3. Research Findings

The results revealed that ultra-processed foods (mainly cheese and cakes, pies and biscuits) were the greatest source of fat and fatty acids in Tunisian children, followed by breakfast cereals for total fat and dairy products for fatty acids. Ultra-processed foods are food products formulated mainly or entirely from processed ingredients, including little or no whole foods [33]. The early consumption of these products could lead to adverse health effects such as obesity or chronic diseases [34,35]. Therefore, it is important to understand the role of food processing and to formulate public health strategies to reduce the consumption of ultra-processed products early in life. Comparing food sources of fat and fatty acids is not easy because food groupings differ between the research studies. The definition of the food groups in the present study was based on the Tunisian food composition table and the USDA table [11,15]. The important contributions of ultra-processed foods, breakfast cereals, and dairy products in children and adolescents’ fat and fatty acids intake were also found elsewhere. 

Asakura and Sasaki (2017) reported that meat, dairy products, and confectionery were the three major sources of SFA in Japanese schoolchildren (26.4%, 25.7% and 11.3% of total SFA intake) [26]. According to Wang et al. (2018), meat, poultry and fish, milk and mixtures consisting mainly of grain were the leading food sources of saturated fats in US children [28]. The Korean study revealed that milk was the major food source of total fat and SFA in 3–5 years old children, with respective percentages contributions of 15.6% and 29.5%, followed by pork and eggs [24]. In Costa Rica, bakery products, red meat and dairy products were the main contributors to SFA and TFA intakes in adolescents [30], while fried eggs, whole milk, breakfast cereals and fresh cheese were among the major food sources of total fat and SFA in diets of Guatemalan schoolchildren [27]. The principal food groups contributing to the total TFA intake in Spanish children were milk (21%), processed baked goods (16%), sweets (12%), fast food (12%) and white bread (10%) [31]. These were comparable to those reported in the Canadian study [32]. Generally, the top three food groups contributing to the total fat and SFA intakes in European adolescents were meat, fish, eggs and meat alternatives (mainly meat), low-nutrient, energy-dense foods (mainly cakes, pies and biscuits) and dairy and soy products (mainly cheese) [29]. In our study, the meat, fish, eggs and fish alternatives were the fifth main contributors to the total fat and SFA intakes in Tunisian children, with respective percentages of 10.7% and 10.8%. This result is probably due to differences in dietary habits between the Tunisian and other world populations. In Tunisia, the average annual meat consumption per capita was around 32.5 kg in 2015, close to the global average of 34.3 kg, but far from 69 kg in the European Union and 98.3 kg in the United States [36,37]. On the other hand, the mean annual consumption of lean meat in 2015 (19.4 kg for poultry and white meat) is much more important than the consumption of fatty meat (7.1 kg for sheep meat and 3.1 kg for bovine meat) [36]. The general food price index, which makes sheep and bovine meat proportionately more expensive than the other food products, could explain this trend of meat consumption among Tunisian people [38].

Given that a large proportion of Tunisian children exceeded the recommended levels of total fat and SFA intake, the implementation of several policy actions is necessary to prevent diseases and promote health in Tunisia. In this context, the WHO regional office has developed policy guidance with recommended actions for countries in the Eastern Mediterranean Region to reduce national fat intake. These recommendations include establishing mandatory labelling schemes for SFA content that are easily understandable for most consumers and replacing industrially-produced TFA with healthier oils and fats [39]. Future health policies should focus primarily on reducing the children’s intake of ultra-processed foods and increasing access to high nutritive quality foods such as vegetables, fruits, whole-grain products and animal source foods with health-promoting fats (e.g., fish) [40].