired physical and mental growth, and reduced efficiency (Bhattacharya, P. T et al., 2016).

Greater than 60% of the overweight child population seem to have at least one added risk factor of cardiovascular disease (Raised blood pressure, hyperlipidemia, hyperinsulinemia), and more than 20% of the obese children have two or more risk factors. The United States National Centre for Health Statistics suggests that nearly 15% of adolescents are overweight or obese, and treatment is harder in adults than children ( International Life Sciences Institutes, 2000 ). It is observed that an adolescent is often negligible to his health due to improper awareness and a busy work schedule. With more than 14.4 million obese children, India has the second-largest obese child population in the world. By 2025 it is anticipated to reach a stunning 17 million.

Since the third wave of COVID-19 is expected to affect children the mostly, it is, therefore, advisable for these children and adolescents who eat Junk foods to be more cautious during Covid situations due to the compromise of Immunity in the individuals and further exacerbating the organ damage.

2. Junk foods overview

Children find themselves amidst a way of living that has been metamorphized to suit the new jet-setting age and the food is no exception to this. Over the last two decades, the variability of healthy eating advice has become a cliché, leading to an alarming increase in the trend of consumption of fast food and sweetened beverages in Indian children. On average, the fast-food industry is growing 40% per year ( Joseph et al., 2015 ). A PAN India survey organized by the Centre for Science and Environment (CSE) among 13,274 children between the ages 9–14 years reported that 93% of the children ate packed food and 68% consumed packaged sweetened beverages more than once a week, and 53% ate these products at least once in a day. Almost 25% of the School going children take ultra-processed food with high levels of sugar, salt, fat, such as pizza and burgers, from fast food outlets more than once a week ( Bhushan et al., 2017 ). The most commonly consumed junk food items are bakery products, beverages, burgers, caffeinated drinks, chips, chocolates, noodles, pizza, soft drinks, and sugar-sweetened drinks. Harmful effects of Junk foods include Overweight/Obesity, Cardiometabolic risk, High blood pressure, Behavioural symptoms and Dental caries.

3. Highly consumed junk foods

Habitual physically inactive lifestyle, advertisements, media, and consumption of junk food have contributed significantly towards causing obesity in children and adolescents. Various list of Junk foods and their associated components showing the impact on health is mentioned in Table 1 .

List of Junk foods and its associated components showing impact on health.

4. Impact of junk foods on body weight

The rates of overweight and obesity have increased tremendously over the past few decades as a health epidemic in most parts of the world ( Mancino and Kinsey, 2008 ; LaCaille et al., 2011 ; Allom and Mullan, 2014 ). High consumption of Junk Foods contributes to the overweight among School-aged children in India from 9.7% to 13.9% over a decade ( Ranjani et al., 2016 ). The potential adverse effects on weight status in younger population include Physical inactivity and unhealthy dietary habits and, consequently, the future health of adults ( Hutchesson et al., 2015 ; Allom and Mullan, 2014 ). High intake of fried foods and artificially sweetened drinks are found to be directly linked with high body mass index and obesity in children. Additionally, diets with elevated amounts of Junk food have very little quantity of nutrients ( Goel et al., 2013 ; Harnack et al., 1999 ).

5. Preclinical evidences of junk food and its effect

The preclinical data is essential in collecting the safety of drug, iterative testing, and the feasibility of experiment which is given in Table 2 . In a study conducted in 1991, brown and white adipose tissue in high fat and junk diet and chow-fed rats with dorsomedial hypothalamic lesion rats ( Bernardis and Bellinger, 1991 ). The animals were grouped as high fat and control rats as group 1 and 3, whereas chow diet and control were grouped as group 2 and 4. He found that obesity is not only linked to calories but rather the sort of calories consumed, brown adipose tissue weight, lipid content, protein and turnover of NE are indicators of metabolic activity and thermogenesis that are unreliable. Oginsky et al. (2016) proposed that intake of junk food shows a rapid and long-lasting increase in NAc CP-AMPA receptors for food addiction. In general, mesolimbic circuits responsiveness is intensified in rats that are vulnerable to diet-induced obesity.

Pre-clinical and clinical evidence of Junk food and its effect.

