The CHANGE Study: A Healthy-Lifestyles Intervention to Improve Rural Children's Diet Quality

Abstract

Background Despite the high rates of overweight and obesity among rural children, there have been limited interventions reported to improve the diet quality of rural, low-income children in the United States. Objective To evaluate student’s diet quality at baseline and after implementing the CHANGE (Creating Healthy, Active and Nurturing Growing-up Environments) study, a two-year (2007-2009) randomized, controlled, community- and school-based intervention to prevent unhealthy weight gain among rural school-aged children. Design School and community-based group randomized controlled design. Participants/setting Data were collected in eight rural communities in California, Kentucky, Mississippi, and South Carolina (one elementary school per community). Children in grades 1-6 participated in the study (n= 432; mean age = 8.65 years ± 1.6 years). Students’ diets were assessed at baseline (spring or early fall 2008) and post-intervention (spring 2009) using the Block Food Screener for ages 2–17 years. Statistical Analyses Mixed-model analysis of variance was used to examine the effect of the CHANGE study intervention on students’ diets. Results were adjusted for corresponding baseline dietary values, sex, age, grade, race/ethnicity, and state, with school included as a random effect nested within condition. Results At the end of one year, students enrolled in the CHANGE study intervention schools consumed significantly more vegetables (0.08cups/1000 kcal per day; p=0.03) and combined fruits and vegetables (0.22 cups/1000 kcal per day; P<0.05) compared to students in control schools. Students in the intervention schools also showed a reduction in the average daily dietary glycemic index (GI= −1.22; P<0.05) and a trend toward more fruit consumption (0.15cups/1000 kcal per day; P =0.07). There were no significant differences in students’ consumption of whole grains, legumes, dairy, potatoes/potato products, saturated fat, added sugars, or dietary fiber consumption. Conclusions The CHANGE study enhanced some aspects of rural students’ dietary intake. Implementing similar interventions in rural America may be promising to support vegetable consumption.

Fat, sugar and water intakes among families from the IDEFICS intervention and control groups: first observations from I.Family

“…Also, the effect of food availability both at home and in school is important . For example, by offering healthier food alternatives, school children increase their intake of fruit and vegetables and decrease their intake of sugar‐sweetened beverages .…”

“…Also, the effect of food availability both at home and in school is important (34,35). For example, by offering healthier food alternatives, school children increase their intake of fruit and vegetables (36) and decrease their intake of sugar-sweetened beverages (37). Although the IDEFICS study aimed at implementing the intervention on community, school and family levels, a majority of the intervention modules were situated at the school level (14,15).…”

Impact of School-Based Interventions on Children’s Healthful Nutritional Outcomes (2009-2013): Implications for Future Research

“…The second most common limitation of this type is related to the participant sample size. This was not as large as desirable in several studies, such as those by Parmer et al [38], Lakkakula et al [39], Hoffman et al [43], Prelip et al [45], and Cohen et al [47]. Finally, previous experience of some schools with these interventions may have resulted in advantages over other schools in implementing the intervention, for example, in the study by Wang et al [40].…”

“…Therefore, future research should develop additional age-and F-specific strategies to encourage child F consumption. Similarly, offering children more FV and whole grains with less added-sugar and saturated-fat products in the school cafeteria has been found to increase children's V and FV consumption while reducing dietary glycaemic index [47]. Furtheremore, providing children with the opportunity to choose the V to ingest once before the meal or whenever they take a bite during the meal has been demonstrated to increase their V intake [49].…”

Results of annual prevention of behavioral risk factors for cardiovascular diseases in first-year students of two Moscow universities

“…Следует отметить, что увеличение потребления овощей и фруктов, как показывает опыт проведения подобных профилактических работ во всем мире, является наиболее легкой задачей в достижении эффективности профилактических программ. Результаты почти всех исследований демонстрируют значительное увеличение сырых овощей и фруктов в рационе школьников и студентов после проведения профилактических мероприятий [6,[10][11][12]. Повлиять на потребление сахара и соли, соленых и сладких закусок студентами и старшими школьниками оказалось несколько трудней.…”