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Background/Objectives: Populations in Mediterranean countries are abandoning the traditional Mediterranean diet (MD) and lifestyle, shifting towards unhealthier habits due to profound cultural and socioeconomic changes. The SWITCHtoHEALTHY project aims to demonstrate the effectiveness of a multi-component nutritional intervention to improve the adherence of families to the MD in three Mediterranean countries, thus prompting a dietary behavior change. Methods: A parallel, randomized, single-blinded, and controlled multicentric nutritional intervention study will be conducted over 3 months in 480 families with children and adolescents aged 3–17 years from Spain, Morocco, and Turkey. The multi-component intervention will combine digital interactive tools, hands-on educational materials, and easy-to-eat healthy snacks developed for this study. Through the developed SWITCHtoHEALTHY app, families will receive personalized weekly meal plans, which also consider what children eat at school. The engagement of all family members will be prompted by using a life simulation game. In addition, a set of activities and educational materials for adolescents based on a learning-through-playing approach will be codesigned. Innovative and sustainable plant-based snacks will be developed and introduced into the children’s dietary plan as healthy alternatives for between meals. By using a full-factorial design, families will be randomized into eight groups (one control and seven interventions) to test the independent and combined effects of each component (application and/or educational materials and/or snacks). The impact of the intervention on diet quality, economy, and the environment, as well as on classical anthropometric parameters and vital signs, will be assessed in three different visits. The COM-B behavioral model will be used to assess essential factors driving the behavior change. The main outcome will be adherence to the MD assessed through MEDAS in adults and KIDMED in children and adolescents. Conclusions: SWITCHtoHEALTHY will provide new insights into the use of sustained models for inducing dietary and lifestyle behavior changes in the family setting. It will facilitate generating, boosting, and maintaining the switch to a healthier MD dietary pattern across the Mediterranean area. Registered Trial, National Institutes of Health, ClinicalTrials.gov (NCT06057324).

Background. Regular physical activity in childhood and adolescent plays an important role in reducing the risk of cardiovascular health diseases, diabetes, and obesity in adulthood. However, little is known about physical activity levels (PA) and sedentary time among children and adolescents in Morocco. Objective. To examine gender, type of day, and age grade differences in objectively measured sedentary time, physical activity levels, and physical activity guideline attainment among children and adolescents in Morocco. Method. 172 children/adolescents (mean age = 10.92 ± 1.55 years, 49.4% are boys) were recruited for this study and wore a tri-axial accelerometer (GT3X+) for 7 consecutive days. Time spent in sedentary, PA levels, and daily steps were measured and compared according to gender, age grade, and the type of day (weekdays/weekends). Results. In weekdays children/adolescents spent more time in sedentary than weekends (p < 0.001). Boys were eight times more likely to meet the recommendation for at least 60 min of moderate to vigorous physical activity per day than girls (OR: 8.569; 95% [CI]: 4.23–17.32), p < 0.001. Conclusion. These findings highlight the need for effective and sustainable strategies and programs aiming to promote physical activity and to reduce sedentary behavior among children and adolescents in Morocco.

Little is currently known about young children’s perceptions and experiences of 24-hour movement behaviours (physical activity, sedentary behaviour, sleep), yet their voices play an important role in contributing to our understanding and ensuring that appropriate action is taken to promote healthy behaviours. With the release of the World Health Organisation’s Guidelines for physical activity, sedentary behaviours and sleep for children under 5 years of age, interest is gathering to examine how young children globally perceive and experience these movement behaviours in their daily lives. Conducting qualitative research with young children, however, presents a host of challenges including identifying suitable methods (interview type), developing appropriate questions (terminology, translation), building rapport (presence of caregivers/educators, incentives), and managing power dynamics, while adjusting to the restrictions imposed by COVID-19. Additional layers of complexity come into play when conducting an international study across culturally, linguistically, and socioeconomically diverse populations. This article describes the reflections of our research group as we considered the effect of diverse contextual influences in Australia, Chile, China, India, Morocco and South Africa, on how movement behaviours are conceptualised by young children. The complexities of working across these diverse contexts is discussed and the implications this has for methodological decisions and data interpretation are reflected upon. While the WHO Guidelines (2019) are universal, globally young children experience considerable differences in how their days are structured, along a continuum of highly supervised to independent play, with varying degrees of agency to make choices regarding their experience of movement behaviours. This suggests the need for a nuanced approach in how we further research and address movement behaviours across different country contexts, taking into consideration social and cultural norms.