Additionally, junk food was found to increase NAc CP-AMPAR function in obesity-susceptible rats. AMPA upregulation occurred more promptly in obesity-susceptible rats and preceded the development of obesity. Cocaine-induced locomotion was seen, and post-junk-food deprivation, cocaine-induced movement was enhanced in Junk-Food-Gainers than in the Non-Gainers, i.e., Junk-Food gainers were more sensitized when compared to non-gainers. He concluded that it will be significant to determine the extent to which these food-induced changes occurring in the striatal function could be part of normal, adaptive processes vs maladaptive, ‘addictive-like behaviors. A study conducted on 2010 by StephanieA stated in a study that a junk food diet in pregnancy and lactation promotes Non-alcoholic fatty liver in the rat offspring. It was observed that those junk food-fed mothers moved to an exclusive chow diet from weaning which resulted in the increase of triglyceride compared to the CCC group at the end of adolescence. The histological analysis did not disclose any signs of fibrosis or inflammation confirmed by unaffected TNF-alpha, IL-6, Collagen, and keratin expressions, suggesting that although they showed NAFLD signs, they did not suffer from NASH. He also mentioned that exacerbated steatosis in those offsprings did not coexist with an increase in carnitine palmitoyltransferase I (Cpt1a) mRNA expression, which might be an indicator of mitochondrial Beta-oxidation saturation leading to further lipid accumulation in the liver. In 2008 an observation was made on off springs of Junk food-fed mothers in pregnancy and lactation exhibited aggravated adiposity, which is highly found in females ( Bayol et al., 2008 ).

The perirenal fat pad mass linked to body weight was greater in the offsprings fed with junk food throughout the study than those fed with junk food diet postweaning. The increase in adiposity is associated with the weight gain previously reported in the same animals. The study on gene expression and changes in adipose tissue cellularity showed that an increase in IGF-1 transcription indicated higher proliferation of pre-adipocyte in females fed with junk food diet after weaning compared to males. Gugusheff et al., 2013 studied extensively the effects of prenatal junk food exposure on food preferences of offspring and how fat deposition can be alleviated by enhanced nutrition during lactation ( Gugusheff et al., 2013 ). He found that habitual cafeteria diet during the suckling period, independent of dietary exposure before birth, led to the development of diet-induced obesity in females and an increase in preference for appetizing foods in male offspring in young adulthood. The animals were given free access to the cafeteria diet. Female offspring suckled by JF dams had increased fat mass compared to those offspring suckled by control dams independent of the diet consumed by the mother during pregnancy. It is to be noted that it took place in the absence of high food consumption, suggesting that these animals had an enhanced propensity to accumulate fat in the body.

6. Clinical evidence of junk food and its effect

The clinical data collection is very much helped by the quality of information generated, which plays a significant part in yielding the study results whose clinical data are given in Table 2 .

Zahedi et al. (2014) studied the relationship between junk food consumption and mental health in a Sample of Iranian Children and Adolescents ( Zahedi et al., 2014 ). In this study, a notable link between junk food consumption and mental health problems in children and adolescents was observed. Students that consumed junk food daily were more likely to be subjected to mental health problems. The Western Australian Pregnancy Cohort Study proposed that the Western dietary pattern of increased consumption of takeaway foods, red meat, and confectionary was significantly associated with poor behavioral outcomes in adolescents. Similarly, two cohort studies in adolescents instigated that increased intake of unhealthy foods like sweets, savory snacks, sweetened soft drinks, chocolate, and fast foods was associated with a high risk of behavioral problems and mental distress such as anxiety worthlessness, and dizziness.

Azemati et al., 2020 studied an association between consumption of junk food and cardiometabolic risk factors in Iranian children and adolescent population ( Azemati et al., 2020 ). A population-based study in Korea showed that fast food consumption was linked to metabolic syndrome in adolescents. The study demonstrated that sweet dietary habits were positively related to metabolic syndrome, and those under junk food consumption were more likely to be overweight. Junk foods are found to be associated with obesity due to their high energy content and the amount of fat present or free sugar, chemical additives, and sodium with the presence of a low amount of micronutrients and fiber. Among junk foods, intake of sweetened beverages is in close relationship with weight fluctuations as it can increase food intake through decreasing satiety mechanisms. In Conclusion, junk food intake among Iranian children and adolescents had undesirable effects on cardiometabolic risk factors. Thus, enhancing knowledge of junk foods among adolescents is one of the possible ways to help them to make healthy food choices and get rid of overweight and obesity.

