Nutritional Assessment of School Children in AlMadinah AlMunawarah City: A Cross-Sectional Study

Nutritional Assessment of School Children in AlMadinah AlMunawarah City: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Nutritional Assessment of School Children in AlMadinah AlMunawarah City: A Cross-Sectional Study Musaad Bin Awadh B Alyabsi, Atta Ur Rehman Khan, Meshal Al Malki Khan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8041088/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Childhood obesity poses a global health concern with implications for long-term health and well-being. In Saudi Arabia, the increasing prevalence of overweight and obesity among children and adolescents requires urgent action to understand the contributing factors affecting lifestyle and dietary choices. This study addresses the nutritional challenges faced by school children in AlMadinah AlMunawarah, Saudi Arabia. Methods : A cross-sectional stratified study was conducted involving 6000 healthy school children aged 5-18 years, selected through random sampling from 20 schools. Anthropometric measurements, dietary intake, and physical activity data were collected using validated questionnaires and analyzed using SPSS. Descriptive statistics and inferential analysis were used to present the major findings of the study. Results: A total of 3987 students responded with a response rate of 67%, including 56% boys and 44% girls. The mean BMI was 20.7 ± 5.84 kg/m². The prevalence of obesity and overweight was 14.7% and 15.4%, respectively, while 19% were underweight. Obesity was more prevalent among boys (16%) than girls (14%). Approximately 88% of participants consumed fried foods regularly, while 61% consumed soft drinks daily. Only 37% of boys and 32% of girls reported daily milk intake. Physical inactivity was common, with 44% of students reporting no daily activity and 77% reporting screen use during meals. Conclusions: Unhealthy dietary practices, high consumption of energy-dense foods, and sedentary lifestyles contribute to the nutritional imbalance among school children in AlMadinah AlMunawarah, Saudi Arabia. Early school-based nutritional interventions and public health policies are crucial to reduce the burden of childhood obesity and promote healthier dietary and physical activity habits. Childhood obesity Nutritional status Dietary habits Physical activity Saudi Arabia School children Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Childhood obesity is now recognized as a major public health concern due to its rapidly rising prevalence (1). The World Health Organization (WHO) estimates that more than 340 million children and adolescents worldwide are affected by overweight and obesity (2). The prevalence of overweight and obesity among children in developing countries is approximately 30% higher than that observed in developed nations (3). By 2025, an estimated 206 million children and adolescents are expected to be living with obesity, with the number projected to rise to an additional 48 million by 2030 (2). A high prevalence of obesity (over 20%) has also been observed in several Middle Eastern countries, as well across North Africa and North America (4). In Saudi Arabia, the prevalence of overweight and obesity among adolescents in 2015 was estimated at 13.4% and 18.2%, respectively (5). Obesity in childhood and adolescence often persists into adulthood (6), posing serious short- and long-term health risks. Childhood obesity is strongly associated with an increased likelihood of developing cardiovascular diseases, diabetes, cancer and musculoskeletal disorders later in adulthood (7). The rising prevalence of obesity is multifactorial, driven by biological, environmental, and socioeconomic factors, including unhealthy dietary habits and sedentary lifestyles (8). Research from various regions of Saudi Arabia shows that frequent intake of calorie-rich food, particularly items higher in added sugars, salt, and unhealthy fats plays a significant role in the rising rates of obesity among children and adolescents (9). Evidence from Riyadh revealed that fast-food consumption was considerably more common among overweight and obese school children than among non-overweight children (10), supporting the role of unhealthy dietary habits in the rising prevalence of childhood obesity (11). Socioeconomic conditions strongly shape household dietary patterns, influencing the availability of healthier food options and overall nutritional quality. Previous studies conducted in high-income countries have demonstrated a positive association between higher SES and healthier dietary intake among children, characterized by greater consumption of fruits, vegetables, and nutrient-dense foods (12, 13). The prevalence of childhood obesity is likely linked to family status and background (14). A 2023 study conducted among adolescent students in the Aseer region reported that adolescents from higher-income families had greater odds of being overweight or obese (15). Both physical factors like availability of healthy foods, restriction of unhealthy options and social factors like family meals, TV during meals plays an important role in dietary choices (16). Obesity in children and adolescents is becoming a public health problem in Saudi Arabia. A recent study conducted in 2023 among female school students aged 12–18 years in Tabuk, Saudi Arabia, reported that 8.8% of participants were obese and 29.4% were overweight, highlighting the growing prevalence of obesity among adolescent girls in the region (17). Similarly, a large multicenter population-based study conducted in 2023 among 351,195 children and adolescents aged 2–19 years across Saudi Arabia reported an overall prevalence of 11.2% overweight and 9.4% obesity. The prevalence was higher among boys than girls, and the highest obesity rate (10.1%) was observed in children aged 2–6 years, indicating a pressing need for early intervention strategies (18). Beyond its nutritional implications, childhood obesity is linked with a range of physical and psychological health challenges that may persist into adulthood (19). Overweight and obese children are more likely to experience insulin resistance, hypertension, and dyslipidemia during adolescence (20), increasing their risk of type 2 diabetes and cardiovascular diseases in adulthood (19) . Moreover, childhood obesity is also linked with low self-esteem, poor academic performance, and social stigmatization, which can negatively impact mental well-being and quality of life (21, 22). Physical activity, paired with excessive screen time, also plays a significant role in the prevalence of obesity among adolescents (11). Globally, approximately 81% of adolescents do not meet World Health Organization’s recommendation of at least 60 minutes of moderate-to-vigorous physical activity per day (23). In Saudi Arabia, sedentary behaviors such as excessive television viewing, use of electronic devices, and limited participation in sports have been consistently associated with higher body mass index (BMI) levels among adolescents (24). This study is designed to assess the nutritional status of school-going children in the western region of Saudi Arabia, AlMadinah AlMunawarah city, using data collected in 2017. By examining dietary patterns, physical activity, and screen-time behaviors contributing to overweight and obesity, the study aims to identify gaps in lifestyle behaviors and nutritional practices among school children. The study findings will allow us to compare the data collected from other regions highlighting the gaps and improvements required for interventions. Ultimately, this research seeks to identify effective strategies for improving school-based nutrition programs, promoting healthier lifestyles, and reducing the long-term health risks associated with childhood obesity in Saudi