War exposure and changes in eating behaviours in Ukrainian school-aged children: A cross-sectional online survey

The war in Ukraine has exposed children to extremely high levels of acute and chronic stressors, which can impact their eating behaviour (EB). We aimed to determine the prevalence of war-induced, stress-related disruptions in EB of Ukrainian children. We conducted a cross-sectional online survey among parents of 5- to 17-year-old children, who had experienced the war in Ukraine in February-May 2023. Guardians reported their child's various war exposure changes in EBs using a modified version of the Child Eating Behaviour Questionnaire. We assessed associations between total and medium-term EB changes and age, sex, and war exposure using bivariate correlations and chi 2 tests. Logistic regression models were fitted to explore the associations between socio-demographic factors, war exposure and frequency of EB changes. Of the 4854 children, 63% had changes in EBs during the war. The most common EB changes included food cravings (38%), food fussiness (37%), and aversion to certain foods (29%). Of the reported EB changes, 40% were medium-term, lasting over a month, and related to altered attitudes towards food. Food insecurity (adjusted OR 2.35, 95% CI: 1.76-3.14), and displacement (internally 2.01, 1.19-3.42) emerged as the most influential determinants of medium-term EB changes. The findings underscore a significant and robust association between war-related exposures and an increased risk of frequent EB changes. As healthy EBs are learned during childhood and have been shown to track into adulthood, the identified disruptions in EB may have medium-term consequences for the physical and mental health of Ukrainian children. This study investigates war-induced stress-related disruptions in eating behaviours among 5- to 17-year-old Ukrainian children who had experienced the war. The findings revealed that two-thirds of children had changes in parent-reported eating behaviours (EBs), most frequently observed among 5- to 10-year-olds. Food insecurity and being displaced emerged as the most influential determinants of EB changes.image Two-thirds of children had changes in parent-reported eating behaviours (EBs) during the war, with the highest frequency observed among 5- to 10-year-olds. The most common EB changes observed during wartime included food cravings, food fussiness, aversion to certain foods, and decreased appetite. More than one-third of the reported EB changes were medium-term, lasting over a month, and related to altered attitudes towards food. Food insecurity, displacement, and separation from close relatives emerged as the most influential determinants of EB changes. The findings underscore a significant and robust association between various war-related exposures and an increased risk of frequent EB changes.