الفهرس 
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Abstract
Adolescence is a time of dramatic physical, social, and cognitive development, which directly affects nutritional status. It is the period of transition from childhood to adulthood with accelerated physical, mental and emotional development; the relatively uniform growth of childhood is suddenly altered by an increase in the velocity of growth. This sudden spurt is also associated with hormonal, cognitive, and emotional changes. These changes create special nutritional needs. Thus, adolescence is considered an especially nutritionally vulnerable period of life.
During adolescence, young people become more responsible for their own eating habits, health-related attitudes and behaviours, and their growing independence is often associated with unconventional eating patterns. Some of the common eating habits of adolescents are: meal skipping, snacking, and fast food consumption. Although dietary behaviour during adolescence may be transitory in some individuals, health related behaviours show tracking through adolescence.
Some of the nutritional concerns during adolescence are: overweight and obesity, anemia, and eating disorders such as bulimia and anorexia. The current poor diet quality and low levels of physical activity in adolescents predispose them to poor health and increased risk for overweight and obesity, if they are not already.
Health promotion from the early stages in life by fostering healthy eating practices and regular physical activity has the potential for a major impact on health and well-being during childhood and later stages in life. Child nutrition programs have the unique ability to provide the opportunity for students to make behavior choices at the point where they are making food selections based on the nutrition education they have received. Thus, the outcome of nutrition education can be made evident in behavior change in child nutrition programs. Policy measures and education within specific settings such as schools, workplaces, hospitals or cities are valuable strategies to influence health. Schools provide the most effective and efficient way to reach a large segment of the population. The most effective nutrition education interventions are focused on behavior change and are based on age-appropriate objectives for behavior change. Additionally, nutrition education programs must be thoroughly evaluated to ensure that they have achieved their objectives.
Currently, there is conflicting research about how well nutrition knowledge precipitates change in healthy lifestyle behaviors.
In the present study a nutrition education intervention program was held in a private school in Alexandria to study the effect of nutrition education on adolescent school children‘s nutritional knowledge and practices. One hundred and fifty adolescent students (78 boys and 72 girls) received nutrition education sessions once weekly for 4 weeks that covered the following topics: Different body frames, How to calculate BMI/age & how to know whether their weights are healthy or not, The amount of calories they should consume per day, The importance of physical activity, Food groups(Vegetables, Fruits, Carbohydrates, Proteins, Dairy products ), For each group they learned its importance, sources, and number of servings required, Healthy food versus junk food, and Food labeling and how to understand them.
The program was conducted throughout 4 weeks in the school. The students were divided into 15 groups of 8-12 students each according to their grade. Each group received 4 sessions; one session weekly at the end of the school day. Each session extended for 60 minutes. Throughout the sessions different educational methods were used including lectures, group discussions, brain storming, in addition to power point presentations.
A pre-designed self-administered questionnaire supervised by the researcher was administered prior to the intervention to collect the following data: age, sex, grade and a Food habit questionnaire based on the questionnaire designed by Turconi G and modified according to social and cultural aspects to assess the students‘ baseline consumption of different foods, dietary habits, nutritional knowledge, physical activity, and anthropometric measurements (weight, height, and BMI/age percentile). Four weeks later, after the intervention program, the questionnaire was re-administered to measure the change that happened in the above categories in response to the education sessions.
The study showed the following results:
The mean nutritional knowledge score significantly increased by 143.6%.The percent of change of nutritional knowledge score of girls was higher than that of boys (82.7%, 57.38% respectively).
Almost one third of the studied sample (32%) consumed sweets and cakes once daily before intervention; after intervention this percentage significantly decreased to (16%). Also, (43.3%) of the studied sample reported ―always‖ eating breakfast before intervention, this percentage significantly increased to (56.7%) after intervention. Before intervention, (46.7%) of the students reported ―always‖ drinking at least 1-1.5L of water every day, they significantly increased to (56.7%) after intervention.