Arabia. Materials and methods Study design/Setting This cross-sectional stratified study was conducted by the dietitians from the Clinical Nutrition Department, Prince Muhammad Bin Abdulaziz Hospital -National Guard Health Affairs, in collaboration with Ministry of Education in Madinah Al Munawarah from April 2017 to December 2017 under granted RM 15-001-M and Institutional Review Board (IRB) as per GCP/ICH standards. Ethical Approval and Consent Ethical approval was obtained from the Institutional Review Board of the King Abdullah International Medical Research Centre (IRB Reference: 13/SC/0630). Written informed consent was obtained from the parents or legal guardians of all participating children prior to data collection. Study subjects recruitment Inclusion Criteria The study population consisted of apparently healthy school-going boys and girls aged 5–18 years. Exclusion criteria: Any student with diagnosed medical problem such as Diabetes Mellitus Type I was excluded from this study. Sampling A stratified random sampling approach was adopted. Schools in Al Madinah Al Munawarah were grouped based on their geographic location before sampling. From a total of 110 schools, 20 schools were randomly selected with coordination from the Ministry of Education. A total of 6000 students (approximately 10% of the target school-aged population) were invited to participate, comprising 3000 boys and 3000 girls. Whereas any student diagnosed with medical problem like Diabetes Mellitus Type I was excluded. All eligible students within the selected schools were invited to take part in the study. Data Collection Demographic information A pre-structured self-administered questionnaire developed was used to collect the demographics data of the children. An informed consent was filled either by parent or guardian or school administration. Anthropometric measurement Weight: The anthropometric measurements including weight was documented at a single study visit or from case note review of the most recent follow-up appointment using a portable scale with a 125 kg maximum capacity and a +/- 100 g error margin was used. Individuals removed shoes and heavy clothing prior to weighing. Height: Height was measured using a standard stadiometer, with subjects standing upright with their scapula, buttocks and heels resting against a wall, the neck was held in a natural non-stretched position, the heels were touching each other, the toe tips formed a 45° angle and the head was positioned upright according to the Frankfurt plane. Body mass index (BMI): BMI was estimated by dividing weight (kg) by height2 (m2) (25). Individuals were considered malnourished if their BMI was less than 18.5, normal from 18.5 to 24.9 and overweight if BMI was ≥ 25 to 30 and obese if ≥ 30. Nutritional status was classified as underweight (<5th percentile), normal weight (5th–84th percentile), overweight (85th–94th percentile), and obese (≥95th percentile) according to the WHO (2007) BMI-for-age growth reference (5–19 years) (26). Dietary and activity assessment Food Frequency Questionnaire (FFQ) was used to collect the data on dietary intake data while a pre structured and self-administered questionnaire was used to collect the data on physical lifestyle of the children. The FFQ used in this study was adapted from the Harvard School of Public Health Youth/Child Food Frequency Questionnaire (1993) (27). The adapted English-language version of the questionnaire used in this study has been uploaded as Supplementary File 1. Data Analysis Data was coded and analyzed using IBM 2014 Statistical Package for the Social Sciences (SPSS). Descriptive statistics was used to determine mean, frequencies and standard deviations. Results A total of 6000 self-administered questionnaires were distributed among 3000 girls and 3000 boys. Of these, 3987 school children responded, yielding a response rate of 67% . The category of participants was recorded where 2222 (56%) were boys and 1765 (44%) were girls . The age distribution for boys was: Category I (5–8 years), 32 (1%); Category II (9–13 years), 636 (29%); and Category III (14–18 years), 1554 (70%). Among girls, the corresponding distribution was: 110 (6%), 624 (35%), and 1031 (58%), respectively (as presented in Fig. 1). The overall mean weight was 50.3 ± 17.6 kg . Mean weight of boys was 52.53 ± 18.26 kg, whereas that of girls was 47.54 ± 16.48 kg . According to age category, the mean weights for Categories I, II, and III were 26.05 ± 6.08 kg , 40.7 ± 13.2 kg , and 57.9 ± 17.45 kg , respectively. Among girls, these were 22.9 ± 5.7 kg , 42.08 ± 14.08 kg , and 53.46 ± 14.99 kg , respectively. The overall mean height of participants was 1.54 ± 0.12 m . The mean height of boys and girls was 1.57 ± 0.13 m and 1.50 ± 0.11 m , respectively. According to age categories, the mean heights for boys in Categories I, II, and III were 1.26 ± 0.04 m , 1.45 ± 0.09 m , and 1.63 ± 0.09 m , respectively. Among girls, the corresponding values were 1.23 ± 0.06 m , 1.46 ± 0.10 m , and 1.55 ± 0.06 m . The overall mean BMI of the study population was 20.7 ± 5.84 kg/m² . Mean BMI of boys and girls was 20.78 ± 6.03 kg/m² and 20.64 ± 5.50 kg/m² , respectively. According to age category, the mean BMI of boys in Categories I, II, and III was 16.08 ± 2.75 kg/m² , 18.95 ± 4.56 kg/m² , and 21.62 ± 6.30 kg/m² , respectively. Similarly, the mean BMI of girls in Categories I, II, and III was 14.94 ± 2.59 kg/m² , 19.25 ± 4.86 kg/m² , and 22.10 ± 5.65 kg/m² , respectively (as shown in Fig. 2 A, B and C). Nutritional Status Nutritional status of population as underweight, overweight and obese is presented in Fig. 3 . The overall prevalence of obesity was 14.7% (n= 588). Obesity prevalence among boys and girls was 16% (n=347) and 14% (n=241), respectively. Across age categories, the highest prevalence of obesity (17%) was observed among children aged 14–18 years , and the lowest ( 9% ) in the 5–8 years group. Among boys, the prevalence of obesity was 14% , 14% , and 17% in Categories I, II, and III, respectively. Among girls, it was 6% , 14% , and 14% , respectively (as shown in Fig. 3 A ). The overall prevalence of overweight was also similar to obesity as 15.4 % (n= 616). The prevalence among boys was 16% (n=366) and while in girls it was 14% (n=250). By age category, overweight prevalence among boys in Categories I, II, and III was 13% , 18% , and 16% , respectively. For girls, it was 9% , 14% , and 15% , respectively (as shown in Fig. 3 B) . The prevalence of underweight among all children was 19% (n= 755). Boys showed a higher prevalence (24%, n=529) compared to girls (13%, n=226). Among boys, underweight prevalence across Categories I, II, and III was 25% , 23% , and 24% , respectively. Among girls, it was 41% , 13% , and 10% , respectively (as shown in Fig. 3 C ). Dietary Intake Patterns Daily dietary intake patterns are presented in Fig. 4 . The data showed that overall 61% of student consumed soft drinks. Among them, 37% were males and 24% were females. The 67% of the students consumed chocolate in which 25% were males and 42% females while 19% of the students consumed hot chocolate in which 8% were males and 11% females. The data showed that 17% of the students consumed pizza in which 7% were males and 10% females. Fried food consumption was notably high, 88 % consumed fried foods comprising of 48% males and 40% females Coffee or tea consumption was reported by 94% of students in which 52% were males and 42% females. The candies consumption was 45% in which 19% were males and 26% females. French fries’ consumption was 43% comprising of 19% males and 24% females. The pasta intake was 17% in which 10% were males and 7% female. Fat and butter consumption was 17% in which 10% were males and 7% females. Frequency of fried foods outside home consumption was 58% in which 30% were males and 28% females while butter and