Diane Stadler

The effects of the HEALTHY study intervention on middle school student dietary intakes

BackgroundThe HEALTHY study was designed to respond to the alarming trends in increasing rates of overweight, obesity, and type 2 diabetes mellitus in youth. The objective of this analysis was to examine the effects of the HEALTHY study on student self-reported dietary intakes (energy, macronutrients and grams consumed of selected food groups).MethodsHEALTHY was a cluster-randomized study in 42 public middle schools. Students, n = 3908, self-reported dietary intake using the Block Kids Questionnaire. General linear mixed models were used to analyze differences in dietary intake at the end of the study between intervention and control schools.ResultsThe reported average daily fruit consumption was 10% higher at the end of the study in the intervention schools than in the control schools (138 g or approximately 2 servings versus 122 g, respectively, p = 0.0016). The reported water intake was approximately 2 fluid ounces higher in the intervention schools than in the control (483 g versus 429 g respectively; p = 0.008). There were no significant differences between intervention and control for mean intakes of energy, macronutrients, fiber, grains, vegetables, legumes, sweets, sweetened beverages, and higher- or lower-fat milk consumption.ConclusionThe HEALTHY study, a five-semester middle school-based intervention program that integrated multiple components in nutrition, physical education, behavior change, and social marketing-based communications, resulted in significant changes to students reported fruit and water intake. Subsequent interventions need to go beyond the school environment to change diet behaviors that may affect weight status of children.Clinical Trials RegistrationNCT00458029

Effect of Nutrition Changes on Foods Selected by Students in a Middle School-Based Diabetes Prevention Intervention Program: The HEALTHY Experience

BACKGROUND The HEALTHY primary prevention trial developed an integrated multicomponent intervention program to moderate risk factors for type 2 diabetes in middle schools. The nutrition component aimed to improve the quality of foods and beverages served to students. Changes in the School Breakfast Program (SBP), National School Lunch Program (NSLP), and à la carte venues are compared to the experience of control schools. METHODS The intervention was implemented in 21 middle schools from winter 2007 through spring 2009 (following a cohort of students from sixth through eighth grades); 21 schools acted as observed controls. The nutrition component targeted school food service environmental change. Data identifying foods and nutrients served (selected by students for consumption) were collected over a 20-day period at baseline and end of study. Analysis compared end of study values for intervention versus control schools. RESULTS Intervention schools more successfully limited dessert and snack food portion size in NSLP and à la carte and lowered fat content of foods served. Servings of high-fiber grain-based foods and/or legumes were improved in SBP but not NSLP. Intervention and control schools eliminated >1% fat milk and added-sugar beverages in SBP, but intervention schools were more successful in NSLP and à la carte. CONCLUSION The HEALTHY program demonstrated significant changes in the nutritional quality of foods and beverages served in the SBP, NSLP, and à la carte venues, as part of an effort to decrease childhood obesity and support beneficial effects in some secondary HEALTHY study outcomes.

Cardiometabolic Risk Assessments by Body Mass Index z -Score or Waist-to-Height Ratio in a Multiethnic Sample of Sixth-Graders

Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R 2) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R 2 attributed to BMIz or WHtR was 19%–28% among high-fatness and 8%–13% among lower-fatness students. R 2 for lipid variables was 4%–9% among high-fatness and 2%–7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13–0.20) than for WHtR (0.17–0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart.

Environmental, dietary and case-control study of Nodding Syndrome in Uganda: A post-measles brain disorder triggered by malnutrition?

Nodding Syndrome (NS) is an epileptic encephalopathy characterized by involuntary vertical head nodding, other types of seizures, and progressive neurological deficits. The etiology of the east African NS epidemic is unknown. In March 2014, we conducted a case-control study of medical, nutritional and other risk factors associated with NS among children (aged 5-18years) of Kitgum District, northern Uganda (Acholiland). Data on food availability, rainfall, and prevalent disease temporally related to the NS epidemic were also analyzed. In NS Cases, the mean age of reported head nodding onset was 7.6years (range 1-17years). The epidemiologic curve of NS incidence spanned 2000-2013, with peaks in 2003 and 2008. Month of onset of head nodding was non-uniform, with all-year-aggregated peaks in April and June when food availability was low. Families with one or more NS Cases had been significantly more dependent on emergency food and, immediately prior to head nodding onset in the child, subsistence on moldy plant materials, specifically moldy maize. Medical history revealed a single significant association with NS, namely prior measles infection. NS is compared with the post-measles disorder subacute sclerosing panencephalitis, with clinical expression triggered by factors associated with poor nutrition.

Body Mass Index and the Development of New-Onset Diabetes Mellitus or the Worsening of Pre-Existing Diabetes Mellitus in Adult Kidney Transplant Patients

OBJECTIVE The purpose of this study was to determine the relationship between body mass index (BMI) and the development of new-onset diabetes after transplant (NODAT) as well as the worsening of pre-existing diabetes mellitus (DM) in adults after kidney transplantation. DESIGN AND SUBJECTS A medical record review was conducted using the records of 204 adult patients who underwent a first renal transplant between September 2009 and February 2011 at a single transplant center. Patients who received simultaneous transplantation of another organ, who were immunosuppressed for nontransplant reasons, or those who were less than 18 years of age were excluded. MAIN OUTCOME MEASURES Outcome data collected at the time of hospital discharge and at 3, 6, and 12 months after kidney transplantation included the development of NODAT and the components of DM treatment regimens. RESULTS The cumulative incidence of NODAT at discharge and 3, 6, and 12 months post-transplantation was 14.2%, 19.4%, 20.1%, and 19.4%, respectively. The odds of developing NODAT by discharge or 3 or 6 months post-transplantation increased by a factor of 1.11 (95% confidence interval [CI]: 1.0-1.23), 1.13 (95% CI: 1.03-1.24), and 1.15 (95% CI: 1.05-1.27), respectively, per unit increase in pretransplantation BMI. The need for more aggressive DM treatment (suggesting a worsening of DM status) was most usually seen between discharge and 3 months; 50% of patients with preexisting DM required more aggressive DM treatment post-transplantation (X3(2) = 13.25; P = .001). CONCLUSION The odds of developing NODAT at discharge and 3 and 6 months post-transplantation increased per unit of pretransplantation BMI. The most common time for NODAT to develop or for preexisting DM to worsen was within 3 months of kidney transplantation.