Well-nourished Children Research Articles

Antioxidant Status and Insulin-Dependent Diabetes Mellitus(IDDM).

The aim of this study was to examine changes in primary and secondary antioxidant defense system in children with insulin-dependent diabetes mellitus (IDDM). A total of 59 children (age range: 3 months 15 years) living in Cairo, Egypt were recruited. Twenty-four of these subjects had type-I diabetes (IDDM); they were admitted at the Abo-Elrish Hospital, Cairo. Thirty-five healthy well-nourished children were recruited from the local community, and used as controls. The antioxidant status of the study population was determined by measuring copper-zinc superoxide dismutase (Cu-Zn SOD) in red blood cells, glutathione peroxidase (GPX) in whole blood, and total antioxidant status (TAS) as well as ceruloplasmin and albumin in plasma. In addition, the plasma levels of trace elements involving antioxidant activities, such as copper (Cu), zinc (Zn), selenium (Se), and iron (Fe) were determined, along with a select group of vitamins. The latter included ascorbic acid, α-tocopherol and retinol. Plasma levels Se, Zn, and Cu were significantly higher in diabetic patients than in control subjects, while the mean plasma levels of albumin, ceruloplasmin, vitamin E, and vitamin C as well as Cu-Zn SOD activity in red blood cells, were significantly lower in IDDM patients than in their non-diabetic counterparts. No significant differences in plasma concentrations of TAS, vitamin A. retinol binding protein (RBP), and Fe as well as whole blood GPX activity were observed between the diabetic patients and control subjects. The plasma glucose level was inversely correlated with SOD and GPX. Overall, children with IDDM and persistent hyperglycemia are characterized by a decreased antioxidant defense system compared with health controls.

Interrelationships among Food Intake, Somatic Traits, and Physical Fitness in 10.5- to 15.5-Year-Old Children From Eastern Poland

The aim of the study was to establish the relationships between energy intake and dietary quality with somatic variables and physical fitness. Energy intake and nutrition quality were assessed from 24-hr dietary recall questionnaires, and physical fitness was measured by applying the EIROFIT tests. Interrelationships between all those variables (simple, partial, and multiple correlation coefficients) were computed from standardized values. The somatic and physical fitness variables related more strongly on the nutrition quality than on the energy intake. Well-nourished children were taller, heavier, and more physically fit than the poorly nourished ones. We believe that dietary quality affected physical fitness indirectly by influencing somatic development. Energy intake did not contribute significantly to the total variance of the physical fitness factor.

Epidemiological study of dental caries.

A total of 2000 children (1-14 year age group) attending pediatric OPD, school clinic & well body clinic of Dr. R.N. Cooper Municipal Hospital & K.E.M Hospital, Mumbai were examined for caries prevalence and 35.6% had dental caries. Parental income was not shown to have any bearing on caries prevalence. Parental literacy, particularly maternal literacy was shown to influence caries prevalence in children. The prevalence was low in well-nourished children and in those taking vegetarian type of diet. Frequency of sweet consumption was shown to be associated with prevalence of dental caries. In 1-4 year age group it was noted that bottle fed children were more affected by dental caries. Tooth brush with paste was the commonest method used for cleaning their teeth in all age groups in our study. Caries prevalence was low in those children using tooth brush than in those using tooth powder. Those children who were using neem datun were found to be less affected with dental caries. Dental caries was also found to be low in those who rinsed their mouth with water after food.

Relation of anthropometry to malaria morbidity and immunity in Papua New Guinean children

The interaction between malnutrition and malaria is complex and there is evidence that malnutrition decreases the susceptibility to malaria. To investigate the relation between anthropometric measurements and subsequent malaria morbidity and to examine whether the effect observed was due to interaction with host immunity, we followed for 1 y a cohort of 136 children aged 10 to < 120 mo in Wosera, East Sepik Province, Papua New Guinea. At baseline, 21% were stunted, 10% were wasted, and 5% were both stunted and wasted. After adjustment for age and use of bed nets, height-for-age z score (HAZ) at baseline predicted the number of clinical episodes of falciparum malaria during the following year: incidence rate increased with increasing HAZ. Humoral responses to specific malarial antigens were lowest in the wasted children. The prevalence of lymphoproliferative responders was not significantly different between well-nourished and undernourished children. In contrast, the prevalence of cytokine producers was higher in the undernourished than in the well-nourished children. Our findings support the view that stunting but not wasting protects against falciparum malaria. The mechanism may be related to an improved ability of malnourished children to produce certain cytokines in response to stimulation by specific malarial antigens.

