Advances in Biomedical and Health Sciences

: 2022  |  Volume : 1  |  Issue : 3  |  Page : 144--155

Nutrition knowledge of caregivers working in health and education centers for children with special healthcare needs

Leila Cheikh Ismail1, Salma Abu Qiyas2, Maysm N Mohamad3, Tareq Mohammed Ibrahim Osaili4, Reyad Rashid Shaker Obaid2, Sheima T Saleh2, Hanin Kassem2, Ayesha S Al Dhaheri3, Rameez Al Daour2, Radhiya Al Rajaby2, Hayder Abbas Hasan2, Mona Sharef Hashim2,  
1 Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates; Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX1 2JD, UK
2 Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
3 Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
4 Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates; Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid 22110, Jordan

Correspondence Address:
Leila Cheikh Ismail
Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah 27272


Background: Children with special healthcare needs are recognized as a high-risk group for malnutrition. Caregivers have a strong influence on the dietary habits of their students, therefore, adequate nutrition knowledge among caregivers and educators has a great potential in improving the health of children. The purpose of this study is to assess the level of nutrition knowledge and demographic influences of knowledge among caregivers working in health and education centers. Methods: a cross-sectional, web-based survey was conducted among educators and caregivers working at Sharjah City for Humanitarian Services to assess their nutritional knowledge using a modified validated general nutrition knowledge questionnaire. Results: 233 participants completed the survey. The basic recommendations about reducing the intake of sugary, salty, and fatty foods and consuming more water and vegetables were best acknowledged. However, an inadequate level of knowledge was identified regarding specified number portion. For instance, more than half of the participants were aware of the need to consume more vegetables and fruits while only 10% knew the minimum number of servings to consume in a day. The overall nutrition knowledge score was adequate at 46.30 (55.1%). Caregivers with nutrition qualifications and who have four children had a significantly higher knowledge score. Older age was associated with better diet-disease relationship knowledge. Conclusions: The level of nutrition knowledge among caregivers and health workers was insufficient. However, periodic nutrition education reinforcement among health caregivers should be considered.

How to cite this article:
Cheikh Ismail L, Abu Qiyas S, Mohamad MN, Osaili TM, Obaid RR, Saleh ST, Kassem H, Al Dhaheri AS, Al Daour R, Al Rajaby R, Hasan HA, Hashim MS. Nutrition knowledge of caregivers working in health and education centers for children with special healthcare needs.Adv Biomed Health Sci 2022;1:144-155

How to cite this URL:
Cheikh Ismail L, Abu Qiyas S, Mohamad MN, Osaili TM, Obaid RR, Saleh ST, Kassem H, Al Dhaheri AS, Al Daour R, Al Rajaby R, Hasan HA, Hashim MS. Nutrition knowledge of caregivers working in health and education centers for children with special healthcare needs. Adv Biomed Health Sci [serial online] 2022 [cited 2022 Aug 11 ];1:144-155
Available from:

Full Text


Children with Special Healthcare Needs (CSHCN) are considered a nutritionally vulnerable community of children and adolescents. The American Academy of Pediatrics and the Maternal and Child Health Bureau define CSHCN as children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and other related services of a type or amount beyond what is required by children generally. CSHCN are recognized as a high-risk group for malnutrition [1,2]. They are more likely to develop comorbidities such as obesity, underweight, and endocrine disorders as well as suffer from several nutritional problems [2]. Previous studies comparing CSHCN to their typically growing counterparts, reported a higher prevalence of growth alterations, [2,3] poor feeding, [4],[5],[6] and gastrointestinal and metabolic disorders [3,7] among the CSHCN group. Parental nutritional status in addition to several other medical, physiological, and behavioral risk factors was found to influence nutrition outcomes in CSHCN [3].

While parents are considered the primary caregivers for their children, with CSHCN, there can be several additional caregivers with different responsibilities. Teachers and healthcare workers who spend a considerable amount of time with CSHCN play a substantial part in facilitating the children’s development and progress [8]. Research suggests that CSHCN can especially benefit from a constructive teacher-student relationship [9]. This is particularly important because the literature indicates that teachers have a strong influence on the dietary habits of their students in many ways, including the use of rewards, role-modeling, and the initiation and implementation of nutritional intervention programs in schools [10,11]. Likewise, malnutrition in children can be decreased if healthcare workers had proper nutrition knowledge and provide accurate and sufficient nutrition guidance to informal (family) caregivers frequently [12].