Zhu et al. (2019) investigated on the current situation and influencing factors on consuming junk foods among children and adolescents in Beijing city ( Zhu et al., 2019 ). He used a questionnaire survey method to survey the junk food habits and their effects. One month before the survey, all individuals have an intake of one type or the other junk foods. Mostly they didn't have an understanding of nutrition, and mostly they have misunderstandings about nutritional value and effect on the human body. Their behavior is affected mainly by personal factors like physiological, psychological, social, family factors, and the food itself. In Conclusion, children and adolescents in Haidian District ate different types of junk food, and the safety, nutritional issues of junk food should be paid great attention to prevent and control the risk factors of children and adolescents eating junk food. Payab et al. (2015) studied the relationship between junk food consumption with high blood pressure and obesity in Iranian children and adolescents ( Payab et al., 2015 ).

This study showed significant link between sweet consumption and both general and abdominal obesity. Nonetheless, there was no meaningful relationship between sweets consumption and high blood pressure. Several studies also showed that in general, central obesity is inversely associated with healthy dietary habits, while the Western dietary habits (refined grains, Red meat, sweets, desserts, pizza, French fries, and soft drinks) were directly linked to obesity.

7. Junk food and compromised immune system

• i) Effect of Junk foods on the signaling pathway

The intake of appetizing food is primarily under the control of the limbic system and stimulates endogenous opioids release, which binds to the opioid receptors present in the ventral tegmental area (VTA). VTA activates dopaminergic neurons in the brain, and in the nucleus accumbent, the site of dopamine release to potentiate dopamine signaling pathway ( Bergevin et al., 2002 ; Fields and Margolis, 2015 ; Berridge, 1996 ). The stimulation of the dopamine signaling pathway by opioid interactions is thought to be involved in the mediation of the short-term pleasurable sensation linked with the consumption of appetizing food ( Bodnar et al., 2005 ; Bodnar, 2015 ). It is observed that a reduction in MuR expression in the offspring of dams maintained on a junk food diet during pregnancy and lactation is present in the VTA at the weaning stage, i.e., 3 weeks after birth ( Gugusheff et al., 2013 ). Nonetheless, MuR expression in the NAcis found in elevated levels during the first postnatal week and declining to adult levels over the next two weeks ( Tong et al., 2000 ).

• ii) Effect of Junk foods on Immunity

Micronutrients like trace elements, antioxidants, and vitamins play a significant role in the regenerative process, coping with existing oxidative stress in the body tissues and providing Immunity against pathogens ( Chapple et al., 2007 ; Enwonwu et al., 2002 ). Obesity in the early years of life alters the immune system by inducing changes in cytokines concentrations and proteins and the number and function of the immune cells, ultimately leading to a pro-inflammatory condition, leading to the onset or exacerbation of numerous diseases like asthma, atopic dermatitis, allergy and sleep apnea ( Kelishadi et al., 2017 ). Various per- and polyfluorinated substances (PFAS)might affect growth, infantile behavior, learning, and older children. It also lowers the chance of pregnancy, interferes with the defense of natural hormones, increases the cholesterol levels, reduces vaccine-induced immune protection in children, and increase the risk of cancer ( Velez et al., 2015 ; Grandjean et al., 2017 ; Bach et al., 2015 ). Various reports from the conducted human studies conclude that some PFAS can take as long as 8–9 years to get cleared from the body ( Bartell et al., 2010 ). It can also cross the placental barrier and be secreted through breastmilk ( Mondal et al., 2013 ; Kingsley et al., 2018 ). It was observed that the immune response was impaired in children, especially cellular to influenza virus, and also inadequate vaccine responses were seen when they were obese ( Green and Beck, 2017 ). Thus, the importance of nutrition must be considered when it comes to Immunity. Similarly, there is enhanced knowledge about food, nutritional habits, and other lifestyle aspects, which are essential in aiding the proper functioning of the immune system ( Gombart et al., 2020 ).

In concern with obesity, there is a negative relationship between BMI and the intake of trace elements identified in obese people ( Farhat et al., 2019 ). Therefore, obesity has a strong correlation with an increased risk of infectious diseases accompanied by severe complications, elevated critical illnesses, and prolonged hospitalization ( Ritter et al., 2020 ). Systemic inflammatory reactions occur in covid 19 due to cytokine storms which leads to the imbalance of the immune system observed in obesity, and it contributes to a worse clinical outcome. Adipocytokines, mainly leptin, play an integral role in Immunity, as they influence the number and the function of immune cells through direct effects on cell metabolism ( Kim and Nam, 2020 ).

