School Meals and BMI Percentile: Secondary Analyses of Non-Self-Report Data

学校膳食和 BMI 百分位：非自我报告数据的二次分析

• 批准号: 7892584
• 负责人: Suzanne Domel Baxter
• 金额: $ 18万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7892584
• 关键词: Address; Behavior; Beverages; Body mass index; Cereals; Child; Cohort Studies; Consent Forms; Consumption; Data; Data Analyses; Data Set; Eating; Energy Intake; Fatty acid glycerol esters; Flavoring; Food; Food Assistance Programs; Future; Height; Ice Cream; Individual; Intake; Knowledge; Measurement; Milk; Obesity; Pathway interactions; Patient Self-Report; Population; Positioning Attribute; Publishing; RQ2; Race; Records; Research; Resources; Schools; Weight; boys; control trial; cost; design; girls; obesity in children; programs; public health relevance; response; sex

DESCRIPTION (provided by applicant): There is concern that participation in food assistance programs may be related to obesity because many obese individuals are served by such programs. An Expert Panel convened in 03/2004 found no consistent evidence of association between childhood obesity and participation in the School Breakfast Program (SBP) and National School Lunch Program (NSLP). That Panel recommended investigative approaches including 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 to understand relationships. Data sets for approach 4 are available from R01 HL063189, which ended in 08/2005. Published results from a small study indicated that observed (but not self-reported) energy intake at school meals was higher for 4th-grade children of high-BMI (e85th percentile) than low-BMI (e5th and <50th percentiles). Unpublished results from preliminary analyses of data from another study provide further evidence that observed energy intake at school meals varies by 4th-grade children's BMI percentile, but results differed when self-reported energy intake was analyzed. We now propose a 2-year project using data for 4th-grade children from 4 studies for R01 HL063189. Aim 1 is to investigate a possible relationship between SBP and NSLP participation and childhood obesity. We have nametag records (compiled on an average of 10 to 34 random days) of SBP and NSLP participation in 4th-grade for 1,542 children total (51% Black, 49% White; 51% girls). Aim 1 has 2 research questions (RQs) for the 4 studies separately and combined: RQ1 - What is the relationship between BMI percentile and SBP and NSLP participation in 4th grade, and does this differ a) for SBP and NSLP participation separately vs. combined, b) by sex, and c) by race? RQ2 - How accurate are parental responses on consent forms concerning children's SBP and/or NSLP participation compared to nametag records, and does this differ by BMI percentile, sex, and race? How does RQ1 differ when parental responses are used? Aim 2 is to examine behaviors and selections for a subset of children to understand differences in actual (observed) school-meal intake. For the subset, we observed 344 children (54% Black, 46% White; 50% girls) for 1 to 3 breakfasts and 1 to 3 lunches for 1,268 total school meals (50% breakfast). For the subset, Aim 2 has 2 RQs for the 4 studies separately and combined: RQ3 - What is the relationship between BMI percentile and observed energy intake at school meals, and does this differ a) for breakfast and lunch separately vs. combined, b) by sex, and c) by race? RQ4 - To what extent are RQ3 differences explained by a) amounts eaten of standardized portions, b) trades, c) milk flavor/fat selections, d) cold (i.e., ready-to-eat cereal) vs. hot (e.g., sausage biscuit) breakfast selection, and e) ` la carte ice cream? Results will inform the design of future controlled trials and/or cohort studies to understand pathways to obesity among children who participate in SBP and NSLP. PUBLIC HEALTH RELEVANCE: 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 an efficient and timely 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 4 existing data sets that uniquely position us to use non-self-report data to investigate the relationship between body mass index (BMI) percentile and SBP and NSLP participation as well as differences in children's actual (observed) energy intake at school meals by BMI percentile along with various aspects of observed behaviors and food/beverage selections at school meals include the following: nametag records of SBP and NSLP participation on an average of 10 to 34 random days for each of 1,542 children; observed intake at school meals for a subset of 344 children (with acceptable results from inter- observer reliability); and weight/height measurements for 1,542 children (with acceptable results from inter- measurer reliability).

描述（由申请人提供）：人们担心参与食品援助计划可能与肥胖有关，因为许多肥胖者都接受了此类计划的服务。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）之间存在关联。该小组建议的调查方法包括：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）使用现有数据集了解关系。方法4的数据集可从2005年8月结束的R 01 HL 063189中获得。一项小型研究的结果表明，高BMI（e85百分位数）的四年级儿童在学校膳食中观察到的（但不是自我报告的）能量摄入量高于低BMI（e5和<50百分位数）。来自另一项研究的数据的初步分析的未发表结果提供了进一步的证据，即在学校膳食中观察到的能量摄入量因四年级儿童的BMI百分位数而异，但当分析自我报告的能量摄入量时，结果有所不同。我们现在提出了一个为期2年的项目，使用的数据，四年级儿童从4项研究R 01 HL 063189。目的1是探讨SBP和NSLP参与与儿童肥胖之间的可能关系。我们有四年级共有1,542名儿童（51%黑人，49%白色; 51%女孩）参加SBP和NSLP的姓名标签记录（平均随机10至34天编制）。目标1有2个研究问题（RQ），分别涉及4项研究和合并研究：RQ 1-BMI百分位数与4年级SBP和NSLP参与率之间的关系，a）SBP和NSLP参与率单独与合并，B）性别和c）种族是否存在差异？RQ 2-与姓名标签记录相比，父母在同意书上对儿童SBP和/或NSLP参与情况的回答有多准确，这是否因BMI百分位数、性别和种族而异？当使用父母的回答时，RQ 1有什么不同？目的2是检查一部分儿童的行为和选择，以了解实际（观察到的）学校膳食摄入量的差异。对于子集，我们观察了344名儿童（54%黑人，46%白色; 50%女孩）的1至3份早餐和1至3份午餐，共1,268份学校餐（50%早餐）。对于子集，目标2有4项研究单独和合并的2个RQ：RQ 3-BMI百分位数与学校膳食中观察到的能量摄入量之间的关系，a）早餐和午餐单独与合并，B）性别和c）种族是否有差异？RQ 4-RQ 3差异在多大程度上可以由a）标准化部分的食用量，B）交易，c）牛奶风味/脂肪选择，d）冷（即，即食谷物）与热的（例如，香肠饼干）早餐选择，和e）'点菜冰淇淋？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：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有效和及时的下一步，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。我们现有的4个数据集的特征使我们能够使用非自我报告的数据来研究体重指数（BMI）百分位数与SBP和NSLP参与之间的关系，以及儿童实际按BMI沿着百分位数列出的在学校用餐时的（观察到的）能量摄入以及在学校用餐时观察到的行为和食物/饮料选择的各个方面包括：随机抽取1,542名儿童，每个儿童平均10 - 34天的SBP和NSLP参与的姓名标签记录; 2观察344名儿童的学校膳食摄入量（观察者间可靠性结果可接受）; 3以及1,542名儿童的体重/身高测量（测量者间可靠性结果可接受）。