Public health challenges – the diet, nutritional status, and health of the Polish population

INTRODUCTION

The challenges for public health related to diet and nutritional status in Poland are multifaceted. They include malnutrition, understood as nutrient deficiencies and related health consequences, and excessive body weight and its health consequences. Both underweight and overweight can be linked to poor nutritional status. This condition can negatively affect the body and lead to various health problems. The work focuses on the diet of Poles, dietary deficiencies and nutritional status, and the occurrence of diet-related diseases, mainly obesity and its prevention. Obesity is currently one of the most significant challenges to public health in many countries of the world, including Europe and Poland.

DIET OF THE POLISH POPULATION – UNHEALTHY DIET-RELATED BEHAVIOUR AND DIETARY RECOMMENDATIONS

Studies on nutritional behaviour indicate the occurrence of certain irregularities in the diets of infants and toddlers [1], school-aged children and adolescents [2-4], and the adult Polish population. The National Multicentre Health Survey (WOBASZ II project) confirmed that the diet quality of the adult Polish population is generally poor [5]. The most frequently mentioned are inadequate consumption of vegetables and fruits, and small amounts of whole grain, milk, dairy, and fish. On the other hand, the Polish diet still records a high consumption of meat, wheat bread, and salt. Previous studies have shown that the Polish diet contains 13.5 grams of salt, with some regions reporting up to 15 grams per person [6]. The World Health Organisation (WHO) recommends, and Polish nutritional standards indicate, a maxi­mum of 5 grams of salt daily [7]. Recent studies have highlighted that the primary sources of salt in the Polish diet are diverse and include household and processed foods [8]. The Polish diet, especially among children, is rich in sugar, sweets, and sweet drinks. Sugar-sweetened beverages (SSBs) are leading sources of sugar in the diet. As a study shows, frequently drinking SSBs is associated with weight gain, obesity, type 2 diabetes, tooth decay and cavities, heart disease, non-alcoholic liver disease, kidney diseases, and gout, a type of arthritis [9]. On the other hand, limiting sugary drink intake can help individuals maintain a healthy weight and have healthy dietary patterns. For many years, the WHO has been drawing attention to the high intake of sugars in the diet, especially in children, which is one of the risk factors for developing diet-related diseases [10]. All age groups should limit free sugars to 10% of total energy intake (strong recommendation). Additionally, a more significant reduction in free sugar consumption to less than 5% of the total energy intake is advised (conditional recommendation) [10]. Maintaining sugar consumption levels below 5% of total energy intake is challenging due to the widespread presence of sugar in various products. However, the health benefits of significantly reducing sugar intake are widely recognised.
The diet of Poles became similar to the so-called Western style of nutrition [11]. Such an unhealthy diet model causes an ample supply of products with high energy density and low nutritional value. This leads to an excessive supply of calories and the demand for an excessive supply of fats, mainly saturated fatty acids (SFA) and trans fatty acids (TFA). Polish nutritional standards [7] for all age groups recommend that the consumption of SFA and TFA should be as low as possible in a diet that provides adequate nutritional value. The WHO’s actions promoting healthy diets and preventing overweight and obesity indicate that total fat intake should not exceed 30% of total energy intake, SFA intake should not exceed 10% of total energy intake, and TFA intake should not exceed 1% of total energy intake [12, 13]. Substituting saturated fats with polyunsaturated fats is recommended. A characteristic feature of the Western diet is the low supply of valuable minerals, vitamins, and fibre, an adequate supply of which is essential in preventing many diet-relat­ed diseases, including obesity. A study observed that the average daily fibre intake in the Polish diet of the adult population is approximately 18 grams per day, which is significantly lower than the recommended level [14]. The re­commended intake is 25 g/day for adults up to 65 years old and 20 g/day for those aged 66 years and older [7].
A poorly balanced diet also means irregular meals and skipping breakfast. Avoiding breakfast is common, mainly in the group of teenagers and affects every third person [3]. An unhealthy diet, combined with a sedentary lifestyle, promotes the occurrence of various diet-related diseases, including obesity. However, each age group has different nutritional irregularities, which result from the specifics of nutrition and the multiple factors that determine them. In the case of younger children (infants and toddlers), the responsibility for irregularities lies mainly with their parents and guardians. Additional factors are significant for older age groups (school-aged children and adolescents). The most frequently mentioned are environment, nutritional knowledge and awareness, attitudes towards food and nutrition, and health status. Research in a group of young adult Poles indicates a correlation between diet quality, dieting, nutrition knowledge, and attitudes toward food and nutrition [15]. However, declarative nutrition knowledge is not a good indicator of healthy dietary behaviour because declarative knowledge is usually not verified and is only sometimes related to actual knowledge and recommendations.

