School Nutrition Programs Research Articles

Health and Grades: Nutrition Programs for Kids in Canada

La version francaise de cet article peut etre consultee a: http://ssrn.com/abstract=3352611. In many parts of Canada and around the globe, elementary and high-school students gain access to nutritious foods via school-based student nutrition programs. Funded by governments, corporations, foundations and the public, these programs are designed to ensure school-age children have access to the necessary nutrition they need to learn. Canada is the only G7 nation without a national student nutrition program. This Commentary investigates the potential short-and long-term impacts of student nutrition programs, including their relation to student performance and health and whether a government-supported and universal national student nutrition program should be established, including in targeted communities. It investigates the potential short- and long-term effects of student nutrition programs through rigorous assessment of available studies from Canada and other developed nations and analysis of the effects of a school nutrition program in Toronto. Although policies supporting student nutrition programs in some countries go back nearly a century, there is a rather surprising lack of consensus in existing research about their effects. School nutrition programs have multiple objectives: ensure children consume enough quality energy, minimize the percentage of food-insecure children through free or subsidized meals and improve nutrition and overall health. How SNPs meet these objectives may put achieving individual goals at odds. With diverse objectives and disparate methodologies and metrics deployed to assess their impact, and with program structures differing from country-to-country, the lack of consensus in the literature becomes understandable. These challenges and the paucity of credible evidence about the long-term effects of nutrition programs overall, led us to investigate the design of the programs themselves. The fundamental goal of school nutrition programs is to feed hungry children. There is quite strong evidence of the benefits of eating breakfast over not doing so, but evidence of the effect of breakfast programs in terms of wider goals of student performance and health is, mixed and inconclusive. Moreover, the success of any nutrition program depends on the logistics and execution of the program. These insights lead us to conclude that: • Providing a healthy breakfast is an effective measure to improve academic performance and cognitive functioning among undernourished populations. The long-term effects of eating breakfast on the performance of school children who do not have physical signs of severe undernourishment are less certain. • At the same time, there is a lack of statistically significant evidence that nutrition programs improve overall learning ability or school attendance in high-income countries. • There are persistent challenges in provisioning high-quality student nutrition programs, many of which stem from inconsistent access to the necessary resources. The temptation to expand a program to cover more students at the expense of improving the program for those already receiving it should be resisted. Scaling a nutrition program that does not meet nutritional standards consistently or that suffers from systemic operational challenges almost certainly would be of little benefit to students generally. Instead, the program should remain targeted at the most at-risk children, who are most likely to benefit, until it is functionally scalable. • To balance the need for universal access while also keeping the program targeted, priority should be given to schools in neighbourhoods with a high percentage of households on social assistance or with low incomes. If a school does have a nutrition program, it should be available to all children within the same peer groups (classes or grades), not restricted to children in need.

Integrated delivery of school health interventions through the school platform: Investing for the future.

School health and nutrition (SHN) programmes are recognized as a significant contributor to both health and education sector goals. The school system offers an ideal platform from which to deliver basic health interventions that target the most common health conditions affecting school-age children (SAC) in low-income countries, leading to improved participation and learning outcomes. However, governments require evidence to cost, design, and implement these programmes. In Ethiopia, prevalent health conditions affecting SAC's education participation and learning outcomes include infection with soil-transmitted helminths (STHs), hunger, and malnutrition. In recognition of the multiple issues affecting the health and education of SAC, the government has taken a proactive approach, coordinating an integrated SHN programme designed to be implemented in partnership and monitored and financed through a single, integrated mechanism. The programme, known as the Enhanced School Health Initiative (ESHI), integrates three complimentary health interventions: deworming; school feeding; and provision of a water, sanitation, and hygiene (WASH) package in schools, which in delivery aim to maximize the benefits of each of the individual components. Operational research surrounding the ESHI programme includes both qualitative and quantitative analyses. Here, we present an overview of the ESHI programme and its genesis. We also introduce three additional supporting papers that provide in-depth analyses of key findings, including the baseline situational analysis, the costs, and community perceptions of the programme. The findings from ESHI provide initial evidence to develop an understanding of the related costs and synergies of integrating multiple health interventions onto a single platform. The work has translated into strengthened institutional capacity and improved cross-sectoral coordination. The government is now committed to supporting 25 million school children in Ethiopia through SHN. The ESHI model serves as a reference point for other countries looking to scale up targeted SHN interventions.