margarine-fried food prepared at home was consumed by 23% in which 3 % were males and 20% females. Physical Activity and Screen Time Physical activity data are presented in Fig. 5 . Overall, 44% of the students reported no daily physical activity. Among males, 35% were inactive and 65% active, whereas among females, 54% were inactive and 46% active. According to the duration of daily physical activity categorized as no activity, 60 minutes, the data showed that 35% of male students and 64% of female students had no physical activity. The 16% of males and 22% of females engaged in physical activity for less than 20 minutes per day. Those performing 20–60 minutes of activity daily comprised 25% of males and 17% of females, whereas 23% of males and 6% of females reported more than 60 minutes of physical activity per day ( as shown in Fig. 5 A) . Screen-time behavior during eating is shown in Fig. 5B. The result showed that overall 77% students reported screen use while eating. Among those, 55% was male and 45% female. With respect to the duration of screen time, 43% of males and 57% of females had less than 1 hour of screen time, 54% of males and 46% of females had 1-3 hours, while 55% of males and 45% of females had > 3 hours of screen time daily. Discussion WHO highlighted obesity as major global health problem and become a global epidemic and its association with medical conditions , including type 2 diabetes mellitus , insulin resistance, cardiovascular disease , stroke , some types of cancer , and nonalcoholic fatty liver disease (28, 29). This study focuses on dietary patterns, physical activity, and sedentary behaviors among school children and provides a comprehensive analysis of the nutritional status of the school-going children aged 5-18 years in AlMadinah AlMunawarah, Saudi Arabia, based on data collected in 2017. The study data revealed that nearly one-third of the school-aged children in AlMadinah AlMunawarah were either overweight or obese. The rate of prevalence of overweight (15.4%) was higher than obesity (14.7%) with a greater obesity prevalence among boys (16%) than in girls (14%), indicating a significant public health concern. While obesity was once primarily reported among adults, it has now become a significant health concern even among children and adolescents due to current unhealthy lifestyle trends (30). Previous study data among Saudi adolescents showed an increased rates in the prevalence of overweight and obesity from 14.1% in 2004 to 18.9% in 2015 , with no significant difference observed between boys and girls during that period (5). However, the findings of the present study are consistent with recent national data from 2023, which reported a higher prevalence of obesity among Saudi adolescent boys (10.4%) compared to girls (8.3%) (18). Childhood and adolescence obesity presents serious health problems because it tends to continue into adulthood (31). The present study is the first in Madinah to investigate nutritional status and lifestyle of school children at primary, elementary and secondary levels. The findings highlight significant concerns regarding the prevalence of overweight and obesity in the study population. The results showed that the mean BMI among students in Madinah was relatively high. As it is reported that rates of obesity and overweight have increased dramatically since 1980 in Arab Peninsula and more than one-third of the Arab Gulf population is obese (32, 33). United Arab Emirates, Bahrain, Kuwait, Oman and Saudi Arabia are among the six Arabic Gulf countries are on the top 10 countries with diabetes prevalence in the world (34). It is reported that adolescents aged 11-18, obesity rates ranges from 20% to 45% in the Arabic Peninsula. Several physical lifestyle changes in the Gulf region including low intake of fruits and vegetables, increased reliance on calorie-dense foods, and reduced physical activity have significantly contributed to rising childhood obesity rates (35). A multicenter study conducted in 2023 with 351,195 participants aged 2-19 years showed the obesity and overweight prevalence of 9.4% and 11.2% respectively (18). The same pattern prevails here in Madinah as we found around 15% prevalence of obesity and overweight in school children. Recent evidence from studies has shown a significant association between obesity prevalence and eating outside the home. The study reported that students who consumed fast food less than three times per week were not associated with overweight or obesity (36). It was revealed in our findings that the underweight incidence has similar pattern as found in poverty stricken countries. The prevalence was as high as overall 19% and based on gender, it was prevalent in 24% male and 13 % in female students. The highest presence was recorded in our data amongst category 1 in both male and female students as 41% and 25%, respectively. Female students showed highest tendency of childhood malnutrition. Consumption of servings of the healthy foods such as milk, fruits, vegetable also seemed to be very low. The intake of milk was significant less than recommended intake as only 37 % of boys and 32% of girls in our study consumed on daily basis. The beans consumption on daily basis is very low as 6% boys and 4% girls. The same pattern of poor intake of fruits, vegetables was recorded. In this study, the consumption of soft drinks and junk foods were significantly contributing to development of overweight and obesity. This finding aligns with the previously reported study demonstrating that children and adolescents with abnormal growth patterns, including stunting and overweight or obesity, had significantly lower intakes of essential nutrients and food groups such as dairy, fruits, and vegetables (37). Similarly, high levels of screen exposure have been associated with unhealthy snacking behaviors and reduced physical activity among children in Gulf countries (38). Physical activity was recorded at minimal levels in our school children. Our study results show that 44% of overall students are sedentary. Only 37% of students are doing physical activity for more than 20 minutes on daily basis. Physical inactivity is more prevalent in girls as compared to boys. Limitations Due to the large sample size and unavailability of Nutritional profiling, we couldn’t map complete nutritional profile of macro nutrients and micro nutrients. In future, studies are strongly recommended including all cities and rural areas for this region. Further investigations should also explore the influence of socioeconomic, cultural, and genetic factors on childhood obesity to more precisely identify high-risk groups. Conclusion Unhealthy dietary intake and practices are key indicators for the nutritionally imbalanced status of school children. Screen time and sedentary lifestyles among Saudi school children exacerbate the impact of poor dietary habits on overweight and obesity. This study emphasizes the urgent need for implementing school-based nutrition education, to promote healthy eating environments, and encouraging regular physical activity among school children. Declarations Acknowledgements We greatly acknowledge and highly appreciate the support and encouragement provided by Mr. Mansour Al Askar, Executive Director, Prince Muhammad Bin Abdulaziz Hospital, Madinah Al Munawarah. We also acknowledge our Clinical Dietitians at Prince Muhammad Bin Abdulaziz Hospital, Madinah Al Munawarah, Ms. Bushra Alharthi, Ms. Nur Adila, Ms. Marwa Al Qarras and all those interns from Taiba University who played a role in the collection of data. We also acknowledge the help extended by Nursing staff namely Mr. Ehab, Kuhail Khldon Hassan, Eyad Numan, Haitham sarhan in data collection. Special thanks for Ms. Eshraq Al Oufi for all her secretarial support during proposal writing and data entry. Bundle of thanks go to the