Meaghan S Christian

Family meals can help children reach their 5 A Day: a cross-sectional survey of children's dietary intake from London primary schools

Background This study aims to explore how the home food environment and parental attitudes and values affect childrens fruit and vegetable (F&V) intake. Methods The sample consists of 2383 children with a mean age of 8.3 years (95% CI 8.2 to 8.3) attending 52 primary schools in London. These children are taking part in two randomised controlled trials to evaluate a school gardening programme. Diet was assessed using a validated 24-h food tick list, the Child And Diet Evaluation Tool (CADET). Results The CADET tool found that children consumed on average 293 g F&V (95% CI 287 to 303) per day. Clustered (by school) multilevel regression models with total F&V as the primary outcome were conducted to explore how the home environment affects childrens F&V intake. Children of families who reported ‘always’ eating a family meal together at a table had 125 g (95% CI 92 to 157; p=<0.001) more F&V than families who never ate a meal together. Daily consumption of F&V by parents was associated with higher F&V (88 g, 95% CI 37 to 138) intake in children compared with rarely/never consumption of F&V by parents. Cutting up fruit and vegetables for children was associated with higher consumption. Families who reported always cutting up F&V for their children had 44 g (95% CI 18 to 71) more F&V than families who never cut up F&V. Conclusions This study identified that cutting up F&V and family consumption of F&V facilitates childrens intake. Eating a family meal together regularly could increase childrens F&V intake and help them achieve the recommended intake. Trial registration ISRCTN11396528.

Process evaluation of a cluster randomised controlled trial of a school-based fruit and vegetable intervention: Project Tomato.

OBJECTIVE The present analysis evaluates the overall appreciation and implementation of an intervention, Project Tomato, designed to maintain fruit and vegetable intake in children aged 8-9 years. DESIGN A random sample of fifty-four English primary schools (658 children) were randomised to either the intervention group or the control. The intervention group received a multi-component programme delivered in school by teachers and items sent home for parents/children. Dietary measurements were collected at baseline and follow-up. The intervention participants completed questionnaires on the intervention materials, to identify implementation and appreciation of the intervention, and other environmental mechanisms. SETTING Fifty-four primary schools were randomly selected, with twenty-seven schools allocated to the intervention group. SUBJECTS A total of 311 children received the intervention. RESULTS Implementation of the intervention was low, 21·3 % of school items and 56·0 % of home items were implemented. The intervention materials were well received by teachers, parents and children. Other mechanisms that may affect fruit and vegetable intake were explored. Children who ate their main meal with their parents 3-7 nights/week on average consumed 37·6 (95 % CI 9·8, 65·4) g more fruit and vegetables than children who ate with their parents 0-2 times/week. CONCLUSIONS Implementation of the trial components was poor. However, the results identified the importance of parental environment and mealtime structure on childrens fruit and vegetable intake.

Measuring diet in primary school children aged 8-11 years: validation of the Child and Diet Evaluation Tool (CADET) with an emphasis on fruit and vegetable intake

Background/Objectives:The Child And Diet Evaluation Tool (CADET) is a 24-h food diary that measures the nutrition intake of children aged 3–7 years, with a focus on fruit and vegetable consumption. Until now CADET has not been used to measure nutrient intake of children aged 8–11 years. To ensure that newly assigned portion sizes for this older age group were valid, participants were asked to complete the CADET diary (the school and home food diary) concurrently with a 1-day weighed record.Subjects/Methods:A total of 67 children with a mean age of 9.3 years (s.d.: ± 1.4, 51% girls) participated in the study. Total fruit and vegetable intake in grams and other nutrients were extracted to compare the mean intakes from the CADET diary and Weighed record using t-tests and Pearson’s r correlations. Bland–Altman analysis was also conducted to assess the agreement between the two methods.Results:Correlations comparing the CADET diary to the weighed record were high for fruit, vegetables and combined fruit and vegetables (r=0.7). The results from the Bland–Altman plots revealed a mean difference of 54 g (95% confidence interval: −88, 152) for combined fruit and vegetables intake. CADET is the only tool recommended by the National Obesity Observatory that has been validated in a UK population and provides nutrient level data on children’s diets.Conclusions:The results from this study conclude that CADET can provide high-quality nutrient data suitable for evaluating intervention studies now for children aged 3–11 years with a focus on fruit and vegetable intake.