THE ROLE OF SOCIAL MEDIA IN PROMOTING KNOWLEDGE, AWARENESS, AND ATTITUDES TOWARDS FOOD AND NUTRITION

We should raise the role of the media, including social media, which are currently creating specific trends in nutrition. So-called “fashionable diets” are eagerly used, especially by adolescents and young people, who often use them without critical thinking and objective knowledge. The authors of studies that assessed the impact of social media showed that social media platforms have become increasingly influential channels for discussing various aspects of children’s health, including dietary habits and food choices [16]. The authors believe that social media can be a valuable resource for individuals. Still, parents and teachers should educate their children about media literacy and critical thinking skills to establish credible dietary information from unauthorised content on social media. Nutrition education and appropriate state policy can help make the right choices in the food market.

DIETARY DEFICIENCIES AND POOR NUTRITIONAL STATUS

Dietary deficiencies can translate into nutritional deficiencies. Infants, small children, and older adults are among the groups that are particularly sensitive to both nutritional excesses and deficiencies. Poor feeding practices during infancy and childhood are associated with an enormous burden of ill health, poor development, and lost opportunities [17]. Some dietary deficiencies can cause rapid deficiencies in nutritional status, while others are late and not very specific. Some can cause consequences already in childhood, and others occur in adulthood.
Common deficiencies in our population, including the youngest children, concern vitamin D. Studies conducted in children aged 13-36 months indicate that 94% consume less than recommended [1]. A similar situation applies to other age groups of children and the adult Polish population [7]. It is challenging to meet the demand for vitamin D with diet. Therefore, supplementation is necessary [18]. In addition to vitamin D, children are particularly vulnerable to iron, iodine, calcium, zinc, and vitamin B₁₂ deficiencies. These deficiencies can lead to delayed growth and development, impaired cognitive function, and other health issues. Deficiencies of these nutrients may also affect adults [6, 19] who eat poorly balanced diets. Deficiencies can also be the result of using poorly balanced alternative diets, for example, vegeta­rian and mainly vegan, which is not recommended, especially for the youngest population. Experts point out that adequately balancing a vegan diet for the youngest children is very difficult, and the risk of failing to follow the recommendations is high. The increasing popularity of plant-based diets is leading to more children being raised on these diets from an early age. Available evidence suggests that due to potential deficiencies in iron, vitamin B₁₂, and calcium, these types of diets may impact children’s growth, body composition, bone health, cardiometabolic risk, and nutritional biochemistry; according to some specialists [20], there is a legitimate need to formulate national and international guidelines aimed at improving the safety of plant-based diets for children.
Poor nutritional status may affect both people with normal and abnormal body weight. Research indicates that individuals living with obesity often follow a nutritional model characterised by a calorie-rich and nutrient-poor diet, which can result in various deficiencies. The most common deficiencies observed are in iron and vitamin D. However, individuals may also lack other essential vitamins, including A, B complex, C, and E, as well as essential minerals like calcium and magnesium [21]. On the other hand, people with low body mass are also at risk of poor nutritional status. This problem is particularly prevalent among older people. The elderly are at greater risk of being underweight and the associated risk of protein and energy malnutrition, which has been confirmed in studies conducted in Polish seniors [22].

