Association of the Healthy, Hunger-Free Kids Act of 2010 With Body Mass Trajectories of Children in Low-Income Families.
Association of the Healthy, Hunger-Free Kids Act of 2010 With Body Mass Trajectories of Children in Low-Income Families.
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DOI：
10.1001/jamanetworkopen.2022.10480
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发表时间：
2022-05-02
影响因子：
13.8
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中科院分区：
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2010 年《健康、无饥饿儿童法案》(HHFKA) 是否改善了低收入家庭儿童的体重轨迹？在这项对 HHFKA 实施前的 3388 名儿童和 HHFKA 实施后的 2570 名儿童进行评估的队列研究中，在 HHFKA 之前未参加免费或减价全国学校午餐计划的低收入家庭的幼儿园儿童，1 年级至 5 年级之间的体重指数 (BMI) 与肥胖阈值的差异比参与的同龄人的下降幅度更大。 HHFKA 实施后，不再观察到国家学校午餐计划与 BMI 差异变化之间的肥胖关联。这些发现表明，HHFKA 的实施可能有助于抑制低收入儿童体重指数的肥胖增加。 2012 年实施的《2010 年健康无饥饿儿童法案》(HHFKA) 提高了国家学校午餐计划 (NSLP) 的营养需求，以扭转 NSLP 在儿童肥胖中的潜在作用。评估实施 HHFKA 后免费或降价 NSLP 与体重增长之间的关联是否有所不同。这项队列研究使用了 1998 年至 1999 年和 2010 年至 2011 年 2 个具有全国代表性的美国幼儿园儿童队列的数据，并对 1998 年至 1999 年早期儿童纵向研究幼儿园班（ECLS-K：1999 年，2003 年至 2004 年）和2010-2011（ECLS-K：2011，2015-2016）。总共有 5958 名儿童被选中进行分析，这些儿童来自符合免费或减价 NSLP 资格的低收入家庭（家庭收入<联邦贫困线的 185%），他们在公立学校就读，并且在幼儿园或一年级和五年级的免费或减价 NSLP 参与或体重指数（BMI；按体重公斤数除以米数平方计算）没有缺失数据。数据分析时间为 2021 年 1 月 1 日至 9 月 7 日。对幼儿园、1 年级和 5 年级免费或减价 NSLP 参与实施 HHFKA 之前和之后的跨队列比较。与肥胖阈值的体重指数差异 (BMID) 是 BMI 单位与年龄和性别特定肥胖阈值（第 95 个百分位）的差异，并且对高 BMI 的变化敏感。按队列的多组模型包括权重，以平衡 2 个队列在广泛协变量中的分布。 Wald 检验用于评估队列之间的关联是否存在差异。最终分析中，纳入了 ECLS-K:1999 中的 3388 名儿童（1696 名女孩 [50.1%]；基线时平均 [SD] 年龄，74.6 [4.3] 个月）和 ECLS-K:2011 中的 2570 名儿童（1348 名男性 [52.5%]；基线时平均 [SD] 年龄，73.6 [4.2] 个月）。通过跨群体免费或降价 NSLP 参与来改变 BID 的最佳拟合模型包括固定关联和随时间变化的关联。在实施 HHFKA 之前，根据之前的 BMID 轨迹调整后，5 级免费或降价 NSLP 参与者的 BID 高于非参与者（β = 0.54；95% CI，0.27-0.81）。 HHFKA 实施后，这种关联性减弱（β = −0.07；95% CI，-0.58 至 0.45），并且 5 级关联性在各队列中存在差异（χ21 = 4.29，P = .04）。在这项使用跨队列比较的队列研究中，参加免费或减价 NSLP 的低收入家庭儿童更有可能进展为高 BMI，而在实施 HHFKA 后就不再观察到这种情况。这一发现表明，HHFKA 可能削弱了先前 NSLP 与儿童肥胖差异之间的关联。这项队列研究使用了 2 个具有全国代表性的美国幼儿园儿童队列的数据，这些队列一直跟踪到 5 年级，以评估 2010 年《健康、无饥饿儿童法案》实施后低收入家庭儿童的体重增长是否存在差异。
Has the Healthy, Hunger-Free Kids Act of 2010 (HHFKA) improved body mass trajectories of children in low-income families? In this cohort study evaluating 3388 children before HHFKA implementation and 2570 children after HHFKA implementation, kindergarteners in low-income families who did not participate in the free or reduced-price National School Lunch Program before the HHFKA had steeper decreases in body mass index (BMI) difference from obesity threshold between grades 1 and 5 than their participating peers. After HHFKA implementation, this obesogenic association between the National School Lunch Program and BMI difference change was no longer observed. These findings suggest that implementation of the HHFKA may have helped curb obesogenic increase in BMI among low-income children. Implemented in 2012, the Healthy, Hunger-Free Kids Act of 2010 (HHFKA) increased nutritional requirements of the National School Lunch Program (NSLP) to reverse the potential role of the NSLP in childhood obesity. To evaluate whether associations between the free or reduced-price NSLP and body mass growth differed after implementation of the HHFKA. This cohort study used data from 2 nationally representative cohorts of US kindergarteners sampled in 1998 to 1999 and 2010 to 2011 and followed up for 6 years, through grade 5, in the Early Childhood Longitudinal Study Kindergarten Class of 1998-1999 (ECLS-K:1999, in 2003-2004) and Kindergarten Class of 2010-2011 (ECLS-K:2011, in 2015-2016). In total, 5958 children were selected for analysis from low-income families eligible for the free or reduced-price NSLP (household income <185% of the federal poverty level) who attended public schools and had no missing data on free or reduced-price NSLP participation or on body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) at kindergarten or grades 1 and 5. Data were analyzed from January 1 to September 7, 2021. Cross-cohort comparison of before vs after implementation of the HHFKA for free or reduced-price NSLP participation at kindergarten and grades 1 and 5. Body mass index difference (BMID) from obesity threshold was the difference in BMI units from the age- and sex-specific obesity thresholds (95th percentile) and is sensitive to change at high BMI. Multigroup models by cohort included weights to balance the distribution of the 2 cohorts across a wide range of covariates. A Wald test was used to assess whether associations differed between the cohorts. In the final analysis, 3388 children in ECLS-K:1999 (1696 girls [50.1%]; mean [SD] age at baseline, 74.6 [4.3] months) and 2570 children in ECLS-K:2011 (1348 males [52.5%]; mean [SD] age at baseline, 73.6 [4.2] months) were included. The best fitting model for BMID change by free or reduced-price NSLP participation across the cohorts included fixed and time-varying associations. Before HHFKA implementation, grade 5 free or reduced-price NSLP participants had higher BMID, adjusted for their prior BMID trajectory, than nonparticipants (β = 0.54; 95% CI, 0.27-0.81). After HHFKA implementation, this association was attenuated (β = −0.07; 95% CI, −0.58 to 0.45), and grade 5 associations were different across cohorts (χ21 = 4.29, P = .04). In this cohort study using cross-cohort comparisons, children from low-income families who participated in the free or reduced-price NSLP had a higher likelihood of progression to high BMI that was no longer observed after HHFKA implementation. This finding suggests that the HHFKA may have attenuated the previous association of the NSLP with child obesity disparities. This cohort study uses data from 2 nationally representative cohorts of US kindergarteners followed up through grade 5 to assess whether body mass growth differed after implementation of the Healthy, Hunger-Free Kids Act of 2010 among children in low-income families.