Ultra-processed food consumption among primary school children and caregivers, children’s anthropometric status, and caregiver food knowledge in Nelson Mandela Bay, South Africa

Abstract

The modern food environment has shifted significantly, with ultra-processed foods (UPFs) becoming increasingly accessible. These foods contribute to poor dietary quality and pose a malnutrition risk among children in low-resource settings.   The aim of this study was to describe UPF consumption among children and caregivers in selected quintile 3 primary schools and to examine the association between the children’s anthropometric status and UPF intake, as well as the caregivers’ knowledge of nutrition and dietary patterns.   A quantitative cross-sectional design was followed, and the study, as part of a longitudinal study, included 1 234 children (2019) and 109 caregivers (2025). The children’s anthropometric and dietary intake data were analysed according to WHO standards and the NOVA classification. Caregivers completed a UPF knowledge questionnaire and a 24-hour dietary recall. Statistical analyses included correlations, Chi-square tests and t-tests.   The study revealed that malnutrition affected 38.41% of children; stunting (20.10%) and overweight/ obesity (15.56%) were most prominent. Children consumed an average of 10.91 UPF items weekly. Overall, the associations between anthropometry and dietary intake in children were weak; except between UPF intake and weight/BMI in nine-year olds. Caregivers scored a mean of 54.70% on UPF knowledge and consumed an average of 4.18 UPFs per day. Education, employment status and age among caregivers correlated with knowledge (rs = 0.40). Caregiver and child UPF intake were significantly associated.   Highly elevated levels of malnutrition and UPF intake, alongside limited caregiver knowledge of nutrition, highlight the need for improved nutrition interventions in these communities.