Urban and rural differences in frequency of fruit, vegetable, and soft drink consumption among 6–9-year-old children from 19 countries from the WHO European region

Mirjam M. Heinen, Silvia Bel-Serrat, Cecily C. Kelleher, Marta Buoncristiano, Angela Spinelli, Paola Nardone, Sanja Musić Milanović, Ana Isabel Rito, A. Tülay Bağci Bosi, Enrique Gutiérrrez-González, Iveta Pudule, Shynar Abdrakhmanova, Zulfiya Abdurrahmonova, Lacramioara Aurelia Brinduse, Alexandra Cucu, Vesselka Duleva, Anna Fijałkowska, Andrea Gualtieri, Tatjana Hejgaard, Jolanda HyskaEnisa Kujundžić, Ausra Petrauskiene, Elena Sacchini, Lela Shengelia, Maya Tanrygulyyeva, Zhamilya Usupova, Ingunn Holden Bergh, Daniel Weghuber, Radka Taxová Braunerová, Marie Kunešová, Victoria Farrugia Sant'Angelo, Eha Nurk, Sergej M. Ostojic, Igor Spiroski, Ľubica Tichá, Harry Rutter, Julianne Williams, Khadichamo Boymatova, Ivo Rakovac, Martin W. Weber, João Breda

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban–rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6–9 years from 19 countries participating in the fourth round (2015–2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30–80% and 30–90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1–2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.

Original languageEnglish
Article numbere12307
JournalObesity Reviews
Early online date7 Jul 2021
Publication statusE-pub ahead of print - 7 Jul 2021


  • children
  • fruit
  • rural
  • soft drinks
  • urban
  • vegetables

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Public Health, Environmental and Occupational Health

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