To determine the contribution of breakfast-eating behavior to dietary adequacy among low-income African-American children, 1151 children attending grades two through five at four elementary schools in East Orange, New Jersey were studied. Results of a 4-day eating behavior survey and a 24-hour dietary recall reveal that on any given day, 12% to 26% of children attend school without having eaten anything. Thirty-six percent of the children were obese, which did not vary with breakfast-eating behavior. A significantly greater proportion of the children who skipped breakfast compared to those who ate breakfast failed to achieve dietary adequacy for nearly every nutrient studied. More than one third of breakfast skippers consumed < 50% of the recommended dietary allowance for vitamins A, E, B6, and folacin, and nearly one fourth consumed < 50% of the recommended dietary allowance for calories, vitamin C, calcium, and iron. Not eating breakfast results in substantial deficits in dietary intake of a variety of essential nutrients among low-income African-American school children. Efforts to improve the nutritional status of children should include nutrition education to promote breakfast.
Data from a dietary-reporting validation study with fourth-grade children were analyzed to investigate a possible relationship of body mass index (BMI) with daily participation in school meals and observed energy intake at school meals, and whether the relationships differed by breakfast location (classroom; cafeteria).
Data were collected in 17, 17, and 8 schools during three school years. For the three years, six, six, and seven of the schools had breakfast in the classroom; all other schools had breakfast in the cafeteria. Information about 180 days of school breakfast and school lunch participation during fourth grade for each of 1,571 children (90% Black; 53% girls) was available in electronic administrative records from the school district. Children were weighed and measured, and BMI was calculated. Each of a subset of 465 children (95% Black; 49% girls) was observed eating school breakfast and school lunch on the same day. Mixed-effects regression was conducted with BMI as the dependent variable and school as the random effect; independent variables were breakfast participation, lunch participation, combined participation (breakfast and lunch on the same day), average observed energy intake for breakfast, average observed energy intake for lunch, sex, age, breakfast location, and school year. Analyses were repeated for BMI category (underweight/healthy weight; overweight; obese; severely obese) using pooled ordered logistic regression models that excluded sex and age.
Breakfast participation, lunch participation, and combined participation were not significantly associated with BMI or BMI category irrespective of whether the model included observed energy intake at school meals. Observed energy intake at school meals was significantly and positively associated with BMI and BMI category. For the total sample and subset, breakfast location was significantly associated with BMI; average BMI was larger for children with breakfast in the classroom than in the cafeteria. Significantly more kilocalories were observed eaten at breakfast in the classroom than in the cafeteria.
For fourth-grade children, results provide evidence of a positive relationship between BMI and observed energy intake at school meals, and between BMI and school breakfast in the classroom; however, BMI and participation in school meals were not significantly associated.
The contribution of school meals to the nutrition of 778 primary and secondary schoolchildren attending schools in Kent was assessed using information collected during a survey made in 1968-70 which included a weighed diet record, a socioeconomic questionnaire, and a medical examination. Younger children, those from larger families, those without fathers, and those whose mothers worked were more likely to take school meals. Significantly more children from lower social classes and without fathers received them free. School meals made an important contribution to the nutrition of schoolchildren. Children who took them had higher weekday lunchtime nutrient intake during term-time. Children in lower social classes, larger families, and without fathers who took school meals obtained a higher proportion of their weekday intake of nutrients from lunchtime than other children. This applied in particular to nutrients important for growth. School meals consumed by children in the study broadly met the standard set by the Department of Education and Science. The mean energy and protein content of school meals consumed in the study was slightly lower and the mean fat content higher than the standard set for the meal. The mean sugar content was about one-third higher than the suggested amount of sugar to be included in a school meal. There was no evidence that children who took school meals were taller, heavier, had greater skinfold thickness, or were more likely to be assessed as obese than other children.
This article investigated (1) parental response accuracy of fourth-grade children's school-meal participation and whether accuracy differed by children's body mass index (BMI), sex, and race, and (2) the relationship between BMI and school-meal participation (based on parental responses).