8. Influence of junk food during COVID-19 pandemic

COVID-19 lockdown had drastically altered the regular food pattern. When compared before pandemic, it shows both negative and beneficial impact on dietary practice associated with poor lifestyle management such as lack of physical activity and obesity. Nonetheless, poor eating habits were noticed such as changes in meal frequency and increased snacking with comfort foods (food bringing emotional comfort). It shows that alteration in dietary habits during the pandemic are at higher risk of further complications ( Bohlouli et al., 2021 ).

Since junk food tends to impact the immune system, it poses a greater risk during the pandemic. Children and adolescents who consume more junk food or are addicted to such consumption might be even more vulnerable during the third wave, which will especially affect the younger category (Janssen et al., 2021; Preethi et al., 2021 ).

9. Conclusion

Overweight and obesity are predominantly associated with numerous cardiac complications and are mostly mediated through the risk of metabolic syndrome. Obesity, like other malnutritional states, is known to impair immune function by altering leucocyte count as well as cell-mediated responses and causes organ damage. Not only is it causing physiological repressions, but it has significant psychological manifestations-that can damage a child's intellect and personality. Covibesity associated individuals are more prone to alteration of the immune system, and thus those people having junk food habits should be more cautious in this pandemic by maintaining health hygiene and getting vaccinated. It is to be noted that junk foods and packaging materials have drastic outcomes on health by impairing the immune system.

Thus, a combination of junk food, physical inactivity, and constant psychological stressors on children and adolescents during the pandemic makes them more vulnerable to increased weight along with decreased Immunity and thus an increased chance of infectivity during the third wave of COVID-19. There is an urgent need to spread awareness among children and young adults about these adverse effects of junk food, and they are not a good substitute for good healthy nourishment. There is no better time than now to build a supportive environment nurturing children and young adults in society and promising good health.

CRediT authorship contribution statement

AS: Methodology and Writing.

DD: Data curation and Review.

NG: Investigation and Resource.

LP: Writing and Editing.

SS: Conceptualization and Supervision.

This research received no grant from any funding agency.

Declaration of competing interest

The authors declare no conflict of interest, financial or otherwise.

Acknowledgement

We extend our sincere thanks to all the health care professionals.

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• Open access
• Published: 25 May 2023

Unhealthy food consumption and its associated factors among infants and young children in Gondar city, northwest Ethiopia: a community based cross sectional study

• Deresegne Fentie Jemere 1 ,
• Mekonnen Sisay Alemayehu 2 &
• Aysheshim Kassahun Belew 2  

BMC Nutrition volume  9 , Article number:  65 ( 2023 ) Cite this article

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Introduction

Many low- and middle-income countries are now shifting toward diets that are higher in added sugars, unhealthy fats, salt, and refined carbohydrates. Childhood obesity and chronic diseases have all been linked to unhealthy food consumption. Despite this, the majority of Ethiopian infants and children consume unhealthy food. There is also a scarcity of evidence. Therefore, the objective of this study was to assess the prevalence of unhealthy food consumption and its associated factors among children ages 6–23 months in Gondar City, northwest Ethiopia.

A community-based cross-sectional study was conducted from June 30 to July 21, 2022, in Gondar city. Multistage sampling was used to select 811 mother-child pairs. Food consumption was measured through a 24-hour recall. Data were entered into EpI Data 3.1 before being exported to STATA 14 for further analysis. A multivariable logistic regression analysis was employed to identify the factors associated with unhealthy food consumption. An adjusted odds ratio (AOR) with a 95% confidence interval was used to show the strength of the association, while a P-value of 0.05 was used to declare the significance of the association.

The percentage of children with unhealthy food consumption was 63.7% (95% CI: 60.4%, 67.2%). Maternal education [AOR = 1.89, 95% CI = 1.05, 3.69], living in an urban residence [AOR = 4.55, 95% CI = 3.61, 7.78], GMP service [AOR = 2.07, 95% CI = 1.48, 3.18], age of the child 18–23 months [AOR = 0.53, 95% CI = 0.34, 0.74], and family size of more than four [AOR = 1.22, 95% CI = 1.07, 2.78] were significantly associated with unhealthy food consumption.

In Gondar City, nearly two thirds of infants and children received unhealthy food. Maternal education, urban residence, GMP service, child age, and family size were all significant predictors of unhealthy food consumption. Thus, improving the uptake of GMP services and family planning services is critical to reducing unhealthy food consumption.

