Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.3
,
No
.3
, Sep
t
em
b
e
r
20
14, pp
. 194
~205
I
S
SN
: 225
2-8
8
0
6
1
94
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Nutritional Intakes of Obese
Elementary School Children
Residing in the Shimokita Peninsula of Aomori, Japan
Takako Ku
m
a
gai
1
,
Y
u
miko
Na
ka
mu
ra
1
, Emi
Nai
j
o
2
,
A
k
i
k
o
Su
gi
mo
t
o
3
,
Barry Kavanagh
1
, H
a
ru
yuki
Ito
1
1
Aom
o
ri Univer
s
i
t
y
of He
al
th an
d W
e
lfar
e,
J
a
pan
2
Departm
e
nt
of
Health
and
W
e
lf
are,
Aom
o
ri P
r
ef
ectur
e,
J
a
pan
3
Kanagaw
a
Children’s
Medical Center
,
Jap
a
n
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
J
u
l 12, 2014
Rev
i
sed
Au
g
20
, 20
14
Accepted Aug 28, 2014
This
res
e
arch
e
x
am
ined th
e l
i
f
e
s
t
yles
and e
a
ti
ng habits
of
42
el
em
enta
r
y
school fifthgr
ad
ers (20 bo
y
s
and 22 gir
l
s)
over a 3-d
a
y
period;th
ese
childr
e
nresided
i
n
the Shim
okit
a
Penins
ula, Aom
o
ri pref
ectur
e, which has
the
highest ch
ildhoo
d obesity
r
a
tein J
a
pan.
The childr
en’s nutri
tional intakeswere
recordedv
i
a qu
estionnair
es and self-doc
umented
meal
record
diar
ies over
a 3-
day
per
i
od (1
weekday
and
the week
end)
.
The m
e
al r
e
cord di
aries
recordedwhi
c
hm
eals
the ch
ildr
e
n ate (inc
ludin
g
s
n
acks
)
duringthe 3-d
a
y
period. A regul
ar featur
e of thes
e childr
e
n’s
li
fes
t
ylewas
th
e vi
ewing of at
least 3 hours of telev
i
sion per d
a
y
.
Compared
withthe National Health and
Nutrition Survey
conducted b
y
the Japa
nese go
vernm
e
nt,th
e
nutrition
a
l and
energ
y
in
tak
e
levels wer
e
the
same but when
we examined
food group
intak
e
s, th
e v
e
g
e
tab
l
e
intak
e
wa
s lower on
wee
k
ends in
com
p
a
r
ison to
the
weekday
s
when
the ch
ildr
e
n wer
e
provide
d
scho
ol lunch
e
s. In
addition, salt
intak
e
ex
ceeded
the r
ecommended stand
a
rd in
more than80%
of the stu
d
y
sam
p
le. W
e
sug
g
est tha
t
th
e pa
t
t
ern of
r
e
duced
vegetable intake juxtaposed
with high salt
in
take stems from chil
dhood
and
is repeated
and
passed down
through gener
a
tions; ther
efore,the guardians o
f
these
childr
e
n require
nutrition
a
l
guida
nce and educ
atio
n.
Keyword:
Ch
ild
hoo
d Ob
esity
Dietary survey
Ru
ral
Salt in
tak
e
Veget
a
bl
e
Copyright ©
201
4 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Taka
ko
K
u
m
a
gai
,
Depa
rt
m
e
nt
of
Nut
r
i
t
i
on,
Facu
lty of
Health
Scien
ces,
Ao
m
o
ri
Un
iv
ersity Health
and
Welfare,
5
8
-1
Mase, H
a
mad
a
te, Ao
m
o
r
i
-
S
h
i
,
0
30-
8505
,
Ao
m
o
r
i
, Japan
.
Em
ail: t_kum
agai@a
uhw.ac
.jp
1.
INTRODUCTION
C
h
i
l
d
h
o
od
o
b
e
s
i
t
y
i
s
an im
port
a
nt
p
u
b
l
i
c
hea
l
t
h
i
ssue.
One i
n
1
0
y
o
u
ng
sch
ool
-age
d c
h
i
l
d
r
e
n i
n
Ja
pa
n
i
s
consi
d
ere
d
obe
se [
1
]
,
[
2
]
.
A re
vi
si
o
n
o
f
l
i
f
est
y
l
e
ha
b
its is n
eed
ed
to
p
r
ev
en
t in
fan
t
an
d
ch
ild
ob
esity, as
th
ese cond
itio
ns lead
to
an
i
n
creased
risk
o
f
h
i
gh
b
l
o
o
d
p
r
essu
re, lip
id
levels, and
abn
o
rmal g
l
u
c
o
s
e to
l
e
ran
c
e
[3]
.
I
n
t
h
e US
A,st
u
d
i
e
s ha
ve
sug
g
est
e
d t
h
at
chi
l
d
re
nw
h
o
b
ecom
e
overwei
ght
at
l
east
once duri
ng i
n
fa
nc
y
have
a 5-f
o
l
d
hi
g
h
er
ri
sk bei
n
g o
v
e
rwei
ght
by
t
h
e age of 1
2
[
4
]
.
In t
h
e UK
, r
e
po
rt
s ha
ve su
gge
st
ed t
h
at
4
0
% o
f
i
ndi
vi
dual
s
w
ho
we
re o
b
es
e i
n
p
u
b
e
rt
y
rem
a
i
n
ed obe
s
e
i
n
t
o
a
dul
t
h
o
od
[
5
]
.
Thes
e
st
udi
es s
h
ow
t
h
at
chi
l
d
h
o
o
d
o
b
esi
t
y
can be h
u
g
el
y
i
n
fl
ue
nt
i
a
l
ons
ubs
eq
ue
n
t
gro
w
t
h
i
n
adul
t
h
o
o
d
.
O
b
e
s
i
t
y
preve
n
t
i
o
n an
d
so
lu
tion
s
h
a
v
e
b
eco
m
e
seriou
s talk
ing
po
i
n
ts in
sch
o
o
l
s. Th
erefore, it
is n
ecessary to i
m
p
r
o
v
e
h
ealt
h
and
main
tain
a h
eal
th
y weigh
t
as
well as to prom
o
t
e p
h
y
sical activ
ity [6
].
In o
r
der t
o
g
r
asp t
h
e seri
o
u
sn
ess of t
h
e
pro
b
l
e
m
of
obe
si
t
y
, Japan
e
se nat
i
onal
s
u
r
v
ey
s ha
ve
beenc
o
nducte
d toexam
ine the
p
h
y
s
i
cal
char
act
eri
s
t
i
c
s of
c
h
i
l
d
re
n
of
b
o
t
h
sexes
f
r
om
nu
rsery
t
o
hi
g
h
s
c
ho
ol
(age
d 5
–
18
year
s)
[
7
].
Th
e r
e
su
lts of
th
es
e
s
u
rveys re
veale
d
that
with in
J
a
pan,
the Aomori pre
f
ecture has
the
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
N
u
t
r
i
t
i
onal
I
n
t
a
kes
of
Obese
El
ement
a
ry
Sc
ho
ol
C
h
i
l
d
ren
Resi
di
n
g
i
n
T
h
e S
h
i
m
oki
t
a
.
...
(
T
ak
ako
K
u
m
a
g
a
i
)
19
5
h
i
gh
est nu
m
b
er of
o
b
e
se ch
il
d
r
en
relativ
e to th
e n
a
tion
a
l
a
v
era
g
e a
n
d tha
t
this has
bee
n
a characte
r
istic of t
h
e
pre
f
ecture formany years [8
]. Th
e Sh
im
o
k
ita Pen
i
n
s
u
l
a with
in
the
Aom
o
ri prefecture contai
nsthe
highes
t
num
ber
of
o
b
e
s
e chi
l
d
ren a
n
d i
s
t
h
e
r
ef
ore
c
onsi
d
ere
d
t
o
h
a
ve t
h
e
hi
g
h
est
num
ber
of
chi
l
dh
oo
d
o
b
esi
t
y
cases
i
n
Ja
pan
[
8
]
.
H
o
we
ve
r, t
h
e rea
s
on
f
o
r
t
h
i
s
hi
g
h
obe
si
t
y
rat
e
a
m
ong chi
l
d
re
n
i
n
t
h
i
s
pe
ni
ns
ul
a i
s
u
n
cl
ear.
Obesity is the accum
u
lation of fat
due t
o
ene
r
gy
inta
ke that surpa
s
ses energy consum
ption.
Ch
ild
hoo
d
o
b
esity resu
lts fro
m
eatin
g
h
a
b
its, ph
ysical
activ
itylev
e
ls, an
d
en
v
i
ron
m
en
tal an
d
h
e
red
itary
factors that vary accordi
ng to
the regi
on
whe
r
e the ch
ildren
reside.The
National Health a
nd
Nut
r
ition Survey
(N
HN
S) c
o
nd
uct
e
d
by
t
h
e J
a
pane
se M
i
ni
s
t
ry
of
Heal
t
h
,
Lab
o
r,
an
d
Wel
f
are
[
9
]
pr
ovi
ded a
n
acc
ou
nt
o
f
Jap
a
n
e
se sch
o
o
l
ch
ildren
'
s nu
tritio
n
a
l in
takes [10
]
.
Th
e su
rv
ey,
h
o
wev
e
r,
u
tilized
rand
o
m
sa
m
p
lin
g an
d
d
i
dn
o
t
specifically ev
alu
a
teo
b
e
se or rural-dwellin
g
ch
ild
ren
.
In
add
itio
n, th
ese su
rv
eys wereon
ly cond
u
c
ted
o
v
e
r a 1-weekd
a
y p
e
ri
o
d
. It
is th
erefo
r
e
d
i
fficu
lt to
assess foo
d
and
nutritio
n
in
tak
e
s
o
v
e
r m
u
ltip
le
d
a
ys,
i
n
cl
udi
ng
t
h
e
weeke
n
d,
an
d
con
s
eq
ue
nt
l
y
i
m
possi
bl
et
o e
v
al
uat
e
h
o
w
eat
i
ng
ha
bi
t
s
co
rr
el
at
e wi
t
h
c
h
i
l
d
h
o
o
d
o
b
e
sity b
a
sed
o
n
t
h
e
NHNS
d
a
ta. St
u
d
i
es i
n
th
e literatu
re th
at ev
alu
a
ted ch
ild
ren’s eatin
g
h
a
b
its du
ri
n
g
t
h
e
weeke
n
d
ha
ve
sh
o
w
n
t
h
at
re
gar
d
l
e
ss
w
h
et
h
e
r t
h
e
en
vi
r
o
n
m
ent
was
u
r
ba
n
or
r
u
ral
,
cal
ci
um
and
vege
t
a
bl
e
i
n
t
a
kes
were
7
0
–
8
0
% l
o
we
r t
h
an
o
n
week
da
y
s
whe
n
sc
h
o
o
l
l
unc
hes
were
eat
en [
1
1]
-[
13
]
;
vi
t
a
m
i
n B
1
i
n
t
a
k
e
was al
so
rep
o
r
t
e
d t
o
be de
f
i
ci
ent
[1
4]
. These st
u
d
i
e
s s
u
g
g
est
t
h
at
w
eekday
sc
ho
ol
l
unc
hes co
nsi
d
era
b
l
y
in
flu
e
n
ce
food
an
d
nu
tritio
n
i
n
tak
e
.
Weekd
a
y sch
o
o
l
lun
c
hes ai
m
to
g
i
v
e
ch
ild
ren
a
g
ood
b
a
lan
ce
o
f
nu
tritio
n
and
fo
o
d
g
r
o
u
p
va
ri
at
i
on
but
on t
h
e
wee
k
e
n
d
,
w
h
e
n
sch
o
o
l
l
unc
h i
s
n
o
t
eat
en, t
h
ere i
s
a need t
o
i
n
ve
st
i
g
at
e
t
h
e eat
i
n
g
habi
t
s
of
chi
l
d
re
n a
s
o
p
p
o
se
d t
o
m
e
rel
y
o
n
week
day
s
wi
t
h
sc
ho
ol
l
u
nche
s.
Research i
n
volving
obese c
h
ildre
n in
rural areas
an
d i
nve
st
i
g
at
i
ons
of t
h
ei
r eat
i
n
g
habi
t
s
a
n
d
lifestyles is n
o
t represen
ted
i
n
th
e literatu
re; th
is rese
arch, wh
ich
i
s an
inv
e
stig
ation
o
f
ch
ild
ren
’
s eatin
g and
lifestyle h
a
b
its
in
th
e Sh
im
o
k
ita Pen
i
n
s
u
l
a
of Ao
m
o
ri pr
efectu
re,aim
s to
add
r
ess th
at
g
a
p
.
