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

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 (P= 1·00). However, it was found that mean arterial pressure was reduced by 0·4 (95 % CI 0·0, 0·8) mmHg (P= 0·04), fasting total cholesterol concentrations by 0·05 (95 % CI 0·02, 0·08) mmol/l (P= 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 (P= 0·001) 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.

[1]  A. Astrup,et al.  Dietary effects of introducing school meals based on the New Nordic Diet – a randomised controlled trial in Danish children. The OPUS School Meal Study , 2014, British Journal of Nutrition.

[2]  E. Trolle,et al.  WebDASC: a web-based dietary assessment software for 8-11-year-old Danish children. , 2014, Journal of human nutrition and dietetics : the official journal of the British Dietetic Association.

[3]  E. Trolle,et al.  Comparison of estimated energy intake using Web-based Dietary Assessment Software with accelerometer-determined energy expenditure in children , 2013, Food & nutrition research.

[4]  A. Astrup,et al.  Seasonal variation in objectively measured physical activity, sedentary time, cardio-respiratory fitness and sleep duration among 8–11 year-old Danish children: a repeated-measures study , 2013, BMC Public Health.

[5]  E. Trolle,et al.  Evaluation of Web-based Dietary Assessment Software for Children: comparing reported fruit, juice and vegetable intakes with plasma carotenoid concentration and school lunch observations. , 2013, The British journal of nutrition.

[6]  A. Astrup,et al.  Design of the OPUS School Meal Study: A randomised controlled trial assessing the impact of serving school meals based on the New Nordic Diet , 2012, Scandinavian journal of public health.

[7]  A. Astrup,et al.  Dietary composition and nutrient content of the New Nordic Diet , 2012, Public Health Nutrition.

[8]  Ulf Ekelund,et al.  Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. , 2012, JAMA.

[9]  C. Mølgaard,et al.  Obesity, inflammation and metabolic syndrome in Danish adolescents , 2012, Acta paediatrica.

[10]  A. Astrup,et al.  Guidelines for the New Nordic Diet , 2012, Public Health Nutrition.

[11]  T. Lehtimäki,et al.  Tracking of serum lipid levels, blood pressure, and body mass index from childhood to adulthood: the Cardiovascular Risk in Young Finns Study. , 2011, The Journal of pediatrics.

[12]  M. Uusitupa,et al.  A diet high in fatty fish, bilberries and wholegrain products improves markers of endothelial function and inflammation in individuals with impaired glucose metabolism in a randomised controlled trial: The Sysdimet study , 2011, Diabetologia.

[13]  Stewart G Trost,et al.  Comparison of accelerometer cut points for predicting activity intensity in youth. , 2011, Medicine and science in sports and exercise.

[14]  A. Tjønneland,et al.  Healthy aspects of the Nordic diet are related to lower total mortality. , 2011, The Journal of nutrition.

[15]  G. Johansson,et al.  Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET) , 2011, Journal of internal medicine.

[16]  T. Sørensen,et al.  Overweight and obesity trends in Copenhagen schoolchildren from 2002 to 2007 , 2010, Acta paediatrica.

[17]  C. Mølgaard,et al.  Effects of fish oil supplementation on markers of the metabolic syndrome. , 2010, The Journal of pediatrics.

[18]  T. Baranowski,et al.  A school-based intervention for diabetes risk reduction. , 2010, The New England journal of medicine.

[19]  A. Agatston,et al.  Effective Multi-level, Multi-sector, School-based Obesity Prevention Programming Improves Weight, Blood Pressure, and Academic Performance, Especially among Low-Income, Minority Children , 2010, Journal of health care for the poor and underserved.

[20]  T. Mori,et al.  Dietary patterns and markers for the metabolic syndrome in Australian adolescents. , 2010, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[21]  P. Shah,et al.  Effects of controlled school-based multi-component model of nutrition and lifestyle interventions on behavior modification, anthropometry and metabolic risk profile of urban Asian Indian adolescents in North India , 2010, European Journal of Clinical Nutrition.

[22]  E. Bachman,et al.  A school-based intervention for diabetes risk reduction. , 2010, The New England journal of medicine.

[23]  J. Eisenmann,et al.  On the use of a continuous metabolic syndrome score in pediatric research , 2008, Cardiovascular diabetology.

[24]  C. Glueck,et al.  Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later. , 2008, The Journal of pediatrics.

[25]  Iain Buchan,et al.  Body Fat Distribution and Risk of Coronary Heart Disease in Men and Women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk Cohort: A Population-Based Prospective Study , 2007, Circulation.