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Many low- and middle-income countries (LMICs) are going through a nutritional transition, with diets shifting toward more added sugars, unhealthy fats, salt, and refined carbohydrates [ 1 ]. As a result, children in both LMICs and industrialized countries consume more unhealthy foods and sugary drinks [ 2 , 3 ]. Sugar-sweetened beverages are related to an increased risk of being overweight and obese due to excessive energy intake [ 4 , 5 ]. Currently, a high intake of unhealthy foods throughout infancy and early childhood has been related to overweight and obesity [ 6 , 7 , 8 , 9 , 10 ].

Globally, 40 (5.9%) million children under the age of five are overweight or obese, with the majority of these children living in low- and middle-income countries [ 11 ]. Central Asia (14.9%) and the Middle East and North Africa (11.2%) have the highest rates of overweight [ 12 ]. According to the Ethiopia Demographic Health Survey (EDHS), the number of overweight children increased from 1 to 2% between 2016 and 2019 [ 13 , 14 ]. Overweight and obesity rank as the fifth leading risk factor for mortality, and morbidity is one of the major public health problems, causing 45% of all deaths among children aged 0–59 months [ 15 ].

Childhood obesity has consequences for adulthood obesity, which can lead to psychosocial problems as well as cardiovascular risk factors such as high blood pressure, high cholesterol, diabetes, and sleep disordered breathing [ 16 , 17 , 18 ]. In addition, low self-esteem increases the likelihood of being bullied, as does poor school attendance and achievement, a low employment rate, and a lower-paying job in adulthood [ 19 , 20 ]. Adult obesity also costs the world $ 2.0 trillion per year [ 21 ].

Reports show that food marketing environments [ 22 ], maternal occupation [ 23 ], the child’s first appointment at the primary healthcare facility [ 23 ], lower income households [ 23 ], TV food advertising [ 24 ], urban residence [ 25 ], the age of the child [ 25 ], and being enrolled in cash transfer programs [ 23 ] are the factors for increasing the consumption of unhealthy food.

Ethiopia has various initiatives and programs in place to minimize all forms of malnutrition, including overweight and obesity, as part of its national development plan since children under the age of two have been identified as being part of the first key window of opportunity [ 26 ]. However, the prevalence of obesity and overweight in Ethiopia ranges from 1.7 to 3.6% [ 27 ]. Furthermore, less attention has been paid to the increased accessibility of unhealthy foods, suboptimal feeding practices, and the rising trend in overweight/obesity. Regular monitoring of infant and child feeding practices helps to provide baseline evidence as well as monitor and evaluate current initiatives. However, little is known, including in the research area, regarding the prevalence of unhealthy food consumption among children aged 6 to 23 months in Ethiopia. As a result, the purpose of this study was to determine the prevalence and associated factors of unhealthy food consumption in 6 to 23 month old children in Gondar City, Northwest Ethiopia.

Study design, period and area

A community-based cross-sectional study was conducted from June 30 to July 21, 2022, in Gondar City, Northwest Ethiopia. Gondar City is the capital city of Gondar city administration and the central Gondar zone, which has six sub-cities. It is 727 km from Addis Ababa, the Federal Democratic Republic of Ethiopia’s capital, and 120 km from Bahir Dar, the capital of the Amhara National Regional State. The city has 3 hospitals, 8 health centers, and 14 health posts. The city has a total population of 454,445 people, including 22,945 children under the age of two.

Source population and study population

All infants and young children aged between 6 and 23 months, with their mothers or caregivers, living in Gondar city were considered the source population, whereas all infants and young children aged between 6 and 23 months, with their mothers or caregivers, in selected Kebeles living in Gondar city were considered the study population.

Sample size and sampling procedure

Based on the following assumptions, a sample size was calculated by using the single population formula: Because there have been no previous studies, a 95% CI was calculated using 50% of the previous prevalence, a 5% margin of error, and a 10% non-response rate. Finally, a total of 845 samples were obtained with 2% design effects. To identify study participants, a simple random sampling procedure was used. A list of infants and children was found in health posts. First, two sub-cities were selected from the total number of sub-cities in Gondar by using the lottery method. Second, six Kebeles were selected from each of the selected sub-cities by using the lottery method. Third, after having the number of all 6–23-month-old children from the selected kebeles, corresponding to the month of the 6-23-month-old children, samples were allocated proportionally to each kebele. Finally, a total of 845 participants were taken from each kebele through a simple random sampling technique.

