Lauren E. Au

Eating School Lunch Is Associated with Higher Diet Quality among Elementary School Students

BACKGROUND Few studies have assessed the dietary quality of children who eat meals from home compared with school meals according to the 2010 Dietary Guidelines for Americans. OBJECTIVE The objective of this study was to examine diet quality for elementary school students in relation to source of breakfast and lunch (whether school meal or from an outside source). DESIGN An observational study was conducted of students in 43 schools in San Diego, CA, during the 2011-2012 school year. PARTICIPANTS/SETTING Fourth- and fifth-grade students (N=3,944) completed a diary-assisted 24-hour food recall. MAIN OUTCOME MEASURES The Healthy Eating Index-2010 (HEI-2010) scores of children who ate breakfast and lunch at school were compared with the HEI-2010 scores of children who obtained their meals from home and a combination of both school and home. STATISTICAL ANALYSIS Analysis of variance, χ2 test, and generalized estimating equation models adjusted for age, sex, race/ethnicity, grade, language, and school level clustering were performed. RESULTS School lunch eaters had a higher mean±standard deviation overall diet quality score (HEI-2010=49.0±11.3) compared with students who ate a lunch obtained from home (46.1±12.2; P=0.02). There was no difference in overall diet quality score by breakfast groups. Students who ate school breakfast had higher total fruit (P=0.01) and whole fruit (P=0.0008) scores compared with students who only ate breakfast obtained from home. Students who ate school foods had higher scores for dairy (P=0.007 for breakfast and P<0.0001 for lunch) and for empty calories from solid fats and added sugars (P=0.01 for breakfast and P=0.007 for lunch). CONCLUSIONS Eating school lunch was associated with higher overall diet quality compared with obtaining lunch from home. Future studies are needed that assess the influence of the Healthy Hunger-Free Kids Act on childrens diet quality.

Evaluation of Online and In-Person Nutrition Education Related to Salt Knowledge and Behaviors among Special Supplemental Nutrition Program for Women, Infants, and Children Participants

BACKGROUND The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) differs from other federal nutrition programs in that nutrition education is a required component. WIC programs traditionally provide in-person education, but recently some WIC sites have started offering online education. Education focused on reducing salt intake is an important topic for WIC participants because a high-sodium diet has been associated with high blood pressure, and low-income populations are at increased risk. OBJECTIVE Our aim was to examine the impacts of traditional in-person and online nutrition education on changes in knowledge, self-efficacy, and behaviors related to reducing salt intake in low-income women enrolled in WIC. DESIGN Although a comparison of groups was not the primary focus, a randomized trial examining the impact of online and in-person nutrition education on participant knowledge, self-efficacy, and behaviors related to salt intake was conducted. PARTICIPANTS/SETTING Five hundred fourteen WIC participants from three Los Angeles, CA, WIC clinics received either in-person (n=257) or online (n=257) education. Questionnaires assessing salt-related knowledge, self-efficacy, and behaviors were administered at baseline and 2 to 4 months and 9 months later from November 2014 through October 2015. RESULTS Positive changes in knowledge and self-efficacy were retained 2 to 4 months and 9 months later for both groups (P<0.05). Both groups reported significant changes in behaviors related to using less salt in cooking (P<0.0001) and eating fewer foods with salt added at the table or during cooking (P<0.001) at 2 to 4 months and 9 months. CONCLUSIONS Both online and in-person education resulted in improvements during a 9-month period in knowledge, self-efficacy, and reported behaviors associated with reducing salt intake in a low-income population. Offering an online education option for WIC participants could broaden the reach of nutrition education and lead to long-term positive dietary changes.

Child Food Insecurity Is Associated with Energy Intake among Fourth- and Fifth-Grade Girls

