Food habits formed early in childhood are likely to follow and form the foundation of adult eating patterns. Early-life food consumption patterns may affect children’s health by increasing susceptibility to developing non-communicable chronic diseases (NCDs) in adulthood. ^{1 , 2} Many NCDs risk factors among children and adolescents, such as obesity, are caused by unhealthy eating behaviors and a lack of physical activity. ^{3 – 5}

It is important to notice that obesity prevalence has been elevated dramatically among Jordanians; a recent report approved that approximately 75% of Jordanians of both sexes are overweight or obese. ⁶

Changes in food consumption patterns in children and adolescents can be attributed to a variety of factors, including but not limited to being at school and interacting with peers during school days, the widespread availability of processed foods, availability of inexpensive food portions with family-size, eating out of home, and the ease of food delivery applications. ^{7 – 9}

Numerous studies have examined how children and adolescents worldwide are adopting unhealthy eating habits, such as skipping meals like breakfast, ^{10 , 11} unhealthy snacking which is composed of energy-dense foods, ^{12 – 14} drinking sweetened beverages, ^{15 , 16} eating fast foods, ^{15 , 17} and consuming little fruits and vegetables. ^{15 , 16 , 18} These unhealthy habits can lead to excessive or insufficient nutrient intake, defined as ‘Nutritional status deterioration,’ and have serious health consequences. ¹⁹ Increased risk of overweight and obesity among children and adolescents is one of these severe health problems. Childhood dietary intake plays a significant role in preventing and treating childhood overweight and obesity as it is a crucial factor in growth and development. ²⁰ Obesogenic eating patterns have been extensively investigated and linked to an increased risk of becoming overweight or obese. ²¹ Among these eating patterns was the consumption of identified obesogenic foods (such as sweetened beverages, fast food, and snacks). ²² An investigation in Greece found that children who consume obesogenic foods are more likely to be obese. ²³ In China, the modern dietary pattern was positively associated with future obesity in children and adolescents. ²⁴ Moreover, a nutritious diet can help prevent cardio-metabolic multi-morbidities frequently observed in adult patients with neuropsychiatric problems. ²⁵ To maintain a regular immune response and lower the risk of adverse mental health disorders and associated co- and multi-morbid conditions later in life and maintain a regular immune response, dietary changes made as early as childhood and adolescence represent a promising preventive strategy. ²⁶

Over the past 40 years, the consumption of discretionary or luxury snack foods has increased globally, ²⁷ and it has been linked to overweight and obesity prevalence and increasing chronic disease risk as a consequence. ²⁸ Discretionary foods are food and beverages that contain added fat and sugar that are not considered necessary for a healthy diet, contribute to excessive energy intake, and displace core foods and essential nutrients. ^{29 , 30} Although some recommendations have been made, most dietary guidelines around the world discourage the consumption of these foods. For American children and adolescents, the discretionary calorie allowance ranges between 8% and 20% for all sex-age groups. ³¹ The recommended maximum discretionary foods and beverages for Australian children and inactive adolescents are 0-1/2 servings/day, which equals 143 kcal. ³²

There has been little research on Jordanian children’s and adolescents’ dietary habits, and there is only sporadic data to suggest that certain food groups or individual items are consumed insufficiently or excessively. ³³ This study aimed to 1) characterize the food consumption of Jordanian children and adolescents and 2) assess their adherence to dietary guidelines, especially MyPlate (It is the last suggested dietary guideline used globally). The present study’s findings will help future interventions or policies or at least describe how this study would contribute to solving the problem of obesity or informing public health interventions.

The food consumption of Jordanian children and adolescents has never been studied before. Furthermore, the COVID-19 pandemic significantly contributes to the shift in dietary intake globally toward obesogenic food choices, besides decreased physical activity and increased screen time, leading to weight gain. ^{42 , 43} The present study characterizing dietary patterns and adherence to guidelines) and explicitly linking the results to these objectives.

