Barbara Shannon

Research perspective on school-based nutrition education

Abstract This review examined the major school-based nutrition education research studies conducted during the decade of the 1980s. General nutrition education studies were based primarily on a knowledge-attitude-behavior approach, while disease reduction/health enhancement studies were behaviorally oriented and generally based on social learning theory. Research designs and methodologies have been greatly improved, compared with previous reviews. A major finding was that most studies involved only 10-15 hours of instruction over a 3-15 week period. These short studies resulted in a positive effect on cognitive outcomes such as nutrition knowledge, diet-related skills, behavioral expectations, and self-efficacy. The effect on attitudes was inconsistent but generally positive. The impact of general nutrition education programs on behavior was minimal. The impact of the more specifically targeted behavioral programs was slightly more positive but still inconsistent. Programs that were several years in duration resulted in changes in dietary intakes and physiological parameters. Teacher preparation increased the time spent on nutrition education. Parent involvement enhanced classroom instruction for younger children, particularly when it was of sufficient intensity and duration. The educational impact of modifying school lunch menus has received little study. Implications for practice and research are discussed.

Body fatness, television viewing and calorie-intake of a sample of pennsylvania sixth grade children

Abstract The body fatness, television viewing time and calorie-intake estimate of 773 sixth grade, Caucasian children in 12 Pennsylvania school districts were examined to ascertain whether or not relationships existed among these variables. Triceps skinfold and body mass index (BMI) computed as wt/ht2 served as body fatness indicators. Television viewing reported by boys and girls, respectively, averaged 29.6 ± 12.5 and 27.1 ± 11.9 hours/week. Multiple regression models using data from a subsample of 489 children, for whom body fatness measures made three years earlier were available, explained 73% and 58% of the variance in BMI and triceps skinfold, respectively. Television viewing time contributed significantly to each model, but calorie-intake estimate did not. The relationship between television viewing and triceps skinfold emerged among both boys and girls but only in the less affluent school districts, while the relationship between television viewing and BMI occurred only among girls in moderately and less affluent districts. We hypothesize that where television viewing was related to body fatness, its influence was likely mediated through energy expenditure rather than energy intake. This emphasizes the importance of physical activity programs for school children.

A three-year school-based nutrition education study

Abstract We conducted a three-year nutrition education study in 12 Pennsylvania school districts. Within the districts we assigned schools to either the treatment (nutrition education) or control group and initiated the study with a cohort of third grade children. At the beginning of their third, fourth, and fifth grade years the children completed instruments that assessed nutrition knowledge, attitudes, and self-reported eating behaviors. Each year, children in the treatment group participated in 9 to 12 weeks of nutrition education. Compared to children in the control group, those in the treatment group exhibited significantly higher adjusted mean posttest knowledge scores throughout the study. Treatment group children who entered the study with attitude scores in a range where there was room for improvement exhibited a consistent tendency toward greater improvement than controls. This treatment effect was generated mainly in third grade. On one of the three eating-behavior assessments the treatment group moved with greater rapidity than controls toward a more desirable eating pattern, or maintained that pattern better. On two of the four attitude scales children with low third grade pretest (entry) scores exhibited improvements, independent of treatment, through fourth grade. This study shows it is difficult to demonstrate that increased nutrition knowledge dramatically affects nutrition attitudes and eating behaviors. However, taken together, the results indicate a positive nutrition education impact.

Lower Fat Diets for Children Did Not Increase Food Costs

Abstract Food cost may be perceived as a barrier to the adoption of a low-fat diet. Therefore, the purpose of this investigation was to examine the food costs in diets of children who were adhering to a low-fat diet. These children were part of a larger study, The Childrens Health Project, examining the effectiveness of a nutrition education intervention in hyper-cholesterolemic children (4–10 years). Dietary intakes were evaluated from three 24-hour recalls collected by telephone at baseline and at 3 and 12 months following the intervention. Food costs were obtained using Nutritionist IV diet analysis software and were compared between two groups of children: a treatment group consisting of children considered at risk (elevated plasma total cholesterol) who received the nutrition education intervention and a control group consisting of children considered to be not at risk (nonelevated plasma total cholesterol) who received no intervention. There were no significant food cost differences between groups for all time periods, nor were there any differences within groups across time periods. These data suggest that among children adhering to a low-fat diet, there was no increase in food costs. Nutrition education programs may benefit by providing educational strategies to reduce or eliminate perceived food cost barriers.