Data collection procedures and tools

The data collection instruments were structured questionnaires that were pretested. The questionnaire was adapted from the World Health Organization (WHO) Infant and Young Child feeding (IYCF) indicators and other literature with some modifications [ 28 , 29 , 30 , 31 , 32 ]. The questionnaire was prepared originally in English and translated from Amharic back to English. It contains different independent variables, like the socio-demographic characteristics of parents, infants, and young children; household-related factors; and maternal health services related factors. The single 24-hour recall method was used to measure infants’ and children’s food consumption. There were four BSc nurse data collectors and one public health nutritionist supervisor assigned.

Data quality control

Two-day training was given on the contents of the questionnaire, interviewing technique, the purpose of the study, and how the principal investigator approaches and maintains the respondents’ confidentiality. A pre-test was conducted with 5% of the total sample size. The quality of the data was checked every day after data collection, and any errors were corrected before the following data gathering measures. Prior to analysis, the data was cleaned up and cross-checked. The principal investigator and the supervisor closely monitored the process throughout the data collection period and made any necessary corrections.

Variable measurnemts

To determine each child’s unhealthy food consumption (UFC), the mother was asked to list all foods consumed by the child in the 24 h preceding the survey, such as Juices, soda, coffee or tea with sugar, candies, chocolate, cakes, sweet biscuits, ice cream, potato chips and instant noodle. Children who got at least one food from the above lists were classified as meeting the unhealthy food consumption; otherwise, they were considered to be getting healthy food consumption [ 32 ].

A mother with less than two-year-old children who read a newspaper or magazine, listened to the radio, or watched television at least once per week is considered to have satisfactory media exposure; children who did so less than once per week are considered to have unsatisfactory media exposure.

Postnatal care (PNC) is defined as care provided to the mother and her newborn baby immediately following placental birth and for the first 42 days of life [ 33 ].

GMP utilization was measured by taking a child’s GMP and having them participate in GMP at least once in the previous three months.

The household wealth index was determined using principal component analysis (PCA) by considering household assets, such as quantity of cereal products, house, livestock, and agricultural land ownership. First, variables were coded between 0 and 1. Then, the variables were entered and analyzed using PCA, and those variables having a communality value of greater than 0.5 were used to produce factor scores. Finally, the factor scores were summed and ranked into poor, medium, and rich wealth index [ 34 ].

Data processing and analysis

Cleaned and coded data was entered into EPI Data Version 3.1 and exported to STATA Version 14 for further analysis. Descriptive and summary statistics were presented in the form of text, tables, and graphs. Both frequency and tables are used to summarize descriptive statistics. Variables with a p-value less than 0.2 in the bivariable analysis were fitted into the multivariable logistic regression analysis. A multivariable logistic regression analysis was employed to identify the factors associated with unhealthy food consumption. An adjusted odds ratio (AOR) with a 95% confidence interval was used to show the strength of the association, while a P-value of 0.05 was used to declare the significance of the association.

Socio-demographic characteristics

A total of 811 mother-child pairs with children aged 6–23 months were enrolled in the study, with a response rate of 96%. The mean age of the respondents was 32.33 years, with a standard deviation of 6.24. More than one-third of the mothers, 277 (34.1%), were between the ages of 25 and 30. More than three-quarters of the respondents, 631 (77.8%) and 608 (75%), were married and Orthodox Christians, respectively. More than one third, 283 (34.9%), of the mothers were housewives. Less than a quarter, 182 (22.4%), and 160 (19.7%) of the mothers and fathers, were able to read and write their educational status, respectively. Housewives made up less than half of the 349 mothers (43%) (Table  1 ).

Child, household, and community-related characteristics

More than one-third, 297 (36.6%), of the children were within the age range of 12 to 17 months. The majority of study participants, 685 (84.5%), lived in urban Kebeles. More than half, 485 (59.8%) of respondents, had fewer than or equal to four family members. Most 724 (89.3%) of the participants did not have a garden at home. More than two-thirds 620 (76.40%) of the study participants, received advice on child feeding practices from health professionals. More than two thirds, 624 (76.94%) of the participants, began providing their children with complementary feeding, and 604 (74.5%) of the respondents had satisfactory media exposure. The vast majority of children, 730 (90%), are currently breastfed (Table  2 ).

Child, and health care level related characteristics

Nearly two thirds, 494 (60.9%) of the respondents’ mothers, had four and above ANC visits during their last pregnancies. Almost three-quarters 579(71.4%) of the mothers received information on infant feeding during any of their antenatal care (ANC) visits. The majority, 720 (88.8%) of the study participants, had PNC visits during their last pregnancies, and nearly two-thirds of 500 (61.7%) of the children had growth monitoring and promotion (GMP) in the last three months. Regarding the birth place, the majority 773, (95.3%) of children were from health facilities (Table  3 ).

