Is Childhood Obesity Related to Participation in School Meals?

描述（由申请人提供）：由于许多肥胖者接受食品援助计划的服务，人们担心参与这些计划可能与肥胖有关。2004年3月召开的一个专家小组会议发现，没有一致的证据表明儿童肥胖与参加学校早餐计划（SBP）和国家学校午餐计划（NSLP）之间存在关系。该小组建议进一步调查这种关系的方法包括：1)利用自然机会进行对照试验；2)在现有研究基础上增加体重、身高和项目参与；3)针对特定人群开展小规模研究；4)使用现有的数据集。方法2、3和4的数据可从R01 HL074358中获得，该方法的数据收集结束于来自一个地区共18所学校的2个学年的四年级儿童。R01 HL074358（2003年8月- 2008年7月）是一项方法学验证研究，旨在调查饮食报告准确性与目标时间段和访谈时间的关系；对收缩压和非slp膳食的观察用于在儿童24小时回忆中验证这些膳食。资助开始后，NHLBI批准增加每个儿童的体重/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，获得了家长的同意，学区向我们公布了儿童在四年级期间180天内每天参加SBP和NSLP的行政记录（即在学校获得的膳食）。这个为期2年的项目的具体目的是使用来自R01 h074358的1264名四年级儿童的现有数据，为每日收缩压和NSLP参与与儿童肥胖之间可能存在的关系提供具有成本效益的初步证据。对于579名儿童的一个子集，我们还将调查学校膳食中观察到的能量摄入。5个研究问题（rq）是：RQ1 -年龄/性别体重指数（BMI）百分位数与四年级每日收缩压和NSLP参与之间的关系是什么？(a)单独参加SBP和NSLP与联合参加，(b)性别，(c)早餐地点，(d)学年有什么不同吗？RQ2 -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之间的关系是什么？(a)早餐和午餐分开吃还是合并吃？ (b)性别？ (c)早餐地点？ (d)学年？RQ3 -对于一部分儿童，当分析中包括学校膳食中观察到的能量摄入时，对RQ1的影响是什么？RQ4 -四年级学生的SBP和/或NSLP参与程度在多大程度上因(a)性别、(b)工作日、(c)月份和(d)学年而异？RQ5 -当SBP和/或NSLP参与基于(a)日常行政记录，(b)家长对同意书的回应和(c)姓名标签记录（10至29天）时，对RQ1， RQ3和RQ4a的影响是什么？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：人们担心参加学校早餐计划（SBP）和国家学校午餐计划（NSLP）可能与儿童肥胖有关，但先前的研究无法提供一致关系的证据。该项目的二次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，并为旨在了解参与SBP和NSLP的儿童肥胖途径的未来对照试验和/或队列研究的设计提供信息。我们现有数据集的独特特征使我们能够研究这种可能的关系，包括1,264名儿童中每个人在180个可能的上学日的每日SBP和NSLP参与情况；观察579名儿童在学校膳食中的能量摄入（从观察者间的信度来看，结果是可以接受的）；避免父母和/或儿童报告儿童的收缩压和NSLP参与情况和/或儿童的饮食摄入情况；以及1264名儿童的体重和身高测量（从测量者之间的可靠性来看，结果可以接受）。

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).