The buildup of multiple hardships, starting before conception and continuing throughout prenatal and early life, can lead to cognitive and physical developmental delays [13]. Physical and cognitive development in childhood is influenced by interaction and maturation. A cross-sectional study of preschool children in Brazil found that children exposed to three or more adverse experiences in childhood had lower communication, gross motor, fine motor, and personal-social domain scores than children with no adverse childhood experiences [14]. Developmental delays begin to surface in the first year of life, get worse in early childhood, and persist into adulthood [13]. Early childhood development requires nurturing care defined by the World Health Organization (WHO) as “a caregiving environment that is sensitive to children’s health and nutritional needs, responsive, emotionally supportive, and developmentally stimulating and appropriate, with opportunities for play and exploration and protection from adversities” [15].

Adequate nutrition early in life enables children to reach their developmental potential by easing the acquisition of developmental competencies for socio-emotional, behavioral, academic, and economic accomplishments [13]. Conversely, early life malnutrition insults can irreversibly impact cognition and behavior later in life. Literature investigating the long-term effects of early childhood malnutrition showed that reduced intelligence quotient (IQ) and intellectual abilities, poorer academic performance and decision-making, and attention deficits are more prevalent among malnourished children compared to control groups [16]. The effects of micronutrient deficiencies on child development have also been reported. Several studies have linked previous [17] and existing [18,19] iron deficiency in children with lower academic performance in school. Stunting (low height for weight as a result of chronic malnutrition) has also been linked to multiple micronutrient deficiencies, such as Vitamin A, D, and Zinc, as well as several genetic and environmental factors [20].

Good nutrition is an essential component of sound health. It has an integral role in health promotion, prevention, and treatment of chronic disease. The past half-century has seen an increasing burden of noncommunicable diseases (NCDs) on public health worldwide; principally cardiovascular diseases (CVDs), cancer, diabetes, and chronic respiratory disease [21]. The positive impact of diet and nutrition on decreasing the burden of NCDs has been well-studied over the years and has been identified as one of the most controllable factors for long-term wellbeing [22],[23],[24]. Promoting healthy lifestyle habits and good dietary habits has become crucial in the past few decades to combat the effects of urbanization, vast economic development, and smart marketing of more westernized dietary patterns [25,26]. Thus, nutrition education on a community level or for hospitalized patients is a cost-effective method for health promotion and disease treatment [27]. It is well-established that healthcare givers and educators in the broad sense are considered trusted health information providers by the public [28]. In this manner, the ability of caregivers to provide evidence-based and appropriate nutrition and health knowledge is crucial to provide a significant contribution to the nutrition knowledge of patients and people of the community [24,29].

As the burden of nutrition-related diseases remains and continues to rise, it is imperative to study the current nutritional knowledge among caregivers as they are providing trusted information to the public. In the United Arab Emirates (UAE) NCDs account for 77% of all deaths [30]. Despite the promising potential of improving the nutrition knowledge and practices of caregivers on improving the health of CSHCN, the literature on the subject remains scarce. The present study aims to assess the nutrition knowledge of caregivers working in health and education centers for CSHCN in Sharjah, United Arab Emirates (UAE).


Study design and participants

A descriptive cross-sectional study was conducted in Sharjah, UAE between October 2017 and January 2018 to assess the nutritional knowledge among caregivers and educators. The target population included a convenience sample of caregivers and educators of children with special needs working at Sharjah City for Humanitarian Services (SHCS) during the study period. SCHS is a local non-profit organization founded in 1979 as a branch of the Arab Family Organization in the Gulf region to develop the social services for the Arab family needs [31]. A total of 233 subjects agreed to participate in the study.

A web link connecting to the online survey was shared with the caregivers at SHCS who agreed to participate in the study. The link was distributed using e-mail invitations through the institution’s internal emailing system. Participation was voluntary and the subjects were free to withdraw at any time. No monetary incentives were provided for participation and no personal identification data was collected. An information sheet was provided on the first page of the online survey explaining the objective of the study and only consenting participants proceeded to the questions.

The study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the Research Ethics Committee at the University of Sharjah (REC-22-03-22-S) and the SCHS institution management. An electronic informed consent was obtained from all participants.

Survey questionnaire

A modified version of the General Nutrition Knowledge Questionnaire (GNKQ) was adopted to measure nutrition knowledge [32]. The GNKQ is a self-administrated, reliable, and validated questionnaire and was previously used to assess general nutrition knowledge in the UK, Australia, and Ireland [33],[34],[35],[36]. Minor modifications were made to the original questionnaire to adjust for the UAE population in terms of commonly consumed foods [37]. For example, Quiche (pie crust filled with eggs) was replaced with Balaleet (eggs and vermicelli) which is a commonly consumed breakfast dish in the UAE. Moreover, some items were omitted to further fulfill the objectives of the study (mainly those related to nutrition knowledge about pork and alcohol as they are banned in the Emirate of Sharjah) resulting in a maximum score of 84 compared to 110 in the original version [32].

