Is Childhood Obesity Related to Participation in School Meals?

描述（由申请人提供）：由于许多肥胖的个人提供的食品援助计划，有人担心，在这些计划的参与可能与肥胖。2004年3月召开的一个专家小组会议没有发现儿童肥胖与参加学校早餐计划（SBP）和国家学校午餐计划（NSLP）之间关系的一致证据。该小组建议进一步研究这种关系的方法包括：1）利用自然机会进行对照试验; 2）在现有研究中增加体重、身高和项目参与; 3）启动针对特定人群的小型研究; 4）使用现有数据集。方法2、3和4的数据可从R 01 HL 074358中获得，其数据收集已在2个学年期间从1个区的总共18所学校的4年级儿童中结束。R 01 HL 074358（08/2003 - 07/2008）是一项方法学验证研究，旨在研究饮食报告准确性与目标期和访谈时间操作的关系; SBP和NSLP膳食观察结果用于验证儿童24小时回忆中的这些膳食。资助开始后，NHLBI批准为每个儿童增加体重/身高测量（n= 1，264，由于过度招募，允许随机选择观察和/或访谈），但没有为这些测量（或这些拟议的二次分析）提供额外的资金。在同意书上，该地区获得了父母的许可，向我们发布了有关儿童每日SBP和NSLP参与的行政记录（即，在学校获得膳食）在180天可能在四年级。这个为期2年的项目的具体目标是使用来自R 01 HL 074358的1,264名四年级儿童的现有数据，提供关于每日SBP和NSLP参与与儿童肥胖之间可能关系的具有成本效益的初步证据。对于一个子集的579名儿童，我们还将调查观察到的能量摄入量在学校餐。5个研究问题（RQ）是：RQ 1-年龄/性别体重指数（BMI）百分位数与4年级期间每日SBP和NSLP参与之间的关系是什么？（a）SBP和NSLP单独参与与合并参与、（B）性别、（c）早餐地点和（d）学年是否存在差异？RQ 2-对于一部分儿童，年龄/性别BMI百分位数与学校膳食中观察到的能量摄入量之间有何关系？（a）早餐和午餐分开还是合并，（B）性别，（c）早餐地点，（d）学年，这是否有差异？RQ 3-对于一个儿童子集，当在学校用餐时观察到的能量摄入被纳入分析时，对RQ 1有什么影响？RQ 4-在多大程度上SBP和/或NSLP参与在四年级不同（a）性别，（B）工作日，（c）月，（d）学年？RQ 5-当SBP和/或NSLP参与基于（a）每日管理记录、（B）父母对知情同意书的回复和（c）姓名标签记录（10 - 29天）时，对RQ 1、RQ 3和RQ 4a有何影响？结果将为未来的对照试验和/或队列研究的设计提供信息，以了解参与SBP和NSLP的儿童肥胖的途径。公共卫生相关性：有人担心，参与学校早餐计划（SBP）和国家学校午餐计划（NSLP）可能与儿童肥胖有关，但以前的研究无法提供一致关系的证据。该项目中的次要分析是一个具有成本效益和谨慎的下一步，因为结果将增加新的知识，并为未来的对照试验和/或队列研究的设计提供信息，旨在了解参与SBP和NSLP的儿童肥胖的途径。我们现有数据集的特征使我们能够独特地研究这种可能的关系，包括1，264名儿童中每个儿童在180个可能的上学日的每日SBP和NSLP参与;观察到579名儿童的学校膳食能量摄入量（观察员间可靠性的结果可接受）;避免父母和/或儿童报告儿童的SBP和NSLP参与和/或儿童的饮食摄入;以及1，264名儿童的体重和身高测量（测量者间可靠性的结果可接受）。

DESCRIPTION (provided by applicant): Because many obese individuals are served by food assistance programs, there is concern that participation in these programs may be related to obesity. An Expert Panel convened in 03/2004 found no consistent evidence of a relationship between childhood obesity and participation in the School Breakfast Program (SBP) and National School Lunch Program (NSLP). Approaches recommended by that Panel to further investigate this relationship include 1) use natural opportunities for controlled trials; 2) add weight, height, and program participation to existing studies; 3) initiate smaller studies with specific populations; and 4) use existing data sets. Data for approaches 2, 3, and 4 are available from R01 HL074358 for which data collection has ended with 4th-grade children during 2 school years from a total of 18 schools in 1 district. R01 HL074358 (08/2003 - 07/2008) is a methodological validation study to investigate the relationship of dietary reporting accuracy to manipulation of target period and interview time; observations of SBP and NSLP meals were used to validate these meals in children's 24-hour recalls. After funding began, NHLBI approved the addition of weight/height measures for each child (n=1,264 due to over-recruitment which allowed random selection for observations and/or interviews), but no additional funding was provided for these measures (or these secondary analyses proposed). On consent forms, parental permission was obtained for the district to release to us administrative records about children's daily SBP and NSLP participation (i.e., obtained meal at school) on 180 possible days during 4th grade. The specific aim of this 2-year project is to use existing data from 1,264 4th-grade children from R01 HL074358 to provide cost-efficient preliminary evidence concerning a possible relationship between daily SBP and NSLP participation and childhood obesity. For a subset of 579 children, we will also investigate observed energy intake at school meals. The 5 research questions (RQs) are: RQ1 - What is the relationship between age/sex body mass index (BMI) percentile and daily SBP and NSLP participation during 4th grade? Does this differ for (a) SBP and NSLP participation separately versus combined, (b) sex, (c) breakfast location, and (d) school year? RQ2 - For a subset of children, what is the relationship between age/sex BMI percentile and observed energy intake at school meals? Does this differ for (a) breakfast and lunch separately versus combined, (b) sex, (c) breakfast location, and (d) school year? RQ3 - For a subset of children, what is the effect on RQ1 when observed energy intake at school meals is included in the analyses? RQ4 - To what extent do SBP and/or NSLP participation during 4th grade vary by (a) sex, (b) weekday, (c) month, and (d) school year? RQ5 - What is the effect on RQ1, RQ3, and RQ4a when SBP and/or NSLP participation is based on (a) daily administrative records, (b) parental responses on consent forms and (c) nametag records (for 10 to 29 days)? Results will inform the design of future controlled trials and/or cohort studies to understand pathways to obesity among children who participate in the SBP and NSLP. PUBLIC HEALTH RELEVANCE: There is concern that participation in the School Breakfast Program (SBP) and National School Lunch Program (NSLP) may be related to childhood obesity, but previous research has been unable to provide evidence of a consistent relationship. The secondary analyses in this project are a cost-efficient and prudent next step because results will add new knowledge and inform the design of future controlled trials and/or cohort studies aimed at understanding pathways to obesity among children who participate in SBP and NSLP. Features of our existing dataset that uniquely position us to examine this possible relationship include daily SBP and NSLP participation on 180 possible school days for each of 1,264 children; observed energy intake at school meals for a subset of 579 children (and with acceptable results from inter-observer reliability); avoidance of parental and/or children's reports of children's SBP and NSLP participation and/or children's dietary intake; and weight and height measurements for 1,264 children (and with acceptable results from inter-measurer reliability).