Calcium is an important mineral playing a vital role to maintain bone health. Calcium intake is considered as one of the most important determinants to assess the calcium status and to evaluate the calcium deficiency in the human body. Our study aims at estimating calcium intake in a sample of children and adolescent to be used in the global strategy to reduce calcium deficiency disorders in Morocco. Thus, 131 children and adolescents were recruited from public schools at Rabat and its regions in the framework of a descriptive cross-sectional study. For each participant, anthropometric parameters were measured. Calcium status was assessed by 24 h dietary recall. Food frequency questionnaire was used to evaluate children’s nutritional habits and to assess the consumption of calcium-rich food. Overall, the mean calcium intake was 522.0 ± 297.0 mg/day, and 85.5% of subjects highlighted calcium deficiency, with no significant difference between boys and girls. Calcium intake was significantly different according to age groups, and high consumption of calcium was found in subjects aged from 14 to 18 years (776.86 ±290.07 mg/day), giving evidence of the low calcium status of the studied population. Daily food intake and food frequency analysis showed that bread, vegetables, and fruits are the most consumed food and the main source of daily calcium intake. Consumption of dairy products, considered as the best source of calcium, is lower and represents only 14% of total calcium intake. Our study clearly showed that calcium status is very lower in Moroccan children and adolescents and a large proportion of this population have inadequate calcium intake. Hence, there’s an urgent need of specific strategies, including children sensitisation and nutritional education, to increase calcium intake and therefore reduce calcium deficiency disorders impacting the whole body during childhood and in adult age.

Background: Excessive sodium intake is linked to high blood pressure. Estimating sodium intake is difficult. The 24-h urine collection is currently the recommended method for estimating intake but cumbersome for large population studies. Predictive model to estimate sodium intake based on single spot urine were developed, but showed inconsistency when used in extern populations. This study aims to develop a specific model for estimating sodium excretion over 24 hours for the Moroccan population. Methods: 371 participants in the urinary validation sub-study of the STEP-wise survey-Morocco 2017-2018 provided a valid 24-hour urine collection and spot urine specimens. Participant were randomly assigned to the training (n=183) and the validation data set (n=188). Results: A prediction model for 24-hour sodium excretion was developed. Adjusted R 2 was 0.258. In the validation data set, correlation was 0.431 [95%CI; 0.258-0.580], and the adjusted R 2 was 0.190. The Bland-Altman plot showed a nonsignificant small mean bias of -18 mg (95%CI, -213 to 177) in predicting 24-h urinary sodium excretion at the group level. At the individual level, limits of agreement were wide. Conclusion: This new model developed from a single spot urine could be used to predict the average 24-h sodium excretion of Moroccan adults.

Iodine is required for the production of the thyroid hormones essential for the growth and development of the brain. All forms of iodine deficiency (ID) affect the mental development of the child. Our study aims to assess the impact of ID on the intellectual development of Moroccan schoolchildren and to evaluate the effect of consumption of fortified milk on reducing ID. In a double-blind controlled trial conducted on schoolchildren, children were divided into two groups to receive fortified milk (30% of cover of RDI iodine) or nonfortified milk for 9 months. Urinary iodine was analyzed using the Sandell-Kolthoff reaction, a dynamic cognitive test using Raven’s Standard Progressive Matrices to assess learning potential was performed at baseline and end line, and anthropometric assessment was done only at baseline. The study included schoolchildren who were severely iodine deficient. The prevalence of malnutrition was high in both groups; in this study, we found improvements in iodine status and in cognitive abilities among Moroccan schoolchildren. Our study showed that the consumption of fortified milk led to a clear improvement in iodine status and also appeared to have a favorable effect on the cognitive ability of Moroccan schoolchildren in a rural mountainous region.

