The National Evaluation of School Nutrition Programs: conclusions

Benefits of a School Breakfast Programme among Andean Children in Huaraz, Peru

A randomized, controlled trial measured the short-term impact of the Peruvian school breakfast programme on the diet, school attendance, and cognition of fourth- and fifth-graders. Ten schools on the rural outskirts of the Andean city of Huaraz were randomly assigned to a control or a treatment group. The programme significantly increased (p <.01) dietary intakes of energy by 15.2%, protein by 16.1%, and iron by 60%, and improved rates of attendance. Analysis of covariance also showed improved performance on a vocabulary test among heavier children, as indicated by a positive and significant weight x treatment interaction (parameter = 0.37; F = 4.97; p < .05). It is plausible that among stunted children, being relatively overweight (by the weight-for-height index) poses a cognitive risk that can be partially reversed by a school breakfast.

Impact of Midday Meal Program on Educational and Nutritional Status of School-going Children in Andhra Pradesh, India

The Midday Meal Program(MDM) is in operation in several states of India. This program aims to improve school enrollment and attendance, to reduce dropout rate to better the children's school performance, and to improve the nutritional status of primary school children. A study was undertaken in the State of Andhra Pradesh to assess the impact of the MDM program on the above parameters. A total of 83 schools from three districts, 45 schools with program and 38 schools without program, were included in the study.

Results of the study on the educational component indicated improved attendance, increased retention rate with reduced dropout rates, and a marginal improvement in the scholastic performance. The nutritional component revealed better growth performance among the regular beneficiaries in the program.

Breakfast intake is associated with nutritional status, Mediterranean diet adherence, serum iron and fasting glucose: the CYFamilies study

OBJECTIVE

To assess the association of breakfast intake with Mediterranean diet adherence, physical activity levels, obesity, selected cardiovascular risk markers and Fe status.

DESIGN

Cross-sectional study. BMI, body fat percentage and waist circumference were assessed. Physical activity was assessed using a pedometer and diet quality was evaluated by applying the KIDMED index. Blood tests to assess blood lipids, high-sensitivity C-reactive protein, fasting glucose, serum Fe and ferritin, as well as Hb, were performed.

SETTING

Primary-school children of the Troodos mountainous area in Cyprus.

SUBJECTS

Eighty-three Cypriot children (mean age 9·2 (sd 1·7) years).

RESULTS

Compared with breakfast skippers, regular breakfast eaters were 40 % more likely to have a KIDMED score higher by one point on average (OR=1·41; 95 % CI 1·08, 1·84) after accounting for obesity levels and other confounders. Breakfast skippers, on the other hand, were by about 14 % more likely to have a body fat percentage value higher by one unit, as well as higher values for both BMI and waist circumference. The relationship was significantly strengthened when combining body fat percentage and waist circumference into a composite variable (OR=0·20; 95 % CI 0·06, 0·69). Fasting glucose was inversely correlated to breakfast intake in descriptive analyses, whereas serum Fe was positively correlated to breakfast intake after considering age, gender and diet quality. The latter relationship disappeared, however, after considering physical activity levels.

CONCLUSIONS

Cypriot children who take breakfast regularly exhibit a higher adherence to the Mediterranean diet and have higher serum Fe concentrations and lower BMI, waist circumference, body fat percentage and fasting glucose levels, compared with children who skip breakfast. Public health professionals, educators and parents should prioritize on actions that will motivate children to regularly eat breakfast.

Impact of NGO run mid day meal program on nutrition status and growth of primary school children

OBJECTIVE

To study the impact of wholesome mid day meal (MDM) program run by an NGO on the growth of the primary school students in rural area of Mathura district.

METHODS

This intervention study involved children enrolled in Government run rural primary schools in Mathura district in Uttar Pradesh from March 06 through August 07. A wholesome, nutritionally balanced MDM provided by an NGO for the students in the 6 primary schools was selected as intervention group. Control group consisted of children in 8 schools which received locally prepared MDM by village panchayats. Height, weight, change in height/month, change in weight/month, prevalence of protein-energy malnutrition and prevalence of signs of vitamin deficiencies, were measured.

RESULTS

Food was provided for 221 days in one year. Within group and between groups repetitive measures were compared using generalized estimating equation (GEE). Within both intervention and control groups height and weight had significantly increased (p < 0.05), while there was no significant difference between the groups. There was no change in prevalence of malnutrition within either of the groups. Reduction in vitamin A deficiency signs was 38% more in intervention group (p < 0.001). Prevalence of Vitamin D deficiency reduced by 50% more in intervention group. No such differences between groups were observed for vitamin B complex and vitamin C.

CONCLUSIONS

MDM provided by the NGO has no better impact on growth of the primary school children, however, it reduced prevalence of vitamin deficiency significantly in comparison to the MDM run by Village Panchayats.

Understanding barriers to implementing quality lunch and nutrition education

Food services and nutrition education are priorities for the Coordinated School Health Program in Massachusetts, which is a CDC funded partnership between the Massachusetts Departments of Education and Public Health. Despite funding and resources provided by governmental and non-governmental agencies, schools are facing barriers in effectively creating a healthy nutritional environment. A qualitative survey was conducted to understand barriers to implementing quality lunch and nutrition education programs perceived by superintendents, principals, food service directors, nurses, and health educators in Massachusetts. The results suggest that while funding can initially enable schools to provide quality lunch, but without changes in students' preference for unhealthy food and parental and community involvement in fostering students' healthy eating behavior, the lunch programs cannot achieve a sustainable success. Lack of opportunity for communication among food service staff, health educators, and teachers appears to hinder the coordination necessary to promote school lunch as well as school-wide nutrition education. Respondents acknowledged that the state's academic assessment system is the priority issue in their schools, but expressed that the interests and initiatives of superintendents and principals in the lunch and nutrition education programs can be enhanced. Overall, the results suggest that successful implementation of quality lunch and nutrition education programs require not only the collaborative efforts of school administration and staff but also the support of parents, community, and the mass media.

What are the key food groups to target for preventing obesity and improving nutrition in schools?

OBJECTIVE

To determine differences in the contribution of foods and beverages to energy consumed in and out of school, and to compare consumption patterns between school canteen users and noncanteen users.

DESIGN

Cross-sectional National Nutrition Survey, 1995.

SETTING

Australia. SUBJECTS ON SCHOOL DAYS: A total of 1656 children aged 5-15 y who had weekday 24-h dietary recall data.

RESULTS

An average of 37% of total energy intake was consumed at school. Energy-dense foods and beverages such as fat spreads, packaged snacks, biscuits and fruit/cordial drinks made a greater contribution to energy intake at school compared to out of school (P< or =0.01). Fast foods and soft drinks contributed 11 and 3% of total energy intake; however, these food groups were mostly consumed out of school. Fruit intake was low and consumption was greater in school. In all, 14% of children purchased food from the canteen and they obtained more energy from fast food, packaged snacks, desserts, milk and confectionary (P< or =0.05) than noncanteen users.

CONCLUSIONS

: Energy-dense foods and beverages are over-represented in the Australian school environment. To help prevent obesity and improve nutrition in schools, biscuits, snack bars and fruit/cordial drinks brought from home and fast food, packaged snacks, and confectionary sold at canteens should be replaced with fruit and water.