3. It is well known that diet and nutrition play important roles in maintaining health and preventing diseases. During adolescence young people are assuming responsibility for their own eating habits, health attitudes and behaviors, their attitudes play an important role in the adoption and maintenance of a variety of health and nutritional habits.

4.  Children are more exposed to unhealthy behaviors like poor nutrition, insufficient daily consumption of many food groups, inactivity, skipping meals and high intake of sugar, fast foods and sweets.

5.  At present, the trend of unhealthy dietary habits, including fast food consumption, skipping breakfast and greater consumption of sweets and soft drinks among adolescents is increasing and the possibility of these bad habits to lead later to obesity and many other health problems is high.

6.  Childhood obesity is rapidly increasing worldwide, in both the developed and developing countries. Moreover, research studies indicate that breakfast skipping is highly prevalent among adolescents in the United States, Europe and in many Arab countries as well as in Jordan.

7.  In Jordan, micronutrient deficiencies are suspected to constitute a public health problem.  Micronutrient deficiencies among adolescents are not documented. ** Vitamin A, iron and zinc deficiencies are identified. In April 2002, Jordan began a wheat flour fortification programme that included iron and folic acid.

8.  In March 2006, the fortification requirements were expanded to include vitamin A, zinc, thiamin, riboflavin, niacin, vitamin B6, and cobalamin in addition to iron and folic acid, and at the end of 2010 vitamin D3 was added to the flour.

9.  To estimate the usual daily intake of selected vitamins in a group of Jordanian school students aged 11-18 years and to compare the intake with the Dietary Reference Intakes (DRIs).

10.  This school-based cross-sectional study was conducted in Amman during the year 2010. The participants were 302 school students of which151males and 151 females, aged 11-18 years, randomly selected using a multistage stratified sampling technique. Only government schools were included in the study.

11.  Dietary intake of vitamins was evaluated by means of a 3 day food record (2 weekdays and 1 weekend day). Nutrient contents were calculated using the USDA database.

12.  … Food Composition Tables were used also to convert intakes of local foods into nutrients. Some information related to the content of Jordanian food was calculated based on the information found on local food labels.

13.  Statistical analyses were performed using SAS software, version 9.0 (SAS, Inc, Chicago, IL) using the F test and the paired Student t test methods to compare the group means. Comparison groups were stratified by age and sex whenever appropriate. P <0.05 and P <0.01 were considered significant.

14. Nutrient11-13 yearsP-value* MalesFemales Mean±S.D Vitamin A (µg)531.7±431.8297.2±199.20.046 Vitamin C (mg)97.6±60.172.4±59.60.377 Vitamin E (mg)10.4±7.38.1±4.50.397 Thiamin (mg)2.1±1.11.3±0.90.040 Ribofavin (mg)2.6±1.11.5±1.10.006 Niacin (mg)25.7±15.215.9±10.60.040 Folate (µg)480.2±116.6402.9±129.70.327 Vitamin B6 (mg)2.6±1.61.5±1.10.130 Vitamin B12(µg)4.4±2.12.2±1.10.004 Table (1): Mean intake of vitamins by gender for students aged between 11-13 years old (IOM, 2010).

15. Nutrient14-18 yearsP-value* MalesFemales Mean±S.D Vitamin A (µg) 350.8±365.3211.6±138 0.053 Vitamin C (mg) 80.7±63.884.7±73.8 0.825 Vitamin E (mg) 8.9±86.7±4.5 0.196 Thiamin (mg) 1.6±1.51.5±1.1 0.684 Ribofavin (mg) 1.8±1.51.6±1.2 0.416 Niacin (mg) 20.4±12.116.2±8.6 0.125 Folate (µg) 376.4±172.5316.5±135.7 0.142 Vitamin B6 (mg) 1.8±1.11.4±0.6 0.077 Vitamin B12(µg)2.8±1.91.9±1.50.046 Table (2): Mean intake of vitamins by gender for students aged between 14-18 years old (IOM, 2010).

16. NutrientMalesFemales Reference/ Goal % DRI Reference/ Goal % DRI Vitamin A (µg)445119.542070.8 Vitamin C (mg)39246.239195.6 Vitamin E (mg)9115.6990.0 Thiamin (mg)0.7300.00.7185.7 Ribofavin (mg)0.8325.00.8187.5 Niacin (mg)9285.69176.7 Folate (µg)250192.1250161.2 Vitamin B6 (mg)0.8325.00.8187.5 Vitamin B12(µg)1.5293.31.5146.7 Table (3): Average vitamins intake in comparison with Dietary Reference Intakes (DRI )*.(Age 11-13Y) * Estimated Average Requirement (EAR)

17. NutrientMalesFemales Reference/ Goal % DRIReference/ Goal% DRI Vitamin A (µg)63055.748543.6 Vitamin C (mg)63128.156151.2 Vitamin E (mg)1274.21255.8 Thiamin (mg)1.0160.00.9166.7 Ribofavin (mg)1.1163.60.9177.8 Niacin (mg)12170.011147.3 Folate (µg)330114.133095.9 Vitamin B6 (mg)1.1163.61.0140.0 Vitamin B12(µg)2.0140.02.095.0 Table (4): Average vitamins intake in comparison with Dietary Reference Intakes(DRI )*.(Age 14-18 Y ) * Estimated Average Requirement (EAR)

18.  Nutrient intakes can be assessed using different methods. Murphy et al.reported several incorrect methods that have been used by investigators. These methods included comparing the mean intake with the EAR (Estimated Average Requirement) or RDA (Recommended Dietary Allowance), and reporting the proportion of individuals that is below (or above) the RDA. In this study, we used the EAR cut-point method which estimates the proportion of children whose usual intake was less than the EAR.

19.  It was reported that lack of information on healthy eating, lack of motivation to eat a healthy diet and not having time to prepare or eat healthy food were the main barriers to healthy eating among Arab adolescents for both genders.

20.  In 1999, Jordan’s Ministry of Education (MoE) initiated a “school snack service” (mid-morning snack) through the School Feeding Programme. The “school snack service” targeted primary school- children in the first three elementary grades from seven disadvantaged semi rural districts. Initially, biscuit, fresh cow’s milk and a piece of fruit were provided to school-children aged 6-8 years. Progressively this programme extended to include children from kindergarten to 10 years of age and biscuits fortified with vitamin A, vitamins B, folate, niacin, iron and zinc were distributed.

21.  Since 2008, milk is no more distributed due to transportation problems. The programme expanded and targeted more than 500,000 children in 2009. It aims to improve the feeding and health status of children in public schools in the less privileged areas, develop and fix life-long positive attitudes and nutritious food habits and reduce dropouts. The MoE plans to continue expanding its reach to over the entire kingdom.

22.  Through the School Feeding programme implemented by the MoE, each child also received, in addition to a snack, a vitamin A oil capsule.  The baseline assessment indicated that the prevalence of sub-clinical vitamin A deficiency among these children aged 5.5-11 years was 22% (although the frequency of consumption of vitamin A rich foods was rather high) and the prevalence of anemia was 19%. After the programme, the prevalence of VAD was halved (11%) and that of anemia was of 15%.  Since 2000, the MoH provides vitamin A supplements to school children (6-11 years) in high risk areas.

23.  Results indicate that school students may be at risk of deficiencies of some vitamins. Special educational programs are strongly recommended for students and integrated strategies should be considered to promote increased intakes to meet nutrient recommendations.

24.  Further intervention programs, School Feeding programs and Food fortification may be necessary.

25. Thank you