Data were from four cross-sectional studies conducted from fall 1999 to spring 2003 with fourth-grade children from 13 schools total. Consent forms asked parents to report children's usual school-meal participation. As two studies' consent forms did not ask about lunch participation, complete data were available for breakfast on 1,496 children (51% Black; 49% boys) and for lunch on 785 children (46% Black; 48% boys). Researchers compiled nametag records (during meal observations) of meal participation on randomly selected days during children's fourth-grade school year for breakfast (average nametag days across studies: 7-35) and for lunch (average nametag days across studies: 4-10) and categorized participation as "usually" (≥ 50% of days) or "not usually" (< 50% of days). Weight and height were measured. Concerning parental response accuracy, marginal regression was used with agreement between parental responses and nametag records as the dependent variable; independent variables were BMI, age, sex, race, and study. Concerning a relationship between BMI and school-meal participation, marginal regression was used with BMI as the dependent variable; independent variables were breakfast participation, lunch participation, age, sex, race, and study.
Concerning breakfast participation and lunch participation, 74% and 92% of parents provided accurate responses, respectively. Parental response accuracy was better for older children for breakfast and lunch participation, and for Black than White children for lunch participation. Usual school-meal participation was significantly related to children's BMI but in opposite directions -- positively for breakfast and inversely for lunch.
Parental response accuracy of children's school-meal participation was moderately high; however, disparate effects for children's age and race warrant caution when relying on parental responses. The BMI results, which showed a relationship between school-meal participation (based on parental responses) and childhood obesity, conflict with results from a recent article that used data from the same four studies and found no significant relationship when participation was based on nametag records compiled for meal observations.
Children; School; Obesity; School-meal participation; Parental response accuracy
Validation-study data were analyzed to investigate the effect of retention interval (time between the to-be-reported meal and interview) on accuracy of children's school-breakfast reports and school-lunch reports in 24-hour recalls, and to compare accuracy of children's school-breakfast reports for two breakfast locations (classroom; cafeteria).
Each of 374 fourth-grade children was interviewed to obtain a 24-hour recall using one of six conditions from crossing two target periods (prior 24 hours; previous day) with three interview times (morning; afternoon; evening). Each condition had 62 or 64 children (half boys). A recall's target period included one school breakfast and one school lunch, for which the child had been observed. Food-item variables (observed number; reported number; omission rate; intrusion rate) and energy variables (observed; reported; report rate; correspondence rate; inflation ratio) were calculated for each child for school breakfast and school lunch separately.
Accuracy for school-breakfast reports and school-lunch reports was inversely related to retention interval. Specifically, as indicated by smaller omission rates, smaller intrusion rates, larger correspondence rates, and smaller inflation ratios, accuracy for school-breakfast reports was best for prior-24-hour recalls in the morning, and accuracy for school-lunch reports was best for prior-24-hour recalls in the afternoon. For neither school meal was a significant sex effect found for any variable. For school-breakfast reports, there was no significant school-breakfast location effect for any variable.
By shortening the retention interval, accuracy can be improved for school-breakfast reports and school-lunch reports in children's 24-hour recalls.
validation study; school meals; retention interval
For school breakfast each day, many elementary schools offer a choice between a cold option that includes ready-to-eat (RTE) cereal and a hot option that includes a non-RTE-cereal entrée such as waffles. For breakfast reports, intrusions (reports of uneaten items) in correctly reported and misreported breakfast options were examined using data from five dietary-reporting validation studies. In each study, fourth-grade children were observed eating school breakfast and school lunch and then interviewed to obtain a dietary recall. A breakfast option was correctly reported in 240 breakfast reports for 203 intrusions total, and misreported in 97 breakfast reports for 189 intrusions total. Asymmetry was evident in misreported options; specifically, children observed eating a cold option almost never misreported a hot option, but children observed eating a hot option often misreported a cold option. Proportionately more breakfast reports were intrusion-free when a breakfast option was correctly reported than misreported. Linking of intrusions (i.e., multiple intrusions from the same option in a breakfast report) was especially evident with misreported breakfast options. Methodological aspects of dietary recalls such as target period (prior 24 hours; previous day), interview time (morning; afternoon; evening), and interview format (meal; open) had implications for intrusions and misreported breakfast options.
Children; Dietary recalls; Intrusions; School breakfast; Ready-to-eat cereal; Validation; Meal observations; Accuracy
The total dietary intake of energy and of individual nutrients of 99 grades 3 and 6 children from 10 greater Winnipeg shcools were generally comparable to those reported by Nutrition Canada for the Manitoba and national samples, although the percentile distributions of total caloric intake and dietary intake of vitamin A for the Winnipeg children tended to be lower. The median daily intake of protein was 212% of the Canadian Dietary Standard and most came from animal sources. Dietary fat was largely from animal sources as well. Hemoglobin concentrations were marginally low in four children, and urinary riboflavin:creatinine ratios were low in six children. There was no biochemical evidence of thiamin deficiency. The results suggest a need for change in dietary patterns and for education in nutrition, including relative nutrient/cost benefits. A well planned school snack program with an education component is a medium by which change could be introduced. This should preferable be part of a total school health program.
