Dairy consumption, motivations, and nutritional status among schoolchildren in northwestern Morocco: socioeconomic factors and place of residence.

内容摘要

Morocco, like many low and middle-income countries, is undergoing a rapid nutritional transition marked by the concurrent persistence of stunting and the emergence of overweight and obesity, a phenomenon known as the double burden of malnutrition (DBM). Dairy products are recognized as nutrient-dense foods that support linear growth through their role in insulin-like growth factor-1 (IGF-1) stimulation; however, dairy intake patterns and their relationship with nutritional status among Moroccan schoolchildren remain poorly documented, particularly across urban-peri-urban gradients. This cross-sectional study was conducted as part of the SUPREM-MILK project, Work Package 1 (WP1). A total of 248 schoolchildren aged 7-14&#x202f;years enrolled in pilot public primary schools located in urban and peri-urban public primary schools in Kenitra province, northwestern Morocco (January-June 2025). Dairy product consumption frequency was assessed using a Food Frequency Questionnaire (FFQ). Nutritional status was evaluated through anthropometric measurements, including height-for-age Z-scores (HAZ), BMI-for-age Z-scores (BAZ), and waist-to-height ratio (WHtR). Liquid milk was the most frequently consumed dairy product among the children surveyed (33.9% reported high consumption; 56.5% moderate), while traditional dairy products such as Lben and Jben were consumed less frequently. Taste preference was the dominant motivation for dairy intake across both residential settings. Urban children showed significantly higher HAZ (0.19&#x202f;&#xb1;&#x202f;1.23 vs. -0.43&#x202f;&#xb1;&#x202f;0.96; p&#x202f;<&#x202f;0.001) and BAZ (0.51&#x202f;&#xb1;&#x202f;1.14 vs. 0.01&#x202f;&#xb1;&#x202f;0.97; p&#x202f;<&#x202f;0.001) than peri-urban peers, yet abdominal obesity was markedly more prevalent in urban areas (16.8% vs. 2.4%; p&#x202f;<&#x202f;0.001). Household income (p&#x202f;=&#x202f;0.006) and parental education (p&#x202f;<&#x202f;0.01) were significant determinants of linear growth. After full covariate adjustment, no independent association was detected between dairy consumption frequency and the risk of overweight, stunting, or abdominal obesity (all p&#x202f;>&#x202f;0.05). These findings indicate a context-specific nutritional transition in which urbanization is associated with improved linear growth but a higher risk of abdominal obesity. The absence of an independent association between dairy consumption frequency and nutritional outcomes after full covariate adjustment reflects the complexity of the diet growth relationship in this context. Differentiated public health strategies are therefore needed: promoting balanced diets in urban settings and improving dietary diversity in peri-urban areas, to address this dual nutritional burden.