A cluster-randomised controlled trial of a school-based fruit and vegetable intervention: Project Tomato

OBJECTIVE The present study aimed to determine whether a multi-component school-based intervention can maintain childrens fruit and vegetable intake post eligibility for free school fruit and vegetables. DESIGN A random sample of fifty-four English primary schools was randomised to receive the 10-month intervention Project Tomato, a multi-component theory-based intervention, or the control. Each group consisted of twenty-seven schools. SETTING Childrens intake of fruit and vegetables is below recommendations. The English School Fruit and Vegetable Scheme has a short-term impact on intake while children are eligible for the scheme. SUBJECTS Dietary measurements were collected from 658 Year 2 pupils aged 7-8 years at baseline and at follow-up 20 months later. RESULTS Following an intention to treat analysis, the intervention as delivered compared with the control had no impact on the intake of fruit and vegetables (2 g/d, 95 % CI -23, 26 g/d) or on the number of portions of fruit (0.0 portions, 95 % CI - 0.3, 0.3) or vegetables (0.0 portions, 95 % CI - 0.2, 0.3) consumed daily by children. Intake of fruit and vegetables at school and home dropped by ≈ 100 g/d and 50 g/d, respectively, between baseline and follow-up in both the intervention and control groups. CONCLUSIONS Implementation of the intervention was low, with associated lack of impact on fruit and vegetable consumption in children. Alternatives to the delivery of an intervention by teachers and parents are needed to improve the dietary intake of primary-school children.

Study protocol: can a school gardening intervention improve children’s diets?

BackgroundThe current academic literature suggests there is a potential for using gardening as a tool to improve children’s fruit and vegetable intake. This study is two parallel randomised controlled trials (RCT) devised to evaluate the school gardening programme of the Royal Horticultural Society (RHS) Campaign for School Gardening, to determine if it has an effect on children’s fruit and vegetable intake.Method/DesignTrial One will consist of 26 schools; these schools will be randomised into two groups, one to receive the intensive intervention as “Partner Schools” and the other to receive the less intensive intervention as “Associate Schools”. Trial Two will consist of 32 schools; these schools will be randomised into either the less intensive intervention “Associate Schools” or a comparison group with delayed intervention. Baseline data collection will be collected using a 24-hour food diary (CADET) to collect data on dietary intake and a questionnaire exploring children’s knowledge and attitudes towards fruit and vegetables. A process measures questionnaire will be used to assess each school’s gardening activities.DiscussionThe results from these trials will provide information on the impact of the RHS Campaign for School Gardening on children’s fruit and vegetable intake. The evaluation will provide valuable information for designing future research in primary school children’s diets and school based interventions.Trial registrationISRCTN11396528

Evaluation of the impact of school gardening interventions on children's knowledge of and attitudes towards fruit and vegetables: a cluster randomised controlled trial.

Involvement of children in gardening has the potential to increase liking of fruit and vegetables (FV) and consequently, intake, but research results are mixed. School gardening led by external specialists such as the Royal Horticultural Society (RHS) could have more impact than teacher-led gardening on childrens knowledge of, and attitudes towards, FV. Data from a cluster randomised controlled trial were used to compare a RHS-led school gardening intervention with a teacher-led gardening intervention amongst 7-10 year olds in 21 London schools. A short questionnaire was developed and used to identify childrens knowledge and attitudes towards FV consumption before the garden intervention and 18 months afterwards. Results from multilevel regression models, both unadjusted and adjusted for baseline responses and socio-demographic factors, were reported. Attitudes to FV intake were compared between groups. Change in FV knowledge was used to predict change in FV consumption assessed using 24-hour food diaries. In comparison with the RHS-led group (n = 373), teacher-led children (n = 404) were more likely to agree they ate lots of fruit (p < 0.009) and tried new fruits (p = 0.045), but RHS-led gardening was associated with a greater increase in the total number of vegetables recognised (p = 0.031). No other differences in improvements in attitudes, or associations between change in FV recognition and intake were found. In relation to improvements in childrens recognition and attitudes towards eating FV, this trial produced limited evidence that gardening activity packages led by external specialists (RHS-led) provide additional benefits over those led by teachers trained by the RHS. Indeed, the latter were potentially more effective.

Impact of school lunch type on nutritional quality of English children's diets.

