Provision of healthy school meals does not affect the metabolic syndrome score in 8–11-year-old children, but reduces cardiometabolic risk markers despite increasing waist circumference

Abstract

An increasing number of children are exhibiting features of the metabolic syndrome (MetS) including abdominal fatness, hypertension, adverse lipid profile and insulin resistance. Healthy eating practices during school hours may improve the cardiometabolic profile, but there is a lack of evidence. In the present study, the effect of provision of school meals rich in fish, vegetables and fibre on a MetS score (primary outcome) and on individual cardiometabolic markers and body composition (secondary outcomes) was investigated in 834 Danish school children. The study was carried out as a cluster-randomised, controlled, non-blinded, cross-over trial at nine schools. Children aged 8-11 years received freshly prepared school lunch and snacks or usual packed lunch from home (control) each for 3 months. Dietary intake, physical activity, cardiometabolic markers and body composition were measured at baseline and after each dietary period. The school meals did not affect the MetS score (P¼ 1·00). However, it was found that mean arterial pressure was reduced by 0·4 (95 % CI 0·0, 0·8) mmHg (P¼0·04), fasting total cholesterol concentrations by 0·05 (95 % CI 0·02, 0·08) mmol/l (P¼ 0·001), HDL-cholesterol concentrations by 0·02 (95 % CI 0·00, 0·03) mmol/l, TAG concentrations by 0·02 (95 % CI 0·00, 0·04) mmol/l (both P,0·05), and homeostasis model of assessment-insulin resistance by 0·10 (95 % CI 0·04, 0·16) points (P¼0·001) compared with the control diet in the intention-to-treat analyses. Waist circumference increased 0·5 (95 % CI 0·3, 0·7) cm (P,0·001), but BMI z-score remained unaffected. Complete-case analyses and analyses adjusted for household educational level, pubertal status and physical activity confirmed the results. In conclusion, the school meals did not affect the MetS score in 8 -11-year-olds, as small improvements in blood pressure, TAG concentrations and insulin resistance were counterbalanced by slight undesired effects on waist circumference and HDL-cholesterol concentrations.Key words: Metabolic syndrome: School meals: Dietary interventions: Children: Body composition An increasing number of children and adolescents are being diagnosed with the metabolic syndrome (MetS), a cluster of risk factors including abdominal fatness, hypertension, adverse lipid profile and insulin resistance, which may increase the later risk of lifestyle diseases (1,2) . Healthy eating practices during childhood may help prevent the development of the MetS and type 2 diabetes, CVD and mortality (3) . Children from most Western populations consume too low amounts of fish, fibre, fruits and vegetables and too high amounts of sugar and saturated fat relative to dietary guidelines (4 -6) . Public schools are a highly relevant setting for nutritional interventions with the potential to reach children from various socio-economic backgrounds. Danish children consume 40 -45 % of their daily energy during school hours and after-school activities, mainly in the form of cold lunches and snacks brought from home (7) . The Danish schoo...

Seasonal variations in growth and body composition of 8–11-y-old Danish children

“…In a previous publication, we demonstrated a gain in FMI of 0.03 kg/m 2 (95% confidence interval: 0.00, 0.05; P = 0.04) during the intervention period compared with the control period (24). However, there was no modifying effect of the order of the diets, which means that this small effect of the intervention on FMI is evenly distributed across the school year and thus is unlikely to explain seasonal variations in FMI.…”

“…However, there was no modifying effect of the order of the diets, which means that this small effect of the intervention on FMI is evenly distributed across the school year and thus is unlikely to explain seasonal variations in FMI. Height, BMI z-score, and FFMI were not influenced by the intervention (24).…”

Vitamin D deficiency in Europe: pandemic?

“…Optimal well-being, development and health for Danish children through a healthy New Nordic Diet School Meal Study (Denmark) (17, 18)…”

The Role of Leptin and Other Hormones Related to Bone Metabolism and Appetite Regulation as Determinants of Gain in Body Fat and Fat-Free Mass in 8–11-Year-Old Children

“…Results were adjusted for time (3 or 6 months), age and pubertal status at baseline and baseline value of FMI/FFMI, and analyses on FFMI were also adjusted for FMI at baseline and at 3 months or 6 months. We have not adjusted for the dietary intervention or order of dietary periods because the intervention did not influence FMI and FFMI (33). Both cross-sectional and longitudinal analyses tested two different models-firstly including only one hormone at a time, and secondly with all hormones in the same model.…”