A Quantitative Assessment of the Nutritional Value of the Food for the School Nutrition Programme in KwaZulu-Natal Province, South Africa

The aim of the study was to determine the nutritional value of the food for the school nutritional programme in one district in KwaZulu-Natal Province. A positivist research paradigm and a quantitative research approach were used in the study. Furthermore, a cross-sectional research design was utilized. The quantitative data was analysed using SPSS and Excel and was presented in texts and tables. The study found that the average daily intake per learner from the school nutrition programme was 218 Kcal energy, 7.7g of protein, 1.8g of fat and 3.2g of dietary fibre. These were all below 30% of RDA values. The observed mean protein, energy and vitamin K intakes per child per day were significantly lower than the expected mean intake for the nutrients. Intakes of other nutrients were within the limits of the prescribed amounts according to the menu quantity schedule.There were variations in the nutrient intake among learners in different schools due to inconsistent supply of food items by service providers.

Public policies of food and nutrition in Brazil: From Lula to Temer

ABSTRACT Objective To analyze public policies on food and nutrition in Brazil, with emphasis on the last fifteen years (2003-2018). Methods Historical-documentary analysis based on a bibliographical survey on indexed bases and exploratory visits to websites of government agencies. Results The scientific and governmental findings were organized according to the Lula, Dilma and Temer governments. They explore the development of several public policies and welfare programs in food and nutrition, focusing mainly on Brazilian Hunger Eradication Program, Assistance for Needy Families Program, National Policy on Food and Nutrition Security, Food Acquisition Program, National School Nutrition Program, National Food and Nutrition Security Policy, National Food and Nutrition Surveillance System and Brazilian Misery Eradication Program. The centrality of the idea of the fight against hunger and misery in public policies during Lula’s first and second terms and Dilma’s first term stand out. Dilma’s second term is marked by the focus on healthy eating, as well as presenting the first signs of fragilization of public policies on food and nutrition. Currently, the Temer government is characterized by processes of institutional and programmatic rupture, budget cuts and setbacks in acquired rights. There is evidence of the need to activate national and international instruments to enforce the human right to adequate food and consequent strengthening of public policies on food and nutrition. Conclusion This period presents an expansion and qualification of public policies on food and nutrition, mainly in the Lula and Dilma administration, with setbacks in the Temer administration, in which continuous budget cuts weaken social, hunger reduction, poverty reduction and food and nutrition security policies.

Prevalence and Factors Associated with Overweight and Obesity among Adolescents in Schools in Benin in 2016

Introduction Overweight and obesity are considered to be global public health concerns. The objective was to estimate the prevalence of overweight and obesity and the associated factors. Methods This was a cross-sectional study conducted in 2016 and involving 3968 adolescents of 10 to 19 years from 40 secondary schools in Benin. Participants were selected using a 2-level random sampling technique. Data were collected through a self-administered questionnaire and were analyzed using Epi Info and Stata softwares. Associated factors were investigated by a logistic regression. Results Mean age was 16.54 ± 0.04 years and sex ratio was 1.16. The prevalence of overweight was 8.1% and that of obesity was 1.6%. Associated risk factors were female gender, sedentary lifestyle, consumption of sugary and carbonated beverages. Consumption of fruits and vegetables, regular physical activity, age over than 15 years were protective factors. Conclusion Overweight and obesity among school adolescents are increasing in Benin. The establishment of a school nutrition program and the promotion of regular physical activity should contribute to reducing their prevalence.