The Dietary Intake of Children With IDDM

OBJECTIVE To assess the dietary intake of children with IDDM and to determine whether the intake meets the current nutritional recommendations for children with IDDM. RESEARCH DESIGN AND METHODS A total of 66 children with IDDM who were < 10 years of age were recruited from two suburban Pennsylvania hospitals. To collect dietary intake data, subjects were asked, via telephone interview, to complete three random-day 24-h dietary recalls. Data were analyzed for the content of nutrients and other food components by a computerized database program. Intakes were expressed as a 3-day average intake for each subject. RESULTS Overall mean intake of protein and cholesterol approximated the current recommendations. The mean intake of saturated fat exceeded recommendations, while fiber intake was < the recommended level. Many of the children consumed levels of saturated fat well above recommendations. Energy, vitamin, and mineral intakes were adequate for the overall sample. However, from 10 to 40% of the sample had an inadequate intake of vitamin D, vitamin E, and zinc. The percentage of those with inadequate intakes of these nutrients decreased with age. CONCLUSIONS These data suggest that, on average, among this sample of children with IDDM aged < 10 years, adherence to the current nutritional recommendations for children with IDDM was adequate, but some individual children had intakes that were not consistent with the recommendations for optimal management of IDDM.

Change in Nutrient Intakes, Number of Servings, and Contributions of Total Fat from Food Groups in 4- to 10-Year-Old Children Enrolled in a Nutrition Education Study

OBJECTIVE To determine change in nutrient intakes, number of servings, and contributions of total fat from food groups in children who lowered their dietary fat intake. DESIGN A research and demonstration study designed to lower plasma low-density lipoprotein cholesterol level. There were four study groups: two intervention and two control groups. All children had hypercholesterolemia except for those in one control group. There 24-hour dietary recalls were collected on randomly assigned days over a 2-week period at baseline and 3 months after the intervention. SUBJECTS Three hundred three 4-to 10-year old children from suburbs north of Philadelphia, Pa. INTERVENTIONS One intervention involved a home-based, parent-child autotutorial program (PCAT group) with audiotaped stories and print materials for the children and their families; the other intervention involved one face-to-face counseling session with a registered dietitian (counseling group). OUTCOME MEASURES Change in mean nutrient intakes compared with the Recommended Dietary Allowance (RDA); change in number of servings and mean grams of total fat contributed from 10 different food groups. STATISTICAL ANALYSES PERFORMED Analyses of variance and chi 3 analyses. RESULTS Children in every study group had mean intakes of all nutrients (except vitamin D) greater than 67% of the RDA 3 months after the baseline measurement. Several food groups (ie, meats, dairy products, fats/oils, and desserts) provided less total fat to the diets of children who reduced their dietary lipid intake after 3 months (i.e., PCAT and counseling groups). These children also reduced the mean number of servings selected from these food groups. Within these same food groups, some children consumed fewer servings of higher fat foods and more servings of lower fat foods. APPLICATIONS/CONCLUSIONS Children who lowered their dietary fat intake after intervention reported both quantitative and qualitative changes in food choices from several food groups. These choices did not significantly reduce their nutrient intakes.

Obesity. Workshop III. AHA Prevention Conference III. Behavior change and compliance: keys to improving cardiovascular health.

The workshop provided the opportunity to discuss issues and develop and integrate ideas. The following recommendations for public policies, education programs, and high-priority research initiatives were developed: Recommendations for Public Policies: Focus on prevention by requiring school programs to emphasize appropriate diet, physical activity, and general health guidance to promote cardiovascular health and prevent disease through federal funding. Provide better access to exercise (city planning, work-site interventions). Influence food availability and accessibility. Influence reimbursement policies for effective early intervention and prevention strategies for obesity. Reevaluate policies for use of drugs in the treatment of obesity. Recommendations for Education Programs: Sponsor scientific workshop to: Define the most appropriate weight standards for prevention and treatment. Identify who should lose weight and why, when, and how. Promote the fact that obesity is an important health risk factor, even at moderate levels, and that excess visceral fat is particularly hazardous. Target health care professionals, consumers, and the media for education about: Nature of obesity as a heterogeneous syndrome. Recommendations for diet, exercise, behavioral interventions, drugs, and surgery. Recognition of special needs of populations of different ethnicity, gender, age, etc. State-of-the-art treatment and treatment programs. High-Priority Research Initiatives: Build better bridges between basic research and treatment/prevention practices. Acknowledge that obesity is a heterogeneous syndrome that may best be characterized as different obesities. Research on defining subtypes. Implications for etiology and treatment. Better characterization of genotypes and phenotypes. Study the effects of weight loss, weight gain,and weight cycling on medical and psychosocial outcomes and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Diet quality of young children who received nutrition education promoting lower dietary fat

