A snapshot of country-specific dietary habits and obesity in European children: the Feel4Diabetes study
Authors: Mahmood Lubna , Moreno Luis A. , Schwarz Peter , Willems Ruben , Cardon Greet , Hilal Soukaina , Rurik Imre , Iotova Violeta , Bazdarska Yuliya , Dimova Roumyana , Anastasiou Kostas , Manios Yannis , Gonzalez-Gil Esther M. ,   on behalf of the Feel4Diabetes-Study Group, Civeira Fernando , Bueno Gloria , De Miguel-Etayo Pilar , Miguel-Berges María L. , Giménez-Legarre Natalia , Flores-Barrantes Paloma , Ayala-Marín Aleli M. , Seral-Cortés Miguel , Baila-Rueda Lucia , Cenarro Ana , Jarauta Estíbaliz , Mateo-Gallego Rocío , Timpel Patrick , Ungvari Timea , Jancsó Zoltán , Nánási Anna , Kolozsvári László , Semánova Csilla , Bíró Éva , Antal Emese , Radó Sándorné , Martinez Remberto , Tong Marcos , Tankova Tsvetalina , Usheva Natalia , Tsochev Kaloyan , Chakarova Nevena , Galcheva Sonya , Bachata Yana , Radkova Zhaneta , Marinova Vanya , Stefanova Tanya , Karatzi Kalliopi , Androutsos Odysseas , Moschonis George , Kanellakis Spyridon , Mavrogianni Christina , Tsoutsoulopoulou Konstantina , Katsarou Christina , Karaglani Eva , Qira Irini , Skoufas Efstathios , Maragkopoulou Konstantina , Tsiafitsa Antigone , Sotiropoulou Irini , Tsolakos Michalis , Argyri Effie , Nikolaou Mary , Vampouli Eleni-Anna , Filippou Christina , Apergi Kyriaki , Filippou Amalia , Katerina Gatsiou , Dimitriadis Efstratios , Makrilakis Konstantinos , Liatis Stavros , Dafoulas George , Lambrinou Christina-Paulina , Giannopoulou Angeliki , Lindström Jaana , Laatikainen Tiina , Wikström Katja , Kivelä Jemina , Valve Päivi , Levälahti Esko , Virtanen Eeva , Pennanen Tiina , lli Seija , Nelimarkka Karoliina , Ko Winne , Karuranga Ernest 
Published: February 2025

Abstract
This study assessed the dietary intake of European children by country, gender, and obesity degree across six European countries participating in the Feel4Diabetes study. It also compared food group intakes with European food-based dietary guidelines. The Feel4Diabetes study included 9,847 children (50.4% girls) from six European countries. Families provided baseline data on energy balance-related behaviors and socioeconomic factors via questionnaires. Children’s dietary intake and breakfast consumption were assessed using semi-quantitative food frequency questionnaires, and anthropometric measurements were taken. Intake from 11 food groups was analyzed by country, gender, and obesity degree. Chi-square analyses compared food intake with dietary guidelines. “Nutrient-dense " foods (e.g., fruits, vegetables, whole grains) and "energy-dense, low-nutrient" foods (e.g., high in added sugars, saturated fats) were categorized based on the European food-based guideline. Over 85% of children consumed breakfast 5–7 days a week, with no significant differences by Body Mass Index (BMI) or country. Mean intakes of nutrient-dense food groups fell below recommendations, while the intake of energy-dense, low-nutrient foods exceeded limits, particularly in children with overweight/obesity (p = 0.048). No significant gender differences were observed in most food groups.

Conclusions: Dietary intake varied by country and obesity degree among European children. Across the six countries, children’s diets did not align with food-based dietary guidelines. These findings underscore the need for interventions promoting healthier eating habits among European children.

Trial registration: The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872), http://clinicaltrials.gov

What is Known:

• Childhood obesity is a growing concern across Europe, with some variations in food consumption observed between European countries

• Previous studies have highlighted the role of diet in childhood obesity, but few have examined cross-country comparisons while accounting for gender and BMI status.

What is New:

• This study provides a comprehensive cross-country analysis of children's dietary intake, considering gender, BMI status, and adherence to European dietary guidelines.

• New insights into gender differences in sweets consumption and the positive association between BMI and food intake (such as soft drinks and sweets) are presented, which can inform targeted dietary interventions.