Background Sedentary behavior (SB) in children is related to different health outcomes such as overweight and cardio-metabolic diseases. These negative effects have been widely supported by evidence. However, no data on sedentary time (ST) among Moroccan children has been available, yet. Therefore, the present study examined gender and grade differences in objectively measured sedentary behavior in a sample of Moroccan primary school children and adolescents. Methods In total, 172 Moroccan children/adolescents aged between 8 to 14 years old (mean age = 10.92 ± 1.55 years; 49.4% were boys) completed the survey. School grade, gender, height, and weight were collected by questionnaires and ST objectively measured using a tri-axial accelerometer (GTX3+). Study required at least 3 valid weekdays and 1 weekend day with? 600 min/day total wear time. Two-way analysis of covariance and logistic regression analyses, adjusted for BMI z-score and accelerometer wear time, were used to examine gender and grade differences in ST. Results Mean time spent in SB was 535.93 ± 87.15 min/day or ∼ 62.94% of the average daily accelerometer wear time of 851.45 ±51.35.min/day with statistical differences between weekend and week days (471.357 ± 127.73 minutes/day vs. 559.7661± 90.75 minutes/day; p > 0.001). Adolescents (11-14y) were more involved in sitting tasks when compared to the early grades (8-10y). 550.011±88.827 vs. 521.845±83.602 respectively; p > 0.001. Conclusion ST increases between ages 11 and 14 years. On week days children and adolescents spent sitting longer than at weekends. Girls and adolescents were identified as potential risk groups. This report on ST presents valuable information for designing and implementing interventions to decrease time spent in SB among children during class time. Acknowledgements This study was performed with the support of the International Atomic Energy Agency (CRP E4.30.24; RAF 6042).

Background/objectivesEstimating body composition using bioelectric impedance analysis (BIA) requires specific prediction equations. The purpose of our study was to examine the validity of published BIA equations for assessing total body water (TBW) and fat-free mass (FFM) using deuterium oxide dilution (D2O) as a reference method and to develop new FFM and TBW BIA equations if needed for Moroccan pre-pubertal children.Subjects/methodsData were collected from 247 schoolchildren aged 8–11 years old. Children were sorted by gender and age group and assigned in development and validation groups. D2O dilution was used as reference method for estimating TBW and FFM. Bland and Altman test, effect size, pure error, and proportional bias were used to assess the reliability of previous published equations. Cross-validation was performed by Bland and Altman test and BIA new equations were developed by linear regression.ResultsPreviously published equations were tested and showed significant bias values indicating that if used they would provide biased values of TBW and FFM. The new prediction equations developed were:\\[\\mathrm{TBW}_{\\mathrm{D}_{2}{\\mathrm{O}}}\\] (l) = 0.269 + 0.292 Ht2/R (cm2/Ω) + 0.221 weight (kg) + 0.824 sex (boys = 1, girls = 0) + 0.291 age (years) (R2 = 0.91, RMSE = 1.54 kg);\\[\\mathrm{FFM}_{\\mathrm{D}_{2}{\\mathrm{O}}}\\] (kg) = −0.450 + 0.380 Ht2/R (cm2/Ω) + 0.291 weight (kg) + 1.294 sex (boys = 1, girls = 0) + 0.446 age (years) (R2 = 0.91, RMSE = 1.97 kg).These equations provide better values of proportional bias, agreement, and pure error than the other tested equations.ConclusionsThe new BIA prediction equations seem to be the most accurate for Moroccan pre-pubertal children.

Iron deficiency constitutes a major public health problem in Morocco, mainly among women and children. The aim of our paper is to assess the efficacy of consumption of multiple micronutrients (MMN) fortified milk on iron status of Moroccan schoolchildren living in rural region. Children ( N = 195 ), aged 7 to 9 y, were recruited from schools and divided into two groups: the nonfortified group (NFG) received daily a nonfortified Ultra-High-Temperature (UHT) milk and the fortified group received (FG) daily UHT milk fortified with multiple micronutrients including iron sulfate. Blood samples were collected at baseline (T0) and after 9 months (T9). Hemoglobin (Hb) was measured in situ by Hemocue device; ferritin and C Reactive Protein were assessed in serum using ELISA and nephelometry techniques, respectively. Results were considered significant when the p value was <0.05. At T9 FG showed a reduction of iron deficiency from 50.9% to 37.2% ( p = 0.037 ). Despite the low prevalence of iron deficiency anemia (1.9%); more than 50% of children in our sample suffered from iron deficiency at baseline. The consumption of fortified milk reduced the prevalence of iron deficiency by 27% in schoolchildren living in high altitude rural region of Morocco. Clinical Trial Registration. Our study is registered in the Pan African Clinical Trial Registry with the identification number PACTR201410000896410.