Nutritional Status Assessment of Children Who Participated in the “Activarse” Program

Introduction: Knowledge of the nutricional status of children participating in the Activarse program allows us to characterize the target population in order to direct actions.
Objective: To evaluate the nutritional status of children who participated in the Activarse program during 2012.
Materials and Methods: A descriptive, cross-sectional study. An anthropometric assessment was performed on 1,253 children aged 5 to 10 years old from 16 schools in argentina participating in the Activarse program. The Z score for the Height/Age and BMI/Age indicators was calculated using Anthro Plus software. For the Height/Age indicator, children with a Z score between -1.5 and 2 were considered at risk or alert for short stature.
Results: The sample consisted of 54% (n=681) girls and 46% (n=572) boys. The average age was 7.23±1.15 years. The Height/Age index showed that 85.6% had an Adequate Height and 14.2% had height alterations (Short Height Alert, Short Height, Very Short Height and Tall Height), distributed evenly between boys and girls. Using the BMI/Age indicator, it was found that 52.9% were normal weight, 18.1% were obese, 21.4% were overweight, 6.2% were at risk of being underweight, 1% were underweight, and 0.4% were very underweight. In the normal weight category, females had the highest percentage, while males dominated the obese category. There were no differences in the other categories.
Conclusion: It is considered pertinent to carry out educational and nutritional interventions that make it possible to reduce the percentages of overweight and obesity found in the population.

PepsiCo's commitment to sustainable growth, defined as "Performance with Purpose," unites business performance with a clear sense of social responsibility that promotes consumer care, employee appreciation, the development of the communities in which it operates, and environmental stewardship and respect. To achieve this objective, PepsiCo creates a comprehensive framework for relationships with various stakeholders in society. In this regard, the company actively participates in chambers and organizations that bring together industry and CSR leaders, seeking to promote actions that positively impact the business and its stakeholders. Since 2006, the PepsiCo Foundation has led the company's social investment initiatives, with the mission of developing educational programs, promoting healthy habits, and corporate volunteering. Each of the Foundation's programs aims to provide information, develop knowledge and skills and promote the development of active citizenship.
Get Activated
This program, which has been promoting healthy lifestyle habits since 2006, is part of the Conciencia Association (CSO). Activarse focuses on providing children with tools for reflection and action on topics related to promoting healthy and sustainable living. It promotes a space for participation and learning by offering educational and recreational activities. The program targets students between the ages of 6 and 10 who are in 1st, 2nd, and 3rd grade, along with their principals, teachers, and families. The program is implemented in various provinces across the country: Bariloche, Buenos Aires (GBA, Mar del Plata, and Otamendi), Mendoza, San Juan, Santa Fe, and Tucumán. From the Activarse program's inception in 2006 to 2012, it reached 45,003 direct and indirect beneficiaries. In 2012, it reached 2,600 children from 17 schools in the Greater Buenos Aires Province (GBA), the Municipality of Buenos Aires (MDP), and Otamendi (Buenos Aires Province), Mendoza, Bariloche (Río Negro), Rosario (Santa Fe), Angaco and Albardón (San Juan), and Tucumán, as well as more than 150 teachers. The program was declared of educational interest by the Ministry of Education of the Nation, the Directorate of Culture and Education of the Province of Buenos Aires, and the Ministry of Education of the Province of Mendoza.
The Bachelor's Degree in Nutrition at Maimonides University supports the Activarse Program with guidance through the program's courses: Applied Statistics, Nutritional Assessment, Anthropometry, Nutritional Pedagogical Techniques, Research Methodology, and Nutrition Research.
In our country, there are no representative figures on the nutritional status of children aged 6 to 10. The National Nutrition and Health Survey 2 was conducted on children under 5 years of age, and the National Risk Factor Survey (2009) 3 was conducted on children over 18 years of age. Isolated studies have been found that reflect a growing increase in the rate of childhood overweight and a decrease in underweight. To determine the nutritional status of the population participating in the Pepsico Foundation's Activarse program, anthropometric measurements of weight and height were taken on 1,253 children from 16 schools in 10 towns in argentina.