The questionnaire was translated to Arabic and reviewed by the research team for any discrepancies between the English and Arabic versions. A pilot test was conducted on 25 subjects before commencing the study. Based on the results of the pilot test, minor changes in wording were incorporated to ensure understandability and feasibility. The pilot test data was not included in the analysis. A master key was developed by a panel of six nutrition experts with a consensus on the correct answer to each question. The survey was then prepared on Google Forms in Arabic.

The questionnaire comprised of four main sections, dietary guideline recommendations (section A); nutrients content of foods (section B); everyday food choices (section C), and links between diet and disease (section D). Socio-demographic characteristics including gender, age group, nationality, level of education, marital status, number of children, and perceived health status were also collected. Altogether, a total of eighty-four items were used to assess nutrition knowledge and the scores were distributed over four sections: Section A (nine items: fifteen points); section B (ten items: thirty-five points); section C (thirteen items: thirteen points); and section D (sixteen items: twenty-one points). Correct responses from each section were added to give a section score, and the four section scores were summed to give an overall knowledge score. Participants answered different types of question styles, including multiple-choice, yes/no, or agree/disagree. The internal consistency of the GNKQ scale was assessed using Cronbach’s alpha test for each section and it was determined as follows: dietary guideline recommendations 0.81; nutrients content of foods 0.8; everyday food choices 0.79; and links between diet and disease 0.82.

Statistical analyses

Descriptive statistics for the sociodemographic characteristics and frequency of correct responses were reported as counts and percentages. A chi-square test was used to determine the association between different categorical variables. Means and standard deviation (SD) were used for continuous variables. A 70% cutoff was used to determine the level of knowledge as adequate (above 70%) or inadequate (below 70%) for each component of the questionnaire [38]. Total and sub-scores were calculated based on the total number of correct answers. Total knowledge scores were derived for each participant based on the sum of correct answers to all questions which can range between 0 and 84. Moreover, sub-scores were calculated for each section of the questionnaire. Knowledge sub-scores can range between 0 and 15 (Section A), 0 and 35 (Section B), 0 and 13 (Section C) and 0 and 21 (Section D). Higher scores indicate a higher level of knowledge. Differences between knowledge scores were determined using an independent t-test and a one-way ANOVA test. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) ver. 26·0 (IBM, Chicago, IL, USA). Results were significant for p-value < 0.05.


Sociodemographic characteristics

A total of 233 caregivers participated in the study. Key sociodemographic characteristics of the study participants are summarized in [Table 1]. The majority of participants were between 31 and 40 years old. The male to female ratio was 1:3 (25.3% males). As shown in the table, most participants were of non-GCC Arabian nationalities (72.5%), married (81.5%), had no children (25.8%), and completed a bachelor’s degree (76.4%). Of the 233 participants, less than 10% had nutrition-related qualifications.{Table 1}

Dietary guideline recommendations

The proportion of participants with correct answers to the first section of the GNKQ is shown in [Table 2]. This section covered dietary recommendations by experts and participants’ related knowledge. Correct responses to expert recommendations on foods to be increased or decreased in the diet ranged from 52.8% to 88.4%. Most participants were aware of unhealthy foods they need to cut down on such as sugary foods (88.4%), fatty foods (83.3%), salty foods (77.2%), and processed meat (74.2%). Moreover, they were aware of the need to consume higher amounts of water (86.7%) and vegetables (83.3%), however, a lesser proportion was recorded in foods such as fruits (64.4%) and high fiber foods (52.8%). No significant difference between males and females was recorded. Interestingly, only 10% of the participants were aware of the minimum number of servings of fruits and vegetables to consume. About half of the participants recognized experts’ recommendations to consume reduced-fat dairy products and cut down on saturated fat with more females answering correctly compared to males (p=0.014, p=0.047 respectively). The vast majority of participants answered correctly with regards to consuming breakfast daily (93.6%). As for the components of My Plate, less than half of the participants were aware of the proper proportion of starchy food on the plate (46.8%) with a significantly higher percentage of females answering correctly (p=0.002).{Table 2}

Nutrients content of foods

[Table 3] shows participants’ results on sources of nutrients and food groups. The knowledge level in this section ranged from 10.3% to 94.4%. Adequate knowledge was reported on foods high or low in certain nutrients. These included foods low in added sugar such as breast milk (85.8%) and melon (78.1%), foods high in added sugar such as ice cream (85.4%), and ketchup (76.8%) which was significantly higher among females (p=0.001). Moreover, the majority of participants correctly identified breakfast cereals as low in sodium (76.8%), canned soup as high in sodium (79.4%), oats as a high fiber source (85.4%), poultry as a high protein source (91.8%), pasta and potato as starchy foods (92.3% and 94.4%, respectively), and cheese and nuts as non-starchy foods (83.7% and 72.1%, respectively). Nonetheless, inadequate knowledge level was evident in few nutrient sources’ food items, such as less than two-thirds of participants identified cheese, baked beans, and nuts as good sources of protein. A similar proportion identified white rice, eggs, and pasta as low-fiber food sources.{Table 3}