Ministry of Education and their dedicated staff, school administration, teachers, students and their parents in Madinah region for their full cooperation. Last but not least King Abdullah International Medical research Centre for their supervision extensive guidance, technical support provided by Institutional Review Board (IRB) and research funding Committee (RFC) for financial support to conduct the study as per GCP/ICH standards. Data Availability: Original data generated and analyzed during this study are included in this published article Authors Contribution Dr. Musaad Bin Awadh Alyabsi outlined the study design and supervised the research process. Dr. Atta Ur Rehman Khan helped in the designing of the study methodology, cleaned the data and carried out the analysis and was the primary writer of the research report. Mr. Meshal Al Malki helped in the coordination with Ministry of Education, and contributed in data collection and data entry procedures. Dr. Muhammed Navid Tahir provided academic supervision, critical review, and guidance throughout the manuscript preparation. Ms. Muneeza Waseem contributed to data interpretation, manuscript formatting, and final editing of the article. All authors read and approved the final version of the manuscript. Ethics Approval and Consent to Participate Ethical approval for this study was obtained from the Institutional Review Board (IRB) of the King Abdullah International Medical Research Centre (Reference: 13/SC/0630). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki and the Good Clinical Practice (GCP/ICH) guidelines. Written informed consent was obtained from the parents or guardians of all participating school children. 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The Relationships of Watching Television, Computer Use, Physical Activity, and Food Preferences to Body Mass Index: Gender and Nativity Differences among Adolescents in Saudi Arabia. International Journal of Environmental Research and Public Health. 2021;18(18):9915. Additional Declarations No competing interests reported. Supplementary Files questionnaireenglish.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":85173,"visible":true,"origin":"","legend":"\u003cp\u003eThe demographic snapshot of school children recruited for nutritional assessment school children in city AlMadinah AlMunawarah, Kingdom of Saudi Arabia. The results are presented as mean.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8041088/v1/517040558a08de2b4906c519.png"},{"id":99260186,"identity":"2b6a38db-6bd5-45d5-be6c-51cc2dea5628","added_by":"auto","created_at":"2025-12-31 01:16:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":151560,"visible":true,"origin":"","legend":"\u003cp\u003eThe anthropometric measurements as weight for age, height for age and body mass index (BMI) of school children aged from 5 to 18 years.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8041088/v1/2f8a318bd23eaf277735ad50.png"},{"id":99260190,"identity":"4765b985-948e-4a7e-8a77-003fce11b15d","added_by":"auto","created_at":"2025-12-31 01:16:48","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":193297,"visible":true,"origin":"","legend":"\u003cp\u003eThe nutritional status of school children aged from 5 to 18 years as underweight, overweight and obese.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8041088/v1/b3af6220b0d0f596e01d5406.png"},{"id":99319502,"identity":"cee4a1ae-9ce5-4e4a-a346-800c09cf71fc","added_by":"auto","created_at":"2025-12-31 16:37:24","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":73638,"visible":true,"origin":"","legend":"\u003cp\u003eThe dietary\u003cstrong\u003e \u003c/strong\u003eintake of frequently consumed food by the school children aged from 5 to 18 years.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8041088/v1/2aeb8432ae98e2193c5d423d.png"},{"id":99260195,"identity":"88cfd233-6735-44c4-b0c3-b66ac7c084d8","added_by":"auto","created_at":"2025-12-31 01:16:48","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":113381,"visible":true,"origin":"","legend":"\u003cp\u003eThe activities pattern (physical and screen time) of school children aged from 5 to 18 years.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8041088/v1/e7d09ec24def972cb864f338.png"},{"id":102747778,"identity":"2a6818a6-7509-496c-9e84-e9416584a1b1","added_by":"auto","created_at":"2026-02-16 09:05:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1629422,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8041088/v1/dbf904c9-3a6d-4cfa-a43c-ea1c7b29379e.pdf"},{"id":99260193,"identity":"e3d51a74-d914-4be5-9573-74c0b75558b1","added_by":"auto","created_at":"2025-12-31 01:16:48","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":273129,"visible":true,"origin":"","legend":"","description":"","filename":"questionnaireenglish.docx","url":"https://assets-eu.researchsquare.com/files/rs-8041088/v1/91f39c16a8f3081ffa127ae0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Nutritional Assessment of School Children in AlMadinah AlMunawarah City: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChildhood obesity is now recognized as a major public health concern\u0026nbsp;due to its rapidly rising prevalence\u0026nbsp;(1). \u0026nbsp;The World Health Organization (WHO) estimates that more than 340 million children and adolescents worldwide are affected by overweight and obesity\u0026nbsp;(2). The prevalence of overweight and obesity among children in developing countries is approximately 30% higher than that observed in developed nations\u0026nbsp;(3). By 2025, an estimated 206 million children and adolescents are expected to be living with obesity, with the number projected to rise to an additional 48 million by 2030\u0026nbsp;(2). \u0026nbsp;A high prevalence of obesity (over 20%) has also been observed in several Middle Eastern countries, as well across North Africa and North America\u0026nbsp;(4).\u0026nbsp;In Saudi Arabia, the prevalence of overweight and obesity among adolescents in 2015 was estimated at 13.4% and 18.2%, respectively\u0026nbsp;(5). \u0026nbsp;\u003cbr\u003e\u0026nbsp;Obesity in childhood and adolescence\u0026nbsp;often persists into adulthood\u0026nbsp;(6),\u0026nbsp;posing serious short- and long-term health risks. Childhood obesity is strongly associated with an increased likelihood of developing\u0026nbsp;cardiovascular diseases, diabetes, cancer and musculoskeletal disorders later in adulthood\u0026nbsp;(7).\u0026nbsp;The rising prevalence of obesity is multifactorial, driven by biological, environmental, and socioeconomic factors, including unhealthy dietary habits and sedentary lifestyles\u0026nbsp;(8). \u0026nbsp;Research from various regions of Saudi Arabia shows that frequent intake of calorie-rich food, particularly items higher in added sugars, salt, and unhealthy fats plays a significant role in the rising rates of obesity among children and adolescents\u0026nbsp;(9).\u0026nbsp;Evidence from Riyadh revealed that \u003cstrong\u003efast-food consumption was considerably more common among overweight and obese school children than among non-overweight children\u003c/strong\u003e(10), supporting the role of unhealthy dietary habits in the rising prevalence of childhood obesity\u0026nbsp;(11).\u003c/p\u003e\n\u003cp\u003eSocioeconomic conditions strongly shape household dietary patterns, influencing the availability of healthier food options and overall nutritional quality. Previous studies conducted in high-income countries have demonstrated a positive association between higher SES and healthier dietary intake among children, characterized by greater consumption of fruits, vegetables, and nutrient-dense foods (12, 13). The prevalence of childhood obesity is likely linked to family status and background (14). A 2023 study conducted among adolescent students in the Aseer region reported that adolescents from higher-income families had greater odds of being overweight or obese\u0026nbsp;(15). Both physical factors like availability of healthy foods, restriction of unhealthy options and social factors like family meals, TV during meals plays an important role in dietary choices\u0026nbsp;(16).