Table 1: Descripción de los Colegios evaluados

Source: Own elaboration
This research provides an opportunity to characterize a population of school-aged children, even though it is not a closed group nor can the data be extrapolated to the entire population. Childhood malnutrition and undernutrition are common consequences of poor nutrition. Growth assessment using anthropometric indicators is important for reflecting children's health status, as it expresses the final common pathway through which all the factors that modulate growth converge: nutrition, health, and general well-being. Therefore, the objective of this research is to evaluate the nutritional status of children who participated in the Activarse program in the different provinces, implemented during 2012, using the anthropometric indicators T/E and BMI/E. This allows for the identification of children with normal growth parameters and those at risk of malnutrition, either due to nutrient excess or deficiency.
General objective
To evaluate the nutritional status of children between 5 and 10 years old who participated in the Activarse program during 2012.
Conduct a nutritional diagnosis of the sample to guide the program's actions.
Specific objectives
To determine the number of children participating in the Activarse Program who are normal weight, underweight, or overweight using BMI/Age during 2012.
Determine the number of children participating in the Activarse Program who are of normal, short, or tall stature using the Height/Age indicator who participated during 2012.
Population and Sample
The total population participating in the PepsiCo Foundation 's Activarse program nationwide is 2,623 children. This time, 1,253 children, representing 47.76% of the total, were evaluated.
The sample was non-probabilistic by volunteers, attempting to evaluate as many children as possible. 
The inclusion criteria were
First-year students from schools participating in the Activarse program who attended class on the day of the measurements.
Have the consent signed by parents/guardian
The total sample consisted of 1,253 children, aged 5 to 10, from 16 schools in 10 localities across 6 provinces in argentina, selected in a non-random and non-probabilistic manner.

Chart No. 1: Distribution of the Schools participating in the Activarse Program grouped by LOCATION (n=1253).
Source: Own elaboration
The 16 schools evaluated belong to the localities of Vicente López, Quilmes, Mar del Plata and Otamendi (Buenos Aires province), Bella Vista and San Miguel de Tucumán (Tucumán province), Rosario (Santa Fé province), Godoy Cruz (Mendoza province), Bariloche (Neuquén province) and Albardón (San Juan province).

A quantitative approach, descriptive in scope, and cross-sectional in design. During 2012, anthropometric measurements were taken from participants in the Activarse program to collect the data necessary for the anthropometric assessment. To perform the calculation, the current weight and height of each child are required. The total sample size obtained was 1,253 children nationwide. For this purpose, the University conducted five operations in participating schools in Buenos Aires to collect the data necessary for the anthropometric assessment. Through these operations, a total of 350 children, between 5 and 10 years old, from five of the 16 schools evaluated throughout the research were evaluated.
Each operation consisted of the transport of qualified personnel in a Maimonides University van designated for this purpose, to measure the weight and height of each child and collect personal data for analysis (e.g., first and last name, date of birth, grade, etc.). During each operation, three to four measurement stations were set up with a properly calibrated University stadiometer and scale. To obtain both body weight and height, the children were asked to remove their coats and shoes, leaving only a light t-shirt and pants. Height measurements were obtained according to international parameters regarding the proper posture for participants. The teachers involved as coordinators were Lic. Lucrecia Brovaronne (student coordinator) and Lic. Carla Carrazana (nutrition and public health teacher). The students who participated were Estela Gómez, Roxana Sánchez, Cristina Serna, and Mariela Greizerstein.
The statistical program developed by the World Health Organization (WHO, 2011). the Anthro Plus Software which allows the evaluation of nutritional status through the use of the Z score [1]. To establish the nutritional diagnosis, the cut-off points were used, as detailed in Table 2. For the Body Mass Index (BMI)/ Age, those published by the WHO and confirmed and adopted by the Argentine Society of Pediatrics (SAP, 2011), Nutrition Committee were used. [4,5] In relation to the cut-off points used for Height/Age, the points adopted by the Ministry of Health of the Province of Buenos Aires (Plan Nacer, 2011) were used in order to include a larger population at risk of short stature [6].
Table 2: Cut-off points used in children for the BMI/ age indicators and their respective nutritional diagnosis. 

Table 3: Cut-off points used in children for the T/age indicators and their respective nutritional diagnosis.