The effect of live measles vaccines on serum vitamin A levels in healthy children.

Serum retinol levels have been shown to be depressed during measles infection. This study aims to demonstrate whether there is any decrease in serum vitamin A level following immunization with live viral vaccine and its relation with vaccine seroconversion in children with measles. Since many children receive measles vaccine alone or in combination with measles-mumps-rubella vaccine, we studied serum vitamin A levels and antibody levels in healthy, well-nourished children before and after immunization with monovalent and combined live attenuated measles vaccine. The first group included 21 healthy children between the ages of 9-11 months who received live measles (Schwarz) vaccine. There were also 21 healthy children (range 14-20 months of age) who received measles-mumps-rubella Trimovax (Pasteur Merieux) vaccine. All children were tested for serum vitamin A levels before vaccination, on days 9-14 and 30-42 following both vaccinations. Measles specific antibody levels were also measured on admission and 30-42 days following vaccinations. In both vaccination groups, mean serum vitamin A levels reduced significantly on days 9-14, but increased slightly on days 30-42 in the measles-mumps-rubella vaccinated group (P < 0.05). The baseline and follow-up levels of mean serum vitamin A did not differ between seroconverted and nonseroconverted cases within the measles vaccinated group. Serum vitamin A levels are reduced following vaccination with monovalent and combined live attenuated measles vaccines.

Impaired dietary lipid oxidation in kwashiorkor

Energy substrate oxidation studies were performed on 12 kwashiorkor children and five well-nourished children fed on a standard recovery diet for kwashiorkor. 13C labeled leucine, Glucose, and hiolein were administered orally on three consecutive days. The recovery of 13C from the breath air was monitored after administration of each feed. The mean cumulative percent dose (CUMPD) recovery of 13C seven hours after the ingestion of labeled leucine was 22.0 ± 1.7% (mean ± SEM) for the kwashiorkor children as compared to 32.7 ± 3.7% for the well-nourished children (p<0.05). The CUMPD recovery of 13C 12 hours after ingestion of labeled glucose was 58.3 ± 4.7% as compared to 70.2 ± 6.0% in the well-nourished children (p<0.05). The CUMPD recovery of 13C 16 hours after the ingestion of labeled hiolein was 4.8 ± 1.1% for the kwashiorkor children as compared to 19.0 ± 2.1% for the well-nourished children (p<0.0001). 13C recovery following hiolein ingestion was inversely correlated to the weight/expected weight for age and sex ratio (r = −0.93; p< 0.001). It is concluded that the well-nourished children oxidize more exogenous energy substrate than do the kwashiorkor children, and that the kwashiorkor children have a grossly impaired capacity to oxidize exogenous lipids.

Mothers prolong breastfeeding of undernourished children in rural Senegal.

Breastfeeding, when prolonged beyond infancy, is a risk factor for low nutritional status in most cross-sectional samples from less developed countries. Therefore, it has been suggested that prolonged breastfeeding impairs growth. To test whether, on the contrary, breastfeeding is prolonged because the child is already undernourished, nutritional status prior to weaning was compared according to age at weaning. Precise dates of birth and weaning were collected weekly through continuous demographic surveillance in a rural area of Senegal. Weight and length at 9-10 months were measured during vaccination sessions (coverage: 78%) from 1989 to 1996. Eight infants weaned before 9 months were excluded, and the duration of breastfeeding of the remaining 4515 children was compared according to nutritional status at 9-10 months by survival analysis. Length-for-age during infancy was associated with duration of breastfeeding: the median duration was 25.0 months for z-scores <-2, 24.1 months for z-scores -2 to -1, 23.4 months for z-scores -1 to 0 and 22.7 months for z-scores >0 (P for trend <0.0001). Weight-for-length during infancy was also associated with duration of breastfeeding (P for trend <0.0001), though the differences among groups were smaller. The relationships remained at the same significance levels after adjustment for season of birth, mother's age, parity, height, occupation and education. Duration of breastfeeding is not determined by characteristics of the mothers only. Women prolong breastfeeding for undernourished children and reduce the duration for well-nourished children, probably because they are aware of the mortality risk following weaning.