\u003c/p\u003e\n\u003cp\u003eObesity in children and adolescents is becoming a public health problem in Saudi Arabia. A recent study conducted in 2023 among female school students aged 12–18 years in Tabuk, Saudi Arabia, reported that 8.8% of participants were obese and 29.4% were overweight, highlighting the growing prevalence of obesity among adolescent girls in the region (17). Similarly, a large multicenter population-based study conducted in 2023 among 351,195 children and adolescents aged 2–19 years across Saudi Arabia reported an overall prevalence of 11.2% overweight and 9.4% obesity. The prevalence was higher among boys than girls, and the highest obesity rate (10.1%) was observed in children aged 2–6 years, indicating a pressing need for early intervention strategies (18). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBeyond its nutritional implications, childhood obesity is linked with a range of physical and psychological health challenges that may persist into adulthood (19). Overweight and obese children are more likely to experience\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003einsulin resistance, hypertension, and dyslipidemia\u003c/strong\u003e\u003c/strong\u003e during adolescence (20), increasing their risk of \u003cstrong\u003etype 2 diabetes and cardiovascular diseases in adulthood\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(19)\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eMoreover, childhood obesity is also linked with low self-esteem, poor academic performance, and social stigmatization, which can negatively impact mental well-being and quality of life\u0026nbsp;(21, 22).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePhysical activity, paired with excessive screen time, also plays a significant role in the prevalence of obesity among adolescents (11).\u0026nbsp;Globally, approximately 81% of adolescents do not meet World Health Organization’s recommendation of at least 60 minutes of moderate-to-vigorous physical activity per day (23). In Saudi Arabia, sedentary behaviors such as excessive television viewing, use of electronic devices, and limited participation in sports have been consistently associated with higher body mass index (BMI) levels among adolescents\u0026nbsp;(24).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study is designed to assess the nutritional status of school-going children in the western region of Saudi Arabia, AlMadinah AlMunawarah city, using data collected in 2017. By examining dietary patterns, physical activity, and screen-time behaviors contributing to overweight and obesity, the study aims to identify gaps in lifestyle behaviors and nutritional practices among school children. The study findings will allow us to compare the data collected from other regions highlighting the gaps and improvements required for interventions. Ultimately, this research seeks to identify effective strategies for improving school-based nutrition programs, promoting healthier lifestyles, and reducing the long-term health risks associated with childhood obesity in Saudi Arabia.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design/Setting \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional stratified study was conducted by the dietitians from the Clinical Nutrition Department, Prince Muhammad Bin Abdulaziz Hospital -National Guard Health Affairs, in collaboration with Ministry of Education in Madinah Al Munawarah from April 2017 to December 2017 under granted RM 15-001-M and Institutional Review Board (IRB) as per GCP/ICH standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board of the King Abdullah International Medical Research Centre (IRB Reference: 13/SC/0630). Written informed consent was obtained from the parents or legal guardians of all participating children prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy subjects recruitment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population consisted of apparently healthy school-going boys and girls aged 5–18 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny student with diagnosed medical problem such as Diabetes Mellitus Type I was excluded from this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA stratified random sampling approach was adopted. Schools in Al Madinah Al Munawarah were grouped based on their geographic location before sampling. From a total of 110 schools, 20 schools were randomly selected with coordination from the Ministry of Education.\u003c/p\u003e\n\u003cp\u003eA total of 6000 students (approximately 10% of the target school-aged population) were invited to participate, comprising 3000 boys and 3000 girls.\u0026nbsp;Whereas any student diagnosed with medical problem like Diabetes Mellitus Type I was excluded. All eligible students within the selected schools were invited to take part in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographic information\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA pre-structured self-administered questionnaire developed was used to collect the demographics data of the children. An informed consent was filled either by parent or guardian or school administration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAnthropometric measurement\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWeight:\u003c/em\u003e\u003c/strong\u003eThe anthropometric measurements including weight was documented at a single study visit or from case note review of the most recent follow-up appointment using a portable scale with a 125 kg maximum capacity and a +/- 100 g error margin was used. Individuals removed shoes and heavy clothing prior to weighing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eHeight:\u003c/em\u003e\u003c/strong\u003e Height was measured using a standard stadiometer, with subjects standing upright with their scapula, buttocks and heels resting against a wall, the neck was held in a natural non-stretched position, the heels were touching each other, the toe tips formed a 45° angle and the head was positioned upright according to the Frankfurt plane.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBody mass index (BMI):\u003c/em\u003e\u003c/strong\u003eBMI was estimated by dividing weight (kg) by height2 (m2) (25). Individuals were considered malnourished if their BMI was less than 18.5, normal from 18.5 to 24.9 and overweight if BMI was ≥ 25 to 30 and obese if ≥ 30. Nutritional status was classified as underweight (\u0026lt;5th percentile), normal weight (5th–84th percentile), overweight (85th–94th percentile), and obese (≥95th percentile) according to the \u003cstrong\u003eWHO (2007) BMI-for-age growth reference (5–19 years)\u003c/strong\u003e (26).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDietary and activity assessment\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFood Frequency Questionnaire (FFQ) was used to collect the data on dietary intake data while a pre structured and self-administered questionnaire was used to collect the data on physical lifestyle of the children.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe FFQ used in this study was adapted from the Harvard School of Public Health Youth/Child Food Frequency Questionnaire (1993) (27). The adapted English-language version of the questionnaire used in this study has been uploaded as Supplementary File 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was coded and analyzed using IBM 2014 Statistical Package for the Social Sciences (SPSS). Descriptive statistics was used to determine mean, frequencies and standard deviations.