First, the ch
ildren’s
meal an
d
fo
od g
r
ou
p
i
n
tak
e
s will b
e
assessed
on
week
d
a
ys an
d
t
h
e week
end
,
fo
llo
wed
b
y
a
d
i
scussio
n
of
h
o
w ch
ild ob
esity can
b
e
p
r
ev
en
ted
.
Th
is research an
d th
e
ev
alu
a
tion
o
f
t
h
e ch
ild
ren’s
nu
tritio
n
a
l i
n
take and
lifestyle
h
a
b
it ch
aracteristics
co
u
l
d
b
e
n
e
fit h
ealth
p
r
o
m
o
t
i
o
n in schoo
ls
an
d assist
h
ouse ho
ld
s w
i
t
h
o
b
e
sity
p
r
ev
en
tio
n.
2.
R
E
SEARC
H M
ETHOD
2.
1.
The targe
t
c
o
mmunity
Th
e pop
u
l
ation
of Ao
m
o
ri h
a
s th
e sh
ortest lifes
pan
of al
l
t
h
e 4
7
pre
f
ect
u
r
es
wi
t
h
i
n
Ja
pa
n.
Shim
okitapeni
nsula
,
whichi
ncludes
1city (Mutsu),
1 t
o
wn (Oom
a), and 3
villages (Sai, Kazam
aura, and
Higas
h
idori
)
, is an area of Aom
o
ri
located in the rem
o
te
northeaste
rn
c
a
pe of the pre
f
ecture
on the
m
a
in
Japa
nese i
s
l
a
n
d
of
Ho
ns
h
ū
. The est
i
m
a
t
e
d
po
p
u
l
a
t
i
on i
s
app
r
oxi
m
a
t
e
ly
78,
00
0 pe
o
p
l
e
. R
e
t
a
i
l
,
whol
es
al
e, and
ad
m
i
n
i
strativ
e serv
ices accoun
t fo
r t
h
e m
a
in
in
du
stries
with
in
t
h
e reg
i
on
.
Mu
tsu
city wit
h
in
Sh
im
o
k
ita h
a
s an
avera
g
e a
n
nua
l te
m
p
erature
of
9.4ºC
with
a m
a
xim
u
m
te
m
p
erature of
27.5ºC in
August and a
m
i
n
i
m
u
m
te
m
p
erature
of -5.4ºC in J
a
nuary. An
nually, the city receive
s 1297.5 mm
of
rain,
70
cm
of s
n
ow, and 1675.6
d
a
ylig
h
t
ho
urs.
W
ith
i
n
t
h
e
Sh
im
o
k
ita area, th
ere is
a
hi
g
h
perce
n
t
a
g
e
o
f
obese
c
h
i
l
d
rena
n
d
obe
s
i
t
y
has
becom
e
a pa
rt
i
c
ul
ar
pr
o
b
l
e
m
am
ong
i
n
fant
s.
2.
2.
The subjects
W
i
t
h
t
h
e ai
d o
f
t
h
e M
u
t
s
u ci
t
y
B
o
ard o
f
Educat
i
o
n a
nd t
h
e Shi
m
oki
t
a
Ed
ucat
i
on
Ad
m
i
ni
st
rat
i
on,
coo
p
e
r
at
i
on
w
a
s obt
ai
ne
d f
r
o
m
5 el
em
ent
a
ry
scho
ol
s wi
t
h
i
n
t
h
e S
h
i
m
oki
t
a
pe
ni
ns
ul
a. Up
o
n
t
h
e a
dvi
ce
of
these education adm
i
nistrations, fi
fth
gra
d
ers were selected as the best
s
u
bjects beca
us
e at 11 years of age
,
t
h
e st
ude
nt
s coul
dsel
f
-
ans
w
e
r
que
st
i
o
n
n
ai
re
s;
fou
r
t
h
g
r
ad
e
r
s were c
onsi
d
ered t
o
o y
o
u
n
g
an
d si
xt
h g
r
aders
were i
n
t
h
ei
r fi
nal
y
ear
bef
o
re
gra
d
uat
i
o
n an
d c
onsi
d
ere
d
t
o
o bu
sy to p
a
rticip
ate in
the
research. T
h
e s
u
rvey
s
com
p
rised asel
f-e
ntry
dietary and lifes
tyle
su
rv
ey
b
a
sed
o
n
th
e subj
ects’ lifestyles such
the tim
esat
wh
ich
they get up and eatm
eals. The survey al
so i
n
cl
u
d
ed
phy
si
c
a
l
st
at
us dat
a
such as wei
ght
s
and hei
ght
s.
A m
e
al
record
diary where in subj
ect
s wrot
e d
o
w
n
and t
o
o
k
pi
ct
u
r
es of
what
t
h
e
y
at
e over a 3
-
day
peri
o
d
(Fe
b
r
u
ary
t
o
M
a
rc
h,
2
0
0
9
)
w
a
s al
s
o
c
o
n
duct
e
d.
Of th
e
15
1
surv
eys sen
t
ou
t as o
u
tlin
ed
ab
ov
e,
on
ly 7
7
g
u
a
rd
ian
s
and
th
eir ch
ild
ren
sign
ed
the
researc
h
co
nse
n
t
fo
rm
al
ong
wi
t
h
t
h
e com
p
l
e
t
e
d di
et
ary
and l
i
f
est
y
l
e
surv
ey
(a col
l
ect
i
on rat
e
of 5
0
.
9
%). O
f
t
h
ese 7
7
pa
rt
i
c
i
p
ant
s
, s
o
m
e
onl
y
com
p
l
e
t
e
d 1 or
2 day
s
o
f
t
h
e 3
-
day
m
e
al
recor
d
di
ary
.
There
f
ore
,
o
n
l
y
42
sub
j
ect
s (
20
b
o
y
s
and
22 gi
r
l
s) wh
o com
p
l
e
t
e
d bot
h t
h
e sel
f-ent
ry
di
et
ar
y
and l
i
f
est
y
l
e
sur
v
ey
andt
h
e
ful
l
3-
day m
eal record diary
we
re
include
d fo
r an
alysis w
ith
i
n
th
is stud
y. Th
i
s
stud
y w
a
s app
r
ov
ed b
y
t
h
e
eth
i
cs
committee of Aom
o
ri
Uni
v
ers
ity Health
and
W
e
lfare.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
94
–
20
5
19
6
2.
3.
Pa
rticipa
n
ts’ phy
sica
l
status
T
h
e
physical
conditions
of
the
par
ticip
an
ts were as certained
th
rou
g
h
self-ev
a
l
u
ation
rep
o
rts
con
d
u
ct
ed
by
t
h
e s
u
b
j
ect
s.
It
em
s wi
t
h
i
n
t
h
e
eval
uat
i
o
n i
n
c
l
ude
d se
x,
wei
ght
, a
n
d
hei
g
h
t
. B
ody
m
a
ss i
n
d
e
x
(B
M
I) wa
s cal
cul
a
t
e
d base
d
oneac
h pa
rt
i
c
i
p
ant
’
s hei
g
ht
and
wei
g
ht
. The
obesi
t
y
l
e
vel
was det
e
rm
i
n
ed usi
n
g
criteria stipulat
ed by t
h
e Ministry of E
d
ucation, C
u
ltu
r
e
, Sp
or
ts, Scien
ce, an
d Techno
log
y
in
Jap
a
n, wh
ich
were
base
d o
n
a scho
ol
heal
t
h
st
at
i
s
t
i
c
al
surv
ey
.The
ob
esity classificatio
n
o
r
lev
e
l
was based
on
th
e
form
u
l
a
b
e
low. Tho
s
e
with
an
ob
esity p
e
rcen
tag
e
of
≥
2
0
%
we
re c
onsi
d
ere
d
o
b
es
e;
t
hose
wi
t
h
a
perc
ent
a
ge
be
l
o
w
-
20
% w
e
re c
o
ns
i
d
ere
d
un
der
w
ei
ght
.
Obesi
t
y
l
e
vel
/
perce
n
t
a
ge =
A
c
t
u
al
bo
dy
wei
ght
(
k
g)
-
st
an
da
rd
(i
deal
)
bo
dy
wei
g
ht
(k
g) ac
cor
d
i
n
g t
o
hei
g
ht
÷
st
an
da
rd
(i
deal
)
bo
dy
wei
g
ht
c
r
i
t
e
ri
a (
k
g
)
acc
or
di
n
g
t
o
hei
g
ht
×1
00
.
Ideal body weight according to height =
a
×a
ct
ual
wei
ght
-
b
. Coefficie
n
ts (
f
o
r
11-year-old subjects):
boy
s,
a=
0.
78
2
and
b
=
7
5.
10
6;
gi
rl
s,
a=
0.
8
0
3
and
b=
7
8
.
8
4
6
2.
4.
Subjec
ts
’ lifes
tyles
The
subjects’ l
i
festyles were
measur
ed
u
s
ing
a self-en
t
ry
lifestyle surv
ey
th
at in
clud
ed
it
e
m
s su
ch
as
waki
ng
, sl
ee
pi
ng
, a
n
d
m
eal
tim
es. Ho
wa
nd
at
w
h
at
t
i
m
es t
h
e c
h
i
l
d
re
n a
t
t
e
nded
sc
ho
ol
was
al
so
rec
o
rde
d
.
These tim
es w
e
re divi
ded ac
cording to the
season. T
h
e children’s activity was
m
easure
d
base
d on
whethe
r
t
h
ey
exerci
se
d
and i
f
so
, f
o
r
h
o
w l
o
n
g
.
I
n
ad
di
t
i
on, t
h
e d
u
r
at
i
on o
f
t
e
l
e
vi
s
i
on
vi
ewi
n
g,
w
h
et
he
r t
h
ey
rec
e
i
v
ed
su
ff
icien
t
sleep, and how
o
f
ten
th
ey
ate brea
kfast
we
re als
o
m
easured. These m
easured i
t
e
m
s were sim
i
lar to
th
o
s
e fo
und
o
n
ph
ysical f
itn
ess sur
v
eys.
2.
5.
Di
et
ary
sur
v
e
y
(Me
al
rec
or
d di
ar
y
)
Th
e d
i
etar
y su
rv
ey w
a
s cond
ucted
ov
er
a 3-day p
e
ri
o
d
. T
h
i
s
i
n
cl
ude
d 1
we
ek day
w
h
e
n
t
h
e chi
l
d
ren
at
e ascho
o
l
l
u
nch;
t
h
e rem
a
ini
n
g 2
day
s
w
e
re t
h
e
wee
k
e
n
d
,
w
h
e
n
t
h
e c
h
i
l
d
re
n
di
d
n
o
t
at
t
e
nd sc
h
ool
or eat
a
sch
ool
l
u
nc
h.
In a
m
eet
i
ng wi
t
h
t
h
e
chi
l
d
ren
’
s
gua
rdi
a
ns,
we e
x
pl
ai
ned
h
o
w
we
wa
n
t
ed t
h
e c
h
i
l
d
r
e
nt
o
d
o
c
u
m
en
t th
eir 3
-
d
a
y m
eal re
co
rd
s,
wh
ich
i
n
clud
ed
ask
i
n
g
th
em
to
p
h
o
t
og
raph
th
eir m
eals. If
fillin
g
ou
t th
e
meal record (of what and when
th
ey ate) was d
i
fficu
lt fo
r ach
ild
, we ask
e
d
th
eir gu
ard
i
an
to
h
e
lp
th
e ch
ild
fill
in
ev
er
yth
i
ng
.
Du
ri
n
g
eac
hch
i
l
d
’s h
o
m
e
roo
m
peri
o
d
at
sc
ho
ol
, t
h
e
resea
r
ch
was e
xpl
ai
ned a
n
d rese
ar
ch d
o
c
u
m
e
nt
s
gi
ve
n t
o
t
h
e ch
i
l
d
ren
.
These d
o
cum
e
nt
s i
n
cl
ude
d t
h
e sel
f-e
nt
ry
que
st
i
o
n
n
a
i
r
es and a
n
expl
a
n
at
i
on
of
ho
w t
o
wri
t
e
up
t
h
e
3
-
day
m
eal
di
ary
rec
o
r
d
as
wel
l
asa
ph
ot
og
rap
h
i
c
gui
det
h
at
g
a
ve a
d
vi
ce re
g
a
rdi
n
g
t
h
e
t
a
rg
et
ed
am
ount
s
o
f
fo
o
d
a
n
d
seas
oni
n
g
.
