Food perceptions and breakfast choices among school-age children and parents in southern Peru: A cross-sectional study using projective techniques

Peru's school feeding program applies largely uniform menus across regions with very different food cultures, yet little is known about how children and parents in these regions represent food. This cross-sectional study compared food perceptions and breakfast choices among school-age children (10-12 years) and their parents in five cities of southern Peru (Arequipa, Cusco, Moquegua, Puno and Tacna). Three projective techniques were applied: free drawing and a sorting task with 600 children from public primary schools (120 per city), and a breakfast composition task with 576 parents. Drawings were analyzed by correspondence analysis, sorting data by DISTATIS, and the cognitive salience index (CSI) was calculated for the foods selected by parents. Of the 1,023 foods depicted, 62.7% were healthy foods, 21.8% ultra-processed foods and 15.5% traditional dishes; the share of ultra-processed foods was highest in Tacna (36.6%). Children clearly distinguished healthy from unhealthy foods: fruits were classified as healthy and liked, ultra-processed foods as liked but unhealthy, and broccoli, beans, almonds and nuts as healthy but disliked. In the breakfast task, bread, oats and eggs were the most salient foods in most cities, whereas quinoa reached the highest CSI in Puno (0.39) compared with 0.11 – 0.23 in the other cities. Native foods such as quinoa and tarwi appeared mainly in the Andean cities of Cusco and Puno. These findings reveal marked regional differences in food representations and support adapting school menus to regional food preferences.