Unhealthy Food Consumption by Children

Outcome

% of children aged 6–23 months who consumed selected sweet foods and/or fried and salty foods during the previous day

This indicator measures the proportion of children aged 6-23 months who consumed selected sweet foods and/or selected fried and salty foods during the previous day. WHO recommends that children in this age group should not consume foods high in sugar, salt and trans fats, as these can displace more nutritious foods and contribute to unhealthy dietary patterns.

There are two main ways to determine the indicator’s value. Both require conducting individual interviews with caregivers of a representative sample of children aged 6-23 months:

 

1) Using Data from Minimum Dietary Diversity

When measuring Minimum Dietary Diversity for Children, the WHO/UNICEF questionnaire also records the data required for this indicator. Use Question 7P on sweet foods and Question 7Q on fried and salty foods. In the WHO/UNICEF 2021 guidance (see below), these questions are on page 30 of the open-recall questionnaire and page 31 of the list-based questionnaire.

 

2) Asking About Unhealthy Foods Only

If you do not want to administer the entire questionnaire on foods consumed, use the following two questions only. Before asking them, remind the caregiver to think about foods the child ate at home or elsewhere, including snacks and small meals as well as main meals. Adapt the examples to foods and terminology commonly used in the survey area. The examples should fit the WHO/UNICEF categories described below. WHO/UNICEF guide (see below) provides guidance on adapting these two food groups on page 44, with more detailed examples of sweet foods and fried and salty foods in Annex 6, pages 88–90.

Q1: Yesterday, during the day or at night, did [child’s name] eat any sweet foods such as chocolates, candies, pastries, cakes, biscuits, frozen treats such as ice cream or popsicles, or [insert other commonly consumed sweet foods]?

Q2: Yesterday, during the day or at night, did [child’s name] eat any chips, crisps, puffs, French fries, fried dough, instant noodles or [insert other commonly consumed fried and salty foods]?

A1-A2: yes / no / does not know

Consumption of any amount of a food belonging to either of these categories counts; there is no minimum quantity.

To calculate the indicator’s value, count the children aged 6–23 months who consumed at least one of the two food types listed above during the previous day. Divide this number by the total number of surveyed children aged 6–23 months and multiply by 100 to convert it to a percentage.

Following the WHO/UNICEF calculation, children with ‘does not know’ or missing responses are still included in the total number of surveyed children. A child meets the indicator if at least one of the two questions is answered ‘yes’. If neither is answered ‘yes’, the child does not meet the indicator.

This data can be disaggregated by child sex and age group, and, if relevant and feasible, also by household wealth and geographical area. Where the sample size is adequate, age groups of 6–11, 12–17 and 18–23 months can be used.

1) According to WHO/UNICEF guidance (see below), selected sentinel unhealthy foods are:

Selected sweet foods:

• candies, chocolate and other sugar confections, including those made with real fruit or vegetables like candied fruit or fruit roll-ups

• frozen treats like ice cream, gelato, sherbet, sorbet, popsicles or similar confections

• cakes, pastries, sweet biscuits and other baked or fried confections which have at least a partial base of a refined grain, including those made with real fruit or vegetables or nuts, like apple cake or cherry pie

Selected fried and salty foods:

• chips, crisps, cheese puffs, french fries, fried dough, instant noodles and similar items which contain mainly fat and carbohydrate and have at least a partial base of a refined grain or tuber

The Global Diet Quality Project provides country-specific materials with locally relevant food examples. Where available, use the materials for infants and young children aged 6–23 months.

 

2) WHO/UNICEF guidance also emphasizes that:

• The food items listed above include those commercially produced and packaged, produced by small-scale producers such as street-food vendors or made at home. While some of the food items reported by interview respondents may also have healthy qualities, in general the selected food categories tend to have unhealthy qualities.

• The food categories covered by the questions above do not cover all types of unhealthy food items that might be consumed by children in any given country. These food categories were selected because they represent some of the most commonly consumed and less healthy choices likely to displace more nutritious foods in children’s diets in many countries.

• You should not broaden the indicator by adding locally defined ‘unhealthy’ foods that fall outside the WHO/UNICEF food categories used for this indicator, as this would create a modified indicator and reduce comparability.

 

3) If a large proportion of unhealthy foods that children consume is purchased, the data might be prone to seasonal differences, as the income and purchasing power of many families vary throughout the year. Do your best to collect baseline and endline data from the same time of year; otherwise, observed differences may partly reflect seasonality rather than programme change.

 

4) If the caregiver is taking care of two children aged 6-23 months (from the same household) and household sampling has been used, then data should be collected for both children. If a list method has been used and children have been identified as the primary sampling unit, then data should only be collected for the sampled child.

 

5) Because this is a previous-day population-level indicator, do not use it to assess an individual child’s usual diet or for individual screening. It also does not measure the quantity consumed. Sweet beverages are not included in this indicator; WHO/UNICEF measures them separately.

6) This indicator relies on accurate age assessment. Use a reliable record of the child’s date of birth where available. If the date of birth is not known or documented, estimate it using a standardised approach; a locally adapted events calendar can help caregivers recall the child’s approximate date of birth. Read FAO’s Guidelines below for guidance on preparing and using local events calendars.

Also consider using the following indicators:

• Sweet Beverage Consumption By Children (captures the separate unhealthy beverage dimension defined by WHO/UNICEF)

• Minimum Dietary Diversity - Children (provides a broader measure of dietary diversity and can use the same food-recall module)

• Zero Vegetable / Fruit Consumption by Children (captures another WHO/UNICEF dimension of poor-quality complementary feeding)

• Egg and/or Flesh Food Consumption by Children (measures consumption of nutrient-dense foods and complements the unhealthy-food measure)