Everyday food choices

[Figure 1] shows the proportion of participants answering correctly when asked to choose healthy everyday foods. Correct responses ranged from 18% to 79.4%. An adequate level of knowledge was recorded in choosing the healthiest sandwich option (75.5%) and soup option (76.8%). However, a low level of knowledge was found with regards to awareness of high vitamin and antioxidant-containing vegetables (25.3%) and the best alternative to chips (15.0%). Females reported adequate knowledge with significantly higher correct responses compared to males in choosing the healthy dessert option (42.0%), lowest fat option soup (78.7%), and choosing herbs as the best salt substitute (67.2%, p=0.030). Participants were asked to read provided nutrition food labels for two different products. Only 18% of the participants were able to answer correctly when asked to identify the higher caloric content of two given products.{Figure 1}

Diet-disease relationship

The last section of the questionnaire included questions on the diet-disease relationship and weight management. [Table 4] shows that general awareness was adequate regarding high blood pressure and high sodium diets (79.4%) and bowel disease and low fiber diets (71.7%). Nonetheless, a moderate level of knowledge was recorded in terms of tooth decay and high sugar diets (67.5%) and low levels of knowledge with regards to the consumption of animal fat and high blood cholesterol (48.9%). More than two-thirds of participants were aware of the role of reducing fat consumption and its relation to preventing heart disease. However, only a third of participants correctly associated reducing red meat with the prevention of cancer and reducing refined foods with diabetes. Participants’ perception of common misperceptions about weight management was also assessed in this section. The majority of participants thought that to maintain a healthy weight they should cut down fat completely (60%), consume high protein diets (90.6%) and that bread consumption causes weight gain (73.8%). However, about two-thirds perceived the positive effects of consuming fiber in weight management. [Figure 2] shows the proportion of participants answering correctly on selected recommendations for a healthy weight. Over 80% of participants correctly identified refraining from eating while watching TV and monitoring eating with females answering more correctly (p=0.012 and p=0.024, respectively). Besides, the majority of participants thought that weight monitoring and reading food labels help them maintain a healthy weight (86.7% and 85.8%, respectively). However, less than half of the participants knew that taking supplements and grazing throughout the day are ineffective in maintaining a healthy weight.{Table 4} {Figure 2}

Demographic variation in nutrition knowledge

[Table 5] indicates the association of total scores and sub-scores with different sociodemographic characteristics. The mean nutrition knowledge score for all participants was 46.30 ± 10.36 (55.1%) out of the highest possible score. Overall, total knowledge did not differ between different ages, however, participants who were 31 years and above were more aware of the diet-disease relationship and weight management section (P = 0.005). Females answered more correctly in all sections of the questionnaire compared to males, however, only they were more significantly aware with regards to choosing everyday food (P = 0.025). Moreover, participants who reported having four children and nutrition-related qualifications had a significantly higher level of awareness with regards to nutrient sources and diet-disease associations (P = 0.010, 0.037 and P = 0.012, P = 0.030) respectively and had significantly higher total knowledge scores (P = 0.006 and P = 0.014) respectively. In contrast, the nutrition knowledge score was not significantly associated with marital status, level of education, and nationality.{Table 5}


To the best of our knowledge, this study is the first to evaluate the level of nutrition understanding among caregivers and health workers of children with special needs using a validated questionnaire in the UAE. The General Nutrition Knowledge questionnaire used in the current study has been used in previous studies to assess nutritional knowledge among members of the healthcare team, people in the community, and athletes. The General Nutrition Knowledge questionnaire provides a useful and reliable scale to assess nutrition knowledge and its relation to dietary practices [32].

Results indicated that only half of our study participants had adequate knowledge in all areas concerned including ‘experts’ advice’, ‘nutrient sources’, ‘choosing everyday foods’, and ‘diet-disease relationship’. These findings were similar to kindergarten teachers in China [39] and lower than scores reported for Australian nurses, [40] Canadian public nurses [41] and American rural nurses [42]. Similar findings were reported among schoolteachers [11] and workers in Ireland [43]. The low level of knowledge in the current study may reflect low interest, lack of education, or lack of perceived importance of general nutrition in their lives and jobs. These results highlight the need to target this group through nutrition education programs and the messages included to be adjusted for their level of knowledge.