Source: and obs: BMI: Body Mass Index
After determining the diagnosis of each child, the frequencies, averages and percentages of the variables analyzed were analyzed.
Statistical Analysis: The results were analyzed using Excel® 97-2003. Descriptive statistical functions were used for analysis and interpretation, and frequencies of the variables of interest were assessed.

Total, of 1,253 children between the ages of 6 and 10 were evaluated. The total sample consisted of 46 % (n=572) males and 54% (n=681) females. See Table 4: Description of the participants evaluated in the Activarse program during 2012, distributed by sex and age (n=1,253).

Table 4: Description of the participants evaluated in the Activarse 2012 Program, distributed by sex and age (n= 1253).

Source: Own elaboration

The Height-for-Age index was used to assess longitudinal growth from birth to the present. The results of this indicator showed that 85.6% of the population had an adequate height, 5.4% had an alert height, 4.4% had a short height, 0.4% had a very short height, and 4.2% had a tall height, with the same distribution between boys and girls.

Chart 2: Evaluation of Nutritional Status through Height/Age Index of the total number of students evaluated participating in the Activarse 2012 Program (n=1253).

Source: Own elaboration

Chart 3: Nutritional Evaluation through the Height/Age Index according to the sex of the total number of students evaluated participating in the Activarse 2012 Program (n=1253).

Source: Own elaboration

To assess current nutritional status, the BMI/Age Index was used. The BMI/Age indicator showed that 52.9% were normal weight, 18.1% were obese, 21.4% were overweight, 6.2% were at risk of being underweight, 1% were underweight, and 0.4% were very underweight.

Chart 4: Evaluation of Nutritional Status through BMI/Age Index of the total number of students evaluated participating in the Activarse 2012 Program (n=1253).

Source: Own elaboration

When the data of the BMI/Age indicator shown are divided according to the sex of the children, a greater presence of Obesity can be observed in the male sex, finding a significant difference of 21.3% in the male sex versus 15.4% in women, with a score Z = 2.69 and the critical Z 1.96, alpha 0.05). With respect to the Normal Weight category , it was found that the female sex has a higher percentage (56.1% versus 49.1% in the male sex) and in relation to the rest of the other categories of the BMI/Age indicator, no differences were found by sex.

Chart 5: Nutritional Evaluation through the BMI/Age Index according to the sex of the total number of students evaluated participating in the Activarse Program (n=1253).
Source: Own elaboration
When differentiating the results of the anthropometric measurements according to the different provinces, it was found that Neuquén had the highest percentage of normal weight with 75.3%, within all the categories of Risk of Low Weight and Low Weight, it was the province of Neuquén that obtained the highest percentages (20% and 2.4% respectively), in the category of Very Low Weight, Buenos Aires and Tucumán obtained the highest percentages (0.6%) and within the categories of overweight and obesity, the province of Tucumán reflected the highest percentages (27.1% and 30% respectively).

Table 5: Distribution percentage of the IMC/E indicator according to the different provinces.

Source: Own elaboration
Regarding longitudinal growth, the T/E indicator determined that the locality with the highest percentage of normal height was Neuquén with 92%, while the provinces of Tucumán and Mendoza showed a higher percentage of the Very Short Stature and Short Stature binomial with 7%. Regarding the short height alert, the highest percentage was 6% present in the provinces of Neuquén, Santa Fe and Tucumán, and tall height was 7

According to the data provided in the first Childhood Obesity Conference "Towards the map of Obesity in argentina", it was determined that the prevalence of overweight and obesity in school age is 19% and 17.7% respectively, establishing a total of 36.7

A nutritional assessment was carried out on a total sample of 1,253 children from six provinces in argentina (Buenos Aires, Mendoza, Neuquén, San Juan, Santa Fé and Tucumán).
The sample was distributed with 54.3% (n=680) girls and 45.7% (n=572) boys.
According to the Height/Age Index, 85.6% of the total population is of adequate height, 10.2% has some alteration in the Short Height categories, and 4.2% is of Tall Height.
When evaluating the BMI/Age Index, it was observed that 52.9% of the total population has Normal Weight, 7.6