The
m
eal
diary
record
aske
d
th
e particip
ants to
reco
rd
everyth
i
ng
th
ey
ate, in
clud
ing
sn
ack
s
,
ov
er
t
h
e 3
-
day
pe
ri
od
.
An
ex
pl
an
at
i
on a
n
d
gui
d
e
o
n
ho
w t
o
c
o
m
p
l
e
t
e
t
h
e m
eal
reco
r
d
di
ar
y
was al
s
o
i
n
c
l
ude
d.
Prior to th
e start of th
e stud
y,
a p
ilo
t test
was con
d
u
c
ted
t
o
h
e
l
p
us
co
n
f
i
r
m
t
h
at
a fi
ft
h
gra
d
er
w
oul
d
be a
b
l
e
t
o
u
n
d
e
rstand
an
d co
m
p
lete th
e
q
u
e
stio
nn
aires
an
d m
eal d
i
ar
y reco
rd
.
With
i
n
th
e d
i
ary,
th
esu
b
j
ectsh
ad to
fill in
th
e fo
llowing
ite
m
s
: 1
)
Na
m
e
o
f
th
e d
i
sh
, 2) In
gred
ien
t
s of th
e d
i
sh
, 3)
Weigh
t
o
f
th
e
d
i
sh, 4
)
How th
e d
i
sh
was c
o
oke
d
(e.g., boiled, grilled,
frie
d
), a
n
d
5) Th
e
qua
n
tity of the
uneaten
am
ount (if applicable).
To
prev
en
t any o
m
issio
n
s
with
in
th
e m
e
a
l
d
i
ary reco
r
d
,
we aske
d pa
rt
i
c
i
p
ant
s
t
o
t
a
ke
ph
ot
os o
f
t
h
e
meals (
i
n
c
lud
i
n
g
sn
ack
s)
t
h
at th
ey ate. Th
ese ph
o
t
o
s
i
n
clud
ed th
e p
l
acing
o
f
chop
sticks and
a spoon
n
e
x
t
t
o
the dish/m
eal,
whic
h provide
d
a scale
fro
m
wh
ich
to
d
e
termin
e th
e size o
f
th
e m
eal. Particip
an
ts were ask
e
d
t
o
t
a
ke
ph
ot
o
s
of t
h
ei
r m
eals bef
o
re an
d a
f
t
e
r c
ons
um
pt
ion
,
w
h
i
c
h
al
l
o
wed
f
o
r est
i
m
at
i
ons
oft
h
e a
m
ount
con
s
um
ed. F
o
r
f
o
o
d
di
s
h
es t
h
at
i
n
cor
p
orat
ed
several
t
y
pes
o
f
i
ngr
edi
e
nt
s o
r
fo
od
s, t
h
e
fo
o
d
nam
e
and
w
e
i
ght
were m
easured according to a food se
rvice industry guide
b
ook.
Altered food wei
ght m
e
asurem
ents (e.g., the
wei
g
ht
cha
n
ge
d aft
e
r c
o
o
k
i
n
g
)
we
re c
o
r
r
ect
e
d
t
o
t
h
e
fo
o
d
wei
g
ht
s be
f
o
re
co
oki
ng
. F
o
r
d
eep f
r
i
e
d
f
o
o
d
di
shes
,
t
h
e am
ount
s of
abso
rbe
d
oi
l
were al
so
base
d o
n
a fo
o
d
se
rvi
ce i
n
du
st
ry
gui
deb
o
o
k
.
As
t
h
e 3-
day
m
e
al
di
ary
record
pe
riod aske
d subjects
to record thei
r eating
habi
t
s
on a
week
da
y
whe
n
at
sch
ool
, t
h
e sch
o
o
l
l
unc
h
m
e
nu was o
b
t
a
i
n
ed f
r
om
t
h
e scho
ol
di
et
i
c
i
a
n on t
h
at
da
y
.
U
s
i
ngt
he
m
eal
diari
e
s and p
h
o
t
o
gra
p
hs, an est
i
m
at
e
of
t
h
e
am
ou
nt
eat
en
co
ul
d be obt
ai
ne
d.
A
n
y
l
e
ft
ove
rs were
al
so
rec
o
rde
d
v
i
aph
o
t
o
gra
p
hs.
Th
e nu
trition
a
l v
a
lu
e calcu
latio
n
s
b
a
sed
on th
e es
ti
m
a
ted
n
u
t
rien
ts, amo
u
n
t
sco
n
s
u
m
e
d
, an
d
food
gr
o
ups
wer
e
con
d
u
ct
ed
usi
n
g
the softwa
re packa
g
eE
xc
el
eiyou kun
versi
on
6 (
K
en
pa
ku
-s
ha,
Toky
o,
Japa
n),a
n
d
t
h
e
ave
r
age
i
n
t
a
k
e
pe
r
day
was
cal
cul
a
t
e
d
fr
o
m
t
h
eove
ral
l
f
o
o
d
i
n
t
a
ke
o
v
e
rt
he
3
d
ay
s.F
r
om
t
h
e
sub
j
ect
s
’
m
eal
di
ari
e
s a
n
d
ph
ot
o
g
ra
p
h
s, t
h
e
nam
e
s of
t
h
e
di
s
h
es
were
l
a
bel
e
d
i
n
a
m
eet
i
ng
of
5
n
a
t
i
onal
l
y
reg
i
stered
d
i
etician
s
(fro
m
th
e Ao
m
o
ri Dietetic Asso
ciation
,
affiliated
with
th
e
Nu
trition Care Station
)
who
sp
ecialized
in
calcu
latin
gn
u
t
ritio
n
a
lv
alu
e
s.
After t
h
is lab
e
l
i
n
g
,
an
exp
e
rien
ced
d
i
etician
co
ndu
cted
a com
p
le
te
dat
a
revi
si
o
n
a
nd r
e
vi
e
w
f
o
l
l
o
wed
by
revi
si
o
n
s t
o
t
h
e f
o
o
d
wei
g
ht
sco
n
s
u
m
e
d by
t
h
e par
t
i
c
i
p
ant
s
. Thi
s
pr
ocess
was
p
e
rfo
rm
ed
in
o
r
d
e
r to
prev
en
t an
y typ
e
of research
b
i
as
to
ward
s th
e
d
a
t
a
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
N
u
t
r
i
t
i
onal
I
n
t
a
kes
of
Obese
El
ement
a
ry
Sc
ho
ol
C
h
i
l
d
ren
Resi
di
n
g
i
n
T
h
e S
h
i
m
oki
t
a
.
...
(
T
ak
ako
K
u
m
a
g
a
i
)
19
7
3.
DAT
A AN
AL
YSIS
A
d
e
scr
i
p
tiv
e
statistical an
al
ysis o
f
t
h
e
p
a
r
t
icip
an
ts’ h
e
i
g
ht, w
e
i
g
h
t
, BMI, and nu
tr
itional and
food
gr
o
up i
n
t
a
kes was pe
rf
orm
e
d. Nut
r
i
t
i
onal
and
fo
o
d
gr
o
up
i
n
t
a
kes we
re c
o
m
p
ared wi
t
h
t
h
e resul
t
s
f
o
r
1
0–
1
1
-
year-o
l
d
ch
il
d
r
en
as d
e
term
in
e
d
b
y
th
e
NHNS. The
NHNS is an annualinves
tig
ation
of th
e subj
ects’
p
hysical
co
nd
itio
ns,
nu
tritio
n
a
l in
tak
e
s, and
lifestyle facto
r
s.
Th
e
no
r
m
ally
d
i
str
i
bu
ted
po
pu
latio
n
of
th
e
N
H
N
S
w
a
s com
p
ar
ed
to
t
h
e
p
opu
latio
n
of
t
h
is stud
y, and
diffe
re
nces
bet
w
een the
population m
ean and the
sam
p
le m
ean of this
st
udy
we
re als
o
com
p
ared. T
h
e
data i
n
t
h
i
s
st
udy
we
re
z-t
r
ans
f
o
r
m
e
d un
der t
h
e ass
u
m
p
ti
on t
h
at
t
h
e
NH
NS dat
a
w
e
re n
o
rm
al
l
y
di
st
ri
but
ed
. The
t
e
st
-
statistic v
a
lu
e
was calcu
lated
fro
m
th
e stan
d
a
rd no
rm
al d
i
strib
u
tion
tab
l
e.
In
ad
d
ition
,
to
co
m
p
are an
d
measu
r
e th
e
d
i
etary
an
d
foo
d
g
r
ou
p
in
tak
e
s o
n
a weekd
a
y, Satu
rd
ay,
and
Sun
d
a
y, a
1
-
way an
alysis o
f
v
a
riance was co
ndu
cted
fo
l
l
o
w
ed
b
y
a mu
ltip
le co
m
p
ariso
n
acco
r
d
i
ng
to
th
e
Bo
nferron
i
m
e
th
od
. In
t
h
e com
p
le
te d
a
ta analysis we
co
nsid
e
r
ed
ad
if
fe
r
e
n
c
e
to
b
e
si
g
n
i
fican
t
wh
en the nu
ll
hypothesis
was
re
jected at
p<
0.05.
4.
RESULT AND DIS
C
USSI
ON
4.
1.
Ph
ysi
c
al
s
t
a
t
uses
a
nd l
i
v
i
n
g c
o
ndi
ti
ons
In
an
anal
y
s
i
s
o
f
t
h
e
pr
op
ort
i
o
ns
of
t
h
e
sub
j
ects
’
phys
i
cal characteri
s
tics and
obe
sity levels,
an
ob
esitylev
e
l o
f
≥
20
%
was
o
b
s
erv
e
d
i
n
5% o
f
t
h
e bo
ys an
d
13
.6
%
o
f
t
h
e g
i
rls, as illu
strated
i
n
Tab
l
e 1
.
In
ad
d
ition
,
90
%
o
f
th
e
bo
ys’ m
eals were co
ok
ed b
y
t
h
eir m
o
th
ers
o
r
grand
m
o
t
h
e
rs, co
m
p
ared
with7
7
.3% of
th
eg
irls’ m
eals
.
All ch
ildren
walk
ed
to
scho
o
lin spring
a
nd
sum
m
er andt
he m
a
jori
t
y
al
so wal
k
ed
i
n
wi
nt
er
.
Participants noted that it
took 14–18
m
i
nutes to reach
school, although in winter the
num
ber of st
ude
nts
traveling
by ca
rs inc
r
ease
d
.
Table 1. Char
acteris
t
ics
of the
subjects
Data ar
e shown as
m
e
ans ± standar
d
deviations or
n(
%)
.
*Ao
m
or
i
Pr
efectur
e School Health
Sur
v
ey
,
2012.
W
i
t
h
i
n
t
h
e sam
p
l
e
,
onl
y
1chi
l
d
di
d
n
o
t
eat
br
eakfast
e
v
e
r
y
d
a
y
.
The
sl
eepi
n
g
du
rat
i
o
ns
we
re
≥
6 h f
o
r
bot
h
boy
s
an
d
gi
rl
s, a
n
d a
p
p
r
oxi
m
a
t
e
l
y
40% o
f
boy
s a
n
d
5
0
%
of
gi
rl
s re
p
o
rt
e
d
t
e
l
e
vi
si
o
n
vi
ewi
n
g
du
rat
i
o
ns
≥
3 h (
T
abl
e
2).
4.
2
Three-day ave
r
age
nutrition and food
gr
oup intake
s
The 3-day a
v
erages
for the
nutritional intake
am
ounts werec
o
m
p
ared to the NHNS results as
illu
strated
in
Tab
l
e 3
.
Th
ere
were
n
o
si
g
n
i
fican
t d
i
ffere
nces in
th
e en
ergy in
tak
e
a
m
o
u
n
t
s b
e
tween
the b
o
y
s
and t
h
e gi
rls in this study sa
m
p
le and thos
e in
the NHNS. Howeve
r, a
m
ong girls from
the study s
a
m
p
le,
sodi
um
i
n
t
a
ke was si
g
n
i
f
i
c
ant
l
y
di
ffe
rent
fr
om
t
h
at
repo
rt
ed i
n
t
h
e
NH
NS
dat
a
(
p
<0
.05
)
. Statistical
di
ffe
re
nces i
n
t
h
e cal
ci
u
m
i
n
t
a
ke bet
w
ee
n bot
h sexe
s in
the current
st
u
d
y
and t
h
e N
H
N
S
were m
i
ni
m
a
l
(
p
<
0
.
0
5).