Although participants had low nutrition knowledge, it is worth mentioning that basic dietary knowledge of participants such as eating more fruits and vegetables was better compared to more detailed information about applying this knowledge and making sound food choices. For instance, basic knowledge of the need to increase fruit and vegetable consumption was good but participants lacked the knowledge of how many servings to consume daily or which vegetables contain the most antioxidants and vitamins. This was comparable to other studies among university students and staff in Sharjah and adults in Australia [37,44].

There are growing rates of metabolic disorders among the Arab population that are primarily influenced by sedentary lifestyle habits and adoption of unhealthy dietary habits such as low intake of fruits and vegetables, high consumption of energy-dense fast foods, eating away from home, and frequent snacking [45],[46],[47]. Furthermore, it was recently reported that unhealthy lifestyle and eating behaviors along with physical inactivity were exacerbated among residents of the Middle East and North Africa region (MENA) and the UAE during the COVID-19 pandemic [48],[49],[50]. Therefore, it became of the utmost importance to develop public health campaigns that support individuals in making healthier lifestyle choices via modern technology such as social media.

Consistent results of an inadequate awareness or usage of dietary guidelines regarding food groups and portion sizes as only half of the participants were aware of how much starch should contribute to their plate following My Plate guidelines. Similar results were found in agreement with our study among Saudi mothers, where half of the sample correctly identified food groups on the My Plate image [51]. It was found that awareness of such guidelines was positively associated with better and healthier dietary intakes [52]. Also, only one in five participants manifested good basic food label reading skills which are considered very low and indicate insufficient knowledge about food labels. Evidence shows that among multiple types of food labels, front-of-package labels and traffic lights labels were most successful in helping shoppers make healthier food choices [53]. This indicates the need for more education and proper reading on food labels for better food options.

Diet-disease knowledge among study participants varied from low to moderate although this area has received much attention in research [54],[55],[56]. In the current study, the awareness of the relationship between low fiber intake and bowel disorders, sodium and high blood pressure, and low-fat diet and heart diseases was satisfactory. These findings are alarming as there has been a long-standing body of research and community education about the implications of such dietary habits [56,57]. A critical finding is the poor understanding of the association between sugar and tooth decay among the participants who are health care providers for people with special needs. Knowing that lack of self-care for oral hygiene among the children will let them prone to developing abnormal oral conditions and tooth decay, especially with the presence of insufficient support from their parents and guardians [58,59]. Including the topic of food-related oral health among other nutrition and diet-disease prevention education sessions will be a need topic for the health care providers.

Weight management encompasses numerous controversies and false claims about dieting, weight loss, and maintenance and is a topic of debate among researchers, dietitians, healthcare professionals, and the general public [60]. The findings of this study indicated an alarmingly low level of knowledge concerning the most common weight management facts. Nonetheless, participants were better informed about general recommendations for a healthy weight such as refraining from eating while watching Tv and practicing food labels reading. Optimal strategies identified for weight loss and management include creating a healthy calorie deficit, focusing on the type of food, and meal timing [60],[61],[62]. Therefore, emphasis should be put on finding creative ways to provide valid and reliable information to prevent any misconceptions and misunderstandings related to weight loss and maintenance.

This study showed a demographic variation in nutrition knowledge levels. Findings show that females were more knowledgeable compared to males in all sections of the questionnaire although they were more aware of choosing healthy food options than males. This can be explained by the fact that women are generally more concerned about dietary recommendations and health and consequently have a better knowledge level [63],[64],[65]. Moreover, older age was associated with a better level of knowledge where people who were 40 years+ scored better than any other age group. This may indicate that educators and health workers gain knowledge and acquire better dietary habits with experience [41,66]. Acquiring reliable nutrition information is essential in making informed food choices and motivating healthier eating habits.


In conclusion, the present study assessed the level of general nutrition knowledge in caregivers and health workers for children with special needs and revealed that their level of knowledge needs improvement. The findings of the study suggest the necessity to improve knowledge, provide more reliable nutrition information detailed nutritional information and particularly focus on the practical aspect of applying this knowledge to choosing healthier options and maintaining healthy body weight. This could be achieved by assigning a nutritionist to SHCS centers to provide periodic nutrition education to staff, children, and their families.

Moreover, it is imperative to implement nutrition-centered educational interventions to target this population as their level of knowledge has a profound impact on the children, they take care of. Future research needs to recruit larger numbers of educators and caregivers with equal representation to provide a better understanding of their knowledge and design proper intervention strategies that eventually pour in the benefit of the children they are responsible for.

