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Trevino R.P.,Social and Health Research Center | Pham T.,George Washington University | Mobley C.,University of Nevada, Las Vegas | Hartstein J.,Irvine Unified School District | And 2 more authors.
Journal of School Health

Background: Food service directors have a concern that federal reimbursement is not meeting the demands of increasing costs of healthier meals. The purpose of this article is to report the food option changes and the annual revenues and expenses of the school food service environment. Methods: The HEALTHY study was a 3-year (2006 to 2009) randomized, cluster-designed trial conducted in 42 middle schools at 7 field centers. The schools selected had at least 50% of students who were eligible for free or reduced-price lunch or who belonged to a minority group. A randomly assigned half of the HEALTHY schools received a school health intervention program consisting of 4 integrated components: nutrition, physical activity, behavioral knowledge and skills, and social marketing. The nutrition component consisted of changing the meal plans to meet 5 nutrition goals. Revenue and expense data were collected from income statements, federal meal records, à la carte sale sheets, school store sale sheets, donated money/food records, and vending machines. Results: Although more intervention schools reached the nutritional goals than control schools, revenues and expenses were not significantly different between groups. Conclusion: The HEALTHY study showed no adverse effect of school food policies on food service finances. © 2012, American School Health Association. Source

Newman A.B.,University of Pittsburgh | Aviles-Santa M.L.,U.S. National Institutes of Health | Anderson G.,Fred Hutchinson Cancer Research Center | Heiss G.,University of North Carolina at Chapel Hill | And 8 more authors.
Contemporary Clinical Trials

Novel approaches to observational studies and clinical trials could improve the cost-effectiveness and speed of translation of research. Hybrid designs that combine elements of clinical trials with observational registries or cohort studies should be considered as part of a long-term strategy to transform clinical trials and epidemiology, adapting to the opportunities of big data and the challenges of constrained budgets. Important considerations include study aims, timing, breadth and depth of the existing infrastructure that can be leveraged, participant burden, likely participation rate and available sample size in the cohort, required sample size for the trial, and investigator expertise. Community engagement and stakeholder (including study participants) support are essential for these efforts to succeed. © 2015. Source

Kahn H.S.,Centers for Disease Control and Prevention | El Ghormli L.,George Washington University | Jago R.,University of Bristol | Foster G.D.,Temple University | And 5 more authors.
Journal of Obesity

Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R2) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R2 attributed to BMIz or WHtR was 19%-28% among high-fatness and 8%-13% among lower-fatness students. R2 for lipid variables was 4%-9% among high-fatness and 2%-7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13-0.20) than for WHtR (0.17-0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart. © 2014 Henry S. Kahn et al. Source

Garcia-Dominic O.,Pennsylvania State University | Wray L.A.,Pennsylvania State University | Ledikwe J.H.,University of Washington | Mitchell D.C.,Pennsylvania State University | And 5 more authors.

We examined the accuracy of self-reported energy intake (rEI) in low-income, urban minority school-aged children at risk for obesity and associated diabetes utilizing a relatively new, simple previously published prediction equation for identifying inaccurate reports of dietary energy intake. Participants included 614 nine-year-old boys (51%) and girls (49%). Three 24-h dietary recalls were collected. Children's height, weight (used to calculate BMI), and percent body fat (%BF) were measured. Physical fitness, reported family history of diabetes, and ethnicity were also collected. A previously published prediction equation was used to determine the validity of rEIs in these children to identify under-, plausible-, and over-reporters. Additionally, we examined the question of whether there is a difference in reporting by sex, ethnicity, BMI, and %BF. On average, 18% of the children were at risk of being overweight, 43% were already overweight at baseline, yet these children reported consuming fewer calories on average than recommended guidelines. Additionally, reported caloric intake in this cohort was negatively associated with BMI and %BF. Using the previously described methods, 49% of participants were identified as under-reporters, whereas 39 and 12% were identified as plausible- and over-reporters, respectively. On average, children reported caloric intakes that were almost 100% of predicted energy requirement (pER) when the sedentary category was assigned. Inactivity and excessive energy intake are important contributors to obesity. With the rising rates of obesity and diabetes in children, accurate measures of energy intake are needed for better understanding of the relationship between energy intake and health outcomes. © 2010 The Obesity Society. Source

Balvin Frantzen L.,Dairy MAX | Trevino R.P.,Social and Health Research Center | Echon R.M.,Social and Health Research Center | Garcia-Dominic O.,Penn State College of Medicine | DiMarco N.,Texas Womans University
Journal of the Academy of Nutrition and Dietetics

Background The consumption of non-ready-to-eat cereal and ready-to-eat cereal (RTEC) breakfasts have been associated with increased nutrient intakes and lower body mass index (BMI). These relationships have not been examined in low-income minority children. Objectives To evaluate, in low-income minority children, whether there is a relationship among the frequency of RTEC consumption and nutrient intakes measured at baseline, and whether there is a relationship between the frequency of RTEC and BMI controlling for age, sex, ethnicity, and energy intake. Design A longitudinal study design where a cohort was followed for 3 years. Subjects/setting Participants were 625 fourth- through sixth-grade, low-income children living in San Antonio, Texas, and enrolled in the control arm of the Bienestar Diabetes Prevention Program's cluster randomized trial. Three multiple-pass 24-hour dietary recalls were collected at the beginning of their fourth-grade year and at the end of their fifth- and sixth-grade years. Children's age, sex, ethnicity, and height and weight (used to calculate BMI) were collected between August 2001 and May 2004. Statistical analyses performed Descriptive and inferential statistical analyses were performed. The frequency of breakfast consumption was examined using a 6×4 crosstabulation table with x2 test to establish categorical differences. The degree of association between BMI percentile and frequency of RTEC consumption adjusted for age, sex, ethnicity, and nutrition-related parameters were calculated using a partial correlation multivariate linear model analysis. Results There was a significant positive relationship between the frequency of RTEC consumption and nutrient intakes measured at baseline. There was also a significant inverse relationship between frequency of RTEC consumption and BMI percentile over the cumulative 3-year period controlling for age, sex, ethnicity, and energy intake. Conclusions Children who frequently consumed RTEC had greater intakes of essential nutrients at baseline and significantly lower BMI over a 3-year period. © 2013 Academy of Nutrition and Dietetics. Source

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