H
o
w
e
ver
,
am
ong
g
i
rl
s, t
h
e
r
ewe
r
e
si
gni
fi
cant
di
f
f
ere
n
ces i
n
t
h
e
vi
t
a
m
i
n D a
n
d c
hol
est
e
r
o
l
i
n
t
a
kes
relativ
e to
th
e NHNS
d
a
ta (
p
<0
.0
1
)
.I
n a
d
d
i
t
i
on, ni
aci
n i
n
t
a
ke was
f
o
u
n
d
t
o
be si
g
n
i
f
i
c
ant
l
y
hi
ghe
r i
n
bot
h
gende
r
s of
the current study
s
a
m
p
le
in
co
m
p
arison
to th
e
NHNS
d
a
ta (
p
<0.
0
1
)
.
Vita
m
i
n
D in
tak
e
was sign
ifican
tly h
i
g
h
e
rwi
t
h
i
n
th
is stu
d
y
sam
p
le
(
p
<0
.0
1)
, and
ni
aci
n i
n
t
a
ke was
significa
ntly
h
i
ghe
r withi
n
t
h
is sam
p
le wh
en c
o
m
p
ared t
o
m
a
le NHNS
su
bjects
(
p
<0
.0
5)
. W
a
t
e
r-s
o
l
ubl
e
di
et
ary
fi
ber
,
i
n
sol
u
bl
e di
et
ar
y
fi
be
r, a
n
d t
o
t
a
l
di
et
ary
fi
ber
i
n
t
a
ke
s
w
e
re si
gni
fi
ca
nt
l
y
hi
g
h
er
wi
t
h
i
n
ou
r
sam
p
le
in
co
mp
ariso
n
t
o
th
e
NHNS
(
p
<
0
.
0
5,
0.
01
, an
d 0
.
05
, res
p
ect
i
v
el
y
)
. Sal
t
equi
va
l
e
nt
i
n
t
a
kes di
ffe
red
si
gni
fi
ca
nt
l
y
o
n
l
y
bet
w
ee
n t
h
e gi
rl
s i
n
ou
r st
udy
a
n
d t
h
e
N
H
N
S
(
p
<0
.0
1)
.
Ag
e
(
y
e
a
r
s
)
10.
9
±
0.
4
1
1
.
0
±
0.
2
H
e
i
g
h
t
(c
m
)
1
44.
7
±
7.
5
148
.
8
±
6
.
3
W
e
i
g
h
t
(k
g
)
37.
5
±
7.
0
4
4
.
2
±
8.
8
BM
I
(
k
g
/
m
2
)
17.
9
±
2.
9
1
9
.
9
±
3.
2
Ob
e
s
it
y in
d
e
x
Th
i
n
(
≤-
20
%
)
1
1
5
(
1
.
9
)
0
1
7
(
2.
4)
N
o
r
m
al
18
647
(
8
3
.
0)
1
9
61
3
(
85.
7
)
O
b
es
e (
≥
20%
)
1
118
(
1
5
.
1)
3
8
5
(
11.
9
)
36
.
1
Bo
y
s
*
(1
0
y
e
ar
s
,
n
=
78
0
）
Bo
y
s
(
n
=
20)
Gir
l
s
(n
=
2
2
)
－
1
39.
7
－
(
90.
0)
(
86.
4
)
(5
.
0
)
(
13.
6
)
－
(
5
.0
)
(
0
)
Gir
l
s*
(
1
0
y
e
ar
s
,
n
=
715
)
－
14
2
36
.
1
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
94
–
20
5
19
8
Ta
bel 2
.
Lifesty
l
e
Data ar
e shown as
n(
%)
,
(
%
)
,
orm
e
an
s ± standar
d
de
viations.
*
Ao
m
o
r
i
Pr
efectur
e School Health Sur
v
ey
2012.
A
co
m
p
ar
ison o
f
t
h
e av
er
age f
ood
gro
u
p
i
n
tak
e
i
n
th
is st
u
d
y
an
d th
e
NH
NS is show
n in
Tab
l
e
4
.
C
o
m
p
ari
s
ons
of
p
o
t
a
t
o
a
nd
st
arch i
n
t
a
ke
r
e
veal
ed sm
al
l
si
gni
fi
ca
nt
di
f
f
e
rence am
on
g
t
h
e b
o
y
s
wi
t
h
i
n
t
h
e
st
udi
es (
p
<0.05
)
. In
ou
r samp
le, to
tal
v
e
g
e
tab
l
e in
tak
e
(g
r
een
veget
a
bl
es
) w
a
s l
o
w
re
ga
rdl
e
ss
o
f
se
x
(
p
<0
.0
1)
.
In
add
itio
n, the ov
erall
v
e
g
e
tab
l
e in
tak
e
for bo
th se
x
e
s
was
1
50g
,
h
a
l
f
of t
h
e reco
m
m
en
d
e
d 350
g. In our
0
(
0
)
2
(
9
.1
)
14
(
7
0
.
0)
1
4
(63.
6)
0
(
0
)
0
( 0 )
1
(
5.
0
)
2
(
9.
1
)
3
(
1
5
.0
)
1
(
4
.5
)
0
(
0
)
0
( 0 )
2
(
10
.
0
)
3
(13.
6)
Sp
r
i
n
g
～
Au
t
u
m
O
n
fo
o
t
/
m
i
n
u
t
e
s
1
2
(
60.
0)
/
1
8
.3
±
1
0
.
1
1
8
(
8
1
.8
)
/
1
3
.7
±
8
.
5
Bu
s
/
m
i
n
u
t
e
s
0
( 0
)
/
–
0
(
0
)
/
–
C
a
r
/
m
i
n
u
t
e
s
4
(20.
0)
/
8.
8
± 4.
1
3
(
1
3
.
6)
/
5
.
3 ±
2
.
1
Bi
c
y
c
l
e
/
m
i
n
u
t
e
s
0
( 0
)
/
–
0
(
0
)
/
–
On
f
o
o
t
&
C
a
r
/
m
i
n
u
t
e
s
4
(20.
0)
/
1
1
.8
±
9
.
5
1
(
4
.5
)
/
3
5
.0
W
i
n
t
er
O
n
f
o
ot
/
m
i
n
u
t
e
s
1
0
(
50.
0)
/
1
8
.0
±
8
.
4
1
5
(
6
8
.2
)
/
1
4
.9
±
9
.
2
Bu
s
/
m
i
n
u
t
e
s
0
( 0
)
/
–
0
(
0
)
/
–
C
a
r
/
m
i
n
u
t
e
s
5
(25.
0)
/
8.
2
±
4.
2
6
(
2
7.
2
)
/
5.
3
±
2.
2
Bi
c
y
c
l
e
/
m
i
n
u
t
e
s
0
( 0
)
/
–
0
(
0
)
/
–
On
f
o
o
t
&
C
a
r
/
m
i
n
u
t
e
s
5
(25.
0)
/
1
2
.6
±
1
1
.
5
1
(
4
.5
)
/
4
5
.0
Boy
s
*
n = 7
8
0
(81.
4)
(
5
4.
4
)
(18.
6)
(
4
5.
6
)
(75.
9)
(
5
4.
7
)
(11.
9)
(
2
8.
1
)
(
6
.3
)
(
1
2
.7
)
(2
.
3
)
(
4
.
5
)
(
9
.5
)
(
2
8
.5
)
(12.
7)
(
2
1.
8
)
(25.
6)
(
2
0.
4
)
(52.
2)
(
2
9.
2
)
––
––
––
––
(92.
4)
(
9
0.
5
)
(6
.
7
)
(
8
.
8
)
(0
.
9
)
(
0
.
7
)
(3
.
6
)
(
4
.
5
)
(42.
7)
(
4
2.
4
)
(53.
7)
(
5
3.
1
)
(13.
8)
(
1
9.
0
)
(36.
0)
(
3
0.
6
)
(24.
4)
(
2
4.
3
)
(25.
8)
(
2
6.
0
)
Gir
l
s (
n
=
2
2
)
W
a
k
e
-
u
p
t
i
m
e
6:
25
A
M
6:
0
8
A
M
Fa
t
h
e
r
Mo
t
h
e
r
B
e
d
t
i
m
e
9
:
16 P
M
M
a
i
n
p
e
r
s
on
w
h
o c
o
ok
s
B
o
y
s
(
n
=
20)
9:
1
5
P
M
Ot
h
e
r
s
A
tte
n
d
i
n
g sc
h
o
o
l
m
e
a
n
s
Mo
t
h
e
r
&
G
r
a
n
d
m
o
t
h
e
r
On
e
s
e
l
f
G
r
an
d
f
at
h
e
r
Gr
a
n
d
m
o
t
h
e
r
no
np
a
r
t
i
c
i
p
a
t
i
o
n
2
(
1
0
.
0
)
E
x
e
r
ci
s
e
o
t
h
e
r t
h
a
n
p
h
y
s
i
c
a
l
e
d
u
c
a
t
i
o
n
(
f
re
q
u
e
n
cy
)
E
x
tr
a
c
u
r
r
i
c
u
la
r
a
c
t
i
vi
tie
s
o
r
sp
o
r
ts
c
l
u
b
s
p
a
r
t
ic
ip
atio
n
1
8
(
9
0.
0
)
E
x
e
r
c
i
se
o
t
he
r
t
h
a
n
p
h
ysic
a
l
e
d
uc
a
t
i
o
n (
d
ur
a
t
i
o
n)
<
3
0 m
i
n
u
t
e
s
2
(
1
0
.
0)
of
t
e
n
(1
～
3
d
a
y
s
/ m
o
n
t
h
)
1
(
5
.0
)
n
e
v
e
r
1
(
5
.0
)
e
v
e
r
y
d
a
y
(
m
o
r
e
t
h
an
3d
ay
s
/
w
e
e
k
)
11
(
5
5
.
0)
s
o
me
t
i
me
s
(
1
～
2d
a
y
s
/
we
e
k
)
7
(
3
5.
0
)
B
a
s
e
b
a
l
l
10 (
5
5
.
6)
B
a
s
k
e
t
ba
l
l
4 (
2
2
.
2)
≥
2
ho
ur
s
7
(
3
5
.
0
)
C
l
u
b
a
c
tiv
i
tie
s
≥
3
0
m
i
n
u
t
e
s
,
<1
ho
ur
3
(
1
5
.
0
)
≥
1
ho
ur
,
<2
ho
ur
s
8
(
4
0
.
0
)
s
o
me
t
i
me
s
2
(
1
0
.
0
)
ne
ve
r
0
(
0
)
Br
e
a
k
f
a
s
t
e
v
e
r
y
d
ay
18 (
9
0
.
0)
Ta
b
l
e
t
e
n
n
i
s
1
(
5
.
6
)
o
t
h
e
r
s
3 (
1
6
.
7)
≥
3
ho
ur
s
8
(
4
0
.
0
)
1
7
(77.
3)
5 (22.
7)
1
7
(77.
3)
2 (
9
.
1
)
3 (13.
6)
0 (
0
)
≥
1
ho
ur
,
<2
ho
ur
s
6
(
3
0
.
0
)
≥
2
ho
ur
s,
<
3
h
o
ur
s
4
(
2
0
.
0
)
W
a
tc
hing
t
e
l
e
vi
si
o
n
(
h
o
u
r
/
d
a
y)
<1
ho
ur
2
(
1
0
.
0
)
≥
6
ho
ur
s,
<
8
h
o
ur
s
3
(
1
5
.
0
)
≥
8
h
o
u
r
s
17
(
8
5
.
0)
S
l
e
e
p
i
ng
ho
u
r
s
<6
ho
ur
s
0
(
0
)
1
1
(50.
0)
3 (13.
6)
4 (18.
2)
4 (18.
2)
1
1
(50.
0)
1
0
(52.
6)
2 (10.
5)
1
9
(86.
4)
2 (
9
.
1
)
1 (
4
.
5
)
0 (
0
)
6 (27.
3)
1 (
4
.
5
)
7 (31.
8)
8 (36.
4)
1 (
5
.
3
)
6 (31.
6)
Gir
l
s *
n
=
7
1
5
1
1
(50.
0)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
N
u
t
r
i
t
i
onal
I
n
t
a
kes
of
Obese
El
ement
a
ry
Sc
ho
ol
C
h
i
l
d
ren
Resi
di
n
g
i
n
T
h
e S
h
i
m
oki
t
a
.
...
(
T
ak
ako
K
u
m
a
g
a
i
)
19
9
sam
p
l
e
, green
veget
a
bl
e i
n
t
a
ke was l
o
w f
o
r
bot
h sexes
,
an
d t
h
e 3
-
day
i
n
t
a
ke o
f
l
i
ght
-col
ore
d
ve
get
a
bl
e
s
was
lo
w (
p
<
0
.