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 6000 self-administered questionnaires were distributed among 3000 girls and 3000 boys. Of these, 3987 school children responded, yielding a \u003cstrong\u003eresponse rate of 67%\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e The category of participants was recorded where \u003cstrong\u003e2222 (56%) were boys\u003c/strong\u003e and \u003cstrong\u003e1765 (44%) were girls\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e The age distribution for boys was: Category I (5–8 years), 32 (1%); Category II (9–13 years), 636 (29%); and Category III (14–18 years), 1554 (70%). Among girls, the corresponding distribution was: 110 (6%), 624 (35%), and 1031 (58%), respectively (as presented in\u0026nbsp;\u003cstrong\u003eFig. 1).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe \u003cstrong\u003eoverall mean weight\u003c/strong\u003e was \u003cstrong\u003e50.3 ± 17.6 kg\u003c/strong\u003e. Mean weight of boys was \u003cstrong\u003e52.53 ± 18.26 kg,\u003c/strong\u003e whereas that of girls was \u003cstrong\u003e47.54 ± 16.48 kg\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e According to age category, the mean weights for Categories I, II, and III were \u003cstrong\u003e26.05 ± 6.08 kg\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e40.7 ± 13.2 kg\u003c/strong\u003e\u003c/strong\u003e, and \u003cstrong\u003e57.9 ± 17.45 kg\u003c/strong\u003e, respectively. Among girls, these were \u003cstrong\u003e22.9 ± 5.7 kg\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e42.08 ± 14.08 kg\u003c/strong\u003e,\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003e53.46 ± 14.99 kg\u003c/strong\u003e\u003c/strong\u003e, respectively.\u003c/p\u003e\n\u003cp\u003eThe overall mean height of participants was \u003cstrong\u003e1.54 ± 0.12 m\u003c/strong\u003e. The mean height of boys and girls was \u003cstrong\u003e1.57 ± 0.13 m\u003c/strong\u003e and \u003cstrong\u003e1.50 ± 0.11 m\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e respectively. According to age categories, the mean heights for boys in Categories I, II, and III were \u003cstrong\u003e1.26 ± 0.04 m\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e1.45 ± 0.09 m\u003c/strong\u003e\u003c/strong\u003e, and \u003cstrong\u003e1.63 ± 0.09 m\u003c/strong\u003e, respectively. Among girls, the corresponding values were \u003cstrong\u003e1.23 ± 0.06 m\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e1.46 ± 0.10 m\u003c/strong\u003e\u003c/strong\u003e, and \u003cstrong\u003e1.55 ± 0.06 m\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall mean BMI of the study population was \u003cstrong\u003e20.7 ± 5.84 kg/m²\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Mean BMI of boys and girls was \u003cstrong\u003e20.78 ± 6.03 kg/m²\u003c/strong\u003e and \u003cstrong\u003e20.64 ± 5.50 kg/m²\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e respectively. According to age category, the mean BMI of boys in Categories I, II, and III was \u003cstrong\u003e16.08 ± 2.75 kg/m²\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e18.95 ± 4.56 kg/m²\u003c/strong\u003e,\u003c/strong\u003e and \u003cstrong\u003e21.62 ± 6.30 kg/m²\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e respectively. Similarly, the mean BMI of girls in Categories I, II, and III was \u003cstrong\u003e14.94 ± 2.59 kg/m²\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e19.25 ± 4.86 kg/m²\u003c/strong\u003e\u003c/strong\u003e, and \u003cstrong\u003e22.10 ± 5.65 kg/m²\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e respectively (as shown in \u003cstrong\u003eFig. 2 A, B and C).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNutritional Status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNutritional status of population as underweight, overweight and obese is presented in\u0026nbsp;\u003cstrong\u003eFig. 3\u003c/strong\u003e.\u0026nbsp;The overall prevalence of obesity was 14.7% (n= 588). Obesity prevalence among boys and girls was 16% (n=347) and 14% (n=241), respectively. Across age categories, the highest prevalence of obesity (17%) was observed among children aged \u003cstrong\u003e14–18 years\u003c/strong\u003e, and the lowest (\u003cstrong\u003e9%\u003c/strong\u003e) in the \u003cstrong\u003e5–8 years\u003c/strong\u003e group. Among boys, the prevalence of obesity was \u003cstrong\u003e14%\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e14%\u003c/strong\u003e,\u003c/strong\u003e and \u003cstrong\u003e17%\u003c/strong\u003e in Categories I, II, and III, respectively. Among girls, it was \u003cstrong\u003e6%\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e14%\u003c/strong\u003e,\u003c/strong\u003e and \u003cstrong\u003e14%\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003erespectively (as shown in \u003cstrong\u003eFig. 3 A\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eThe overall prevalence of overweight was also similar to obesity as 15.4 % (n= 616). The prevalence among boys was 16% (n=366) and while in girls it was 14% (n=250). By age category, overweight prevalence among boys in Categories I, II, and III was \u003cstrong\u003e13%\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e18%\u003c/strong\u003e,\u0026nbsp;\u003c/strong\u003eand \u003cstrong\u003e16%\u003c/strong\u003e, respectively. For girls, it was \u003cstrong\u003e9%\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e14%\u003c/strong\u003e,\u003c/strong\u003e and \u003cstrong\u003e15%\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e respectively (as shown in \u003cstrong\u003eFig. 3 B)\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prevalence of underweight among all children was 19% (n= 755). Boys showed a higher prevalence (24%, n=529) compared to girls (13%, n=226). Among boys, underweight prevalence across Categories I, II, and III was \u003cstrong\u003e25%\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e23%\u003c/strong\u003e,\u0026nbsp;\u003c/strong\u003eand \u003cstrong\u003e24%\u003c/strong\u003e, respectively. Among girls, it was \u003cstrong\u003e41%\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003e13%\u003c/strong\u003e,\u003c/strong\u003e and \u003cstrong\u003e10%\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e respectively (as shown in \u003cstrong\u003eFig. 3 C\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDietary Intake Patterns\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDaily dietary intake patterns are presented in \u003cstrong\u003eFig. 4\u003c/strong\u003e. \u0026nbsp; The data showed that overall 61% of student consumed soft drinks. Among them, 37% were males and 24% were females. The 67% of the students consumed chocolate in which 25% were males and 42% females while 19% of the students consumed hot chocolate in which 8% were males and 11% females. The data showed that 17% of the students consumed pizza in which 7% were males and 10% females. Fried food consumption was notably high, 88 % consumed fried foods comprising of 48% males and 40% females Coffee or tea consumption was reported by \u003cstrong\u003e94%\u003c/strong\u003e of students in which 52% were males and 42% females. The candies consumption was 45% in which 19% were males and 26% females. French fries’ consumption was 43% comprising of 19% males and 24% females. The pasta intake was 17% in which 10% were males and 7% female. Fat and butter consumption was 17% in which 10% were males and 7% females. Frequency of fried foods outside home consumption was 58% in which 30% were males and 28% females while butter and margarine-fried food prepared at home was consumed by 23% in which 3 % were males and 20% females.