Child Nutrition: From School Nutrition Policy to Diet Quality

Abstract

Overweight and obesity in children continues to be a concern in the US. Many factors play a role in this epidemic including decrease in physical activity, increase in sedentary time, and increase in the consumption of sugar sweetened beverages. Dietary behaviors develop in early childhood and these behaviors are influenced by individual experience as well as the larger environment. Paper 1 examines whether school district characteristics are related to school district compliance with the Massachusetts 2012 school competitive food and beverage standards. A linear mixed effects regression model with random effects for schools nested within school district is used to examine the relationships between district characteristics and compliance. Paper 2 examines the association between chocolate milk intake and change in BMI-z-score among children and adolescents over a 4-year period. Paper 3 examines the association between the AHEI-2010 diet quality score and BMI z-score change among children and adolescents. Both papers 2 and 3 use generalized estimating equations with repeated measures within subjects to assess the association between chocolate milk intake and BMI-z-score change, and between AHEI-2010 score and BMI z-score change, adjusting for potential confounders. In paper 1, compliance with standards increased from 17.5% to 66.9% (food) and from 41.9% to 83.4% (beverages) from baseline to one year after implementation. In paper 2, children who increased their chocolate milk intake from 2004 to 2008 gained 0.09 BMI z-score units (95% CI: 0.04, 0.14) more than children over the same four year period. Children who started drinking chocolate milk during follow-up gained 0.12 BMI z-score units (95% CI: 0.05, 0.18) than children who never drank chocolate milk. In paper 3, three points decrease or more in AHEI-2010 score was associated with higher gains in BMI z-score (0.80 units; 95% CI= 0.02, 0.14) in children and adolescents in the same 4-year period. School districts appear equally able to implement healthier environments for students. Increasing or starting consumption of chocolate milk is associated with greater weight gain in children and adolescents. Our findings suggest that decreasing diet quality may influence weight change.