0
5
)
.
The gi
rl
s i
n
o
u
r
sam
p
l
e
had a
si
gni
fi
ca
nt
l
y
hi
ghe
r i
n
t
a
ke
of
egg
s
(
p
<0.01
)
.
Milk
in
tak
e
was lo
w
a
m
o
n
g
st bo
th sex
e
s
with
in our sam
p
le (
p
<
0
.
0
1
)
.
The
boy
s had
a hi
g
h
i
n
t
a
ke of
co
n
f
ect
i
o
nary
fo
o
d
s (
p
<0
.01)
and t
h
e
gi
rl
s h
a
d a l
o
w i
n
t
a
k
e
of be
ve
rages
(al
l
no
n-al
c
o
h
o
l
i
c
bevera
ges;
p
<0.01). Com
p
ared
with
th
e NHNS
dat
a
, t
h
e
gi
rl
s i
n
ou
r st
udy
had
a si
g
n
i
f
i
cant
l
y
hi
g
h
e
r
pant
ot
h
e
ni
c aci
d
i
n
t
a
k
e
(
p
<0.05).
T
a
bl
e
3.
Di
et
a
r
y i
n
ta
ke
over
the
3
-
d
a
y
per
i
od
Data a
r
e shown as
m
e
ans ± st
andard deviations. NHNS,N
ational Health an
d Nutrition Survey 2011, 10–
11y
ears. *
p
<0.
05,
**
p
<
0
.
0
1
;
*1
RE
: r
e
tinol equivalent,
*2
α
-
tocopher
o
l,
*3 niacin,
*4 sodiu
m
×2.
54/100,
*5 Av
er
agedr
a
tio of
a per
s
onal calculated value.
E
n
e
r
g
y
k
c
al
2097
±
455
1
967
±
404
0.
150
1
910
±
421
1
801
±
353
0.
147
P
r
o
t
e
i
n
g
7
2
.
7
±
20.
1
70.
1
±
14.
6
0
.
424
69
.
3
±
1
7
6
6
.
7
±
15.
8
0
.
435
F
a
t
g
7
2
.
0
±
27.
5
64.
4
±
19.
6
0
.
082
62
.
9
±
23.
1
6
0
.
2
±
17.
5
0
.
478
C
a
r
b
o
h
y
d
r
a
t
e
g
2
7
8
.
8
±
60.
0
269.
1
±
64.
7
0
.
503
257
.
7
±
55.
6
241
.
8
±
48.
3
0
.
124
So
d
i
u
m
m
g
3970
±
106
1
3
741
±
1194
0.
390
3951.
5
±
1112
*
*
3
427
±
914
0.
007
P
o
t
a
s
s
i
u
m
m
g
2128
±
690
2
126
±
566
0.
984
2
123
±
489
2
035
±
481
0.
390
C
a
l
c
i
u
m
m
g
560
±
221
6
7
4
±
252 *
0
.
043
501
±
209 *
638
±
200
0.
013
Ma
g
n
e
s
i
u
m
m
g
226
±
7
0
2
13
±
5
7
0
.
298
221
±
5
4
211
±
5
2
0
.
384
P
h
o
s
p
h
o
r
u
s
m
g
1055
±
314
1
062
±
244
0.
897
1
030
±
261
1
015
±
248
0.
787
Ir
o
n
m
g
7.
2
±
2.
1
6
.
8
±
3
.
0
0.
529
7
.
1
±
2.
0
6
.
7
±
2
.
1
0.
347
Z
i
n
c
m
g
8.
2
±
2.
5
8
.
7
±
2
.
0
0.
234
7
.
8
±
2.
0
8
.
2
±
2
0.
317
C
o
p
p
e
r
m
g
1
.
05
±
0
.
2
6
1
.
0
4
±
0.
2
9
0.
881
1.
07
±
0
.
2
9
1
.
0
1
±
0.
3
0
.
347
Ma
n
g
an
e
s
e
m
g
2
.
5
±
0
.
9
–
±
–
–
2
.
4
±
1.
0
–
±
–
–
V
it
a
m
in
A
*
1
µ
g
R
E
459
±
452
5
2
6
±
241
0.
215
644
±
928
534
±
296
0.
082
Vi
t
a
m
i
n
D
µ
ℊ
6.
1
±
6.
3
4
.
9
±
4
.
0
0.
194
9
.
2
±
10.
1 *
*
5
.
8
±
6.
0
0
.
009
V
it
a
m
in
E
*
2
m
g
6.
7
±
2.
4
6
.
3
±
3
.
0
0.
522
6
.
5
±
2.
5
5
.
7
±
1
.
9
0.
055
Vi
t
a
m
i
n
K
µ
ℊ
177
±
144
1
8
7
±
130
0.
741
203
±
158
184
±
132
0.
503
Vi
t
a
m
i
n
B
1
m
g
1
.
02
±
0
.
3
6
1
.
0
8
±
0.
6
3
0.
674
1.
01
±
0
.
4
3
0
.
9
3
±
0.
42
0.
358
Vi
t
a
m
i
n
B
2
m
g
1
.
28
±
0
.
5
4
1
.
2
9
±
0.
4
3
0.
936
1.
28
±
0
.
5
1
1
.
1
9
±
0.
44
0.
337
Ni
a
c
i
n
*
3
m
g
1
4
.
4
±
6
.
4
*
*
11.
5
±
3.
6
0
.
000
14
.
8
±
7.
0
*
*
11
.
1
±
4
.
6
0.
000
Vi
t
a
m
i
n
B
6
m
g
1
.
03
±
0
.
4
6
1
.
0
8
±
0.
5
6
0.
711
1.
00
±
0
.
3
3
0
.
9
8
±
0.
28
0.
726
Vi
t
a
m
i
n
B
12
µ
ℊ
5.
9
±
4.
8
4
.
8
±
3
.
6
0.
187
7
.
2
±
6.
6
5
.
3
±
5
.
2
0.
087
Fo
l
a
t
e
µ
ℊ
225
±
103
2
2
2
±
79
0.
881
238
±
9
6
231
±
7
3
0
.
660
P
a
n
t
o
t
h
e
n
i
c
a
c
id
m
g
6
.
05
±
2
.
1
0
5
.
9
6
±
1.
4
9
0.
779
6.
04
±
1
.
6
1 *
5
.
4
5
±
1.
29
0.
032
A
s
c
o
r
b
ic
ac
id
m
g
77
±
102
87
±
159
0.
787
63
±
3
8
6
6
±
36
0.
741
Sat
u
r
a
t
e
d
F
a
t
t
y
ac
id
s
g
21
.
6
8
±
11.
62
20.
87
±
6
.
4
2
0
.
575
19.
54
±
8
.
6
0
19.
50
±
6
.
8
5
0
.
976
Mo
n
o
u
n
s
at
u
r
at
e
d
g
2
5
.
00
±
10.
94
21.
70
±
7
.
8
0
0
.
059
21.
64
±
8
.
6
0
19.
79
±
6
.
2
6
0
.
185
P
o
ly
u
n
s
a
t
u
r
at
e
d
g
1
4
.
14
±
5
.
3
6
–
±
–
–
12.
56
±
4
.
9
0
–
±
–
–
C
h
o
l
e
s
t
e
r
o
l
m
g
379
±
243
3
3
0
±
171
0.
201
389
±
206 *
*
287
±
145
0.
001
So
lu
ble
D
i
e
t
ar
y
F
i
be
r
s
g
2
.
7
±
1
.
0
3.
2
±
1.
3
0
.
069
2
.
6
±
1.
3
*
3
.
1
±
1
.
0
0.
024
In
s
o
lu
bl
e
D
i
e
t
ar
y
F
i
be
r
s
g
8
.
0
±
2
.
9
9.
2
±
2.
9
0
.
066
7
.
5
±
2.
2
*
*
9
.
3
±
2.
7
0
.
002
T
o
t
a
l
D
i
e
t
ar
y
F
i
be
r
s
g
1
1.
4
±
3.
6
12.
8
±
4.
0
0
.
112
11
.
1
±
3
.
2
*
1
2
.
8
±
3.
7
0
.
027
Salt
e
q
ui
va
l
e
nt
s
*
4
g
1
0.
1
±
2.
7
9
.
5
±
3
.
0
0.
384
10
.
0
±
2.
8
*
*
8
.
7
±
2.
3
0
.
006
E
n
er
g
y
s
u
pp
l
i
es
f
r
om
P
r
ot
ei
n
*
5
％
1
3
.9
±
2
.
6
–
±
–
–
1
4
.7
±
2
.6
–
±
–
–
Ca
r
b
o
h
y
dr
a
t
e
*5
％
5
3
.
7
±
7
.
7
56.
2
±
6.
8
0
.
097
54
.
5
±
6
.
7
55
.
3
±
5
.
4
0.
472
Fa
t
*
5
％
3
0
.
4
±
7
.
0
29.
4
±
6.
0
0
.
484
28
.
9
±
6
.
6
29
.
9
±
4
.
7
0.
332
Gi
r
l
s
n = 2
2
NH
NS
2
0
1
1
Fe
m
a
l
e
(
1
0
-
11
y
e
ar
s
,
n
=
93)
p-
v
a
l
u
e
p-
v
a
l
u
e
Bo
y
s
n =
2
0
NH
NS
2
0
1
1
Ma
l
e
(
1
0-
11
y
e
ar
s
,
n
=
1
0
0
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
94
–
20
5
20
0
T
a
bl
e 4.
F
o
od gro
up
i
n
t
a
ke over
t
h
e 3-d
a
y
peri
od
Data
are
shown as
m
eans ±
standard deviati
ons. NHNS
, National H
ealth a
nd Nutrition Survey
2011. *
p
<0.
05,
*
*
p
<0.
01.
Table
5. B
o
ys’nutriti
on
al intakes
o
n
the
weekday,
S
a
tur
d
ay,
and
Su
nd
ay
Data are shown as
m
eans ± standar
d
deviations.
*p
<0.05
,
**p
<0.01
,
n.
s.
: n
o
t significant.
*
1
RE
: r
e
tinol equivalent,
*2
α
-
tocopher
o
l,
*3
niacin,
*4 sodiu
m
×2.
54/100,
*5 Av
er
aged r
a
tio of a
per
s
onal calcu
lated value.
W
eekday, Satur
d
ay,
a
ndSunday
i
ntakes were analy
zed
via1-wayanal
ysis of
variance(
m
u
ltiple co
m
p
arison,Bonferroni).
C
e
r
e
a
l
s
g
4
10.
9
±
104.
7
440.
3
±
145
.
1
1.
4
1
4
401
.
5
±
114.
4
390
.
6
±
1
05.
6
0
.
631
P
o
t
a
t
o
e
s
an
d
St
ar
c
h
e
s
g
36.
4
±
31.
3 *
57.
7
±
48.
5
0
.
0
49
40
.
4
±
43.
3
5
8
.
6
±
4
7
.
3
0.
238
Su
g
a
r
s
an
d
Sw
e
e
t
e
n
e
r
s
g
7
.
0
±
10.
2
4
.
9
±
6
.
3
0.
1
4
4
6
.
4
±
11.
1
5
.
9
±
6
.
9
0.
741
N
u
t
s
an
d
Se
e
d
s
g
1.
7
±
4.
5
2
.
0
±
5
.
5
0.
8
1
0
0
.
9
±
3
.
8
1
.
4
±
3
.
5
0
.
472
V
e
g
e
t
able
s
g
1
48.
3
±
107.
8 *
*
237.
6
±
127
.
4
0.
0
0
2
149
.
1
±
72.
2
*
*
242
.
6
±
1
03.
9
0
.
000
G
r
e
e
n
V
e
g
e
t
able
s
g
42.
4
±
39.
2 *
70.
5
±
55.
5
0
.
0
23
46
.
0
±
39.
2
*
6
7
.
9
±
5
0
.
3
0.
041
L
i
g
h
t
c
o
l
o
r
V
e
g
e
t
abl
e
s
g
1
05.
9
±
90.
5 *
162.
9
±
112
.
0
0.
0
2
3
103
.
1
±
64.
8
*
*
167
.
5
±
8
2.
7
0
.
003
F
r
u
i
t
s
g
82.
3
±
133.
4
91.
6
±
130
.
1
0.
7
4
9
6
4
.
7
±
96.
8
7
2
.
8
±
8
9
.
9
0.
674
Mu
s
h
r
o
o
m
s
g
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1
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5
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6
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0
0
.
4
07
7
.
0
±
13.
8
1
2
.
3
±
1
8
.
8
0.
