Danielle Hollar

Effect of a Two-Year Obesity Prevention Intervention on Percentile Changes in Body Mass Index and Academic Performance in Low-Income Elementary School Children

OBJECTIVES We assessed the effects of a school-based obesity prevention intervention that included dietary, curricula, and physical activity components on body mass index (BMI) percentiles and academic performance among low-income elementary school children. METHODS The study had a quasi-experimental design (4 intervention schools and 1 control school; 4588 schoolchildren; 48% Hispanic) and was conducted over a 2-year period. Data are presented for the subset of the cohort who qualified for free or reduced-price school lunches (68% Hispanic; n = 1197). Demographic and anthropometric data were collected in the fall and spring of each year, and academic data were collected at the end of each year. RESULTS Significantly more intervention than control children stayed within normal BMI percentile ranges both years (P = .02). Although not significantly so, more obese children in the intervention (4.4%) than in the control (2.5%) decreased their BMI percentiles. Overall, intervention schoolchildren had significantly higher math scores both years (P < .001). Hispanic and White intervention schoolchildren were significantly more likely to have higher math scores (P < .001). Although not significantly so, intervention schoolchildren had higher reading scores both years. CONCLUSIONS School-based interventions can improve health and academic performance among low-income schoolchildren.

Effective Multi-level, Multi-sector, School-based Obesity Prevention Programming Improves Weight, Blood Pressure, and Academic Performance, Especially among Low-Income, Minority Children

Introduction. Successfully addressing childhood onset obesity requires multilevel (individual, community, and governmental), multi-agency collaboration. Methods. The Healthier Options for Public Schoolchildren (HOPS)/OrganWise Guys® (OWG) quasi-experimental controlled pilot study (four intervention schools, one control school, total N=3,769; 50.2% Hispanic) was an elementary school-based obesity prevention intervention designed to keep children at a normal, healthy weight, and improve health status and academic achievement. The HOPS/OWG included the following replicable, holistic components: (1) modified dietary offerings, (2) nutrition/lifestyle educational curricula; (3) physical activity component; and (4) wellness projects. Demographic, anthropometric (body mass index [BMI]), blood pressure, and academic data were collected during the two-year study period (2004-6). Results. Statistically significant improvements in BMI, blood pressure, and academic scores, among low-income Hispanic and White children in particular, were seen in the intervention versus controls. Conclusion. Holistic school-based obesity prevention interventions can improve health outcomes and academic performance, in particular among high-risk populations.

Healthier options for public schoolchildren program improves weight and blood pressure in 6- to 13-year-olds.

Childhood obesity and related health consequences continue to be major clinical and public health issues in the United States. Schools provide an opportunity to implement obesity prevention strategies to large and diverse pediatric audiences. Healthier Options for Public Schoolchildren was a quasiexperimental elementary school-based obesity prevention intervention targeting ethnically diverse 6- to 13-year-olds (kindergarten through sixth grade). Over 2 school years (August 2004 to June 2006), five elementary schools (four intervention, one control, N=2,494, 48% Hispanic) in Osceola County, FL, participated in the study. Intervention components included integrated and replicable nutrition, physical activity, and lifestyle educational curricula matched to state curricula standards; modified school meals, including nutrient-dense items, created by registered dietitians; and parent and staff educational components. Demographic, anthropometric, and blood pressure data were collected at baseline and at three time points over 2 years. Repeated measures analysis showed significantly decreased diastolic blood pressure in girls in the intervention group compared to controls (P<0.05). Systolic blood pressure decreased significantly for girls in the intervention group compared to controls during Year 1 (fall 2004 to fall 2005) (P<0.05); while not statistically significant the second year, the trend continued through Year 2. Overall weight z scores and body mass index z scores decreased significantly for girls in the intervention group compared to controls (P<0.05 and P<0.01, respectively). School-based prevention interventions, including nutrition and physical activity components, show promise in improving health, particularly among girls. If healthy weight and blood pressure can be maintained from an early age, cardiovascular disease in early adulthood may be prevented.

