The effect of direct or indirect nutrition education on children's nutritional status

This study was performed to determine the effect of different educational approaches that were given indirectly by teachers who had nutrition education from dietitian or directly by a dietitian to second and third grade students at a selected primary school on their nutritional status. The study was carried out on all the second and third grade students who were educated in Istanbul Okan College Primary School in the 2017-2018 academic year. In the first phase of the study, one 2nd and one 3rd grade teachers were given nutrition education by the dietitian twice for seventy minutes. The teachers educated by the dietitian gave a healthy nutrition education for 2 months in their relevant courses to 38 students gathered from one 2nd and one 3rd grade classes. Other 32 students gathered from a second and a third grade classes were given 4 steps nutrition education lessons, totally 140 minutes, by a dietitian. Nutrition education was completed concurrently with 70 students in total. Demographic characteristics, nutrient consumption frequency, anthropometric measurements, nutritional knowledge test, evaluation of the mediterranean diet quality index (KIDMED) and physical activity levels of students were determined before the education. After waiting for 2 months, during which the information given in nutrition education is expected to be absorbed and transformed into a behavior, food consumption frequency, anthropometric measurements, physical activity determination form, KIDMED and nutritional information tests were repeated. At the end of the education, a decrease is observed in the number of students who are skipping meals and not having a breakfast. The number of students who are skipping meals at the end of the education is found to be lower for the indirect education group (p<0.001). With the completion of education, significant increases were observed in the number of students consuming fruits and vegetables with peel and the amount of fruits and vegetables consumed. Indirect education is found to be significantly more effective in these increases (p<0.05). The percentages of energy from total fat and saturated fat (SF) are decreased at the end of the educations while the percentages of energy from mono unsaturated fatty acids (MUFA) and poly unsaturated fatty acids (PUFA) are increased (in the percentages of energy from total fats, SF and PUFA for every groups p<0.05). The decrease in the percentages of energy from total fat and SF at the end of the education is more effective for indirect education (p<0.05). Change in the percentages of energy from MUFA is found to be similar between both groups (p>0.05). Direct education is found to be more effective for the change in percentages of energy from PUFA (p<0.05). In all of the students, the intakes of fiber, calcium, iron, MUFA, vitamin E and B1 before the education were determined to be below the requirements. At the end of the both direct and indirect educations, macro and micro nutritional intakes of all students have reached the requirements. While direct education is found to have a higher influence on the increases in riboflavin, niasin and vitamin B12 intakes, indirect education observed to have a higher influence on the increase in tiamin, vitamins A, B6, E and C intakes (p<0.05). All of the students' KIDMED scores improved and students achieved optimal diet quality levels with the completion of education. In terms of KIDMED improvements, indirect education was found to be more effective (p<0.05). Although an improvement on nutrional knowledge test score is observed with the education for whole sample, classification is remained to be avarage. With the direct education, score is improved from low to average knowledge levels (p<0.05). On the other hand, with the indirect education, KIDMED score is improved from average to high knowledge levels (p<0.05). It was found that direct nutrition education had a higher effect on increase rate of nutritional knowledge test score. As a result, nutrition education given to children had a positive effect on both nutritional knowledge and status of children. It is observed that indirect education is more effective due to the teachers being the role model for the students.