Child Nutrition Programs in Kindergarten Schools Implemented by the Governmental Sector and Global Nutrition Consulting Companies: A Systematic Review

Child Nutrition Programs in schools are considered one of the best approaches towards improving diet and health. Yet it is considered a newly developed approach to be applied in Saudi Arabia. According to the ministry of health, under nutrition and obesity both are increasing in Saudi Arabia, due to various factors, which include both diet and environmental factors associated with schools and home environments. We have chosen a descriptive study to describe Child Nutrition Programs run by governmental sectors in United States and United Kingdom, in addition to global nutrition consulting companies in different countires, which included India and Singapore. The objectives of this review is to demonstrate successful Child Nutrition Programs approaches, strategies, tools, marketing plans and resources targeting pupils, parents, teachers and schools staff. Thus, this review supports implementing Child Nutrition Programs in Saudi Arabia, by choosing the most suitable strategies to improve child health and nutrition.

The Impact of Canadian School Food Programs on Children's Nutrition and Health: A Systematic Review.

The quality of children's diets has declined over the past few decades, giving rise to a variety of health-related consequences. In response to this trend, school food programs have become an increasingly effective method to support nutrition and lifelong healthy eating habits. This systematic review synthesizes current academic literature pertaining to school nutrition programs in Canada to identify existing interventions and their impacts on children's nutritional knowledge, dietary behaviour, and food intake. The review was conducted through a search of the following databases: ERIC, Education Source, CINAHL, PubMed, SagePub, SCOPUS, EMBASE, and CBCA. Information extracted from the articles included the program objectives, intervention design and components, research evaluation, and primary outcomes. A total of 11 articles evaluating Canadian school nutrition programs were identified. The programs incorporated a variety of intervention components including policy, education, family and community involvement, and/or food provision. These multi-component interventions were positively associated with children's development of nutrition knowledge, dietary behaviour changes, and intake of healthy foods; however, barriers associated with intervention duration, intensity, and availability of resources may have influenced the extent to which these programs impacted children's diets and overall health.

Prevalence and factors associated with stunting and thinness among school-age children in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia.

IntroductionDespite consistent economic growth in the country, malnutrition remains one of the major public health problems in Ethiopia. The prevalence of malnutrition and its associated factors are well studied among under-five children. However, there is a paucity of evidence among older children in developing countries including Ethiopia. The aim of the study was to assess the prevalence of stunting and thinness and their associated factors among school-age children.MethodsA community-based cross-sectional study was conducted among randomly selected 389 school-age children in Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia, during April and May 2017. Height for age and body mass index for age z scores were calculated using WHO Anthro Plus software as indicators of stunting and thinness respectively. A binary logistic regression model was used to assess the association between independent and outcome variables.ResultsThe prevalence of stunting and thinness were 41.9% (95% CI: 37–47) and 8.0% (95% CI: 5.4–10.8) respectively. The likelihood of stunting was significantly higher among children within the age group of 12–14 years old (AOR = 2.97, 95% CI: 1.78–4.95); children who were male (AOR = 1.94, 95% CI: 1.21–3.10); children living in households with medium wealth terciles (AOR = 2.90, 95%CI: 1.39–6.04); and children who were non-enrolled in schools (AOR = 2.25, 95% CI: (1.37–3.70). Moreover, thinness was 63% less common among children who had a dietary diversity score of <4 food groups (AOR = 0.37, 95%CI: 0.16–0.89).ConclusionThe prevalence of thinness is low when compared to the prevalence reported by a single national school health and nutrition survey in Ethiopia. Stunting is a major public health concern. Therefore, this finding warrants the need to implement school health and nutrition programs to improve the nutritional status of school-age children in the study area. The interventions should focus towards both gender and special emphasis should also be given to increase the enrollment of children in schools. In addition, effort should be taken by stakeholders in different hierarchies to improve the family wealth status.