[26]  R. Collins,et al.  Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55 000 vascular deaths , 2007, The Lancet.

[27]  Peter Bennett,et al.  The metabolic syndrome in children and adolescents – an IDF consensus report , 2007, Pediatric diabetes.

[28]  T. Cole,et al.  children and adolescents: international survey Body mass index cut offs to define thinness in , 2007 .

[29]  Corby K. Martin,et al.  Wise Mind Project: A School‐based Environmental Approach for Preventing Weight Gain in Children , 2007, Obesity.

[30]  Mikael Fogelholm,et al.  [Nordic nutrition recommendations]. , 2006, Ugeskrift for laeger.

[31]  G. Bedogni,et al.  Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children , 2006, International Journal of Obesity.

[32]  C J K Henry,et al.  Basal metabolic rate studies in humans: measurement and development of new equations. , 2005, Public health nutrition.

[33]  John B Carlin,et al.  Regression models for twin studies: a critical review. , 2005, International journal of epidemiology.

[34]  Ian R White,et al.  Adjusting for partially missing baseline measurements in randomized trials , 2005, Statistics in medicine.

[35]  Alan Agresti,et al.  Random effect models for repeated measures of zero-inflated count data , 2005 .

[36]  Eugene Demidenko,et al.  Influence analysis for linear mixed‐effects models , 2005, Statistics in medicine.

[37]  G. Duncan,et al.  Prevalence and trends of a metabolic syndrome phenotype among u.s. Adolescents, 1999-2000. , 2004, Diabetes care.

[38]  D. Hale,et al.  Impact of the Bienestar school-based diabetes mellitus prevention program on fasting capillary glucose levels: a randomized controlled trial. , 2004, Archives of pediatrics & adolescent medicine.

[39]  June Stevens,et al.  Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. , 2003, The American journal of clinical nutrition.

[40]  J. Prochaska,et al.  Environmental interventions for eating and physical activity: a randomized controlled trial in middle schools. , 2003, American journal of preventive medicine.

[41]  A. Hill,et al.  Randomised controlled trial of primary school based intervention to reduce risk factors for obesity , 2001, BMJ : British Medical Journal.

[42]  V. Stevens,et al.  Efficacy and safety of lowering dietary intake of total fat, saturated fat, and cholesterol in children with elevated LDL cholesterol: the Dietary Intervention Study in Children. , 2000, The American journal of clinical nutrition.

[43]  T. Cole,et al.  Establishing a standard definition for child overweight and obesity worldwide: international survey , 2000, BMJ : British Medical Journal.

[44]  A. Black.  The sensitivity and specificity of the Goldberg cut-off for EI:BMR for identifying diet reports of poor validity , 2000, European Journal of Clinical Nutrition.

[45]  W. Harris,et al.  n-3 fatty acids and serum lipoproteins: animal studies. , 1997, The American journal of clinical nutrition.

[46]  H. Wechsler,et al.  Guidelines for school health programs to promote lifelong healthy eating. , 1996, The Journal of school health.

[47]  W. Harris,et al.  n-3 fatty acids and serum lipoproteins: human studies. , 1997, The American journal of clinical nutrition.

[48]  Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. , 1996, JAMA.

[49]  N. Cook,et al.  Implications of small reductions in diastolic blood pressure for primary prevention. , 1995, Archives of internal medicine.

[50]  D. Jacobs,et al.  Plasma triglyceride level and mortality from coronary heart disease. , 1993, The New England journal of medicine.

[51]  G. Berenson,et al.  The Heart Smart cardiovascular school health promotion: behavior correlates of risk factor change. , 1992, Preventive medicine.

[52]  S. Srinivasan,et al.  Tracking of serum lipids and lipoproteins from childhood to adulthood. The Bogalusa Heart Study. , 1991, American journal of epidemiology.

[53]  S. Heymsfield,et al.  Height-normalized indices of the body's fat-free mass and fat mass: potentially useful indicators of nutritional status. , 1990, The American journal of clinical nutrition.

[54]  Ralph B. D'Agostino,et al.  Blood Pressure as a Risk Factor for Cardiovascular Disease The Framingham Study—30 Years of Follow‐up , 1989, Hypertension.

[55]  P Ducimetière,et al.  Coronary heart disease mortality in relation with diabetes, blood glucose and plasma insulin levels. The Paris Prospective Study, ten years later. , 1985, Hormone and metabolic research. Supplement series.

[56]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.