Study limitations

The present research has acknowledged limitations. Firstly, the use of self-reported online questionnaires may have attributed to under or over-reporting. Also, the convenient sampling approach used may have potentially reduced the representativeness of the group. Lastly, the sample may not be completely representative as the questionnaire was filled by more females than males consequently overestimating the true level of awareness in this group. Nonetheless, the study has multiple strengths including the use of the GNK questionnaire as this tool successfully identified gaps in nutrition knowledge concerning dietary behavior and identified the aspects that need further education. Besides, this study provides important insight as there are no available data to date assessing the nutritional knowledge among this group.

Authors’ contributions

LCI, TMO, HH, and MH conceived the research concept. LCI, TMO, RRSO, ASA, and MH developed the research design. LCI, TMO, SAQ, HK, RAD, RAR, and MH performed fieldwork and data analysis. MNM and STS conducted data analysis. LCI, SAQ, MNM, STS, and HS prepared the first draft and all reviewers reviewed and approved the final draft of the manuscript. All authors are responsible for the contents and integrity of this manuscript.

Ethical statement

The study protocol was approved by the Research Ethics Committee at the University of Sharjah and the SCHS institution management (March 2019).

Declaration of patient consent

An electronic informed consent was obtained from all participants before taking part in the research study.

Financial support and sponsorship

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


1Edwards L, Leafman JS Perceptions of gastrostomy buttons among caregivers of children with special health care needs. J Pediatr Health Care 2019;33:270-9.
2Ptomey LT, Wittenbrook W Position of the Academy of Nutrition and Dietetics: Nutrition services for individuals with intellectual and developmental disabilities and special health care needs. Journal of the Academy of Nutrition and Dietetics 2015;115:593-608.
3Ogata BWHaBMT. Nutrition for children with special health care needs. In: Coulston AM, Boushey CJ, Ferruzzi M, editors. Nutrition in the Prevention and Treatment of Disease. 4 ed. San Diego, CA: Academic Press; 2017. p. 273-97.
4Lockner DW, Crowe TK, Skipper BJ Dietary intake and parents’ perception of mealtime behaviors in preschool-age children with autism spectrum disorder and in typically developing children. J Am Diet Assoc 2008;108:1360-3.
5Sullivan PB, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford feeding study. Dev Med Child Neurol 2000;42:674-80.
6Williams KE, Seiverling L Eating problems in children with autism spectrum disorders. Top Clin Nutr 2010;25:27-37.
7Adams JB, Audhya T, McDonough-Means S, Rubin RA, Quig D, Geis E, et al. Nutritional and metabolic status of children with autism vs. Neurotypical children, and the association with autism severity. Nutr Metab (Lond) 2011;8:34.
8Enoch A, Mprah WK, Owusu I, Bediako J Role of caregivers of children with intellectual disabilities and support systems available to them in Ghana. Disability, CBR & Inclusive Development 2018; 28:80-95.
9Lopez C, Corcoran T Relationships with special needs students: Exploring primary teachers’ descriptions. International Journal of Inclusive Education 2014;18:1304-20.
10Kaschalk E, Foland E, Fly A P99 improved self-efficacy and nutrition knowledge among Indiana high school teachers after training in and implementation of a new nutrition curriculum. J Nutr Educ Behav 2020;52:S63.
11Katsagoni CN, Apostolou A, Georgoulis M, Psarra G, Bathrellou E, Filippou C, et al. Schoolteachers’ nutrition knowledge, beliefs, and attitudes before and after an E-learning program. J Nutr Educ Behav 2019;51:1088-98.
12Sunguya BF, Poudel KC, Mlunde LB, Urassa DP, Yasuoka J, Jimba M Nutrition training improves health workers’ nutrition knowledge and competence to manage child undernutrition: A systematic review. Front Public Health 2013;1:37.
13Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu C, et al; Lancet Early Childhood Development Series Steering Committee. Early childhood development coming of age: Science through the life course. Lancet 2017;389:77-90.
14Rocha HAL, Sudfeld CR, Leite ÁJM, Rocha SGMO, Machado MMT, Campos JS, et al. Adverse childhood experiences and child development outcomes in ceará, brazil: A population-based study. Am J Prev Med 2021;60:579-86.