184
A
l
g
a
e
g
5.
0
±
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7
9
.
1
±
19.
0
0
.
1
77
5
.
7
±
12.
8
7
.
6
±
1
5.
5
0
.
555
B
e
an
s
g
29.
5
±
35.
9
31.
0
±
39.
9
0
.
8
57
33
.
7
±
38.
7
4
5
.
8
±
5
7
.
7
0.
327
F
i
s
h
e
s
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d
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h
e
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lfis
h
e
s
g
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6
±
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4
49.
6
±
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4
0
.
3
73
62
.
7
±
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1
4
9
.
2
±
5
3
.
2
0.
234
Me
a
t
s
g
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9
±
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3
108.
1
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5
0
.
2
76
73
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5
±
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0
9
6
.
9
±
6
0
.
5
0.
070
E
g
g
s
g
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7
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4
34.
6
±
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0
0
.
2
04
47
.
1
±
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7
*
*
25
.
5
±
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7
0
.
001
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k
s
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01.
4
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1 *
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323.
1
±
161
.
5
0.
0
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1
178
.
4
±
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2 *
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281
.
5
±
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45.
0
0
.
001
F
a
t
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d
O
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ls
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6
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1
11.
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7
0
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8
49
11
.
6
±
7
.
4
9
.
1
±
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.
3
0
.
067
C
o
n
f
ec
t
i
o
n
er
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e
s
g
6
5
.
3
±
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1 *
33.
4
±
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8
0
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0
02
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1
3
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6
±
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7
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4
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984
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e
v
e
r
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e
g
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84.
1
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239.
2
290.
6
±
289
.
7
0.
1
0
1
162
.
0
±
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8 *
*
334
.
8
±
2
82.
9
0
.
004
Se
as
o
n
i
n
g
s
g
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6
±
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5
82.
0
±
73.
4
0
.
5
82
51
.
7
±
28.
5
5
7
.
3
±
2
9
.
3
0.
373
p-v
a
l
u
e
p-
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a
l
u
e
Gi
r
l
s
(n =
2
2
)
N
H
N
S
2011
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m
a
l
e
(1
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e
ar
s
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）
N
H
N
S
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l
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=
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）
Bo
y
s
(n
=
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E
n
e
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y
k
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al
2084
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2083
±
533
2125
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n
.
s
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r
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t
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n
g
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4
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4
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8
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s
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a
t
g
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2
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9
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5
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74.
2
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3
n
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s
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a
r
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y
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r
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3
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1
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280.
3
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3
n
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d
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m
g
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889
4211
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4017
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s
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o
t
a
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g
2317
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655
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±
613
2082
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778
n
.
s
C
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187
494
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585
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213
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225
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Su
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a
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e
Bo
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(
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W
eek
da
y
S
a
t
u
r
da
y
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
N
u
t
r
i
t
i
onal
I
n
t
a
kes
of
Obese
El
ement
a
ry
Sc
ho
ol
C
h
i
l
d
ren
Resi
di
n
g
i
n
T
h
e S
h
i
m
oki
t
a
.
...
(
T
ak
ako
K
u
m
a
g
a
i
)
20
1
4.
3
Com
p
a
r
i
s
on
of
f
o
od i
n
t
a
kes
on
t
h
e w
eekda
y
an
d t
h
e w
eekend
Co
m
p
ariso
n
s
o
f
th
e nu
trition
a
l
in
ta
k
e
s are shown in
Tab
l
e 5 (bo
y
s)
an
d Tab
l
e 6 (g
i
r
ls). In
tak
e
s
according to food
group on the weekda
y and the weeke
nd a
r
e shown in Ta
bl
e 7. In each
category, there
was
no st
at
i
s
t
i
cal
di
ffe
rence
bet
w
e
e
n t
h
e b
o
y
s
an
d gi
rl
s
.
H
o
wever, a tend
en
cy
to
ward
in
creased
salt in
tak
e
o
n
t
h
e
weeke
n
d rel
a
t
i
v
e t
o
t
h
e
wee
k
day
was
o
b
se
rve
d
.
Am
ong
boy
s,
t
o
t
a
l
ve
g
e
t
a
bl
e an
d g
r
e
e
n an
d l
i
g
ht
-c
ol
o
r
ed
veget
a
bl
e i
n
t
a
kes
were sl
i
g
h
t
l
y
si
gni
fi
cant
l
y
hi
g
h
er
o
n
S
u
nday
t
h
an
o
n
t
h
e w
eek
day
(
p
<0.
0
5
)
.
Am
on
g gi
rl
s,
fish
and
sh
ellfish
in
tak
e
was
slig
h
tly and
si
g
n
i
fican
tly
h
i
gh
er
on
Sun
d
a
y
th
an th
e
w
e
ekd
a
y (p
<0
.0
5)
.
A
m
o
ng
b
o
y
s, egg
in
take was lower on Satu
rd
ay th
an
o
n
t
h
e weekd
a
y (p
<0
.0
5), and
m
i
lk
in
tak
e
was lower
on
Sun
d
a
y
t
h
an
on t
h
e we
ekday
(p<
0
.
0
5
)
. Am
on
g gi
rl
s, fat
an
d oi
l
i
n
t
a
ke i
n
c
r
eased
s
i
gni
fi
ca
nt
l
y
on
Sat
u
r
d
ay
com
p
are
d
w
ith
th
at
o
n
th
e w
e
ek
d
a
y
(p
<0.05
)
. A
l
t
h
oug
h th
er
e w
a
s no
d
i
f
f
e
r
e
n
ce
b
e
tw
een th
e
bo
ys
an
d g
i
r
l
s, th
er
e w
a
s
a
t
e
nde
ncy
t
o
war
d
i
n
c
r
ease
d
be
vera
ge a
n
d c
o
n
f
ect
i
ona
ry
i
n
t
a
k
e
o
n
th
e
weeken
d in
co
m
p
ariso
n
to th
e
week
d
a
y.
Table
6.
Girls’nu
tritional in
tak
e
son the w
eekday,
S
a
tu
r
d
ay,
an
d S
u
n
d
ay
Data ar
e shown as
m
ean± standar
d
deviations.
*
p
<0.05, **
p
<0.
01,
n.
s.
: no
t
s
ignificant.
*1 R
E
: r
e
tinol equivalent,
*2
α
-
tocopher
o
l,
*3
niacin,
*4 sodiu
m
×2.
54/100,
*5 Av
er
aged r
a
tio of a
per
s
onal calcu
lated value.
W
eekday, Satur
d
ay,
a
ndSunday
intakes wer
e
analy
zed
via1-wayanal
ysis of
variance(
m
u
ltiple co
m
p
arison,Bonferroni).
E
n
e
r
g
y
k
c
al
182
9
±
3
5
4
1
955
±
4
55
19
64
±
4
6
4
n
.
s
P
r
o
t
e
i
n
g
7
2
.2
±
1
8
.
1
6
7
.
9
±
1
6
.1
6
7
.2
±
1
6
.
9
n
.s
F
a
t
g
5
6
.8
±
1
8
.
2
6
8
.
2
±
2
2
.7
6
4
.8
±
2
8
.
0
n
.s
C
a
r
b
o
h
y
d
r
a
t
e
g
247
.
7
±
4
3.
3
2
58.
5
±
6
6
.
3
2
69.
3
±
57
.
4
n
.
s
So
d
i
u
m
m
g
366
8
±
1
0
2
7
3
912
±
1
161
43
47
±
1
0
9
8
n
.
s
P
o
t
a
s
s
i
u
m
m
g
223
4
±
5
4
3
1
958
±
4
86
21
58
±
3
8
7
n
.
s
C
a
l
c
i
u
m
m
g
5
6
5
±
1
84
460
±
2
09
4
6
5
±
22
9
n
.
s
M
a
g
n
e
s
i
u
m
m
g
2
2
6
±
5
0
220
±
7
1
2
15
±
3
8
n
.
s
P
h
o
s
p
h
o
r
u
s
m
g
109
7
±
2
6
1
1
001
±
2
54
9
7
5
±
26
2
n
.
s
Ir
o
n
m
g
7.
0
±
1.
7
6
.
9
±
2
.
2
7
.
5
±
2
.
2
n
.
s
Zi
nc
m
g
8
.
2
±
2
.
0
7
.
5
±
1
.
9
7
.
6
±
2
.
0
n
.
s
C
o
p
p
e
r
m
g
1
.
1
3
±
0
.
31
1.
02
±
0
.
2
5
1
.
0
5
±
0.
3
1
n
.
s
M
a
n
g
a
n
e
s
e
m
g
2
.3
±
0
.6
2
.
6
±
1
.
6
2
.2
±
0
.6
n
.
s
Vi
t
a
m
i
n
A
*
1
µ
g
R
E
82
1
±
7
5
0
351
±
1
65
7
2
9
±
14
37
n
.
s
Vi
t
a
m
i
n
D
µ
ℊ
12
.
8
±
1
1.
3
7
.
2
±
9
.
9
6.
7
±
7.
6
n
.
s
Vi
t
a
m
i
n
E
*
2
m
g
6.
3
±
2.
7
6
.
3
±
2
.
2
6
.
9
±
2
.
8
n
.
s
Vi
t
a
m
i
n
K
µ
ℊ
22
6
±
2
0
0
169
±
1
28
2
0
9
±
12
4
n
.
s
Vi
t
a
m
i
n
B
1
m
g
1
.
01
±
0
.
4
3
0
.
9
2
±
0.
31
1.
1
1
±
0
.
5
3
n
.
s
Vi
t
a
m
i
n
B
2
mg
1
.
3
4
±
0
.4
6
1
.1
±
0
.
3
7
1
.3
6
±
0
.
6
8
n
.
s
Ni
a
c
i
n
*
3
m
g
16
.
1
±
9
.
6
13.
7
±
5
.
1
1
4.
4
±
4.
6
n
.
s
Vi
t
a
m
i
n
B
6
m
g
1
.
08
±
0
.
3
7
0
.
9
1
±
0.
28
1.
0
2
±
0
.
3
1
n
.
s
Vi
t
a
m
i
n
B
12
µ
ℊ
8.
4
±
5.
5
7
.
6
±
9
.
3
5
.
2
±
3
.
7
n
.
s
Fo
l
a
t
e
µ
ℊ
24
6
±
9
4
223
±
9
2
2
43
±
1
0
5
n
.
s
P
a
n
t
o
t
h
e
n
i
c
a
c
i
d
m
g
6
.
55
±
1
.
7
8
5
.
4
4
±
1.
13
6.
0
3
±
1
.
6
6
n
.
s
A
s
c
o
r
b
i
c
ac
i
d
m
g
67
±
3
5
5
6
±
40
6
7
±
4
1
n
.
s
Sa
t
u
r
a
t
e
d
F
a
t
t
y
a
c
i
d
s
g
18.
2
6
±
6
.
0
4
2
1.
05
±
9
.
7
1
1
9.
55
±
1
0
.
21
n
.
s
M
o
n
o
u
n
s
a
t
u
r
a
t
e
d
g
19.
0
6
±
7
.
0
8
2
3.
23
±
8
.
3
6
2
3.
19
±
1
0
.
10
n
.
s
P
o
l
y
u
n
s
a
t
u
r
at
e
d
g
11.
2
9
±
4
.
5
9
1
3.
50
±
4
.
9
5
1
3.
17
±
5
.
0
1
n
.
s
C
h
o
l
e
s
t
e
r
o
l
m
g
3
7
3
±
1
83
371
±
1
92
4
2
7
±
24
8
n
.
s
So
l
u
bl
e
Di
e
t
ar
y
F
i
be
r
s
g
2
.
6
±
1
.
7
2.
4
±
0
.
8
2
.
9
±
1
.
1
n
.
s
I
n
s
o
l
u
b
l
e
D
i
e
t
a
r
y
Fi
b
e
r
s
g
7
.5
±
2
.1
7
.
2
±
2
.
3
8
.0
±
2
.2
n
.
s
T
o
t
a
l
Di
e
t
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F
i
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r
s
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1
0
.
9
±
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.
2
10.
4
±
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.
0
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±
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3
n
.
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a
l
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ui
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s *
4
g
9
.
3
±
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.
6
9.
9
±
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.
0
1
1.
0
±
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8
n
.
s
E
n
e
r
gy
su
p
p
l
i
e
s f
r
o
m
Pro
t
e
i
n
*
5
%
1
5
.
8
±
2
.
1
14.
2
±
2
.
8
1
3.
8
±
2.
7
n
.
s
C
a
rb
o
h
y
d
ra
t
e
*
5
%
5
4
.
