Distribution of macro- and micronutrient intakes in relation to the meal pattern of third- and fourth-grade schoolchildren in the city of Quetzaltenango, Guatemala

Objective: Our objective was to assess the distribution of energy, macro- and micronutrient intakes by meal (breakfast, lunch, dinner and combined snacks) in a cross-sectional sample of schoolchildren. Design: Cross-sectional dietary survey in schoolchildren. Setting: Twelve private and public schools in the urban setting of Quetzaltenango, Guatemala. Subjects: A total of 449 schoolchildren (from higher and lower socio-economic strata) were enrolled in the Study. Methods: Each child completed a single, pictorial 24 h prospective diary and a face-to-face interview to check completeness and estimate portion sizes. Estimated daily intakes were examined by mealtime as: (i) absolute intakes; (ii) relative nutrient distribution; and (iii) critical micronutrient density (i.e. nutrient density in relation to the WHO Recommended Nutrient Intakes/median age-specific Guatemalan energy requirements). Results: The daily distribution of energy intake was 24% at breakfast, 30% at lunch, 23% at dinner and 23% among snacks. Lunch was also the leading meal for macronutrients, providing 35% of proteins, 27% of far and 30% of carbohydrate. The distribution of selected micronutrients did not follow the pattern of energy, insofar as lunch provided relatively more vitamin C and Zn, whereas breakfast led in terms of vitamins A and D, thiamin, riboflavin, folate, Ca and Fe. Conclusions: Meal-specific distribution of energy, macro- and micronutrients provides a unique and little used perspective for evaluation of children's habitual intake, and may provide guidance to strategies to improve dietary balance in an era of coexisting energy overnutrition and micronutrient inadequacy.