Nutrition and education: a randomized trial of the effects of breakfast in rural primary school children. An evaluation of giving the Jamaican government school meal to a class of children. Evaluation of a ghetto school breakfast program. School breakfast improves verbal fluency in undernourished Jamaican children. Results from a dietary intervention study in preschools "Beastly Healthy at School". A national evaluation of school breakfast clubs: evidence from a cluster randomized controlled trial and an observational analysis. Evaluating the effect of nutritional education on the prevalence of overweight/obesity and on foods eaten at primary schools. Effect of mid-day meal programme on physical growth & mental function. Evaluation of implementation and effect of primary school based intervention to reduce risk factors for obesity. Evaluation of a pilot school programme aimed at the prevention of obesity in children. Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group.
Hunger during school may prevent children in developing countries from benefiting from education. Although many countries have implemented school feeding programs, few programs have been rigorously evaluated. We conducted a randomized, controlled trial of giving breakfast to undernourished and adequately nourished children. The undernourished group comprised 407 children in grades 2-5 in 16 rural Jamaican schools (weights-for-age < or = -1 SD of the National Center for Health Statistics references) and the adequately nourished group comprised 407 children matched for school and class (weights-for-age >-1 SD). Both groups were stratified by class and school, then randomly assigned to breakfast or control groups. After the initial measurements, breakfast was provided every school day for 1 school year. Children in the control group were given one-quarter of an orange and the same amount of attention as children in the breakfast group. All children had their heights and weights measured and were given the Wide Range Achievement Test before and after the intervention. School attendance was taken from the schools' registers. Compared with the control group, height, weight, and attendance improved significantly in the breakfast group. Both groups made poor progress in Wide Range Achievement Test scores. Younger children in the breakfast group improved in arithmetic. There was no effect of nutritional group on the response to breakfast. In conclusion, the provision of a school breakfast produced small benefits in children's nutritional status, school attendance, and achievement. Greater improvements may occur in more undernourished populations; however, the massive problem of poor achievement levels requires integrated programs including health and educational inputs as well as school meals. We evaluated the effects of giving the standard Jamaican government school meal to a class of school children. Unlike many other school-feeding studies, this project was carefully controlled and carried out with undernourished children who had low levels of school attendance and achievement. In spite of this, no improvement was found in the children's nutritional status as reflected by weight for age. However, small benefits were found in attendance and school achievement. These findings remained when sex, age, improvements over the previous term, and the effects of 'benevolent attention' were taken into account. A program was initiated to provide a free breakfast at a ghetto elementary school. Community support was achieved at the expense of randomization of study subjects. While no significantly greater increase in school attendance or performance was detected in comparison with a control school, none of the students was malnourished and diets of students in the control school were as adequate as those in the breakfast school. Thus, it cannot be concluded that school breakfast programs would not benefit malnourished children or teen-agers who most often go without breakfast. School feeding programs exist in many countries, but few have been properly evaluated. In this study, the short-term effects of breakfast on children's cognitive functions were examined. The subjects were 97 undernourished (weight-for-age < or = -1 SD of reference) and 100 adequately nourished (weight-for-age > -1 SD) children in four primary schools in rural Jamaica. The children were randomly assigned to a group provided with breakfast or a group given a quarter of an orange as a placebo, and then given a battery of four cognitive function tests. After a few weeks the treatments were reversed and the tests repeated. Undernourished children's performance improved significantly on a test of verbal fluency when they received breakfast, whereas that of the adequately nourished children did not change (breakfast x group interaction, P < 0.05). There were no other effects of breakfast on test scores. The findings extend those of a previous Jamaican study conducted under more controlled conditions, and support the targeting of school meals to undernourished children. Applying the Intervention Mapping Protocol, an intervention was developed to assist Belgian preschools in the implementation of a healthy school food policy. In the present study the impact of the intervention on children's food consumption is investigated.
                Teachers and parents from 16 schools (8 intervention; 8 control) were asked to participate in the study. Teachers registered the children's available food and beverages during the morning and afternoon breaks (data of baseline and follow-up was matched for 618 intervention and 445 control children). Parents were asked to complete a food frequency questionnaire on their children's general consumption (308 intervention and 168 control matches).Linear mixed model analyses were used to investigate the intervention effect.
                Both assessment methods indicate an increased fruit consumption for intervention children in comparison with control children, although the effect was only significant for the parental reported fruit consumption. Additionally the results suggest that the change is mainly due to increased availability at school. No significant associations were found for the other food items (snacks, vegetables and different types of beverages).
                The results indicate that a healthy food policy at school can improve young children's diet. To measure the health, educational and social impacts of breakfast club provision in schools serving deprived areas across England.
                A cluster randomized controlled trial and an observational analysis.
                England, the UK. Intervention: funding to establish a school-based breakfast club vs. control (no funding).
                Intention to treat analysis showed improved concentration (Trail Making Test Part A) amongst the intervention group at 3 months. Fewer pupils within the intervention group reported having skipped classes within the last month and fewer pupils within the intervention group reported having skipped 1 or more days of school within the last month at 1 year. Observational analysis at 1 year showed a higher proportion of primary-aged breakfast club attendees reported eating fruit for breakfast in comparison to non-attendees. A higher proportion of breakfast club attendees had borderline or abnormal conduct and total difficulties scores (primary-aged pupils) and prosocial score (secondary-aged pupils).