Management of school nutrition programmes to improve environmental justice in schools: a South African case study

Objective: The objective of this study was to determine how school principals and nutrition coordinators see their roles in the management of school nutrition programmes for learners from disadvantaged communities.Design: In this qualitative study, a single case study design was used to collect data through open-ended questionnaires, follow-up interviews and field notes.Subjects and setting: Principals and nutrition coordinators at five primary schools and three secondary township schools in Alexandra.Results: The findings highlight the importance of school nutrition programmes in contributing to a healthy learning environment. Principals and nutrition coordinators were clear about their management roles and responsibilities in the programme. The biggest challenges were the work overload of nutrition coordinators, a lack of training and inadequate food delivery.Conclusion: Based on the findings, the study recommends the implementation of a training programme for school principals and nutrition coordinators on time and human resource management to assist them in balancing teaching time and the management of food handlers, the appointment of a nutrition coordinator and collaboration with non-government organisations, volunteers and businesses to assist schools. Finally, this study reveals that the struggle for environmental justice to address shortage of nutritious food to feed needy learners remains valid and that school nutrition programmes, if managed properly, can make a crucial contribution in this regard.

Prevalence and predictors of under-nutrition among school children in a rural South-eastern Nigerian community: a cross sectional study

BackgroundSchool children in developing countries like Nigeria are faced with numerous nutrition and health problems. Lack of functional school health and nutrition programmes in Enugu state, Nigeria may be associated with dearth of data on associated factors. Identifying these factors could inform the design and implementation of school-based programmes aimed at ameliorating these problems.MethodsA cross sectional survey involving 450 primary and secondary school children aged 6–15 years was conducted in Ede-Oballa, a rural community in Enugu state, South-eastern Nigeria. Selection of the pupils was by multistage sampling technique. Data were collected through interviewer administered questionnaire, anthropometric measurements of weight and height, 3-day weighed food intake, stool microscopy and blood analyses for malaria, zinc and vitamin A. Bivariate and multivariate logistic regression analyses were used to evaluate associations of interest with significance accepted at P < 0.05.ResultsThe school children were affected by underweight (18.2%), stunting (41.6%), thinness (20.0%), zinc (43.3%) and vitamin A (51.1%) deficiencies. After adjusting for potential confounders, weekly food expenditure was a major predictor of under-weight (AOR = 0.19, 95% CI: 0.08, 0.46), stunting (AOR = 0.36, 95% CI: 0.13, 0.95) and thinness (AOR = 0.49, 95% CI: 0.30, 0.80); household income was also a predictor of thinness (AOR = 0.47, 95% CI: 0.25, 0.88). Males had lower odds of being stunted than females (AOR = 0.31, 95% CI: 0.11, 0.83). The odd of being underweight was higher in female headed households than in households headed by males (AOR = 0.30, 95% CI: 0.12, 0.75). Tapeworm was an independent predictor of vitamin A (AOR = 3.59; 95% CI: 1.06, 12.13) and zinc (AOR = 3.64; 95% CI: 1.02, 12.98) deficiencies. Children with whipworm were more likely to be zinc (AOR = 3.80; 95% CI: 1.11, 13.04) and vitamin A (AOR = 3.79; 95% CI: 1.12, 12.89) deficient than those uninfected.ConclusionUnderweight, stunting, thinness, vitamin A and zinc deficiency among the school children were functions of weekly food expenditure, gender of household head and household income, tapeworm, whipworm, and sex. These findings emphasize the need for effective school- and community-based interventions.

Effectiveness of a School Nutrition Program for Preventing Iron Deficiency Anemia in School Children

Effectiveness of a School Nutrition Program for Preventing Iron Deficiency Anemia in School Children

Risk factors for disordered weight control behaviors among Korean adolescents: Multilevel analysis of the Korea Youth Risk Behavior Survey.