6
±
5
.
3
53.
2
±
6
.
6
5
5.
7
±
8.
3
n
.
s
Fa
t
*
5
%
2
7
.
5
±
4
.
8
30.
8
±
6
.
9
2
8.
7
±
7.
9
n
.
s
S
und
a
y
p-
v
a
l
u
e
Gir
l
s
(n
=
2
2
)
we
e
k
d
a
y
S
a
t
u
r
d
a
y
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
94
–
20
5
20
2
T
a
bl
e 7.
I
n
t
a
k
e
s
acc
o
rdi
n
g t
o
fo
od gr
oup
s
on the
w
e
e
kda
y, Sa
turd
a
y
, a
nd
S
und
a
y
Data ar
e shown as
m
e
ans ± standa
r
d
deviations.
*
p
<
0
.
05,
**
p
<0.
01,
n.
s
.
: not sig
n
ificant.
W
eekday,
Satur
d
ay
,
and Sunday
intakes were
co
m
p
ared via1-wa
y
anal
ysis
of variance(
multiple co
m
p
a
r
ison,Bonferroni).
Th
is p
a
p
e
r d
e
scrib
e
s th
e first
research
to
ex
amin
e th
e ru
ral Sh
im
o
k
ita p
e
n
i
n
s
u
l
a in
Jap
a
n, wh
ere th
e
ch
ild
hoo
d ob
esity rate is p
a
rticu
l
arly h
i
gh
.
Th
e
ob
esity
ra
tes were
rec
o
r
d
ed
at
13
.6%
fo
r
girls a
n
d
5
%
f
o
r
boy
s.
Acc
o
r
d
i
ng t
o
t
h
e an
nu
al
repo
rt
of
Sc
ho
ol
Heal
t
h
St
at
i
s
t
i
c
s R
e
sear
ch, am
ong el
e
m
ent
a
ry
scho
o
l
fi
ft
h
g
r
ad
ers, t
h
e
o
b
esity r
a
tes w
e
re 10
.9
%
f
o
r
boys an
d 8% for
g
i
r
l
s
[
8
]; th
er
efo
r
e, th
e r
a
te
f
o
r
our
sam
p
le of
g
i
r
l
s
exceede
d
the national a
v
era
g
e. In a
ddition, e
v
en
when
com
p
ared with
the 11.9%
ov
erall obesity rate
of
chi
l
d
re
n i
n
t
h
e
Aom
o
ri
pre
f
ect
ure
[
10]
,
t
h
e
o
b
esi
t
y
rat
e
o
f
o
u
r
sam
p
l
e
of
gi
rl
s rem
a
i
n
ed
hi
gh
.
Lifestyle is a c
o
n
t
ribu
tin
g
facto
r
to
o
b
e
sity. Reg
a
rd
ing
th
e
ch
ild
ren
’
s ph
y
s
ical activ
ity
l
e
v
e
ls, m
o
st
walk
ed
to
sch
o
o
l
alth
ou
gh
th
e n
u
m
b
e
r of those trav
elin
g to
school by car i
n
crease
d
in
win
t
er. Accord
ing
to
th
e literatu
re,
5
0–8
0% of ch
ild
ren
who
resi
d
e
in
rural ar
eas u
s
e cars to
atten
d
scho
o
l
[12
]
,[1
3
]
b
u
t
with
in our
sam
p
le, therate was 14–27%;
therefore,
we c
a
nnot say
th
at
th
e nu
m
b
er o
f
ch
ild
ren
trav
elin
g
t
o
schoo
l by car
was
p
a
rticu
l
arly h
i
gh
.
In additio
n
,
it too
k
th
e ch
ild
ren
i
n
o
u
r sam
p
le 14–
18
m
i
n
u
t
es t
o
walk
t
o
scho
o
l
bu
t
with
in
ru
ral areas wh
ere ch
il
d
r
en
are tak
e
n to
scho
o
l
by
car, t
h
e tim
e requi
red to
wal
k
that
distance
is 5
m
i
nut
es [1
5]
or app
r
oxi
m
a
t
e
ly
15
m
i
nut
es l
e
ss t
h
an t
h
e ch
i
l
d
ren
’
s com
m
u
t
e
i
n
ou
r st
ud
y
.
Accor
d
i
n
g t
o
t
h
e
Jap
a
n
e
se So
ciety o
f
Schoo
l Health
surveillan
ce su
rv
ey,
t
h
e av
erag
e duratio
n
for a 1-way j
ourn
e
y
on
fo
o
t
t
o
sch
ool
fo
r el
e
m
ent
a
ry
fi
ft
h
and
si
xt
h
gra
d
ers
was
16
–
1
7
m
i
nut
es [
1
6]
,
w
h
i
c
h
d
o
es
n
o
t
s
u
r
p
ass t
h
e
l
o
n
g
est
ti
m
e
o
f
18
m
i
n
u
t
es repo
rted
with
in
t
h
e cu
rren
t
stud
y sam
p
le.
p-
v
a
l
u
e
C
e
r
e
al
s
g
388.
4
±
102.
1
442.
2
±
104.
0
404.
9
±
105.
9
n
.
s
P
o
t
a
t
o
e
s
an
d
St
ar
c
h
e
s
g
49.
9
±
29.
7
27.
6
±
31.
0
30.
6
±
29.
9
n
.
s
Su
g
a
r
s
a
n
d
S
w
e
e
t
e
n
e
r
s
g
5.
0
±
4.
7
8
.
4
±
13.
8
7
.
6
±
10.
7
n
.
s
N
u
t
s
an
d
Se
e
d
s
g
1.
7
±
3.
1
0
.
4
±
0
.
8
3.
0
±
6.
9
n
.
s
V
e
g
e
t
abl
e
s
g
197.
4
±
110.
3
137.
2
±
74.
9
107.
3
±
115.
9 *
0
.
020
G
r
e
e
n
V
e
g
e
t
a
bl
e
s
g
61.
7
±
47.
7
33.
8
±
33.
8
30.
2
±
25.
6
*
0
.
026
L
i
g
h
t
c
o
l
o
r
V
e
g
e
t
abl
e
s
g
135.
7
±
85.
0
103.
5
±
63.
4
77.
1
±
110.
4
n
.
s
F
r
u
i
t
s
g
90.
0
±
139.
7
75.
8
±
114.
6
80.
3
±
148.
9
n
.
s
M
u
s
h
r
o
o
m
s
g
10.
0
±
8.
8
6
.
0
±
8
.
6
5.
1
±
7.
7
n
.
s
A
l
g
a
e
g
1.
8
±
3.
3
12.
4
±
34.
2
1
.
4
±
2
.
3
n
.
s
B
e
an
s
g
31.
8
±
29.
3
23.
9
±
19.
6
32.
3
±
51.
9
n
.
s
F
i
s
h
e
s
an
d
S
h
e
l
l
f
i
s
h
e
s
g
69.
7
±
55.
7
61.
1
±
58.
6
50.
6
±
49.
9
n
.
s
M
e
at
s
g
94.
1
±
57.
3
88.
8
±
63.
6
101.
4
±
71.
1
n
.
s
E
g
g
s
g
52.
3
±
38.
2
34.
4
±
39.
0*
43.
5
±
49.
3
0
.
033
M
i
l
k
s
g
270.
0
±
118.
0
152.
4
±
112.
0
176.
1
±
182.
5
n
.
s
F
a
t
s
an
d
O
i
l
s
g
12.
0
±
7.
7
9
.
6
±
7
.
6
13.
1
±
11.
5
n
.
s
C
o
n
f
e
c
t
i
o
n
e
r
i
e
s
g
34.
3
±
42.
2
74.
2
±
77.
7
89.
4
±
95.
4
n
.
s
B
e
v
e
r
a
g
e
g
115.
3
±
156.
9
229.
9
±
311.
4
212.
7
±
227.
2
n
.
s
Se
as
o
n
i
n
g
s
g
52.
6
±
24.
4
42.
2
±
19.
9
47.
5
±
59.
6
n
.
s
p-
v
a
l
u
e
C
e
r
e
al
s
g
368.
7
±
123.
6
403.
8
±
91.
8
440.
0
±
116.
9
n
.
s
P
o
t
a
t
o
e
s
an
d
St
ar
c
h
e
s
g
53.
3
±
51.
8
31.
7
±
29.
5
33.
3
±
42.
0
n
.
s
Su
g
a
r
s
a
n
d
S
w
e
e
t
e
n
e
r
s
g
6.
3
±
6.
1
9
.
1
±
17.
6
3
.
6
±
6
.
0
n
.
s
N
u
t
s
an
d
Se
e
d
s
g
0.
2
±
0.
7
2
.
4
±
6
.
5
0.
1
±
0.
3
n
.
s
V
e
g
e
t
abl
e
s
g
162.
1
±
79.
4
127.
3
±
76.
8
155.
6
±
53.
6
n
.
s
G
r
e
e
n
V
e
g
e
t
a
bl
e
s
g
55.
7
±
41.
3
35.
7
±
33.
6
44.
5
±
40.
9
n
.
s
L
i
g
h
t
c
o
l
o
r
V
a
g
e
t
abl
e
s
g
106.
4
±
71.
7
91.
6
±
67.
0
111.
1
±
54.
3
n
.
s
F
r
u
i
t
s
g
59.
6
±
98.
1
68.
4
±
93.
1
67.
3
±
103.
6
n
.
s
M
u
s
h
r
o
o
m
s
g
8.
1
±
8.
7
7
.
0
±
18.
0
5
.
6
±
14.
7
n
.
s
A
l
g
a
e
g
3.
2
±
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1
7
.
6
±
18.
2
6
.
7
±
12.
3
n
.
s
B
e
an
s
g
36.
2
±
39.
6
37.
3
±
46.
9
26.
9
±
27.
7
n
.
s
F
i
s
h
e
s
an
d
S
h
e
l
l
f
i
s
h
e
s
g
81.
3
±
46.
3
63.
9
±
74.
8
38.
1
±
38.
4 *
0
.
034
M
e
at
s
g
67.
1
±
41.
1
72.
8
±
46.
0
82.
3
±
49.
2
n
.
s
E
g
g
s
g
39.
9
±
37.
1
46.
4
±
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4
56.
8
±
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1
n
.
s
M
i
l
k
s
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253.
4
±
139.
9
146.
9
±
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1
117.
7
±
134.
2 *
*
0
.
009
F
a
t
s
an
d
O
i
l
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g
8
.
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±
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.
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4
±
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6*
12.
6
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8.
0
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.
013
C
o
n
f
e
c
t
i
o
n
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r
i
e
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g
28.
0
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48.
7
29.
5
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53.
3
54.
2
±
65.
6
n
.
s
B
e
v
e
r
a
g
e
g
96.
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160.
2
217.
0
±
243.
7
186.
7
±
204.
1
n
.
s
Se
as
o
n
i
n
g
s
g
48.
7
±
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0
47.
7
±
27.
2
59.
8
±
37.
2
n
.
s
w
eek
da
y
S
a
t
u
r
d
a
y
S
u
n
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o
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s
(
n
=
20)
Gir
l
s
(
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=
22)
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eek
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
N
u
t
r
i
t
i
onal
I
n
t
a
kes
of
Obese
El
ement
a
ry
Sc
ho
ol
C
h
i
l
d
ren
Resi
di
n
g
i
n
T
h
e S
h
i
m
oki
t
a
.
...
(
T
ak
ako
K
u
m
a
g
a
i
)
20
3
Go
tet al. [17
]
sh
owed
th
at with
in
large schoo
l d
i
stricts, th
e co
mm
u
tin
g
d
i
stan
ces are lo
ng
, resu
lting
in
th
e ten
d
e
n
c
y
to
tak
e
ch
ildren
to schoo
l b
y
car,
wh
ich
in
turn lea
d
s to a highe
r obesity rate. Heelan et
al.[18]
rep
o
rt
e
d
t
h
at
t
h
e m
a
i
n
fact
or
l
eadi
ng chi
l
d
r
e
n t
o
be dri
v
e
n
t
o
scho
ol
as opp
ose
d
t
o
wal
k
i
n
g was t
h
e d
i
st
ance
i
n
v
o
l
v
e
d
.
W
i
t
h
i
n
t
h
i
s
st
udy
,
ho
we
ver
,
beca
use t
h
e com
m
u
t
i
ng
di
st
ances
and sc
ho
ol
di
st
ri
ct
scal
es were n
o
t
ex
am
in
ed
, it is
n
o
t
kn
own
wheth
e
r t
h
e
factors ou
tlin
ed b
y
Heelan
et al.[18
] in
fl
u
e
n
c
ed
t
h
e p
a
ren
t
s to
tak
e
th
eir
chi
l
d
re
n t
o
sc
h
ool
by
ca
r.