Breakfast and cognition: an integrative summary

In this supplement, the papers presented at the International Symposium on Breakfast and Performance in Napa, CA in 1995 are summarized and integrated with data published since that time. In particular, the focus is on issues of research design, measurements, mechanisms, potential effect modifiers (eg, age), and relevance for public policy. No definitive conclusions can be drawn from the existing data on either the long- and short-term benefits of breakfast on cognition and school learning or the mechanisms that mediate this relation. The pooled data suggest that omitting breakfast interferes with cognition and learning, an effect that is more pronounced in nutritionally at-risk children than in well-nourished children. At the very least, breakfast consumption improves school attendance and enhances the quality of the students' diets.

Measles and malnutrition.

1. Peter R. Belamarich, MD* 1. 2. *Albert Einstein College of Medicine Jacobi Medical Center Bronx, NY 1. Measles in Kenyan Children . O’Donovan C. East Afr Med J . 1971;48:536-542 [OpenUrl][1] 2. Malnutrition and Immunity . Puri S, Chandra RK. In: Grand RJ, Sutphen JL, Dietz WH, eds. Pediatric Nutrition . 1987:433-443 Butterworths Boston, Mass 3. Cellular Immunity and T-Lymphocyte Subsets in Young Children with Acute Measles . Dagan R, Phillip M, Sarov I, Skibin A, Epstein S, Kuperman O. J Med Virol . 1987;22:175-182 [OpenUrl][2][PubMed][3][Web of Science][4] 4. Malnutrition and Overcrowding/Intensive Exposure in Severe Infection: Review of Community Studies . Aaby P. Rev Infect Dis . 1988;10:478-491 [OpenUrl][5][PubMed][6][Web of Science][7] “Count your children after the measles has passed.”—Arabic Proverb Measles is a major cause of childhood morbidity and mortality worldwide. Case fatality rates of 5% to 25% are common in developing countries in contrast to the less than 1% case fatality rate in the United States during the epidemic of 1989 to 1990. In the developing world, epidemiologic factors associated with severe measles include younger age, overcrowding, poor access to care, pre-existing medical conditions, and malnutrition. Because these factors frequently coexist in the developing world, the relative contribution of each to measles morbidity is unclear. However, malnutrition has been implicated most markedly and repeatedly. It had been suspected that malnutrition increased the morbidity and mortality of childhood measles as early as 1885 by Drinkwater, who investigated an epidemic in Sunderland, England, that had an unusually high case fatality rate of 10%. He attributed this finding to “semi-starvation among the poor.” Drink-water’s hunch has been supported by a number of other workers on different continents who have found higher fatality rates among malnourished children who have measles. For example, O’Donovan analyzed measles mortality among 507 hospitalized children … [1]: {openurl}?query=rft.jtitle%253DEast%2BAfr%2BMed%2BJ.%26rft.volume%253D48%26rft.spage%253D536%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: {openurl}?query=rft.jtitle%253DJournal%2Bof%2Bmedical%2Bvirology%26rft.stitle%253DJ%2BMed%2BVirol%26rft.aulast%253DDagan%26rft.auinit1%253DR.%26rft.volume%253D22%26rft.issue%253D2%26rft.spage%253D175%26rft.epage%253D182%26rft.atitle%253DCellular%2Bimmunity%2Band%2BT-lymphocyte%2Bsubsets%2Bin%2Byoung%2Bchildren%2Bwith%2Bacute%2Bmeasles.%26rft_id%253Dinfo%253Apmid%252F2956361%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [3]: /lookup/external-ref?access_num=2956361&link_type=MED&atom=%2Fpedsinreview%2F19%2F2%2F70.atom [4]: /lookup/external-ref?access_num=A1987H623900008&link_type=ISI [5]: {openurl}?query=rft.jtitle%253DReviews%2Bof%2Binfectious%2Bdiseases%26rft.stitle%253DRev%2BInfect%2BDis%26rft.aulast%253DAaby%26rft.auinit1%253DP.%26rft.volume%253D10%26rft.issue%253D2%26rft.spage%253D478%26rft.epage%253D491%26rft.atitle%253DMalnutrition%2Band%2Bovercrowding%252Fintensive%2Bexposure%2Bin%2Bsevere%2Bmeasles%2Binfection%253A%2Breview%2Bof%2Bcommunity%2Bstudies.%26rft_id%253Dinfo%253Apmid%252F3287570%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/external-ref?access_num=3287570&link_type=MED&atom=%2Fpedsinreview%2F19%2F2%2F70.atom [7]: /lookup/external-ref?access_num=A1988M696500028&link_type=ISI