Dietary-reporting validation study data and school foodservice production records were used to examine intrusions (reports of uneaten items) in school meals in 24-hour recalls. Fourth-grade children (20 low-body mass index [BMI; ≥5th and <50th percentiles]; 20 high-BMI [≥85th percentile];50% boys; 75% Black) were each observed eating two school meals (breakfast, lunch) and interviewed about the prior 24 hours that evening (24E) or the previous day the next morning (PDM). Social desirability was assessed. Intrusions were classified as stretches (on meal tray), internal confabulations (in school foodservice environment but not on meal tray), and external confabulations (not in school foodservice environment). For breakfast, reported items were less likely to be intrusions for Black than White children, and for low-BMI boys than the other BMI-x-sex groups, and to be external confabulations for high-BMI girls than high-BMI boys. For lunch, reported items and intrusions were more likely to be stretches for 24E than PDM interviews. As social desirability increased, fewer items were reported for breakfast, and reported items and intrusions were more likely to be internal confabulations for lunch. For breakfast, compared to low-BMI girls, as social desirability increased, intruded amounts were larger for high-BMI boys and smaller for high-BMI girls. For lunch, intruded amounts were smaller for high-BMI girls than the other BMI-x-sex groups. Amounts reported were smaller for stretches than internal confabulations and external confabulations for breakfast, and external confabulations for lunch. To better understand intrusions, dietary-reporting validation studies are needed with larger samples by BMI-group, sex, and race.
Childhood Obesity; Dietary Assessment; Youth
Previous studies have shown that fasting increases lead absorption in the gastrointestinal tract of adults. Regular meals/snacks are recommended as a nutritional intervention for lead poisoning in children, but epidemiological evidence of links between fasting and blood lead levels (B-Pb) is rare. The purpose of this study was to examine the association between eating a regular breakfast and B-Pb among children using data from the China Jintan Child Cohort Study.
Parents completed a questionnaire regarding children's breakfast-eating habit (regular or not), demographics, and food frequency. Whole blood samples were collected from 1,344 children for the measurements of B-Pb and micronutrients (iron, copper, zinc, calcium, and magnesium). B-Pb and other measures were compared between children with and without regular breakfast. Linear regression modeling was used to evaluate the association between regular breakfast and log-transformed B-Pb. The association between regular breakfast and risk of lead poisoning (B-Pb≥10 μg/dL) was examined using logistic regression modeling.
Median B-Pb among children who ate breakfast regularly and those who did not eat breakfast regularly were 6.1 μg/dL and 7.2 μg/dL, respectively. Eating breakfast was also associated with greater zinc blood levels. Adjusting for other relevant factors, the linear regression model revealed that eating breakfast regularly was significantly associated with lower B-Pb (beta = -0.10 units of log-transformed B-Pb compared with children who did not eat breakfast regularly, p = 0.02).
The present study provides some initial human data supporting the notion that eating a regular breakfast might reduce B-Pb in young children. To our knowledge, this is the first human study exploring the association between breakfast frequency and B-Pb in young children.
lead exposure lead poisoning nutrition diet nutrients breakfast
To determine whether nutrient intake and academic and psychosocial functioning improve after the start of a universal-free school breakfast program (USBP).
Information was gathered from 97 inner city students prior to the start of a USBP and again after the program had been in place for 6 months. Students who had total energy intakes of <50% of the recommended daily allowance (RDA) and/or 2 or more micronutrients of <50% of RDA were considered to be at nutritional risk.
Prior to the USBP, 33% of all study children were classified as being at nutritional risk. Children who were at nutritional risk had significantly poorer attendance, punctuality, and grades at school, more behavior problems, and were less likely to eat breakfast at school than children who were not at nutritional risk. Six months after the start of the free school breakfast programs, students who decreased their nutritional risk showed significantly greater: improvements in attendance and school breakfast participation, decreases in hunger, and improvements in math grades and behavior than children who did not decrease their nutritional risk.
Participation in a school breakfast program enhanced daily nutrient intake and improvements in nutrient intake were associated with significant improvements in student academic performance and psychosocial functioning and decreases in hunger.