To investigate the prevalence and risk factors for disordered weight control behaviors (DWCB) in South Korean adolescents at multiple levels, including individual, family, school, and geographic area. We drew participants from the 11th Korea Youth Risk Behavior Web-based Survey, conducted in 2015, with 65,529 adolescents (31,687 girls, 33,842 boys) aged 12-18 years. DWCB was defined as engaging in any of the following behaviors for weight control over the past month: fasting, one-food diet (eating only one food over an extended period of time for weight control), vomiting, and taking laxatives/diuretics/unprescribed diet pills. Sex-stratified four-level multilevel logistic models examined potential predictors of DWCB, including age, body-mass index, puberty, perceived household economic status, parental education, living structure, school type and sex-composition, percentage of students participating in school nutrition programs, and urbanicity. Overall, 6.2% of Korean adolescents (8.9% of girls, 3.7% of boys) exhibited any DWCB. We found significant between-school variation among girls and boys and between-classroom variation among girls. Older age, overweight/obesity, pubertal maturity, high household economic status (vs. mid-range economic status), and vocational schooling (vs. general) were positively associated with DWCB among girls and boys. Low household economic status (vs. mid-range economic status), higher parental education, and coeducational schooling (vs. single-sex) were positively associated with DWCB among girls only. The findings suggest that DWCB are prevalent among Korean adolescents across age, sex, and socioeconomic status. Social contextual factors including school and familial environmental factors, as well as individual characteristics, should be considered when developing effective prevention strategies.

Why and How Schools Make Nutrition Education Programs "Work".

There are many potential health benefits to having nutrition education programs offered by expert outside sources in schools. However, little is known about why and how schools initiate, implement, and institutionalize them. Gaining this understanding may allow the impact and reach of nutrition and other health education programs in schools to be extended. A total of 22 school community members from 21 purposefully selected New York City public elementary schools were interviewed using a semistructured interview protocol about their schools' experiences initiating, implementing, and institutionalizing nutrition education programs. Interviews were audiotaped and transcribed. Chronological narratives were written detailing each school's experience and passages highlighting key aspects of each school's experience were identified. These passages (N = 266) were sorted into domains and themes which were regrouped, resorted, and adjusted until all researchers agreed the domains and themes represented the collective experiences of the schools. The interviews elicited 4 broad domains of action: building motivation, choosing programs, developing capacity, and legitimizing nutrition education. Within each domain, themes reflecting specific actions and thoughts emerged. The identified domains of action and their themes highlight specific, practical actions that school health advocates can use to initiate, implement, and institutionalize nutrition education programs in schools.

Effect of the Strong4Life School Nutrition Program on Cafeterias and on Manager and Staff Member Knowledge and Practice, Georgia, 2015.

The goal of the Strong4Life School Nutrition Program is to promote healthy eating in school cafeterias in Georgia by training school nutrition managers and staff members to implement changes in the cafeteria to nudge children to make healthier choices. The objective of our study was to evaluate program effect on (1) school nutrition manager and staff member knowledge of evidence-based strategies and their self-efficacy to make positive changes, (2) the school cafeteria environment, and (3) National School Lunch Program participation. We assessed changes in participant knowledge, beliefs, and self-efficacy by administering a survey before and after training (February-July 2015); a follow-up survey (3 school months posttraining) assessed changes in the cafeteria. A total of 842 school nutrition managers and staff members were trained and completed pre- and posttraining surveys; 325 managers completed the follow-up survey. We used cafeteria records from a subsample of the first schools trained (40 intervention and 40 control) to assess National School Lunch Program participation. From pretraining to posttraining, we found a significant increase in manager and staff member (n = 842) knowledge of strategies for enhancing taste perception through the use of creative menu item names (from 78% to 95%, P < .001) and understanding that food placement in the lunch line influences food selection (from 78% to 95%, P < .001), and in their self-perceived ability to influence the cafeteria environment (from 91% to 96%, P < .001). From pretraining to 3-month follow-up, managers (n = 325) reported increased use of evidence-based serving strategies: visibility (from 84% to 96% for placing healthy options in >2 locations, P < .001), convenience (from 63% to 84% for placing plain milk in front of other beverages, P < .001), sell (from 25% to 38% for branding healthy items with stickers, P < .001), price (from 17% to 27% for using bundle pricing to encourage sales, P < .001), and taste (from 77% to 85% for signage demonstrating the benefits of healthy eating, P = .01). National School Lunch Program participation did not change significantly. Training cafeteria managers and staff members in Smarter Lunchrooms Movement techniques may be an effective way to make changes in the school cafeteria environment to encourage healthier choices among students. Additional studies allowing time for more complex changes to be implemented are needed to assess the full effect of the program.