Dose of Aspirin in the Treatment and Prevention of Cardiovascular Disease: Current and Future Directions

In meta-analyses of randomized trials of aspirin among patients with prior occlusive vascular disease events (secondary prevention), doses from 75 mg to more than 1500 mg daily provide similar benefits on myocardial infarction, stroke, and cardiovascular death. In acute myocardial infarction and during acute occlusive stroke, a loading dose of 162.5 to 325 mg is necessary to achieve a rapid clinical antithrombotic effect. In primary prevention trials, predominantly among men, aspirin (75 mg daily to 325 mg on alternate days) reduced the risk of a first myocardial infarction. In a large-scale trial in women, aspirin (100 mg on alternate days) reduced risk of a first stroke. In subgroup analyses of women older than age 65, aspirin significantly reduced first myocar-dial infarction and ischemic stroke. Direct comparisons of higher doses may yield additional cardiovascular benefits. At present, daily doses of 75 to 325 mg aspirin are sufficient for long-term treatment and prevention of cardiovascular disease.

The glycemic response is a personal attribute.

The Glycemic Index (GI) is a measure of the extent of the change in blood glucose content (glycemic response) following consumption of digestible carbohydrate, relative to a standard such as glucose. We have explored whether the reported GIs of foods are a sufficient guide to a person wishing to avoid large glycemic responses and thereby avoid hyperglycemia. For this purpose, volunteers carried out multiple tests of four foods, following overnight fasting, measuring the glycemic response over 2 H. The areas under the blood glucose/time curves (AUCs) were compared. Each food tester displayed individual, characteristic glycemic responses to each food, unrelated to any other testers response. Wide variations (up to 5‐fold) were seen between the average AUCs for the same test by different testers. The absolute magnitudes of the glycemic responses are important for individuals trying to control blood sugar and/or body weight, but using published GI lists as a guide to control the glycemic response is not fully informative. This is because in calculating the GI, individual glycemic responses to glucose are normalized to 100. GI values are, therefore, relative and are not necessarily a reliable guide to the persons actual individual AUC when consuming a food. Without knowledge of the persons characteristic blood glucose responses, reliance only on the GI may be misleading.

Blood glucose response to rate of consumption of digestible carbohydrate

When the glycemic response to consuming digestible carbohydrate is measured, little or no attention appears to have been paid to the possible effect on this response of the rate at which the food is consumed. We compared glycemic responses when volunteers ate or drank foods containing digestible carbohydrate as rapidly as possible, or in five equal portions over 12 min. Expecting that the response would be greater when the food was consumed rapidly, we found that the responses were equally and randomly distributed between the two rates of eating. At the same time, marked differences were noted in the responses elicited when different individuals consumed the same foods, leading to an investigation of this phenomenon, published elsewhere.

Lack of Deleterious Interaction Between Angiotensin Receptor Blockers and β-Blockers in the Treatment of Patients With Heart Failure

The Valsartan-Heart Failure trial formulated the hypothesis that combination therapy with angiotensin-converting enzyme inhibitors and β-blockers with an angiotensin-receptor blocker had a deleterious interaction. Furthermore, the Food and Drug Administration (FDA)-approved heart failure indication for valsartan included the statement that concomitant use of an angiotensin-converting enzyme inhibitor, a β-blocker was not recommended. The Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM)-Added and the VALsartan In Acute Myocardial Infarction Trial (VALIANT) provide reassuring evidence to support concomitant use of angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, and β-blockers. The FDA-approved heart failure indication for candesartan included the statement of additive benefits with angiotensin-converting enzyme inhibitors and β-blockers and led to a change in the valsartan label. These considerations have great clinical and public health importance given the increasing numbers of patients with heart failure, their high morbidity and mortality, and the relatively limited number of effective drug therapies

Moving Clinic- and Community-Based Practice into Policy to Address Child Healthy Weight (and Vice Versa)