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical Activity and Screen Time\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysical activity data are presented in \u003cstrong\u003eFig. 5\u003c/strong\u003e. Overall, \u003cstrong\u003e44%\u003c/strong\u003e of the students reported no daily physical activity. Among males, \u003cstrong\u003e35%\u003c/strong\u003e were inactive and \u003cstrong\u003e65%\u003c/strong\u003e active, whereas among females, \u003cstrong\u003e54%\u003c/strong\u003e were inactive and \u003cstrong\u003e46%\u003c/strong\u003e active. According to the duration of daily physical activity categorized as no activity, \u0026lt;20 minutes, 20–60 minutes, and \u0026gt;60 minutes, the data showed that 35% of male students and 64% of female students had no physical activity. \u0026nbsp;The 16% of males and 22% of females engaged in physical activity for less than 20 minutes per day. Those performing 20–60 minutes of activity daily comprised 25% of males and 17% of females, whereas 23% of males and 6% of females reported more than 60 minutes of physical activity per day \u003cstrong\u003e(\u003c/strong\u003eas shown in\u003cstrong\u003e\u0026nbsp;Fig. 5 A)\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScreen-time behavior during eating is shown in \u003cstrong\u003eFig. 5B.\u0026nbsp;\u003c/strong\u003eThe result showed that overall 77% students reported screen use while eating. Among those, 55% was male and 45% female. With respect to the duration of screen time, 43% of males and 57% of females had less than 1 hour of screen time, 54% of males and 46% of females had 1-3 hours, while 55% of males and 45% of females had \u0026gt; 3 hours of screen time daily.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWHO highlighted obesity as major global health problem and become a global epidemic and its association with medical conditions , including type 2 diabetes mellitus , insulin resistance, cardiovascular disease , stroke , some types of cancer , and nonalcoholic fatty liver disease (28, 29).\u0026nbsp;This study focuses on dietary patterns, physical activity, and sedentary behaviors among school children and provides a comprehensive analysis of the nutritional status of the school-going children aged 5-18 years in AlMadinah AlMunawarah, Saudi Arabia, based on data collected in 2017. The study data revealed that nearly one-third of the school-aged children in AlMadinah AlMunawarah were either overweight or obese. The rate of prevalence of overweight (15.4%) was higher than obesity (14.7%) with a greater obesity prevalence among boys (16%) than in girls (14%), indicating a significant public health concern. While obesity was once primarily reported among adults, it has now become a significant health concern even among children and adolescents due to current unhealthy lifestyle trends\u0026nbsp;(30).\u003c/p\u003e\n\u003cp\u003ePrevious study data among Saudi adolescents showed an increased rates in the prevalence of overweight and obesity from \u003cstrong\u003e14.1% in 2004 to 18.9% in 2015\u003c/strong\u003e, with no significant difference observed between boys and girls during that period (5). However, the findings of the present study are consistent with recent national data from 2023, which reported a higher prevalence of obesity among Saudi adolescent boys (10.4%) compared to girls (8.3%) (18).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChildhood and adolescence obesity presents serious health problems because it tends to continue into adulthood (31). The present study is the first in Madinah to investigate nutritional status and lifestyle of school children at primary, elementary and secondary levels. The findings highlight significant concerns regarding the prevalence of overweight and obesity in the study population. The results showed that the mean BMI among students in Madinah was relatively high. As it is reported that rates of obesity and overweight have increased dramatically since 1980 in Arab Peninsula and more than one-third of the Arab Gulf population is obese (32, 33). United Arab Emirates, Bahrain, Kuwait, Oman and Saudi Arabia are among the six Arabic Gulf countries are on the top 10 countries with diabetes prevalence in the world (34). It is reported that adolescents aged 11-18, obesity rates ranges from 20% to 45% in the Arabic Peninsula. \u0026nbsp;Several physical lifestyle changes in the Gulf region including low intake of fruits and vegetables, increased reliance on calorie-dense foods, and reduced physical activity have significantly contributed to rising childhood obesity rates (35). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA multicenter study conducted in 2023 with 351,195 participants aged 2-19 years showed the obesity and overweight prevalence of 9.4% and 11.2% respectively (18).\u0026nbsp;\u0026nbsp;The same pattern prevails here in Madinah as we found around 15% prevalence of obesity and overweight in school children. Recent evidence from studies has shown a significant association between obesity prevalence and eating outside the home. The study reported that students who consumed fast food less than three times per week were not associated with overweight or obesity\u0026nbsp;(36). It was revealed in our findings that the underweight incidence has similar pattern as found in poverty stricken countries. The prevalence was as high as overall 19% and based on gender, it was prevalent in 24% male and 13 % in female students. The highest presence was recorded in our data amongst category 1 in both male and female students as 41% and 25%, respectively. Female students showed highest tendency of childhood malnutrition. Consumption of servings of the healthy foods such as milk, fruits, vegetable also seemed to be very low. The intake of milk was significant less than recommended intake as only 37 % of boys and 32% of girls in our study consumed on daily basis. The beans consumption on daily basis is very low as 6% boys and 4% girls. The same pattern of poor intake of fruits, vegetables was recorded. In this study, the consumption of soft drinks and junk foods were significantly contributing to development of overweight and obesity. This finding aligns with the previously reported study demonstrating that children and adolescents with abnormal growth patterns, including stunting and overweight or obesity, had significantly lower intakes of essential nutrients and food groups such as dairy, fruits, and vegetables\u0026nbsp;(37). Similarly, high levels of screen exposure have been associated with unhealthy snacking behaviors and reduced physical activity among children in Gulf countries\u0026nbsp;(38). Physical activity was recorded at minimal levels in our school children. Our study results show that 44% of overall students are sedentary. Only 37% of students are doing physical activity for more than 20 minutes on daily basis. Physical inactivity is more prevalent in girls as compared to boys.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the large sample size and unavailability of Nutritional profiling, we couldn’t map complete nutritional profile of macro nutrients and micro nutrients. In future, studies are strongly recommended including all cities and rural areas for this region. Further investigations should also explore the influence of socioeconomic, cultural, and genetic factors on childhood obesity to more precisely identify high-risk groups.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eUnhealthy dietary intake and practices are key indicators for the nutritionally imbalanced status of school children. Screen time and sedentary lifestyles among Saudi school children exacerbate the impact of poor dietary habits on overweight and obesity. This study emphasizes the urgent need for implementing school-based nutrition education, to promote healthy eating environments, and encouraging regular physical activity among school children.