                Analyses revealed a mixed picture of benefit and apparent disbenefit. This study illustrated the challenges of evaluating a complex intervention in which the evaluators had less control than is usual in randomized trials over recruitment, eligibility checking and implementation. If the impact of new policy initiatives is to be assessed using the most robust forms of evaluation, social policy needs to be organized so that evaluations can be constructed as experiments. This is likely to prove most difficult where the perceived value of implementing an intervention rapidly is high. To assess the effects of a nutritional education program on the prevalence of overweight/obesity and on the foods eaten by schoolchildren in the 2nd grade of primary education.
                The sample was made up of 135 schoolchildren, recruited from one private and one public school in Florianópolis, Brazil, and allocated to either an intervention group (n = 55) or a no-intervention group (n = 80). The children underwent two anthropometric assessments and two dietary intake assessments, before and after attending a nutritional education program. The program consisted of eight fortnightly meetings and covered subjects related to healthy diets, how to make healthy snacks, and physical activity. Nutritional status was classified according to body mass index for age, using the Centers for Disease Control and Prevention growth charts as reference, and the foods the children ate at school were classified according to the Santa Catarina School Canteens Act. Data were analyzed using the Statistical Package for the Social Sciences, and values of p <or= 0.05 were defined as significant.
                The percentage of overweight/obese schoolchildren increased from 21.8 to 23.6% in the intervention group and from 33.7 to 35.0% in the no-intervention group (p > 0.05). The intervention group significantly (p = 0.013) reduced its intake of artificial juice, which is prohibited by the Act. In the no-intervention group, there was a significant increase in intake of prohibited foods, such as mass-produced snacks (p = 0.021) and soda (p = 0.031). Furthermore, the intake of breakfast cereal, which is appropriate for eating at school, decreased (p = 0.039).
                Despite its short duration, after attending the nutritional education program, there were improvements in the quality of the food the schoolchildren were eating. The effect of food supplementation in rural primary school children was studied on physical growth and mental functions. Children (146) received 450-500 calories with 10-12 g of protein for an average of 172 days a year, for 2 yr (1984-1986). Height was found not to differ significantly in the supplemented group as compared to controls. However, there was marginally better weight gain. More children in the supplemented group remained in grade I in contrast to the controls who shifted to grade II nutritional status after 2 yr. Children receiving the supplementation showed marginal increment in full scale, verbal and performance IQ. The improvement was significant for all subtests except for comprehension and maze tests. The observations on unstructured Piagetian developmental tasks also indicated that the performance of children on task conservation of liquid was improved marginally after supplementation. However, on Bender Gestalt test, no change was observed. The scores on arithmetic achievement test showed improvement of 12-14 points in the supplementation group. It appears that nutrition supplementation is beneficial for better school attendance, and reduction in the drop out rate; it also improves intelligence and cognitive function to a marginal extent. However, as this age group falls in the slow growth period, no catch up was observed in physical growth. To implement a school based health promotion programme aimed at reducing risk factors for obesity and to evaluate the implementation process and its effect on the school.
                Data from 10 schools participating in a group randomised controlled crossover trial were pooled and analysed.
                10 primary schools in Leeds.
                634 children (350 boys and 284 girls) aged 7-11 years.
                Response rates to questionnaires, teachers' evaluation of training and input, success of school action plans, content of school meals, and children's knowledge of healthy living and self reported behaviour.
                All 10 schools participated throughout the study. 76 (89%) of the action points determined by schools in their school action plans were achieved, along with positive changes in school meals. A high level of support for nutrition education and promotion of physical activity was expressed by both teachers and parents. 410 (64%) parents responded to the questionnaire concerning changes they would like to see implemented in school. 19 out of 20 teachers attended the training, and all reported satisfaction with the training, resources, and support. Intervention children showed a higher score for knowledge, attitudes, and self reported behaviour for healthy eating and physical activity.
                This programme was successfully implemented and produced changes at school level that tackled risk factors for obesity. This paper describes the development, implementation and evaluation of a school- and family-based intervention to prevent obesity in children aged 5-7 years. In addition, the efficacy of three different intervention programmes was compared. Children aged 5-7 years (n=213) were recruited from three primary schools in Oxford and randomly allocated to a control group or one of three intervention groups: nutrition group, physical activity group, and combined nutrition and physical activity group. The setting for the interventions was lunchtime clubs, where an interactive and age-appropriate nutrition and/or physical activity curriculum was delivered. The intervention lasted for 20 weeks over four school terms (approximately 14 months). Children's growth, nutrition knowledge, diet and physical activity were assessed at baseline and at the end of the intervention. Significant improvements in nutrition knowledge were seen in all children (p<0.01) between baseline and post-intervention, and results were highly significant in the nutrition and combined group (p<0.001). Overall, fruit and vegetable intake increased significantly (p<0.01 and <0.05, respectively), with changes seen in fruit consumption in the nutrition group (p<0.05) and the control group (p<0.05) in particular. No significant changes in the rates of overweight and obesity were seen as a result of the intervention. Gender differences were not detected in the majority of assessments and there was no clear effect of programme type per se. This pilot study has demonstrated that school may be a suitable setting for the promotion of healthy lifestyles in children, but requires replication in other social settings. Future initiatives should be long-lasting, multi-faceted and sustainable, involving all children in a school, and should target the whole environment and be behaviourally focused. The ultimate goal of any such programme is to lead to positive behaviour change which will have a beneficial effect on long-term health. Successful targeting of the family remains a challenge to such interventions. To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease.
                A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994).
                A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas.
                Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education.
                At the school level, two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychological factors, recall measures of eating and physical activity patterns, and other physiologic measures.
                In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%)(P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed.
                The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years.
School meals may have some small benefits for disadvantaged children. We recommend further well-designed studies on the effectiveness of school meals be undertaken, that results should be reported according to socio-economic status, and that researchers gather robust data on both processes and carefully chosen outcomes.