The present study showed that the overall prevalence of generalized overweight and obesity among the studied sample was 36.6%. The prevalence of overweight and obesity was higher in children than in adolescents (44.3% vs. 32%). About 1/5 to 1/4 of participants from all age groups were classified as overweight. Hamad and colleagues (2016) found that the overall average prevalence of overweight and obesity among school-age adolescents was 36.2% and 9.9 %, respectively. ⁴⁴ Globally, overweight and obesity have increased dramatically among children and adolescents aged five to 19, from 4% in 1975 to just over 18% in 2016. ⁴⁵ In Jordan, the image was not dissimilar to other countries worldwide. Zayed et al. (2016) reported that analysis by sex showed that obesity was more prevalent among Jordanian males, with 18.9% obese compared to 11.2% of females. ⁴⁶ Jordanian obesity prevalence and its related sex patterns appear consistent with what has been reported in the literature.

Another obesity index, WHtR, revealed that nearly a quarter of the children’s boys (25.5%) and 23.8% of the same group of girls had abnormal WHtR; however, 30.4% and 21.4% of adolescent boys and girls, respectively, were also classified as having abnormal WHtR. WHtR was not used to assess abdominal obesity in Jordanian children and adolescents earlier. A few studies on WHtR as an indicator of obesity in the Eastern Mediterranean region reported similar results; in the United Arab Emirates (UAE), 27.2% of subjects had abnormal WHtR, ⁴⁷ and in Lebanon, 38.3% had abnormal WHtR. ⁴⁸

Obesity as a result of diet has been extensively studied. Fast food and sugar-sweetened beverages are directly linked to the childhood obesity epidemic. The initial findings on the prevalence of obesity were primarily related to food intake. This study found that adolescents engaged in eating behaviors are associated with an increased risk of being overweight and obese.

The MyPlate dietary guidelines were created in 2011, indicating how much of the plate should be allocated to protein foods, grains, fruits, and vegetables. The current study’s findings revealed that children’s girls consumed fewer than the recommended servings from all MyPlate dietary guidelines groups. On the other hand, children’s boys nearly consumed the recommended amount of grains (30.6% vs. 30% of the plate), while all different food groups consumed less than the recommended number of servings. However, adolescents’ intake was off-balance in all recommended servings of MyPlate dietary guidelines, regardless of sex.

Compared with studies in the Eastern Mediterranean countries, 28% of Emirati adolescents met the recommended daily fruit and vegetable intake, with significantly more males than females. ⁴⁹ A multinational comparison study of eleven Eastern Mediterranean countries revealed that 19.4% of adolescents reported consuming fruits and vegetables ≥5 times/day. ⁵⁰ In Iran, a study found that only 30.3% and 34.6% of adolescents consumed the recommended amount of fruit and vegetables, respectively. ⁵¹ In Egypt, 45.9% of children and adolescents have fruits and vegetables 1-6 times daily. ⁵² In the UAE, around 50% of school-age adolescents had less than five servings of fruits and vegetables. ⁴⁷ Similar findings were reported among Saudi children, with 69% and 71% of the samples not consuming fruits and vegetables daily. ⁵³ Furthermore, a review of the dietary patterns and nutrient intakes of children (5-10 years) and adolescents (10-19 years) in the Eastern Mediterranean Regions revealed that their diet was poor, with fruits, vegetables, and dairy products. ⁵⁴ According to current study findings and studies from Eastern Mediterranean countries, Western countries did not achieve better results in this area. In Belgium, adolescents were less likely to follow food-based dietary recommendations than the youngest children and adults. ³⁷ A study in 33 countries in Europe and North America reported that many adolescents do not eat fruit and vegetables daily. ⁵⁵

Although most studies reported low fruit and vegetable consumption among children and adolescents worldwide, it is essential to note that the methods used to assess their intake vary; some studies rely on self-reporting food frequency, while others rely on face-to-face 24-DR.

Although the current study’s findings showed a low consumption of fruits, vegetables, and dairy groups, the mean energy intake was within the normal range of requirements for age and sex. The mean total energy intake among the children was 1796.4 ± 557.09 kcal/day, with a significant difference between boys and girls. Similar findings were shown among the adolescent group: a significantly higher mean energy intake among boys compared to girls (2116.34 kcal/day vs. 1688.5 kcal/day; respectively) ( p < 0.001), while the average overall group intake was 1872.57± 579.06 kcal/day.