School breakfast; Low-income children; Psychosocial functioning; Nutrition; Dietary intake
Objective: To explore fourth-graders' school breakfast participation by gender and race (black, white) and examine the extent to which parents' responses to “Does this child usually eat school breakfast?” reflected their children's participation.
Design: Parents answered “yes” or “no” to the questions printed on consent forms. Observers documented which children participated in school breakfast on 26 to 51 randomly selected days per school during 24 weeks in the 1999-2000 school year.
Subjects: 357 children recruited from all 22 fourth-grade classes from 6 schools in 1 public school district.
Variables Measured: Participation rate, participation rate grouping [usually participated (≥ 50% of days observed), did not usually participate (< 50% of days observed)].
Statistical Analyses Performed: Komolgorov-Smirnov tests, McNemar's test.
Results: Median participation rate was 37.5% overall. Distribution of participation rates differed significantly by race (K-S test, P < .001) but not gender. There was a significant difference in the percentage of parents who said “yes” or “no” compared to children's usual participation grouping (McNemar test, P < .001). Of parents who said “yes,” 66% of children usually participated; of parents who said “no,” 92% of children did not usually participate.
Implications: Children, not parents, must be the source for learning about what children eat at school.
children; parents; School Breakfast Program participation
To compare reporting accuracy for breakfast and lunch in two studies.
Children were observed eating school meals and interviewed the following morning about the previous day. Study 1 – 104 children were each interviewed one to three times with ≥25 days separating any two interviews. Study 2 – 121 children were each interviewed once in forward (morning-to-evening) and once in reverse (evening-to-morning) order, separated by ≥29 days.
Main Outcome Measures
For each meal: food-item variables – observed number, reported number, omission rate, intrusion rate, total inaccuracy; kilocalorie variables – observed, reported, correspondence rate, inflation ratio.
General linear mixed-models.
For each study, observed and reported numbers of items and kilocalories, and correspondence rate (reporting accuracy), were greater for lunch than breakfast; omission rate, intrusion rate, and inflation ratio (measures of reporting error) were greater for breakfast than lunch. Study 1 – for each meal over interviews, total inaccuracy decreased and correspondence rate increased. Study 2 – for each meal for boys for reverse and girls for forward order, omission rate was lower and correspondence rate was higher.
Conclusions and Implications
Breakfast was reported less accurately than lunch. Despite improvement over interviews (Study 1) and differences for order × sex (Study 2), reporting accuracy was low for breakfast and lunch.
children; dietary recalls; reporting accuracy; school breakfast; school lunch; observation; validation
To investigate whether school-meal observations influenced children’s 24-hour dietary recalls.
Study Design and Setting
Over three school years, 555 randomly selected fourth-grade children were interviewed to obtain a 24-hour dietary recall; before being interviewed, 374 children were observed eating two school meals (breakfast, lunch) and 181 children were not observed. Within observation-status groups (observed; unobserved), children were randomized within sex to one of six combinations from two target periods (prior-24-hours; previous-day) crossed with three interview times (morning; afternoon; evening).
For each of five variables (interview length, meals/snacks, meal components, items, kilocalories), naïve and adjusted equivalence tests rejected that observation-status groups were different, indicating that school-meal observations did not influence children’s 24-hour dietary recalls. There was a target-period effect on length (P<0.0001) (longer for prior-24-hour recalls), a school year effect on length (P=0.0002) (longer for third year), and a target-period-by-interview-time interaction on items (P=0.0110) and kilocalories (P=0.0047) (both smaller for previous-day recalls in the afternoon than prior-24-hour recalls in the afternoon and previous-day recalls in the evening), indicating that variables were sufficiently sensitive and psychometrically reliable.
Conclusions about 24-hour dietary recalls by fourth-grade children observed eating school meals in validation studies are generalizable to 24-hour dietary recalls by comparable but unobserved children in non-validation studies.
24-hour dietary recalls; children; validation; observation; school breakfast; school lunch
Overweight and obesity in children in Mexico was among the countries with the highest prevalence's in the world. Mexico currently has few innovative and comprehensive experiences to help curb the growth of this serious public health problem. Therefore, the aim of this study is to assess the effectiveness of a nutrition and physical activity strategy, called "Nutrition on the Go" ("nutrición en movimiento") in maintaining the BMI values of school children in the State of Mexico.
A two-stage cluster trial was carried out. Sixty schools were selected in the State of Mexico, of which 30 were randomly assigned to the intervention group (IG) and 30 to the control group (CG). A total of 1020 fifth grade school children participated. The intervention strategy aimed to decrease the energy content of school breakfasts and include fruits and vegetables, as well as increase physical activity and the consumption of water during the time spent at school. The strategy was implemented over a 6-month period.