Th
e
d
a
ta
with
i
n
th
is stud
y an
d in surv
eys
o
n
ch
il
d
r
en
’s
p
h
y
sical activ
i
t
y in
co
mm
u
n
ities with
in
so
u
t
h
e
rn
Ao
mo
r
i
p
r
ef
ectur
e
sh
ow
ed
t
h
at ch
ild
r
e
n
w
a
lk
ed less on
the
w
e
ek
end
t
h
an
o
n
schoo
l w
e
ekdays. A
pre
v
i
o
us s
u
r
v
e
y
repo
rt
ed t
h
a
t
for 2
5
%
of
chi
l
d
re
n, t
h
ei
r wal
k
i
ng
di
st
ances we
re re
duce
d
by
>
5
0
%
o
n
week
end
s
relativ
e
to
week
d
a
ys
[19
]
.
The com
b
i
n
at
i
on
of
red
u
ce
d
wal
k
i
n
g o
n
t
h
e wee
k
e
nd a
nd t
r
a
v
el
i
n
g t
o
scho
ol
by
car
can l
ead t
o
lo
wer lev
e
ls
o
f
ph
ysical activ
ity in
ch
ild
ren
.
To
i
n
cr
ease ph
ysical activ
ity, we sug
g
e
st
th
at ev
en
if child
ren
are
d
r
iven to
sch
o
o
l
,
wh
en they are
p
i
ck
ed
up
, t
h
ey sh
ou
ld
b
e
m
a
d
e
to
wal
k
to wh
ere their
g
u
a
rd
ian
will m
e
e
t
th
em rath
er than
b
e
ing
p
i
ck
ed
up
d
i
rectly i
n
fron
t o
f
th
e
scho
o
l
. Th
is wo
u
l
d
p
r
ov
id
et
he ch
ild
with
a slig
h
t
increase i
n
phy
sical activity.
Ap
art fro
m
co
mmin
u
tin
g
to
scho
o
l
, t
h
e ch
i
l
d
r
en
were also
inv
o
l
v
e
d
i
n
o
t
h
e
r ph
ysical activ
ities. Th
e
num
ber o
f
chi
l
dre
n
w
ho
bel
o
n
g
e
d
t
o
sp
ort
s
cl
ubs an
d p
e
rf
orm
e
d exer
ci
se on a re
gu
l
a
r basi
s o
u
t
s
i
d
e
o
f
phy
si
cal
edu
c
a
t
i
on cl
asses wa
s hi
ghe
r
than t
h
e pre
f
ecture avera
g
e; howe
ve
r, t
h
e t
e
l
e
vi
si
on
vi
ewi
n
g d
u
r
at
i
on
exceede
d
3 hours
pe
rday, a
pa
rticular
ly high le
vel.
It
has bee
n
sugge
s
ted that l
o
ng television
viewing
du
rat
i
o
ns are a
ssoci
at
ed wi
t
h
a hi
ghe
r o
b
esi
t
y
rat
e
[20]
;
t
h
eref
ore
,
red
u
ci
n
g
t
h
e am
ount
o
f
t
e
l
e
vi
si
on
vi
ewi
n
g
is
c
o
n
s
id
er
e
d
an
ef
f
e
c
tiv
e me
a
s
u
r
e fo
r r
e
du
cin
g
ob
e
s
ity [
21].
Th
ere
were no g
r
eat
d
i
fferences in
nu
trition
a
l in
tak
e
s b
e
t
w
een
t
h
e
reported
NHNS d
a
ta
fo
r10
–11
-
year-o
l
d
and
th
e d
a
ta ob
tained
du
ri
n
g
th
is
stu
d
y
, bu
t th
ere were d
i
fferen
ces in
calo
r
ie in
tak
e
b
a
sed
o
n
the
n
a
tio
n
a
l
n
u
t
ritio
n
criteria th
at stip
u
l
ate th
e n
ecessary
cal
o
r
ic in
tak
e
fo
r 1
0–1
1-year-o
l
d
s. Th
e in
tak
e
s o
f
ch
ild
r
e
n
i
n
th
e cu
rr
en
t sam
p
le
w
e
re b
e
low
the
stand
a
rd
s o
f
2
,
2
5
0
cal
o
r
ies f
o
r
1
0–1
1-
year-
o
l
d
bo
ys
an
d
2,000
calo
r
ies f
o
r
10–1
1-
year-
o
l
d
g
i
rls.
The
fat
energy
and
carbohy
drate energy ratios (%)
were within
t
h
e standa
rd range
s
. When
c
o
m
p
ared
with
nu
trition
a
l su
rv
eys of the en
erg
y
in
takes o
f
elem
en
tary scho
o
l
fi
fth
g
r
ad
ers, our stu
d
y
sam
p
le rep
o
rted
th
e sam
e
en
erg
y
in
tak
e
lev
e
l
s
; th
erefo
r
e, we can
no
t sa
y th
at ou
r sam
p
le’s in
tak
e
was
p
a
rticu
l
arly h
i
g
h
. The
lack
of calcium in
tak
e
with
i
n
th
e sam
p
le is a refl
ect
i
o
n of nat
i
o
n
wi
de
cal
ci
um
deficiency. Low ca
lciu
m
i
n
t
a
ke o
n
no
n-
sch
ool
day
s
w
h
en
sc
ho
ol
l
u
n
c
h was n
o
t
co
nsum
ed has
al
so bee
n
r
e
fl
ect
ed
i
n
ot
her
st
udi
e
s
[11
]
,[12
]. Calciu
m is essen
tia
l fo
r fu
ture bon
e growth
an
d
o
s
teopo
ro
sis prev
en
tion
,
an
d
i
t
s in
tak
e
is stro
ng
ly
encourage
d
.
The sal
t
i
n
t
a
ke
l
e
vel
s
of
ou
r s
a
m
p
l
e
excee
de
d t
h
e
rec
o
m
m
ende
d l
e
vel
s
of
8
g
f
o
r
boy
s
a
n
d
7
.
5
g
f
o
r
gi
rl
s.
17
of t
h
e boy
s (
8
5%) a
n
d 1
9
o
f
t
h
e
gi
r
l
s (86
.
4%)
wer
e
ove
r t
h
e rec
o
m
m
e
nded l
e
v
e
l
s
. Take
n t
o
g
e
t
h
er
,
80% of the
tot
a
l sa
m
p
le exce
eded th
e
reco
m
m
e
nded sal
t
i
n
t
a
ke. T
h
i
s
hi
gh
sal
t
i
n
t
a
ke
coul
d
be at
t
r
i
b
ut
ed t
o
th
e fr
equ
e
n
c
y
o
f
in
stan
t
nood
le con
s
u
m
p
t
i
o
n. Th
e salt con
t
en
tso
f
f
a
st foo
d
w
e
r
e
also
co
n
s
i
d
er
ed
, bu
t
o
n
l
y
2
boy
s
(
1
0
%
)
an
d
2
gi
rl
s
(9
.1
%
)
at
e
fast
f
o
od
du
ri
n
g
t
h
e st
ud
y
peri
od
an
d
as
o
n
l
y
4
pa
rt
i
c
i
p
ant
s
at
e
fast
f
o
od
, i
t
wo
ul
d
be di
ffi
c
u
l
t
t
o
m
a
ke assum
p
t
i
ons. O
n
t
h
e ot
he
r ha
nd
, 7 b
o
y
s
(3
5%) a
nd
5 gi
rl
s (2
2.
7
%
) rep
o
r
t
e
d i
n
st
ant
no
o
d
l
e
co
ns
um
pt
i
o
n
.
T
o
cha
n
ge t
h
e c
u
st
om
of eat
i
n
g
heavi
l
y
seasone
d,
hi
gh
-cal
o
r
i
e
f
o
o
d
[
22]
, t
h
e chi
l
dre
n
’
s
g
u
a
rd
ian
s
m
u
st b
e
in
stru
cted
t
o
in
itiate a n
e
w h
a
b
it o
f
servin
g
ch
ild
ren
lig
h
tly season
ed d
i
sh
es
with
low salt
cont
e
n
t
s
.
Acc
o
rdi
n
g
t
o
t
h
e
A
o
m
o
ri
pr
efecture Co
mm
u
n
ity Surv
ey, th
e salt in
tak
e
lev
e
l
s
of scho
o
l
ch
i
l
d
r
en
who
reside i
n
rural a
r
eas e
x
ce
eded the
national avera
g
e.
Thi
s
finding was reflected
in
t
h
e
current st
udy,
and it
is felt th
at a
lth
o
ugh
salt in
tak
e
was n
o
t
consid
ered
a c
o
n
t
rib
u
ting
factor to
ob
esity in
th
is stu
d
y
, th
is facto
r
sh
ou
l
d
b
e
co
n
s
id
ered
in fu
ture stud
ies.
W
i
t
h
i
n
o
u
r
sa
m
p
l
e
, veget
a
bl
e i
n
t
a
ke
wa
s
very
l
o
w;
o
n
t
h
e
wee
k
en
d
w
h
en
sc
ho
ol
l
u
nch
was
n
o
t
p
r
ov
id
ed
,
th
e p
a
r
ticip
an
ts
con
s
u
m
ed
10
0–12
0g
o
f
v
e
g
e
tab
l
es,
in
cl
u
d
i
n
g
3
0–4
0g
o
f
d
a
rk
gr
een
and
yellow
v
e
g
e
tab
l
es.
Acco
rd
ing
to
the literatu
re, th
e
no
n-sch
o
o
l
-l
u
n
c
h
d
a
y
v
e
g
e
tab
l
e in
tak
e
is 20
0g
[1
4
]
.
Acco
rdin
g
t
o
t
h
e Aom
o
ri
Pr
efect
ure
Heal
t
h
an
d Nut
r
i
t
i
on Su
rvey
,t
he d
a
i
l
y
veget
a
bl
e i
n
t
a
ke was 2
5
0g am
ong
7–
1
4
-y
ear
-
ol
ds
[
10]
,
w
h
i
c
h i
s
50
% m
o
re t
h
a
n
t
h
e
ve
get
a
bl
e i
n
t
a
k
e
o
f
ou
r stud
y
p
a
r
ticip
an
ts.Onereason
for t
h
is low
veget
a
bl
e i
n
t
a
k
e
m
i
ght
be t
h
e
fact
t
h
e l
ong
-t
e
r
m
average re
g
i
onal
ve
get
a
bl
e
i
n
t
a
ke has al
w
a
y
s
been l
o
w
,
and
th
is f
act inf
l
u
e
n
ces young
er
g
e
n
e
r
a
tion
s
[
2
3
]
-
[
27
].
W
e
wo
u
l
d
lik
e t
o
see g
r
eater
in
corp
or
ation
o
f
v
e
g
e
tab
l
es
in the m
eals prepa
r
edby th
e
chi
l
d
re
n’
s
gua
rdi
a
ns a
n
d
f
o
r
i
n
crease
d
ve
g
e
t
a
bl
e i
n
t
a
ke
t
o
becom
e
a re
gul
a
r
eat
i
ng ha
bi
t
.
I
n
ad
ul
t
s
,
veget
a
bl
e co
ns
um
pti
on i
s
kn
o
w
n t
o
re
d
u
ce t
h
e ri
sk o
f
obesi
t
y
,
cancer
, an
d c
h
ro
ni
c
di
sease;
h
o
we
ver
,
t
h
e rel
a
t
i
o
nshi
p bet
w
een
veget
a
bl
e i
n
t
a
ke an
d o
b
esi
t
y
pre
v
ent
i
o
n am
on
g chi
l
dre
n
r
e
m
a
i
n
s
lar
g
ely un
know
n. So
m
e
stu
d
ies h
a
v
e
shown
th
at
w
h
en
co
m
p
ar
in
g
ob
esean
d non
-o
b
e
se ch
ild
r
e
n
r
e
si
d
i
ng
in
ru
ral
areas, t
h
e
obese chi
l
d
re
n
cons
um
e
m
o
r
e
veget
a
bl
es
[
2
8]
. R
e
po
rt
s ha
ve sh
ow
n t
h
at
peo
p
l
e
w
ho c
o
nsum
e
veget
a
bl
es,
fr
u
i
t
s
, fi
sh,
an
d c
e
real
s are
m
o
re l
i
k
el
y
t
o
ha
ve l
o
w
bl
o
o
d
press
u
re [
2
9]
.
A
bal
a
nce
d
m
eal
i
s
therefore desirable.
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