OBJECTIVE Nutrient and food standards exist for school lunches in English primary schools although packed lunches brought from home are not regulated. The aim of the present study was to determine nutritional and dietary differences by lunch type. DESIGN A cross-sectional survey was carried out in 2007 assessing diet using the Child and Diet Evaluation Tool (CADET), a validated 24 h estimated food diary. The data were analysed to determine nutritional and dietary intakes over the whole day by school meal type: school meals and packed lunches. SETTING Fifty-four primary schools across England. SUBJECTS Children (n 2709) aged 6-8 years. RESULTS Children having a packed lunch consumed on average 11·0 g more total sugars (95 % CI 6·6, 15·3 g) and 101 mg more Na (95 % CI 29, 173 mg) over the whole day. Conversely, children having a school meal consumed, on average, 4·0 g more protein (95 % CI 2·3, 5·7 g), 0·9 g more fibre (NSP; 95 % CI 0·5, 1·3 g) and 0·4 mg more Zn (95 % CI 0·1, 0·6 mg). There was no difference in daily energy intake by lunch type. Children having a packed lunch were more likely to consume snacks and sweetened drinks; while children having a school meal were more likely to consume different types of vegetables and drink water over the whole day. CONCLUSIONS Compared with children having a school meal, children taking a packed lunch to school consumed a lower-quality diet over the whole day, including higher levels of sugar and Na and fewer vegetables. These findings support the introduction of policies that increase school meal uptake.

Comparison of school day eating behaviours of 8–11 year old children from Adelaide, South Australia, and London, England Running title: Child eating behaviours in South Australia and England

Objective School food intake makes a considerable contribution to childrens overall diet, especially fruit and vegetable intake. Comparing differing school food provision systems can provide novel insights for intervention and improved nutrition policy. This study compared school day food in children from Australia and England. Design Children completed food frequency questionnaires reporting school day food intake, breakfast intake and family evening meals. Differences in food consumed over the school day between Australian and English children were evaluated. Multinomial logistic regressions compared fruit and vegetable intake, family dinner frequency and breakfast in Australian and English children adjusting for confounders: age, sex, ethnicity and parent education. Setting 27 Primary schools in Adelaide, Australia and 32 in London, England. Subjects N = 772 children aged 8–11 years from the Australian REACH study (n = 347) and UK RHS School Gardening Trial in England (n = 425). Results Considerably more English children reported consuming vegetables at school than Australian children (recess/lunchtime Australian children 3.4%/6.1%; English children recess/lunctime 3.6/51.1%). However, Australian children were more likely to consume vegetables daily (OR = 4.1; 1.3, 12.5), and have family evening meals everyday [OR = 4.01; 1.88, 8.55], and were less likely to consume breakfast (OR = 0.26; 0.08, 0.79) than English children. Conclusions Findings indicate that provision of a school lunch meal, compared to a packed lunch from home, may be more supportive of childrens vegetable intake. However, without a supportive home environment that encourages vegetable intake, children will not be able to consume sufficient amounts of vegetables.

Primary school education programmes can decrease child salt intake

Commentary on: He FJ, Wu Y, Feng XX, et al. School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial. BMJ 2015;350:h770.[OpenUrl][1][Abstract/FREE Full Text][2] Educating children about low salt intake could have significant effects on their long-term health by preventing them from developing hypertension and CVD in later life.1 ,2 For children 7–11 years of age the … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.h770%26rft_id%253Dinfo%253Apmid%252F25788018%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=350/mar18_13/h770&atom=%2Febnurs%2F19%2F1%2F15.atom

The impact of the family meal on children's fruit and vegetable intake: a cross-sectional survey of children's dietary intake from London primary schools

The current recommendations suggest children should eat 400 grams or five portions of fruit and vegetables a day. This study uses a specially developed questionnaire for use with primary school children and explores how aspects of the home environment and parental attitudes and values affect children’s fruit and vegetable intake. This study includes baseline measurements from children attending 51 primary schools in London. These children are taking part in two randomized controlled trials to evaluate a school gardening programme. Baseline data collection consisted of a previously validated 24-hour food ticklist, the Child And Diet Evaluation Tool (CADET). The CADET uses age and gender specific food portion sizes to calculate food and nutrient intake. Children’s intake at school was recorded in the CADET tool by trained fieldworkers and intake at home was recorded by parents/carers. A DVD with instructions for completing the questionnaire was sent home for parents/carers and children to watch. The total sample consists of 2389 children with a mean age of 8.3 years old (SD: + / 0.6). Overall, the CADET tool found that children consumed on average 293 g fruit and vegetables (SD: + / 245). Clustered (by school) multilevel regression models with total fruit and vegetables as the primary outcome were conducted to explore how the home environment affects children’s fruit and vegetable intake (please see the table below). Children of families who “always” ate a family meal together at a table, had on average, 130 g more fruit and vegetables, than those families who never ate a meal together. Children whose parents’ always cut up fruit and vegetables for them, consumed on average, half a portion more fruit and vegetables compared to children with parents who sometimes or never cut up their fruit and vegetables.