OBESITY – AN EXAMPLE OF A DIET-RELATED DISEASE

In the last 2-3 decades in Poland, there has been a constantly growing problem of obesity, which affects various age groups of children and adults. Excessive body weight affects over 4% of infants [1], about 10% of toddlers [1], and preschool children [23], as well as every third child of early school age (approx. 34%) [24] and every fifth teenager (21.3% BMI according to the WHO 2007 cate­gory, 16.5% BMI according to the IOTF standard criteria) [3]. As indicated by the Eurostat data from 2019, the problem of overweight and obesity affects more than half of adult poles (58.1%), including women 50.3% and men 66.9% [25]. The situation regarding the occurrence of overweight and obesity in various age groups has worsened even more during the COVID-19 pandemic [26]. In general, an increase in body weight was noted due to a deterioration in eating habits and a decrease in physi­cal activity, which was influenced by isolation. Other diet-related diseases such as cardiovascular diseases, hypertension, type 2 diabetes, and gastrointestinal cancers are associated with obesity and unhealthy lifestyles. It is worth noting that age is also a risk factor for many of these diseases, and Poland is one of those European countries with an aging population [27]. According to Eurostat data, in 2100 there will be fewer than 2 working-age people for every person aged 65 years and over.
One of the operational objectives of the Polish National Health Program for 2021-2025 is the prevention of overweight and obesity. The list of tasks to achieve this objective includes several activities related to promoting pro-health attitudes, proper nutrition, and physical activity, as well as conducting training and nutritional education for various population groups. The multitude of planned tasks should translate into their implementation. The National Centre for Nutrition Education was established as part of such tasks. Different activities are also carried out, which are not always nationwide, which reduces their availability to all those in need. There is a justified need to undertake systemic, comprehensive, and targeted actions for specific, needy groups of recipients.

NUTRITIONAL EDUCATION AND HEALTH POLICY

Health education improves public health by informing individuals and communities about health risks and promoting healthy behaviours. It is crucial for building a skilled public health workforce and is the foundation for public health policies and programs. Health education encompasses nutritional education, which includes processes and interactions to change dietary behaviours, particularly for children and adolescents. This approach seeks to promote positive attitudes towards food and nutrition. Promoting healthy eating habits is essential for preventing numerous diet-related diseases.
Additionally, the impact of these efforts is enhanced when combined with other healthy lifestyle components. Essential factors include regular physical activity, ensuring adequate sleep, avoiding stimulants and risky behaviours, maintaining a healthy body weight, and prio­ritising mental health. In the last decade in Poland, several nationwide programs have been implemented, with the primary goal of nutritional education targeted at various age groups of children and adolescents, as well as their parents and guardians, care and educational facilities, and teachers. Selected examples of these programs include the following:
Eating Healthy, Growing Healthy (EHGH) – this program was designed for childcare facilities, such as nurseries and kindergartens, that care for children up to 6 years old. The program was implemented from 2014 to 2017 and covered 2672 facilities.
Wise Nutrition – Healthy Generation (WN-HG) – a program aimed at school youths aged 13-19 years. The program was implemented from 2013 to 2015 and covered 2058 secondary schools and 14,044 students.
Yello Plate (YP) – this is a nutritional support program for children of various ages, implemented in 2016, with 350 facilities participating and over 10,000 children involved.
The effectiveness of these programs is expressed by the improvement of nutritional behaviours of children and adolescents and better organisation of nutrition in care and educational facilities, as assessed in the studies described in publications [28-31].
Since 2022, the Junior-Edu-Żywienie (JEŻ) project has been implemented in Poland, and since 2024 it has been continued as a JEŻbis. The Ministry of Education and Science funds this program. This program targets primary school students in grades 1-8, along with their parents and teachers, and aims to develop and implement a nutritional education. The program includes an assessment of children’s nutritional status and eating habits. The program has covered 2210 schools, 2467 teachers, and 27,207 students.
Selected examples of other programs include: The First 1000 Days of Life for Health – a program initiated in 2013 aimed at pregnant and breastfeeding women and parents and caregivers of infants and young children. In addition, programs addressed to primary school students, Milk at School (implemented since 2004) and Fruit and Vegetables at School (implemented since 2009), are financed from EU funds and the Polish budget, for which the Polish government will allocate PLN 138 million in the 2024/2025 school year.
The effectiveness of education is increased by the regularity of activities carried out, their comprehensiveness, and the constant updating of knowledge. Learning proper eating habits should be implemented from the youngest age. Proper nutrition is a crucial component of a healthy lifestyle, playing a pivotal role in preventing obesity and various diet-related diseases. Adopting a healthy lifestyle, especially a balanced diet, is the best investment for the health of children and future generations.

CONCLUSIONS

Constant monitoring of different age groups’ nutritional status and diet is essential to identify high-risk groups and undertake effective interventions. Promoting a healthy lifestyle, including healthy eating habits, is critical in interventions. For interventions to be effective, systemic actions directed at the general public are necessary. Public health initiatives should focus on increasing public awareness of the benefits of a healthy lifestyle, including a balanced diet and the risks associated with malnutrition and excess body weight. Comprehensive and well-planned public health interventions implemented in different age groups are an opportunity to improve the health of the Polish population.

DISCLOSURE

The author reports no conflict of interest.

References