As mentioned in previous chapters, childhood obesity and the attendant clinical manifestations of metabolic syndrome and type 2 diabetes have a strong, negative effect on a child’s organs, bones, sleep patterns, cancer risk, psychological health, and overall future cardiometabolic risk. And despite the fact that the prevalence of childhood overweight and obesity in the USA continues to grow, especially among underserved subgroups, there is hope for reversing these trends. One approach with much potential is a model of collaborative care for child healthy weight that uses a “hub and spoke” design whereby the school/child care center is a “hub” of good nutrition and healthy living in action, with messages and activities filtering out into the community organically through the “spokes” (clinics, after-school programs, grocery stores, etc.). This multi-sector, community contextually specific collaborative approach helps child healthy weight activities become embedded in clinical- and community-based practice and transforms policies to improve child health, which in turn provide ongoing guidance for practice implementation in all settings. Implementing evidence-based programming throughout the hub and the spokes, linking activities to sustainable, currently operationalized programs (such as the United States Department of Agriculture Supplementation Nutrition Assistance Program-Education, school wellness policies/Coordinated School Health programming, etc.), and commencing strategic community-wide social marketing efforts, allows a wide variety of partnerships to develop that share consistent healthy messaging. The true power of this model lies in community collaborations of diverse organizations. It will take all of us working together to achieve healthy weight on our communities, the USA at large, as well as other countries that are struggling with similar challenges of keeping children at a healthy weight.

1442 Elementary School-Based Obesity Prevention Intervention Effect on Waist Circumference Among Multiethnic 6–13 Year Olds

Background Childhood onset obesity and related health consequences continue to be major clinical and public health issues in the USA and abroad. Schools provide an opportunity to implement prevention strategies to large, diverse pediatric audiences. Healthier Options for Public Schoolchildren (HOPS) was a school-based obesity prevention intervention with nutrition and physical activity components implemented in the elementary school setting targeting 6–13 year olds. Methods HOPS was a quasi-experimental elementary school-based obesity prevention intervention targeting ethnically diverse 6–13-year-olds (Kindergarten-6th). Over four school years (August 2004-June 2009), five schools (four intervention; one control, N=3,183, 48% Hispanic) in Florida participated in the study. Waist circumference (WC) data was reported in the Fall of 2005 and Spring of 2006 only and these one year results are reported here. Results Among boys, the mean incremental change in WC (measured in centimeters [cm]) increase was significantly less in the intervention (1.35 cm +/- 0.88 [SD]) versus control schools (3.83 cm +/- 0.94) (P<0.0001). Among girls the mean incremental change in WC increase was significantly less in the intervention (1.20 cm +/- 0.84) versus control schools (4.17cm +/- 0.89) (P<0.0001). Similarly, waist-to-height ratio results showed that the intervention group mean incremental change was significantly less versus the control group for boys (P=0.0002) and girls (P<0.0001). Conclusions Elevated WC is strongly correlated with cardiometabolic disease risk factors and should be monitored in young children as such. School-based obesity prevention interventions show promise in improving weight and potentially cardiometabolic health in elementary-school aged children.

363 School-Based Obesity and Related Cardiovascular Disease Prevention Interventions Improve Weight and Academic Performance over a Three-Year Study

Background Childhood obesity and related health consequences continue to be major clinical and public health issues in the US and abroad. Healthier Options for Public Schoolchildren (HOPS) was a school-based obesity prevention intervention with nutrition and physical activity components implemented in the elementary school setting and targeting 6–12 year olds. Methods HOPS was implemented in August, 2004 through December 2009, and included approximately 3,200 children (48% Hispanic) attending four elementary schools in Florida. Demographic, anthropometric (height, weight, body mass index [BMI]) and academic (Florida Comprehensive Assessment Test [FCAT]) were collected during the school year. Interventions included modified dietary offerings, nutrition and lifestyle educational curricula, school gardens, and other school-based wellness projects. Results Repeated measures analysis showed over a three year study period the intervention Z weight scores decreased significantly among boys (0.81 to 0.71, P<0.001) with a trend among girls (0.56 to 0.51, P<0.07). Within ethnicity, a significant decrease in Z weight score for Hispanics (0.66 to 0.59 P<0.01) and whites (0.62 to 0.54, p<0.02) was shown. Over the same time period, FCAT math scores improved significantly among girls (308 to 319, p<0.001) and reading scores improved significantly among boys (299 to 307, P<0.01). Within ethnicity, Hispanics significantly improved both FCAT math (298 to 309, p<0.001) and reading (286 to 301, p<0.0001) scores. Conclusions School-based obesity prevention interventions including nutrition and physical activity components show promise in improving health and academic performance in elementary-aged children longitudinally, especially among Hispanics.