Low Levels of Linoleic Acid in Plasma Total Lipids of HIV-1 Seropositive Children

Objective: To assess the plasma fatty acid status of a group of well-nourished children with the human immunodeficiency virus type-1 (HIV-1) and how this relates to the blood total CD4+ lymphocyte count.Subjects: Fourteen HIV-1 seropositive children at various stages of disease and with adequate growth indices were assessed and compared to a control group of 30 healthy children.Results: The concentrations (mg/dL) of plasma total fatty acids were not different between the two groups. HIV-1 seropositive children presented lower levels of 18-C essential polyunsaturated fatty acids (PUFA: linoleic acid, LA, and alpha-linolenic acid) and higher levels of their 20-C long-chain derivatives (di-homo-γ-linolenic acid, arachidonic acid, AA, and eicosapentaenoic acid) and docosahexaenoic acid in their plasma total lipids. The lowest plasma LA levels were observed in the subgroup of patients with more advanced stages of disease. In bivariate analyses the plasma LA levels related positively (Spearman r=0.50, p=0.06), while the LA/AA ratio related negatively (Spearman r=−0.51, p=0.06), to the total CD4+ count.Conclusions: Childhood HIV-1 infection is associated with changes in plasma fatty acid profile suggestive of an increased PUFA turnover. Decreased levels of LA (together with higher plasma AA levels) appear to be associated with more advanced clinical and biochemical stages of disease.

Analysis of mitomycin C-induced micronuclei in lymphocytes from malnourished infected children.

The purpose of this study was to determine if peripheral blood lymphocytes from malnourished children with gastrointestinal or respiratory bacterial infection show increased frequencies of Mitomycin C (MMC)-induced micronuclei as compared to well-nourished, infected children. The results indicate that cells from malnourished, infected children had greater chromosome damage. This may indicate that such children would be more susceptible to environmental damage and malignant transformation. Micronucleus frequencies were analyzed in binucleate cells produced by the cytokinesis block method; the overall micronucleus frequency was significantly higher in binucleate cells from malnourished, infected children. The mean micronucleus frequency in MMC-free cultures was 4.3/1000 in malnourished infected children and 1.0/1000 in well-nourished infected children. In MMC-exposed cultures the mean induced micronucleus frequency was 32.6 +/- 6.1 vs. 12.9 +/- 2.3; 68.6 +/- 12.1 vs. 21.0 +/- 5.1, and 88.1 +/- 16.2 vs. 41.7 +/- 5.0 for malnourished and well-nourished children at 20, 40, and 60 ng/ml MMC, respectively. The number of binucleated cells with more than one micronucleus was also higher in malnourished, infected children at all doses tested, including cells with two micronuclei in MMC-free cultures from malnourished, infected children. This increase was not found in peripheral blood lymphocytes from well-nourished infected children.

A Comparative Study Of Wellnourished And Malnourished Under-Five Clinic Attenders: Risk Factors And Caregiver Psychosocial Functioning

Abstract We studied the sociodemographic variables and the psychosocial functioning of caregivers of 14 malnourished and nine well-nourished under-five clinic attenders in a poor peri-urban community, situated 30 km from the centre of Cape Town. Malnourished compared to well-nourished children had significantly lower mean birth weights and a higher prevalence of tuberculosis. Statistically significant determinants identified in the biological mothers of the malnourished group were inferior anthropometric status, poor education, a lower mean family income and single parenthood. Caregivers of malnourished children had significantly less social support, less stable relationships with their partners, poor selfesteem and negative perceptions of their children. These findings have implications for future nutrition intervention strategies.