BACKGROUND Food insecurity is associated with poor diet and obesity among adult women, but evidence among children is mixed, and few studies have examined differences between boys and girls. OBJECTIVE This study examined the relationship between self-reported food insecurity and dietary intake among boys and girls. DESIGN Cross-sectional survey data were used from the Childrens PowerPlay! Campaign evaluation. PARTICIPANTS AND SETTING In all, 3,547 fourth- and fifth-grade students (9 to 11 years old) from 44 San Diego-area elementary schools in 2012 completed diary-assisted 24-hour recalls and a questionnaire that included five questions from the Child Food Security Assessment. MAIN OUTCOME MEASURES Individual dietary components (including total energy, nutrients, and sugar-sweetened beverages), Healthy Eating Index-2010 scores, and meal patterns (such as meal sizes and missed meals) were derived from 24-hour recalls. STATISTICAL ANALYSES Multivariable linear and logistic regression models were used to estimate the relationships between food insecurity and diet characteristics. RESULTS Girls with the highest food insecurity consumed 135 total kilocalories (P<0.005) and 60 snack kilocalories (P<0.05) more per day than girls with no food insecurity. These relationships were absent among boys. CONCLUSIONS Food insecurity among girls in grades 4 and 5 was associated with higher energy intake. Findings support the need for further research to better understand the nature of this relationship and its implications for energy balance.

School Wellness Committees Are Associated With Lower Body Mass Index Z-Scores and Improved Dietary Intakes in US Children: The Healthy Communities Study

BACKGROUND Our objective was to examine the association between school wellness committees and implementation of nutrition wellness policies and childrens weight status and obesity-related dietary outcomes. METHODS A cross-sectional study was conducted of 4790 children aged 4-15 years recruited from 130 communities in the Healthy Communities Study. Multilevel statistical models assessed associations between school wellness policies and anthropometric (body mass index z-score [BMIz]) and nutrition measures, adjusting for child and community-level covariates. RESULTS Children had lower BMI z-scores (-0.11, 95% confidence interval [CI]: -0.19, -0.03) and ate breakfast more frequently (0.14 days/week, 95% CI: 0.02-0.25) if attending a school with a wellness committee that met once or more in the past year compared to attending a school with a wellness committee that did not meet/did not exist. Children had lower added sugar (p < .0001), lower energy-dense foods (p = .0004), lower sugar intake from sugar-sweetened beverages (p = .0002), and lower dairy consumption (p = .001) if attending a school with similar or stronger implementation of the nutrition components of the school wellness policies compared to other schools in the district. CONCLUSIONS A more active wellness committee was associated with lower BMI z-scores in US schoolchildren. Active school engagement in wellness policy implementation appears to play a positive role in efforts to reduce childhood obesity.

Breastfeeding Is Associated With Higher Retention in WIC After Age 1

Objective: Examine factors associated with retention on the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) after 1 year of age. Setting: A large California WIC program. Participants: WIC participants 14 months old (9,632) between July and September, 2016. Main Outcome Measure: Recertification in WIC by 14 months of age. Analysis: Multivariate logistic regression was performed and odds ratios (ORs) and 95% confidence intervals (CIs) were computed to examine factors associated with child retention in WIC at age 14 months. Results: Mothers performing any amount of breastfeeding from 6 to 12 months were more likely than mothers not breastfeeding to recertify their children in WIC at age 14 months. The odds of retention for children fully breastfed from 6 to 12 months was about 3 times higher than for fully formula‐fed children (95% CI, 2.46–3.59). The odds of retention for mostly breastfed children and children fed some breast milk but mostly formula were 1.95 (95% CI, 1.57–2.43) and 1.72 (95% CI, 1.41–2.10) times higher than fully formula‐fed children. Prenatal intention to breastfeed (OR = 1.34; 95% CI, 1.16–1.55), online education (OR = 1.08; 95% CI, 1.03–1.13), missing benefits (OR = 0.19; 95% CI, 0.17–0.21), underredemption of WIC benefits (OR = 0.51, 95% CI, 0.45–0.58), early enrollment in WIC (OR = 1.11; 95% CI, 1.09–1.14), number of family members receiving WIC (OR = 1.29, 95% CI, 1.14–1.46), English language preference (OR, 0.55; 95% CI, 0.47–0.64), and participation in Medicaid (OR = 1.29; 95% CI, 1.14–1.47) were also associated with retention. Conclusions and Implications: Results from this study suggested there are a number of areas WIC programs may target to promote ongoing participation in the program. These include support for both breastfeeding and non‐breastfeeding women, technology‐based strategies, and targeted outreach to pregnant women, participants who have missed benefits, and participants who have not redeemed their benefits. Research that examines the impact of targeted interventions directed at ≥1 of these areas is essential to help WIC programs maintain contact with children into early childhood.