The estimated probability (EP) of obesity between baseline and the final stage for the IG decreased 1% (Initial EP = 11.8%, 95%CI 9.0, 15.2, final EP = 10.8, 95%CI 8.4, 13.) For the CG, the probability increased 0.9% (baseline EP = 10.6%; 95%CI 8.1, 13.7; final EP = 11.5, 95%CI 9.0, 14.6). The interaction between the intervention and the stage is the average odd time corrected treatment effect, which is statistically significant (p = 0.01) (OR = 0.68, 95%CI 0.52, 091).
This represents the interaction between intervention and stage, which is highly significant (p = 0.01) (OR = 0.68; 95%CI 0.52, 091). In addition, girls had a protective effect on obesity (OR = 0.56; 95%CI 0.39, 0.80).
The intervention strategy is effective in maintaining the BMI of school children.
Obesity; Scholars; Effectiveness; Mexico; Eating; Physical activity
Free school breakfast programmes (SBPs) exist in a number of high-income countries, but their effects on educational outcomes have rarely been evaluated in randomised controlled trials.
A 1-year stepped-wedge, cluster randomised controlled trial was undertaken in 14 New Zealand schools in low socioeconomic resource areas. Participants were 424 children, mean age 9±2 years, 53% female. The intervention was a free daily SBP. The primary outcome was children's school attendance. Secondary outcomes were academic achievement, self-reported grades, sense of belonging at school, behaviour, short-term hunger, breakfast habits and food security.
There was no statistically significant effect of the breakfast programme on children's school attendance. The odds of children achieving an attendance rate <95% was 0.76 (95% CI 0.56 to 1.02) during the intervention phase and 0.93 (95% CI 0.67 to 1.31) during the control phase, giving an OR of 0.81 (95% CI 0.59 to 1.11), p=0.19. There was a significant decrease in children's self-reported short-term hunger during the intervention phase compared with the control phase, demonstrated by an increase of 8.6 units on the Freddy satiety scale (95% CI 3.4 to 13.7, p=0.001). There were no effects of the intervention on any other outcome.
A free SBP did not have a significant effect on children's school attendance or academic achievement but had significant positive effects on children's short-term satiety ratings. More frequent programme attendance may be required to influence school attendance and academic achievement.
Australian New Zealand Clinical Trials Registry (ANZCTR)—ACTRN12609000854235.
Breakfast; intervention; randomised controlled trial; schools; education; child health; diet; public health; randomised trials; exercise
Results from a 2012 article showed a positive relationship between children’s body mass index (BMI) and energy intake at school-provided meals. To help explain that positive relationship, secondary analyses investigated 1) whether the relationship differed by sex and race, and 2) the relationship between BMI and six aspects of school-provided meals—amounts eaten of standardized portions, energy content given in trades, energy intake received in trades, energy intake from flavored milk, energy intake from a la carte ice cream, and breakfast type. Data were from four studies conducted one per school year (1999–2000 to 2002–2003). Fourth-grade children (n=328; 50% female; 54% Black) from 13 schools total were observed eating school-provided breakfast and lunch on one to three days per child for 1,178 total meals (50% breakfast). Children were weighed and measured. Marginal regression models were fit using BMI as the dependent variable. For Purpose One, independent variables were energy intake at school-provided meals, sex, race, age, and study; additional models included interaction terms involving energy intake and sex/race. For Purpose Two, independent variables were the six aspects of school-provided meals, sex, race, age, and study. The relationship between BMI and energy intake at school-provided meals differed by sex (p<0.0001; stronger for females) and race (p=0.0063; stronger for Black children). BMI was positively related to amounts eaten of standardized portions (p<0.0001) and negatively related to energy content given in trades (p=0.0052). Explaining the positive relationship between BMI and energy intake at school-provided meals may contribute to school-based obesity prevention efforts.
Body Mass Index; Children; Energy Intake; Nutrition Surveys; Primary Schools
Federal policy has encouraged researchers to include children in research studies; thus, it is important to report experiences recruiting children to participate in studies. This article compares fourth-graders' participation rates across four school-based nutrition studies conducted in one school district in a southeastern state. For each study, children were observed eating school meals (breakfast and lunch); interviewed regarding dietary intake; and weighed and measured. For Study 1, children from 11 schools received $10 per interview for up to two interviews conducted in the morning at school. For Study 2, children from 10 schools received $25 if interviewed once in the evening, either by telephone or in a van parked outside the child's home. For Study 3, children from three schools received $10 per interview for up to three interviews held in the evening by telephone. For Study 4, children from six schools received $15 per interview for up to two interviews conducted either in the morning or afternoon at school, or in the evening by telephone. Recruitment procedures were similar for all studies.