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe greatly acknowledge and highly appreciate the support and encouragement provided by Mr. Mansour Al Askar, Executive Director, Prince Muhammad Bin Abdulaziz Hospital, Madinah Al Munawarah. \u0026nbsp;We also acknowledge our Clinical Dietitians at Prince Muhammad Bin Abdulaziz Hospital, Madinah Al Munawarah, Ms. Bushra Alharthi, Ms. Nur Adila, Ms. Marwa Al Qarras and all those interns from Taiba University who played a role in the collection of data. We also acknowledge the help extended by Nursing staff namely Mr. Ehab, Kuhail Khldon Hassan, Eyad Numan, Haitham sarhan in data collection. Special thanks for Ms. Eshraq Al Oufi for all her secretarial support during proposal writing and data entry. Bundle of thanks go to the Ministry of Education and their dedicated staff, school administration, teachers, students and their parents in Madinah region for their full cooperation. Last but not least King Abdullah International Medical research Centre for their supervision extensive guidance, technical support provided by Institutional Review Board (IRB) and research funding Committee (RFC) for financial support to conduct the study as per GCP/ICH standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eOriginal data generated and analyzed during this study are included in this published article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Musaad Bin Awadh Alyabsi outlined the study design and supervised the research process. Dr. Atta Ur Rehman Khan helped in the designing of the study methodology, cleaned the data and carried out the analysis and was the primary writer of the research report. Mr. Meshal Al Malki helped in the coordination with Ministry of Education, and contributed in data collection and data entry procedures. Dr. Muhammed Navid Tahir provided academic supervision, critical review, and guidance throughout the manuscript preparation. Ms. Muneeza Waseem contributed to data interpretation, manuscript formatting, and final editing of the article. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Institutional Review Board (IRB) of the King Abdullah International Medical Research Centre (Reference: 13/SC/0630). The study was conducted in accordance with the ethical principles of the\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003eDeclaration of Helsinki\u003c/strong\u003e\u003c/strong\u003e and the \u003cstrong\u003eGood Clinical Practice (GCP/ICH)\u003c/strong\u003e guidelines. Written informed consent was obtained from the parents or guardians of all participating school children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding source:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKing Abdullah International Medical Research Center provided the funds for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors report no conflict of interest for this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAl Shaikh A, Farahat F, Abaalkhail B, Kaddam I, Aseri K, Al Saleh Y, et al. Prevalence of Obesity and Overweight among School-Aged Children in Saudi Arabia and Its Association with Vitamin D Status. Acta Biomed. 2020;91(4):e2020133.\u003c/li\u003e\n\u003cli\u003eKutbi HA, Mumena WA. 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Cureus. 2023;15(5):e38902.\u003c/li\u003e\n\u003cli\u003eMajzoub R, Al Noaim K, Alnaim A, Alabdulqader M, Al Alawi Z, Ali S, et al. The Weight of Emotions: Childhood Obesity and Psychosocial Well-Being in Saudi Arabia. Healthcare (Basel). 2025;13(17).\u003c/li\u003e\n\u003cli\u003eKhodari BH, Shami MO, Shajry RM, Shami JA, Names AA, Alamer AA, et al. The Relationship Between Weight Self-Stigma and Quality of Life Among Youth in the Jazan Region, Saudi Arabia. Cureus. 2021;13(9):e18158.\u003c/li\u003e\n\u003cli\u003eGuthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1\u0026middot;6 million participants. Lancet Child Adolesc Health. 2020;4(1):23-35.\u003c/li\u003e\n\u003cli\u003eAl-Agha AE, Nizar FS, Nahhas AM. The association between body mass index and duration spent on electronic devices in children and adolescents in Western Saudi Arabia. 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Fast-Food Consumption, Dietary Quality, and Dietary Intake of Adolescents in Saudi Arabia. Int J Environ Res Public Health. 2022;19(22).\u003c/li\u003e\n\u003cli\u003eIbrahim MH, Alzaher AA, Alshumemri WA, Alfaleh AF, Alabdulkareem KI, Alabdulkareem KI. Lifestyle and its association with obesity among adolescents in Kingdom of Saudi Arabia. The Egyptian Journal of Community Medicine. 2022;40(4):268-80.\u003c/li\u003e\n\u003cli\u003eAlsubaie ASR. Intake of fruit, vegetables and milk products and correlates among school boys in Saudi Arabia. Int J Adolesc Med Health. 2018;33(1).\u003c/li\u003e\n\u003cli\u003eAlghadir AH, Iqbal ZA, A. Gabr S. The Relationships of Watching Television, Computer Use, Physical Activity, and Food Preferences to Body Mass Index: Gender and Nativity Differences among Adolescents in Saudi Arabia. International Journal of Environmental Research and Public Health. 2021;18(18):9915.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Childhood obesity, Nutritional status, Dietary habits, Physical activity, Saudi Arabia, School children","lastPublishedDoi":"10.21203/rs.3.rs-8041088/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8041088/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eChildhood obesity poses a global health concern with implications for long-term health and well-being. In Saudi Arabia, the increasing prevalence of overweight and obesity among children and adolescents requires urgent action to understand the contributing factors affecting lifestyle and dietary choices. This study addresses the nutritional challenges faced by school children in AlMadinah AlMunawarah, Saudi Arabia.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e:\u003c/strong\u003e A cross-sectional stratified study was conducted involving 6000 healthy school children aged 5-18 years, selected through random sampling from 20 schools. Anthropometric measurements, dietary intake, and physical activity data were collected using validated questionnaires and analyzed using SPSS. Descriptive statistics and inferential analysis were used to present the major findings of the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eA total of 3987 students responded with a response rate of 67%, including 56% boys and 44% girls. The mean BMI was 20.7 ± 5.84 kg/m². The prevalence of obesity and overweight was 14.7% and 15.4%, respectively, while 19% were underweight. Obesity was more prevalent among boys (16%) than girls (14%). Approximately 88% of participants consumed fried foods regularly, while 61% consumed soft drinks daily. Only 37% of boys and 32% of girls reported daily milk intake. Physical inactivity was common, with 44% of students reporting no daily activity and 77% reporting screen use during meals.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003e\u003c/em\u003eUnhealthy dietary practices, high consumption of energy-dense foods, and sedentary lifestyles contribute to the nutritional imbalance among school children in AlMadinah AlMunawarah, Saudi Arabia. Early school-based nutritional interventions and public health policies are crucial to reduce the burden of childhood obesity and promote healthier dietary and physical activity habits.\u003c/p\u003e","manuscriptTitle":"Nutritional Assessment of School Children in AlMadinah AlMunawarah City: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-31 01:16:43","doi":"10.21203/rs.3.rs-8041088/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4cb9a510-340a-450c-8a90-571ac8a063df","owner":[],"postedDate":"December 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-13T20:55:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-31 01:16:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8041088","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8041088","identity":"rs-8041088","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}