The present findings indicated that means of macronutrient percentages were found to comply with the AMDRs for both carbohydrates and protein. Fat was high among Jordanian children and adolescents (36.33±6.05% and 36.05±6.6%; AMDRs for both groups: 25-35%). Similar results were observed in a previous study conducted among Jordanian adolescents aged 14-18 with a fat intake of around 37% of EI. ⁵⁶ Such findings are comparable to those reported in other countries in the region, including Lebanon (39.2% of EI for 4-13 years), ⁵⁷ and Palestine (39.8% of EI for boys 11-16 years). ⁵⁸ The picture appears similar to what has been reported in Western countries, including Spain, where about 43.4% of boys and 46.9% of girls between 4 and 17 years exceeded the AMDR in total fat intake, ⁵⁹ while the mean contribution of fats to EI was 36.9% and 37.2% in Italian boys and girls; respectively (teenagers: 10-17.9 years). ⁶⁰ Remarkably, the results of our study were consistent with those of other studies, showing that the pattern of energy and macronutrient intake has become a popular choice for trendy styles among children and adolescents worldwide.

Discretionary calories, including added fat and sugar, are unnecessary for health. These foods contribute excess energy to the diet by displacing nutritious foods and should be consumed in moderation. The total intake of discretionary calories in the current study exceeded the recommendations for both age groups by three times (30.7% and 28.6% of total EI for children and adolescents, respectively), considering that the advice is <10% of the total EI. ⁶¹ These results are comparable to those of other countries worldwide. Discretionary foods and beverages accounted for more than a third of the daily energy intake of Australian children aged 2 to 18. ³² The same findings were found in Pakistan, where adolescents consumed 31.3% of their energy from discretionary foods. ⁶² On average, about 14% of total EI in American children and adolescents was from added sugars. ⁶³

Despite adequate carbohydrate intake, the average intake of added sugars was nearly 57 g/day (about 13% and 12% of total EI for children and adolescents, respectively), and these averages were higher than the levels allowed by the MyPlate dietary guidelines and WHO guidelines. These findings might be related to the frequent consumption of sweet snacks, including cakes, pastries, and sweets/chocolates. Adolescents in some Middle Eastern countries, such as Sudan and Kuwait, have increased their daily consumption of sweets and desserts. ^{54 , 64} Consistently, the German Child and Adolescent Study results were no better than the present results, reporting that 50% of carbohydrate intake came from added sugars (23.5%) and total sugars (28.1%). ⁶⁵ In addition, the percentage of energy contribution from added sugars in US children and adolescents was 14.3% at 2-8 years and 16.2% at 9-18 years, while the primary sources are sweetened beverages, candy, and sweet baked goods. ⁶⁶ The primary sources of added sugars in the present study were sweetened beverages such as carbonated beverages, canned juices (fruit beverages), many types of sweetened ready-to-drink beverages, and sweetened tea; chocolate, cakes, as well as various kinds of Arabic sweets such as baklava, as well as Western desserts.

Contrary to previously published studies, the present findings’ mean intake of saturated fats was almost equal for both age groups and rounded at 16 g/day; it was within an acceptable amount compared to the MyPlate dietary guidelines’ allowed amounts. Notably, boys from both age groups consumed significantly higher amounts of cholesterol, saturated, polyunsaturated, and monounsaturated fatty acids than girls from the same age group. Many Middle Eastern countries, including Lebanon, ⁵⁷ Iran, ⁵¹ Palestine, ⁵⁸ and Saudi Arabia, ⁶⁷ had average saturated fat intakes (10.7%,10.3%, 10.3%, and 11.3%, respectively) that exceeded the recommendations (AMDR upper limit for saturated fat is 10% of total EI). A similar pattern of results was obtained in Western countries such as Italy (11.5%), the UK (13.2%), France (15%), and Spain (12.3%). ^{59 , 60 , 68 , 69}

In conclusion, the prevalence of overweight and obesity approached about half of children, and a third of adolescents were classified as overweight and obese. On the other hand, about a quarter of the children and adolescents had abnormal WHtR. Notably, children and adolescents mismatched the intake of all recommended servings of MyPlate dietary guidelines (except grain intake in ’boys’ children). Despite the mean energy intake being within the estimated recommendations, children and adolescents consumed a slightly higher fat proportion than the AMDRs. Noticeably, the mean intake of added sugar was higher than the MyPlate dietary guidelines allowed amounts, while the mean intake of saturated fats was within an acceptable MyPlate dietary guidelines amount for both groups. Moreover, about 1/3 of energy consumed was from discretionary calories. Remarkably, boys consumed higher amounts of cholesterol, saturated, polyunsaturated, and monounsaturated fats than girls.