Participation rates were 73% (n=635) for Study 1, 57% (n=432) for Study 2, 66% (n=158) for Study 3, and 71% (n=296) for Study 4. Logistic regression was used to determine whether study (1, 2, 3, 4), race (black, white), or gender (male, female) were significant predictors of participation (agreed, denied). The results indicated that study (p<0.0001), race (p=0.0198), and gender (p=0.0188) were significant predictors, however, no two-factor interactions among these effects were significant. Post hoc pairwise comparisons with Bonferroni adjustment indicated that agreement to participate for Study 2 was lower (p<0.0001) than that for Studies 1, 3, and 4, which did not differ. Agreement to participate across all four studies was higher for black (69%) than white (63%; p=0.0054) children and for females (69%) than males (64%; p=0.0209). Schools provide a natural environment for nutrition research because school foodservice programs feed millions of children one or two meals (breakfast and/or lunch) each school day. Observations of children eating school meals provide a convenient and relatively unobtrusive means of validating children's dietary recalls. Thus, at some point, most child nutrition professionals are likely to be involved in research either directly (i.e. by conducting studies themselves) or indirectly (i.e. by allowing others access to their school cafeterias to collect data).
This paper references the following data: Table 1. Similarities and Differences in the Designs for Each of the Four Studies. Table 2. Number and Percent of Fourth-Grade Children Who Agreed or Denied to Participate by Race and Gender Across all Four Studies Combined. Table 3. Number and Percent of Fourth-Grade Children Who Agreed or Denied to Participate by Gender and Race for Each of the Four Studies Separately.
To examine the relationship between lifestyles and psychosomatic symptoms in children, we conducted a self-administered questionnaire survey of elementary school students and junior high school students in Japan.
We designed an original questionnaire to investigate the lifestyles and psychosomatic symptoms of children. In 1997, responses to the questionnaires were elicited from public elementary school fourth grade students (then aged 9–10) and public junior high school seventh grade students (then aged 12–13). The survey was repeated annually for three years as the students advanced through school.
For both boys and girls, each cross-sectional analysis revealed a strong relationship between lifestyle behaviors and psychosomatic symptoms. Psychosomatic, symptoms scores varied according to daily hours of sleep, eating of breakfast, having strong likes and dislikes of food, bowel habits, and daily hours of television watching. Both boys and girls with “good” lifestyle, behaviors evaluated by the HPI (Health Practice Index) showed lower scores for psychosomatic symptoms.
These findings show that the lifestyle behaviors of children are significantly associated with psychosomatic symptoms and suggest that poor lifestyle behaviors are likely to increase physical and psychological health risks.
lifestyles; psychosomatic symptoms; elementary school; junior high school; health practice index
Intrusions in dietary recalls may originate in confusion of episodic memories manifested as temporal dating errors.
Data from a validation study (concerning reporting accuracy over multiple recalls) and school foodservice production records were used to investigate origins of intrusions in school meals in children’s 24-hour recalls.
During the 1999–2000 school year, 104 fourth-grade children were observed eating school meals on one to three non-consecutive days separated by ≥25 days, and interviewed about the previous day’s intake in the morning on the day after each observation day.
Statistical analyses performed
For breakfast and lunch separately, logistic regression was used to investigate the effect of time (i.e., days) before the interview day on the probability that intrusions referred to items available in the school foodservice environment. Exploratory analyses were conducted for breakfast options observed and/or reported eaten.
For interviews in which reported meals met criteria to be considered school meals and that contained intrusions, of 634 and 699 items reported eaten at breakfast and lunch, respectively, 394 and 331 were intrusions. Availability in the school foodservice environment of items referred to by intrusions in reports of lunch, but not breakfast, decreased as days increased before the interview day (P values=0.031 and 0.285, respectively). Concerning breakfast, children observed eating a cold option (i.e., ready-to-eat [RTE] cereal, milk, juice, crackers [graham; animal]) almost always reported a cold option, whereas children observed eating a hot option (i.e., non-RTE-cereal entrée [e.g., sausage biscuit], milk, fruit or juice) reported a cold option in approximately 50% of interviews.