15 WHO. Improving early childhood development: WHO Guideline WHO Guidelines Approved by the Guidelines Review Committee. Geneva: World Health Organization; 2020.
16Galler JR, Bringas-Vega ML, Tang Q, Rabinowitz AG, Musa KI, Chai WJ, et al. Neurodevelopmental effects of childhood malnutrition: A neuroimaging perspective. Neuroimage 2021;231:117828.
17Hurtado EK, Claussen AH, Scott KG Early childhood anemia and mild or moderate mental retardation. Am J Clin Nutr 1999;69:115-9.
18Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG Iron deficiency and cognitive achievement among school-aged children and adolescents in the united states. Pediatrics 2001;107:1381-6.
19Soleimani N, Abbaszadeh N Relationship between anaemia, caused from the iron deficiency, and academic achievement among third grade high school female students. Procedia Soc Behav Sci 2011;29:1877-84.
20Sharif Y, Sadeghi O, Dorosty A, Siassi F, Jalali M, Djazayery A, et al. Association of vitamin D, retinol and zinc deficiencies with stunting in toddlers: Findings from a national study in iran. Public Health 2020;181:1-7.
21Fadhil I, Belaila B, Razzak H National accountability and response for noncommunicable diseases in the United Arab Emirates. Int J Noncommun Dis 2019;4:4.
22WHO. Diet, nutrition and the prevention of chronic diseases: Report of a joint WHO/FAO expert consultation. Geneva: World Health Organization; 2002.
23Shlisky J, Bloom DE, Beaudreault AR, Tucker KL, Keller HH, Freund-Levi Y, et al. Nutritional considerations for healthy aging and reduction in age-related chronic disease. Adv Nutr 2017;8:17-26.
24Subratty AH, Heesambee YB, Jowaheer V, Doreemiah N Nutritional knowledge of a heart-healthy diet among health care professionals and cardiac patients in Mauritius. Nutr Food Sci 2002;32:184-9.
25WHO. Globalization, Diets and Noncommunicable Diseases. Geneva: World Health Organization; 2003.
26Aggarwal M, Devries S, Freeman AM, Ostfeld R, Gaggin H, Taub P, et al. The deficit of nutrition education of physicians. Am J Med 2018;131:339-45.
27Hunt JR, Kristal AR, White E, Lynch JC, Fries E Physician recommendations for dietary change: Their prevalence and impact in a population-based sample. Am J Public Health 1995;85:722-6.
28Truswell AS Family physicians and patients: Is effective nutrition interaction possible? Am J Clin Nutr 2000;71:6-12.
29Murray S, Narayan V, Mitchell M, Witte H Study of dietetic knowledge among members of the primary health care team. Br J Gen Pract 1993;43:229-31.
30WHO. Noncommunicable diseases progress monitor 2022. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
31SHCS. Sharjah City for Humanitarian Services Homepage UAE2014 [cited 2021 8 Feb]. Available from: [Last accessed on 12 Dec 2021].
32Parmenter K, Wardle J Development of a general nutrition knowledge questionnaire for adults. Eur J Clin Nutr 1999;53:298-308.
33Hendrie GA, Cox DN, Coveney J Validation of the General Nutrition Knowledge Questionnaire in an Australian community sample. Nutr Diet 2008;65:72-7.
34Kliemann N, Wardle J, Johnson F, Croker H Reliability and validity of a revised version of the general nutrition knowledge questionnaire. Eur J Clin Nutr 2016;70:1174-80.
35Putnoky S, Banu AM, Moleriu LC, Putnoky S, Șerban DM, Niculescu MD, et al. Reliability and validity of a general nutrition knowledge questionnaire for adults in a romanian population. Eur J Clin Nutr 2020;74:1576-84.
36O’Brien G, Davies M Nutrition knowledge and body mass index. Health Educ Res 2007;22:571-5.
37Attlee A, Abu Qiyas S, Shaker Obaid R Assessment of nutrition knowledge of a university community in Sharjah, united Arab emirates. Malaysian Journal of Nutrition 2014;20:327-37.
38Biddle RE How to set cutoff scores for knowledge tests used in promotion, training, certification, and licensing. Public Personnel Management 1993;22:63-79.
39Liu H, Xu X, Liu D, Rao Y, Reis C, Sharma M, et al. Nutrition-related knowledge, attitudes, and practices (KAP) among kindergarten teachers in Chongqing, China: A cross-sectional survey. Int J Environ Res Public Health 2018;15.
40Schaller C, James EL The nutritional knowledge of australian nurses. Nurse Educ Today 2005;25:405-12.
41Sabry JH, Hedley MR, Kirstine ML Nutrition applications in public health nursing: A survey of needs and preferences of public health nurses for continuing education in nutrition. Can J Public Health 1987;78:51-6.