How effective are family-based and institutional nutrition interventions in improving children\u2019s diet and health? A systematic review

BackgroundEffective strategies to improve dietary intake in young children are a priority to reduce the high prevalence of chronic non-communicable diseases in adulthood. This study aimed to assess the impact of family-based and school/preschool nutrition programs on the health of children aged 12 or younger, including the sustainability of these impacts and the relevance to socio-economic inequalities.MethodsA systematic review of literature published from 1980 to December 2014 was undertaken. Randomised controlled trials involving families with children aged up to 12 years in high income countries were included. The primary outcomes were dietary intake and health status. Results were presented in a narrative synthesis due to the heterogeneity of the interventions and outcomes.ResultsThe systematic search and assessment identified 39 eligible studies. 82% of these studies were set in school/preschools. Only one school study assessed the impact of involving parents systematically. The family-based programs which provided simple positive dietary advice to parents and regular follow-up reduced fat intake significantly. School and family-based studies, if designed and implemented well, increased F&V intake, particularly fruit. Effective school-based programs have incorporated role-models including peers, teachers and heroic figures, rewards and increased access to healthy foods. School nutrition programs in disadvantaged communities were as effective as programs in other communities.ConclusionsFamily and school nutrition programs can improve dietary intake, however evidence of the long-term sustainability of these impacts is limited. The modest overall impact of even these successful programs suggest complementary nutrition interventions are needed to build a supportive environment for healthy eating generally.

Incorporating orange-fleshed sweet potato into the food system as a strategy for improved nutrition: The context of South Africa

Orange-fleshed sweet potato (OFSP) is considered the single most successful example of biofortification of a staple crop, and presents a feasible option to address vitamin A deficiency. Though initially promoted as part of a crop-based approach focusing on production and consumption at household level, it evolved into small-scale commercial production, predominantly in Sub-Saharan Africa. This paper reviews OFSP initiatives in relation to the South African food environment and food supply systems, also identifying opportunities for scaling out OFSP in a situation where sweet potato is not eaten as a staple. Current per capita consumption of sweet potato is low; the focus is thus on increasing consumption of OFSP, rather than replacing cream-fleshed varieties. For the major OFSP variety, Bophelo, 66g consumption can be sufficient to meet the recommended daily allowance for 1–3year old children (300μRE vitamin A). Despite a national Vitamin A supplementation programme and fortified staple foods in South Africa, 43.6% of children under 5years of age were reported to be vitamin A deficient in 2012, indicating a stronger need to promote the consumption of Vitamin A-rich foods, such as OFSP. To increase availability of and access to OFSP, all aspects of the food supply system need to be considered, including agricultural production, trade, food transformation and food retail and provisioning. Currently, small-scale commercial OFSP producers in South Africa prefer to deliver their produce to local informal markets. To enter the formal market, small-scale producers often have difficulties to meet the high standards of the retailers' centralised procurement system in terms of food quality, quantity and safety. Large retailers may have the power to increase the demand of OFSP, not just by improving availability but also by developing marketing strategies to raise awareness of the health benefits of OFSP. However, currently the largest scope for scaling out is through a number of public sector programmes such as the National School Nutrition Programme, Community Nutrition and Development Centres, Small-holder Farmer programmes and Agriparks. Though the major approach is focused on unprocessed, boiled OFSP, there are unexploited opportunities for processing of OFSP. However, the nutritional quality of products should be a main consideration within the context of the co-existence of undernutrition, overnutrition and micronutrient deficiencies in the country.