In children’s 24-hour recalls, confusion of episodic memories contributes to intrusions in school lunch, and generic dietary information (e.g., cold option items available daily) or confusion of episodic memories may contribute to intrusions in school breakfast. Understanding the origins of intrusions may help in developing interview methods to decrease the occurrence of intrusions.
Children; dietary recalls; intrusions
In dietary recall for a specified target period, an intrusion denotes an item reported eaten that was not consumed during that period. Intrusions may denote items available during the specified period, items consumed during other periods, or items from general knowledge of dietary intake. To investigate a cognitive basis of intrusions, we analyzed data from a dietary-reporting validation study in which 69 fourth-grade children were observed eating two school meals (breakfast; lunch) and interviewed that evening about that day’s intake in person or by telephone. Of 450 items reported eaten for school meals, 82 were intrusions. Observations and school foodservice production records were used to determine whether items denoted by intrusions were available in school foodservice environments on the interview day, as many as three school days prior to the interview day, and the day following the interview. Availability of items denoted by intrusions decreased backward over days from the interview day, and decreased from the interview day to the following day. Among 40 children who reported at least one intrusion, mean number of intrusions (controlling for number of items reported) increased as interviews occurred later in the week. These results are consistent with the idea that some intrusions are based on specific memories of items encountered but not eaten during the target period, or encountered before the target period. Other intrusions are likely based on general dietary knowledge. It may be possible to design interview techniques to reduce the occurrence of intrusions that are incorrectly based on specific memories.
validity (epidemiology); nutrition assessment; mental recall; diet surveys; child
The benefits of breakfast during childhood and adolescence have been reported previously though few studies have considered family structure inequalities in breakfast consumption. The proportion of young people living in non-traditional family types has increased in recent years, strengthening the need to describe and monitor the impact of the changing family unit on adolescent breakfast consumption. This study aimed to describe changes in daily breakfast consumption among adolescents in Scotland between 1994 and 2010, while also considering family structure inequalities, and the degree to which these have changed over time.
Data from the 1994, 1998, 2002, 2006 and 2010 Scottish Health Behaviour in School-aged Children (HBSC) surveys were analysed using logistic multilevel regression models for binary outcome variable daily breakfast consumption.
Daily breakfast consumption among adolescents increased between 1994 and 2010, although there were differences by age and sex. In fact those aged over 14.5 years saw decreases in breakfast consumption, and girls saw significantly larger increases than boys. Daily breakfast consumption was more prevalent among adolescents from 'both parent' families, with lowest prevalence among those from single parent families. Trends in daily breakfast consumption between 1994 and 2010 also varied by family structure. While prevalence of daily breakfast consumption increased among those living with 'both parents', the largest proportion of the population, prevalence decreased over time among adolescents of single parent families, and particularly among those living with their father.
Family structure inequalities in daily breakfast consumption increased between 1994 and 2010, while breakfast consumption across the population as a whole increased. As the proportion of young people living in an alternative family structure continues to grow it is important to understand why these inequalities have increased and how these may be overcome. Possible reasons for family structure inequalities and their increase in recent years are discussed.
Breakfast; Nutrition; Adolescent; Socioeconomic factors; Multilevel modelling; Survey methodology
Few studies on impact of meals served in school have been published. However, implications of school meals are an actual issue of both public and political concern in several countries. The objective of this study was to evaluate if breakfast served in a lower secondary school could improve dietary habits and school performance among the students.
All students in 10th grade in a lower secondary school, consisting of two school classes, were invited to participate in a controlled study. The students in one class were offered a free breakfast at the beginning of each school day for 4 months, while the students in the second class were controls. Both classes were educated in the importance of healthy eating, and a data program enabling them to evaluate dietary intake was introduced. The students answered two questionnaires, one on school performance and one short food frequency questionnaire, four weeks before study start and one week after. Body weight and height were measured by the school nurse at the beginning and end of the study. Because of few students in each group, non-parametrical statistic analyses were used.
All students in the intervention group had breakfast at school during the intervention. One week after the intervention the students in the class who received breakfast had returned to their normal breakfast pattern. In the control group the frequency of a lunch intake had increase, as compared to before study start (p < 0.01). An improved food pattern was seen among the male students in the intervention group, as measured by a healthy eating index after the intervention (p < 0.01). Body Mass Index increased statistically significant in both males and females in the control group (p < 0,01 for males and p < 0.05 for females), but not in the intervention group. Improvement in school performance following school breakfast was not found, but the males in the intervention group reported a significant increase in school contentment (p < 0.05).