Prevalence of unhealthy food consumption

The overall prevalence of unhealthy food consumption among children aged 6–23 months was 63.7% (95% (CI: 60.4, 67.2%).

Factors associated with unhealthy food consumption

The multivariable logistic regression revealed that educational status of the mother, age of the child; urban residence, family size, and GMP service were all significantly associated with unhealthy food consumption (Table  4 ).

Mothers unable to read and write were 1.89 times [AOR = 1.89, 95%CI = 1.05, 3.69] more likely to consume unhealthy food as compared to those with a diploma and above.

Children aged 18–23 months were 47% less likely [AOR = 0.53; 95% CI = 0.34; 0.74] to consume unhealthy food than those aged 6–11 months.

Children living in families larger than four were 1.22 times more likely to consume unhealthy food than those living in families smaller than or equal to four [AOR = 1.22, 95% CI = 1.07, 2.78].

Moreover, mothers who lived in urban areas were 4.55 times more likely [AOR = 4.55, 95% CI = 3.61, 7.78] to provide unhealthy food as compared to mothers who lived in rural areas.

Mothers who had not received GMP services were 2.07 [AOR = 2.07, 95% CI = 1.48, 3.18] times more likely to provide unhealthy foods as compared with mothers who had received GMP services.

Unhealthy food consumption among children aged 6–23 months in Gondar city was 63.7%. This finding is consistent with a study done in Iran (66.8%) [ 35 ]. Whereas, this report is lower than a study done in Nepal (74.1%) [ 36 ]. The possible reason might be due to different sociodemogrphic characteristics, cultural variation, and study design. However, this finding is higher than in Tanzania (23.10%) [ 37 ], Dakar (58.7%) [ 29 ], and Peru (19.30%) [ 38 ]. One possible explanation is that the Peru study was conducted during the COVID-19 pandemic, which limited market access to unhealthy foods [ 39 ].

Mothers unable to read and write were 1.89 times more likely to consume unhealthy food as compared to those with a diploma and above. The possible explanation might be that women who are unable to read or write are unconcerned about the short- and long-term consequences of unhealthy food consumption [ 40 ]. In addition, mothers who are unable to read or write will have poor knowledge of nutrients, limited access to high-quality food sources, lower incomes, and are less likely to buy recommended health foods, preferring instead to buy sugary beverages or sweet baked foods [ 41 , 42 ].

Children living in families larger than four were 1.22 times more likely to consume unhealthy food than those living in families smaller than or equal to four. This could be due to the fact that mothers with larger families take longer to prepare foods and, as a result, purchase unhealthy items for their family. Furthermore, intra-household food distribution may boost the desire to consume unhealthy foods [ 43 ]; unhealthy foods are less expensive and easier to prepare than healthy foods [ 28 ].

Moreover, mothers who lived in urban areas were 4.55 times more likely to provide unhealthy food as compared to mothers who lived in rural areas. The finding is supported by the global food policy report [ 44 ]. The possible reason might be due to the fact that mothers living in urban residences may have the chance to access and purchase different kinds of unhealthy food from small shops, supermarkets, and street food vendors to provide unhealthy food for their children. Mothers who are living residences may be affected by food insecurity [ 45 ], shifting to purchasing less costly food from the market [ 46 ]. The other possible reason might be the urban poor population, for whom the most easily available and affordable diets are often unhealthy foods [ 47 ].

Children aged 18–23 months were 47% less likely to consume unhealthy food than those aged 6–11 months. Our finding is contradicted by studies done in Africa, Asia [ 29 ], and Nepal [ 48 ]. Possible reasons include child preference and a strong demand for sweet and convenient foods to begin complementary feeding at a young age. In addition, 18- to 23-month-old children have a higher probability of eating a family diet, which decreases unhealthy food consumption [ 49 ].

Mothers who hadn’t had GMP visits were 2.07 times more likely to provide unhealthy foods as compared to mothers who had GMP visits. The possible reason might be due to the fact that GMP focuses on empowering mothers to know about and become competent in appropriate child care and feeding practices through individual and group child feeding practices [ 50 ]. GMP is one of the techniques used to develop mothers’ and caregivers’ awareness, knowledge, and skill in preparing a diverse diet at home through community conversion and porridge preparation rather than providing unhealthy food for their children [ 51 ].