42Lindseth G Nutrition preparation and the geriatric nurse. West J Nurs Res 1994;16:692-703.
43Geaney F, Fitzgerald S, Harrington JM, Kelly C, Greiner BA, Perry IJ Nutrition knowledge, diet quality and hypertension in a working population. Prev Med Rep 2015;2:105-13.
44Hendrie GA, Coveney J, Cox D Exploring nutrition knowledge and the demographic variation in knowledge levels in an australian community sample. Public Health Nutr 2008;11:1365-71.
45Hajat C, Shather Z Prevalence of metabolic syndrome and prediction of diabetes using Idf versus Atpiii criteria in a middle east population. Diabetes Res Clin Pract 2012;98:481-6.
46Henry CJK, Lightowler HJ, Al-Hourani HM Physical activity and levels of inactivity in adolescent females ages 11–16 years in the United Arab Emirates. American Journal of Human Biology 2004;16:346-53.
47Malik M, Razig SA The prevalence of the metabolic syndrome among the multiethnic population of the United Arab Emirates: A report of a national survey. Metab Syndr Relat Disord 2008;6:177-86.
48Cheikh Ismail L, Osaili TM, Mohamad MN, Al Marzouqi A, Jarrar AH, Abu Jamous DO, et al. Eating habits and lifestyle during COVID-19 lockdown in the United Arab Emirates: A cross-sectional study. Nutrients 2020;12:3314.
49Radwan H, Al Kitbi M, Hasan H, Al Hilali M, Abbas N, Hamadeh R, et al. Indirect Health Effects of COVID-19: Unhealthy Lifestyle Behaviors during the Lockdown in the United Arab Emirates. International Journal of Environmental Research and Public Health 2021;18:1964.
50Cheikh Ismail L, Osaili TM, Mohamad MN, Al Marzouqi A, Jarrar AH, Zampelas A, et al. Assessment of eating habits and lifestyle during the coronavirus 2019 pandemic in the Middle East and North Africa region: A cross-sectional study. British Journal of Nutrition 2020 ;126:757-66.
51Hakim N, Alsini N, Kutbi H, Mosli R, Eid N, Mulla UZ Knowledge status of dietary guidelines and portion sizes in Saudi Arabian mothers; A cross-sectional study. J Food Nutr Res 2020;8:716-21.
52Schwartz JL, Vernarelli JA Assessing the public’s comprehension of dietary guidelines: Use of mypyramid or myplate is associated with healthier diets among Us adults. J Acad Nutr Diet 2019;119:482-9.
53Temple NJ Front-of-package food labels: A narrative review. Appetite 2020;144:104485.
54Boeing H Nutritional epidemiology: New perspectives for understanding the diet-disease relationship? Eur J Clin Nutr 2013;67:424-9.
55Harrison S, Couture P, Lamarche B Diet quality, saturated fat and metabolic syndrome. Nutrients 2020;12:3232.
56Heileson JL Dietary saturated fat and heart disease: A narrative review. Nutr Rev 2020;78:474-85.
57Tuli DM, Gangasani DA, Khurshid DA, Manchikalapudi DJ, Kadhiwala DP, Patel DJ, et al. Knowledge of parents about multi-level influences on oral hygiene practice’s in pediatric patients: A qualitative research. Saudi J Med 2020;05:248-52.
58Liu Z, Yu D, Luo W, Yang J, Lu J, Gao S, et al. Impact of oral health behaviors on dental caries in children with intellectual disabilities in guangzhou, china. Int J Environ Res Public Health 2014;11: 11015-27.
59Uwayezu D, Gatarayiha A, Nzayirambaho M Prevalence of dental caries and associated risk factors in children living with disabilities in rwanda: A cross-sectional study. Pan Afr Med J 2020;36:193.
60Soeliman FA, Azadbakht L Weight loss maintenance: A review on dietary related strategies. J Res Med Sci 2014;19:268-75.
61Kim JY Optimal diet strategies for weight loss and weight loss maintenance. J Obes Metab Syndr 2020;30:20-31.
62Doucet E, Hall K, Miller A, Taylor VH, Ricupero M, Haines J, et al. Emerging insights in weight management and prevention: Implications for practice and research. Appl Physiol Nutr Metab 2021;46:288-93.
63Heaney S, O’Connor H, Michael S, Gifford J, Naughton G Nutrition knowledge in athletes: A systematic review. Int J Sport Nutr Exerc Metab 2011;21:248-61.
64Arganini C, Saba A, Comitato R, Virgili F, Turrini A. Gender differences in food choice and dietary intake in modern western societies. In: Maddock J, editor. Public Health - Social and Behavioral Health. New York: InTech; 2012.
65Azizi M Nutrition knowledge, the attitude and practices of college students. Phys Educ Sport Phys Educ Sport 2011;9:349-57.
66Deroover K, Bucher T, Vandelanotte C, de Vries H, Duncan MJ Practical nutrition knowledge mediates the relationship between sociodemographic characteristics and diet quality in adults: A cross-sectional analysis. Am J Health Promot 2020;34:59-62.