Comparison of seroconversion rates between well-nourished and malnourished children after measles immunization at nine months of age

The study was based on activities developed at Embu, SP, between October 1989 and June 1990. Its purpose was to study serological turning after child vaccination against measles at the age of nine months. Two groups were compared, both within the same age limits. Group number I included eutrophic children and group number II included undernourished children. Gomes criteria was used to evaluate the childreńs nutritional state. Antibodies (AB) dosage was done through hemagglutination inhibition (HI) and ELISA. These two laboratory methods were also checked regarding its sensibility. Out of 130 children studied, 80 could be evaluated. From this total, 56 (70%) belonged to group I and 24 (30%) belonged to group II. When the ELISA method was used, a significantly higher seroconversion percentage (P < 0.05 or 5%) was found among children belonging to group II. This percentage was not detected when the HI method was used.

ABSTRACT

This article addresses the unsettled controversy about the use of iron in the treatment of children with malnutrition. Although many malnourished children are iron-deficient, there are at least two reasons why oral iron may be detrimental: 1) low levels of transferrin are common in such children which decreases the absorption of oral iron, thus promoting the growth of intestinal bacteria; and 2) iron that is absorbed, but which remains unbound, is converted from the ferrous to the ferric state and becomes an aggressive and potentially damaging free oxygen radical. The authors used the bleomycin assay to quantify the free or loosely bound iron in 50 children with kwashiorkor and compared this data with that found in six children with marasmus and 12 well-nourished children. Nonprotein-bound iron was found in 58% of the children with kwashiorkor, but in none of the others. Many children who are malnourished are deficient in micronutrients, such as vitamins A and E, zinc, and glutathione, which serve as free oxygen scavengers. An imbalance in free radicals and their scavengers results in tissue damage and potentially increases the morbidity and mortality in these precarious children. If the finding of these investigators is substantiated, it will add credence to the argument advising caution in respect to oral iron therapy in children with kwashiorkor.

6 LACTOBACILLUS REUTERI EFFECTIVELY COLONISES Gl TRACT AND SHORTENS ACUTE DIARRHOEA IN CHILDREN

Lactobacillus reuteri is a commonly occurring lactobacillus species in the gastrointestinal tract of humans, which has not previously been used as a therapeutic agent. This study sought to find out if exogenous administration of L. reuteri would inhibit the overgrowth of pathogenic bacteria and promote clinical recovery from acute diarrhoea. In a randomised, double-blind study 40 well-nourished children 6 to 36 months of age, hospitalised for acute diarrhoea during the rotavirus season, received either 1010 to 1011 CFU of L. reuteri SD 2112 or a matching placebo once a day for the duration of hospital stay. Cultures of stool samples demonstrated that L. reuteri administration resulted in colonisation of Gl tract in all recipients. Concomitantly, urease activity of stools remained low in L. reuteri recipients, but increased in those receiving placebo. The mean (SD) duration of watery diarrhoea after commencing the therapy was 1.7 (SD 1.6) days in L. reuteri group and 2.9 (SD 2.3) days in placebo group (p=0.07). On the second day of treatment only 26% of patients receiving L. reuteri had watery stools, as compared with 81% of those receiving placebo (p=0.0005). The corresponding figures on the third day of treatment were 11% and 53% (p=0.004). The results of the present study indicate that exogenously administered L. reuteri shortens the duration of acute diarrhoea in children. The therapeutic effect can be achieved by once a day administration which results in high level colonisation of Gl tract. If confirmed, the results may give rise to a new effective and practical probiotic agent for management of paediatric diarrhoea.