The mean dietary habit score increased significantly by (11.7%). The percentage of students who had bad dietary habits significantly dropped from (4%) to (0%) after intervention, while those who had good dietary habits significantly increased from (47.3%) to (71.3%). The % of change of dietary habits of girls was higher than that of boys (9.4%, 8.1% respectively), while the difference between them was non-significant.
The percent change of knowledge was highest among underweight students followed by normal weight students, obese students, and then overweight students, while the percent change of dietary habits was the highest among normal weight students, followed by obese students, overweight students, and then underweight students. Also, there was a weak positive significant correlation between dietary habits and nutritional knowledge after intervention (0.289) across the studied sample.
The percentage of the students who reported practicing physical activity during the entire year was (40%), and this percentage significantly increased to (47.3%) post intervention. Moreover, the percentage of the students who spent their free time doing sedentary activities (Watching TV/ listening to music/ using the computer/ reading a book) decreased from (59.3 %) to (46%) and this was not statistically significant, while the percentage of those who practiced sports during their free time increased from (28.7%) to (36.7%), and that was not statistically significant.
The mean of the BMI/age percentile of the studied sample significantly decreased by (2.58%). Both boys and girls lost weight significantly, and female adolescents lost more weight than male adolescents (5.55%, 1.54% respectively), although the difference was not statistically significant. The weight of students in the overweight category significantly decreased after intervention by (3.7%), which was the highest change among BMI/age categories. Also, students in the normal weight category showed a significant DROP in their weights after intervention by (3.02%), and this was most evident in overweight and normal weight girls. The normal weight girls lost the highest percentage of weight (11.3%), and this was statistically significant, followed by overweight girls who significantly lost (3.4%) of their weights.
There was a positive intermediate correlation (0.518) between change in nutritional knowledge and change in weight, and this was evident only in obese adolescents. This study also found that, the factors mostly affecting dietary habits of studied sample; female gender, consuming less sweets and cakes, and spending leisure time walking.
It can be concluded from the results of this study that:
1. The frequency of fruits and vegetables consumption among adolescents can be significantly improved by nutrition education programs, and the frequency of consumption of calorie dense foods and fast-food can be significantly decreased through nutrition education.
2. Dietary habits score showed a weak positive relation to nutrition knowledge after nutrition education program
3. Girls in general have significantly better dietary habits than boys, however there is no significant difference between their change in response to nutrition education.
4. Nutrition education program significantly improved nutritional knowledge score and dietary habits score of adolescents.
5. Adolescent boys and girls don‘t show a significant difference in their mean scores of nutritional knowledge; however after receiving nutrition education, girls become significantly more knowledgeable than boys.
6. The change in nutrition knowledge score was strongly correlated with weight loss in obese adolescents.
7. Nutrition education programs can significantly increase adolescents‘ physical activity and decrease the time they spend on computer or watching TV.
8. Nutrition education may have a negative impact on normal weight girls if it‘s not targeted to them, by increasing their dieting attempts to lose more weight.
9. The most important lifestyle factors that should be emphasized in changing the habits of adolescents are daily consumption of dairy products and legumes lesser consumption of sweets and cakes, practicing walking in leisure time and decreased time spent watching screens.
- Recommendations:
from the results of this study, the following can be recommended:
Create nutrition education programs in elementary schools, because dietary habits are more likely to be shaped in younger ages;
Organize programs and activities in science and health classes to motivate students‘ learning about nutrition.
The results from this study cannot be generalized as a result of data collection for a relatively small sample in a single school. Data from multiple schools, representing greater student diversity, would be easier for generalization.
Children‘s dietary habits could be improved if parents were involved in the program. Parents may also benefit from a nutrition instructional program. If their children‘s diets are usually poor, the whole family‘s diet is inadequate.
The results suggest that to develop nutrition education programs for adolescents, differences between gender and weight status, dietary habits, and nutrition knowledge level should be considered.