Michigan School Nutrition Programs Team Nutrition Smarter Lunchroom Initiative

Michigan School Nutrition Programs Team Nutrition Smarter Lunchroom Initiative

School nutrition program about fruits and its impact on knowledge, fruit preference and fruit intake in 8–10 year old Slovak children

IntroductionFruit plays an important role in the prevention of various diseases. Eating fruit in Slovak children is not entirely adequate. Nutrition programs include the possibility of improving children's eating habits. Study designNon-randomized controlled trial. AimTo create a nutrition education program, implement it and analyze its effectiveness on children's eating habits. MethodologyThe school nutrition program was focused on fruit and fruit intake for health. We assessed the knowledge level of fruit, fruit preference and fruit intake in an intervention and control group. Before the nutrition program children reported their home availability of fruit, and fruit model (parent/teacher/friend as a model of fruit intake). We used Chi-square test, t-test, and analysis of covariance (ANCOVA). SampleThe research enrolled 136 children aged 8–10 years (M=8.67, SD=0.55). The school nutrition program has been accomplished in 68 children (intervention group), the control group consisted of 68 children. ResultsWe found a higher level of knowledge (p=0.000) and higher fruit preference (p=0.001) in the intervention group. The fruit intake in the intervention and control group was similar (M=7.51 vs. M=6.74, p=0.059). There is not a significant effect of the nutrition program on the frequency of eating fruits in children after controlling for the effect of covariate – “fruit availability” [F(1.133)=3.254, p=0.074], but the program has a significant effect on the frequency of fruit eating in children after controlling for the covariate – “parent as a fruit model” [F(1.133)=5.033, p=0.027] and “teacher as a fruit model” [F(1.133)=4.071, p=0.046]. ConclusionParents and teachers play an important role in supporting the effectiveness of a nutrition program and the modification of children eating habits.

Horizontal schools-based health programme in rural Kenya

BackgroundPrimary school children in low-income countries are at risk of many diseases and poor health affects attendance, cognition and ability to learn. Developing school health and nutrition strategies has been...

School nutrition programs and policies, dietary intake, and obesity: The Healthy Communities Study

The study objective was to examine the association between the school nutrition environment and children's dietary intake and weight status in an observational sample of 5,138 U.S. children ages 4–15 years recruited from 130 communities in the Healthy Communities Study. The study includes information obtained on school characteristics (school participation in state and federal nutrition programs, school wellness committee and coordinator, and district food‐related school wellness policies), measurements of children's dietary practices (dietary screener and dietary behaviors related to child obesity), and measured child height and weight to calculate BMI z‐score. Hierarchical statistical models were generated to relate school nutrition policies and programs to dietary outcomes and BMI z‐score, adjusted for individual‐level covariates (e.g., child race/ethnicity, household income, maximum parent education, maximum parent employment), community covariates (e.g., region, minority status, urbanicity), and school and community level clustering. Children in schools where wellness committees were more active, i.e. met at least once in the past year, compared to children in schools where wellness committees were less active, i.e. met less than once per year, children had 0.10 lower BMI z‐scores (95% CI: −0.17, −0.02; P=0.02) and consumed breakfast on 0.14 more days/week (95% CI: 0.02, 0.25; P=0.02). Schools with farm to school programs compared to schools without such programs had children with a lower frequency of intake of energy dense foods by −0.19 times/day (95% CI: −0.33, −0.05; P=0.01). The presence of the USDA's Team Nutrition Initiative also was associated with an increase in children's intake of 0.14 servings/day of fruits and vegetables (95% CI: 0.00002, 0.14; P=0.05) compared to schools that did not have the program. In pair‐wise comparisons (at a 5% procedure‐wise error rate), schools with wellness committees that met more than once in the past year compared to schools with wellness committees that did not meet, children had significantly lower added sugar intake (−0.78 tsp/day) and significantly lower sugar intake from sugar‐sweetened beverages (−0.43 tsp/day). Overall, improved child diet and weight outcomes were found when schools had an active wellness committee, involvement in a farm to school program, and/or participated in the USDA's Team Nutrition Initiative.Support or Funding InformationSupported by: NHLBI #1K01HL131630 and RWJF HER #73272.