Pyomyositis in Babies Presenting with Painful Hip: Clinical and Radiographic Course of Two Cases

Two cases of pyomyositis in babies, one in the ilio-psoas muscle, the other in the quadriceps, are reported. The presenting sign was a painful hip in both, suggesting osteomyelitis of the proximal femur or arthritis. Pyomyositis is unusual in western countries and in healthy, well-nourished children, but these cases suggest considering this pathology in the differential diagnosis of a painful hip in babies. In the first case an upper respiratory tract infection was followed by haematogenous spread to the ilio-psoas muscle; in the second an injection of vaccine in the quadriceps played a determinant role. The latter case was complicated by secondary osteomyelitis; a metaphyseal radiolucent band just below the growth plate appeared in the early stage together with metaphyseal osteopenia and was interpreted as a consequence of altered blood flow in the metaphysis, not specific osteomyelitis, but indicative of some disturbance of the growth plate-metaphyseal complex.

Psychosocial Aspects of Mothers of Malnourished and Well-Nourished Children

In order to determine whether differences in sociopsychological environment and related factors exist between malnourished and well-nourished children, a study on 126 underfive children was carried out in Bogor, West Java, Indonesia. The children were grouped into severely malnourished, mild-moderately malnourished, and well-nourished children. Each group consisted of 42 children, and they were selected from the same surrounding which have fairly same housing condition, age, and sex. Differences were found between the three groups on parent's education, the birth order of the child, the expenditure per capita, and breast feeding history. However, there was no significant difference on knowledge about health and nutrition, mother and child relationship. It was observed that children who were never breastfed had a tendency to be severely or moderately malnourished. The mother who were doing only household chores were worried about the future of their children; on the other hand, the mothers who have more contact with community (monthly welfare movement meethings, and other activities homes) have a tendency to have well nourished children. The proposed hypothesis that mother and child interaction affects the leved of the nutritional status of the children requires more testing in a more comprehensive study.

Does serum albumin/phospholipid index better reflect overall protein status in man?

Serum albumin concentration is a commonly used, but inadequate index of protein status in man. A study of serum lipid changes in malnourished children reported a progressive increase in serum phospholipid concentration with deterioration of protein status in the children. This led us to assess the usefulness of serum albumin/phospholipid index (API) in groups of healthy young adults, malnourished children, and their age-and-sex-matched well-nourished controls. We found that API discriminated between malnourished and well-nourished children. There was no difference between the index for well-nourished children and adults in spite of differences in body sizes. However, since serum albumin showed a similar discrimination between malnourished and well-nourished children, API may possibly not be superior to serum albumin in the assessment of protein status in man.

Growth profile of rural Meitei children of Manipur state of India

Patterns of growth in 10 anthropometric measurements among the rural Manipuri children (N=425), aged 5 to 14 years, with poor socio-economic backgrounds are reported. The anthropometric dimensions include weight, stature, sitting-height, head, chest and midupper-arm circumferences, biepicondylar widths of humerus and femur, and triceps and biceps skinfolds. Except skinfolds, the boys measured more than the girls in all measurements at all ages, except from 10 to 12 years in weight, stature, sitting-height, and chest and mid-upper-arm circumferences. Across all ages, the girls had thicker fat folds. Up to 12 years, the children lie approximately on the 10th centile of NCHS in stature and weight. The arm circumferences was below the 3rd centile of the Dutch children, until 11 years. The triceps fat fold fluctuated between 10th and 25th centiles of US whites. The rural Meiteis were taller and heavier than rural Burmese and urban Meiteis. The overall growth performance of the rural Meitei children was poor as compared to US, Urban Chinese, and well-nourished Indian children.

Does Breakfast Make a Difference in School?

This article reviews selectively the literature on the effects of breakfast on cognition and school performance. The focus is on studies published in refereed journals after 1978 that tested those effects on well-nourished and nutritionally at-risk children. In at-risk subjects (defined by clinical history and anthropometry), a morning and overnight fast had adverse effects on cognition, particularly the speed of information retrieval in working memory. Contradictions in the data from different studies prevent definitive conclusions on whether well-nourished children experience similar functional deficits. Nonetheless, available information suggests that brain function is sensitive to short-term variations in the availability of nutrient supplies. Moreover, well-conducted evaluations suggest that the availability of feeding programs in public schools throughout the academic year increases the probability that children will eat breakfast and improve their educational status. J Am Diet Assoc. 1995; 95: 1134-1139.