Strength and limitation of the study

The strength of this study was that it was the first of its kind in the study area targeting unhealthy food consumption among children aged 6–23 months. As a limitation, the data collection was done based on past feeding practices, which might be socially desirable. Since the data collection was done in a single 24-hour recall, the finding did not indicate the usual dietary habit of an individual child.

Data Availability

Data will be available upon request from the corresponding authors.

Abbreviations

Adjusted Odds Ratio

Antenatal Care

Bachelors of Science

Confidence Interval

Crud Odds Ratio

Ethiopian Demographic and Health Survey

Growth Monitoring and promotion

Low- and middle-income countries

Infant and young child feeding

Principal component analysis

Postnatal care

Unhealthy Food Consumption

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Acknowledgements

The authors would like to thank all respondents for their willingness to participate in the study. They are also grateful to all parents for their cooperation and Central Gondar Zone health department for material support.

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Mekonnen Sisay Alemayehu & Aysheshim Kassahun Belew

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DF conceived the study, developed the tool, coordinated the data collection activity, and carried out the statistical analysis. AK participated in the design of the study, tool development, and drafting the manuscript. MS participated in the design of the study and tool development, performed statistical analysis, and reviewed the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Aysheshim Kassahun Belew .

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Jemere, D.F., Alemayehu, M.S. & Belew, A.K. Unhealthy food consumption and its associated factors among infants and young children in Gondar city, northwest Ethiopia: a community based cross sectional study. BMC Nutr 9 , 65 (2023). https://doi.org/10.1186/s40795-023-00722-z

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International Journal of Ayurvedic Medicine

charu bansal

Background- Ayurveda has given a unique concept of Viruddha Ahara. Junk food an energy-dense food could be consider as Viruddha Ahara because of its serious physical and mental health consequences. Aim - Find out the frequency of consumption of Junk food preparation and their effects on Physical & Mental health in the youngsters of Bhopal city with special reference to Viruddha Ahara. Study Design- was Observational cross sectional study. Material and Method- Modified Questionnaire based on WHO STEPS1, 2 and 3 guidelines was used to collect the data. 600 youngsters of age group between 12-25 years from various schools and colleges of Bhopal city were selected by stratified random sampling technique and Statistical Analysis was done with epi infoTM version 7 software. Appropriate statistical tests were applied such as frequency distribution, cross tabulation (M x N/ 2 x 2 Table), chi square test, z statistics and logistic regression analysis. Odds ratios (OR) with 95% confidence inte...

IP Journal of Paediatrics and Nursing Science

Jagadeesh Hubballi

International Journal of Trend in Scientific Research and Development

Nisha Vikraman

Indian Journal of Public Health Research & Development

Dr. Suman Madan

International Res Jour Managt Socio Human , E.Michael Jeya PRIYA

Junk foods are rich in calories, salt and fats. Excess consumption of junk foods leads rise to wide variety of health disorders. Foods rich in high fat and sugar leads to weight gain along with other problems like infections, food poisoning, cancer, ulcer and dental diseases.Nutrition counselling regarding the importance of balanced diet, harmful effects of junk foods will help to curb the junk food addiction and improving their nutritional status. The main objective of the study was to find out the awareness on the ill effects of Junk food among Higher Secondary Students in Tirunelveli district. Survey method was adopted in this study. Sample consists of 300 Higher Secondary Students in Tirunelveli. Junk Food Awareness Scale was developed by Maria Saroja. M and Michael JeyaPriya.E (2018) has been used for collecting data. Mean, SD and't'-test was used for analysis the data.Present study revealed that, there was a significant difference among Higher Secondary Students in their awareness about the ill effects of Junk food.

Journal of Evolution of Medical and Dental Sciences

Ghanshyam Saini

Shanlax International Journal of Arts, Science and Humanities

Prabhavathy Devi

Background: Adequate and balanced nourishment is vital for upholding health and quality of life. Maintaining the right eating habits of college students means a lot for the prevention of many diseases that could occur in the adult period. Thus the purpose of the study is to assess the junk food consumption of college students.Aim: To study the dietary habits concerning junk food consumption of college studentsResults: About 16% consume junk foods daily. Hungry was the main reason to consume junk foods; Ice cream was the most preferred food for most of the participants. Majority of the participant mentioned taste as the major factor influencing the food intake.Conclusion: Nutrition professionals should take up the role and spread awareness in the general public and give them better guidance. A well-balanced diet, periodic physical activity, sufficient sleep, with good life style habits help in sound mind and healthy body leading to a happy life.

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