In a lower secondary school class served breakfast for 4 months, dietary intake changed to a more healthy profile and weight gain was reduced.
Approximately 55,000 children in New Zealand do not eat breakfast on any given day. Regular breakfast skipping has been associated with poor diets, higher body mass index, and adverse effects on children's behaviour and academic performance. Research suggests that regular breakfast consumption can improve academic performance, nutrition and behaviour. This paper describes the protocol for a stepped wedge cluster randomised trial of a free school breakfast programme. The aim of the trial is to determine the effects of the breakfast intervention on school attendance, achievement, psychosocial function, dietary habits and food security.
Sixteen primary schools in the North Island of New Zealand will be randomised in a sequential stepped wedge design to a free before-school breakfast programme consisting of non-sugar coated breakfast cereal, milk products, and/or toast and spreads. Four hundred children aged 5-13 years (approximately 25 per school) will be recruited. Data collection will be undertaken once each school term over the 2010 school year (February to December). The primary trial outcome is school attendance, defined as the proportion of students achieving an attendance rate of 95% or higher. Secondary outcomes are academic achievement (literacy, numeracy, self-reported grades), sense of belonging at school, psychosocial function, dietary habits, and food security. A concurrent process evaluation seeks information on parents', schools' and providers' perspectives of the breakfast programme.
This randomised controlled trial will provide robust evidence of the effects of a school breakfast programme on students' attendance, achievement and nutrition. Furthermore the study provides an excellent example of the feasibility and value of the stepped wedge trial design in evaluating pragmatic public health intervention programmes.
Trial Registration Number
Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12609000854235
Use data from a published validation study concerning retention interval and school foodservice production records to examine intrusions (uneaten items reported eaten) in the school-meal parts of 24-hour recalls.
For that study, children were observed eating two school meals (breakfast, lunch) and interviewed under one of six conditions from two target periods (previous day [PDTP], prior 24 hours [24TP]) crossed with three interview times (morning, afternoon [AIT], evening). For this article, a catalog was constructed of foods available for that study’s school meals. That study’s intrusions were classified as stretches (on children’s meal trays but uneaten), internal confabulations (in children’s school foodservice environments for that meal but not on children’s trays), or external confabulations (not in children’s school foodservice environments for that meal). Occurrence, types, and amounts of intrusions were investigated.
Six schools; 60 fourth-grade children (10/condition).
For breakfast, for the 24TP versus PDTP, reported items were less likely to be intrusions, internal confabulations, and external confabulations; and intrusions were more likely to be stretches. For lunch, for the 24TP-AIT condition versus the other five conditions, reported items were less likely to be intrusions and external confabulations. Mean amounts reported eaten were smaller for stretches than internal confabulations or external confabulations at breakfast, and for stretches than internal confabulations at lunch.
Accuracy was better for the 24TP (with fewer intrusions of which proportionally more were stretches which had smaller amounts reported eaten) than PDTP. Studies with 24-hour recalls should minimize retention interval to improve accuracy.
children; dietary recalls; intrusions; retention interval; validation
Data on overweight and obesity prevalence among children enable state and local officials to develop, target, fund, and evaluate policies and programs to address childhood overweight. During the 2004-2005 school year, the Ohio Department of Health (ODH) conducted surveillance of elementary school-aged children through coordination with the ODH oral health survey to create a system that would provide county and state estimates of obesity and overweight prevalence.
We used a stratified, cluster-sampling survey design. Schools were considered clusters and were sampled from strata determined by their county and by their participation rate in the Free and Reduced Price Meal program. We selected public elementary schools by probability proportional to size sampling without replacement. We requested consent from the guardian or parent of each third-grade student. Trained health care professionals used state-purchased equipment to weigh students and measure their height. We removed implausible observations and calculated sex-specific, body mass index (BMI)-for-age percentiles using Centers for Disease Control and Prevention growth charts.
Of eligible schools, 374 agreed to height and weight screening; 41 were considered substitutes. Of 26,590 enrolled students, 17,557 (66.0%) returned consent forms, and 15,209 (57.2%) provided consent. BMI estimates were generated for 14,451 students, resulting in an overall response rate of 54.3%. The overall oral health response rate was 52.8%.
By adding BMI screening to Ohio's third-grade oral health survey and incorporating trained volunteer screeners, the ODH successfully implemented overweight and obesity surveillance using minimal resources. Future efforts should focus on improving student response rate.