OBJECTIVE : To evaluate the impact of nutrition education promoting lower dietary fat on the overall diet quality in children using a multidimensional index that measures nutrient and food intakes in relation to US dietary recommendations. DESIGN : Prospective cohort study with two intervention and two control groups. Children with elevated low density lipoprotein (LDL) cholesterol were randomized to one of two intervention groups or an at-risk control group. The intervention children received either the parent-child autotutorial (PCAT) programme, a 10-week home-based self-instruction nutrition education programme, or nutrition counselling from a registered dietitian. Children with non-elevated plasma cholesterol formed the not-at-risk control group. Dietary and blood data were collected at baseline and at 3 months. SETTING : Paediatric practices in suburbs north of Philadelphia, PA. SUBJECTS : Two hundred and twenty-seven 4-10-year-old children with elevated LDL cholesterol between the 80th and 98th percentiles, and 76 age- and gender-matched children with non-elevated plasma cholesterol, were studied. RESULTS : Children who received PCAT or counselling significantly improved their overall diet quality (-0.6 and -0.4 change in diet quality index (DQI) scores) compared with at-risk control children. Children who received either form of nutrition education were more likely to meet the recommendations for three components of the DQI (total fat, saturated fat, sodium) (OR >1.7), but did not improve their intakes of three components of the DQI (vegetables and fruits, complex carbohydrates, calcium) at 3 months. CONCLUSIONS : Nutrition education promoting lower dietary fat improved childrens overall diet quality. However, several dietary behaviours important for long-term health remained unchanged.

Junior High Home Economics Curriculum: Its Effect on Students' Knowledge, Attitude, and Behavior

The objective of this study was to determine the effect of nutrition instruction, using the curriculum Nutrition In a Changing World, A Curriculum for Home Economics, Grades 7-9, on improving the nutrition knowledge, selected food/nutrition attitudes, and dietary behavior of junior high home economics students. There were three groups of students, one experimental and two control groups, at each grade level (seven through nine). The experimental group was pretested, taught the nutrition curriculum and posttested. One control group was only posttested to measure the effect of the pretest on posttest performance. A second control group was pretested and posttested. Neither control group received nutrition instruction until after the study was completed. Three instruments were used to collect data: a nutrition knowledge test, a food/nutrition attitude instrument, and a food frequency form. The results indicate that, at all grade levels, the experimental group had significantly improved knowledge scores. Little change in attitude scale scores was noted in grades seven and eight, while ninth grade experimental students scored significantly higher on the posttest for all attitude scales. Little improvement was seen in the posttest food frequency scores.

Age-related changes in cardiovascular disease risk factors of hypercholesterolemic children☆☆☆★★★

OBJECTIVE To describe the age-related changes in cardiovascular disease risk factors in young, hypercholesterolemic (HC) children. METHODS Hypercholesterolemic (n = 227) and nonhypercholesterolemic (NHC) (n = 80) children between the ages of 4 and 10 years were identified. Height, weight, skin-fold and blood pressure measurements, and total cholesterol levels were measured. The HC group also had insulin levels evaluated. The groups were compared by analysis of variance. Simple Spearman correlations evaluated the associations between factors within each group. RESULTS The HC and NHC groups had similar mean ages, heights, and weights, both contained 51% girls, and all were white subjects. Percent weight-for-height median, and biceps, triceps, suprailiac and subscapular skin-fold measurements were all larger for the HC group. A significant age interaction demonstrated that the HC groups larger suprailiac and sum of skin-fold measures were expressed in the 8.0- to 9.9-year-old children, but not the 4.0- to 5.9-year-olds. For both groups, systolic blood pressure was associated with the measures of adiposity. For the HC group, insulin levels were also associated with adiposity. CONCLUSIONS These results suggest that: (1) children with HC have greater body fat, (2) the expression of the hypercholesterolemia precedes the expression of increased body fat, (3) body fat increases with age, and (4) altered insulin and blood pressure levels are expressed in association with the increased body fat in children with HC. Confirmation with longitudinal data is necessary.