marc acsm 2015_ higgins
TRANSCRIPT
Longitudinal Changes of Breakfast and Physical Activity Behaviors of
Children in 5th Grade
Brianna D. Higgins, Emily N. Werner, Abigail
Gilman, Patricia A. Shewokis,
Stella Lucia Volpe, FACSM
Department of Nutrition Sciences
Drexel University, Philadelphia, PA
Importance of Breakfast and Physical Activity in Children
• Key behaviors associated with excess weight gain among youth and adolescents
• Infrequent breakfast consumption
• Infrequent physical activity
(Barlow, Pediatrics. 2007;120 Suppl 4:S164-192)
(Freedman et al., J Pediatr. 2007;150(1):12-17.e12; Sinha et al. NEJM. 2002;346(11):802-810; Wiegand et al., Eur
J Endocrinol. 2004;151(2):199-206; Fernandez et al., J Pediatr. 2004;145(4), 439-444; Skoczen et al., Exp Clin
Endocrinol Diabetes. 2015;123(4):252-259; Bekkers et al., PloS one. 2012;7(12):e51801)
Measure How Defined for Children Associations with Health
Status
Body Mass
Index (BMI)
Weight-to-height ratio (kg/m2)
≥ 95th percentile for
sex and age
Increased risk for
cardiovascular disease
Impaired glucose tolerance
Type 2 diabetes mellitus
Abdominal
Obesity
Waist circumference
≥ 90th percentile for
sex and age
Increased risk for metabolic and
cardiovascular diseases
Insulin resistance
Hypertension
Hypercholesterolemia
Current Childhood Obesity Rates
• United States
• 16% overweight
• 17% obese
• Philadelphia, PA
• 15% overweight
• 25% obese
• 57% of children, 6 to 11 years of age, categorized as overweight or obese
(http://www.cdc.gov/obesity/data/childhood.html; http://www.cdc.gov/HealthyYouth/obesity/facts.htm;
http://www.cdc.gov/nccdphp/dch/programs/CommunitiesPuttingPreventiontoWork/communities/profiles/both-
pa_philadelphia.htm; http://www.phila.gov/health/pdfs/Obesity_in_Philadelphia_3.10.10.pdf)
Effective Strategies to Prevent Childhood Obesity
• Multi-component, community-based approaches show promise to be effective
• School-based
• Institute of Medicine recommends that schools be the focal point for childhood obesity prevention
• No other institution has as much contact with children
• Play a pivotal role in promoting healthy behaviors to prevent obesity
(Summerbell et al., Cochrane Database Syst Rev. 2005;CD001871; Gortmaker et al., Arch Pediatr Adolesc Med
1999;153:409-418; Koplan et al., J Am Diet Assoc. 2005; 105(1), 131-138; Baranowski, et al., Am J Health Behav.
2002; 26(6), 486-493)
Purpose
• To assess the changes in the number of days of breakfast consumption and days spent participating in 60 minutes of physical activity per week, over the 2014 to 2015 school year, in children in the fifth grade provided a school-based health intervention
Methods
• 13 schools recruited to participate in a three-year school-based intervention
• From five counties in Greater Philadelphia Area
• Chester, Delaware, Montgomery, Bucks, Philadelphia
• Mixture of public, charter and parochial schools
• Children followed from 4th through 6th grades
Methods
• Randomized into three levels of intervention
• 4 Core Schools
• 5 Level 1 Schools
• 4 Control Schools
Partner Programs for Core Schools
Vetri Foundation
For Children
Eatiquette 1 to 2 days per week
Up to 4 Culinary Classrooms per school year
Greener Partners Monthly in-classroom Seed-2-Snack lessons
2 Farm Explorer visits per year
Fit Essentials One 45-minute fitness period per week, with one take-away fitness
assignment to complete outside of school
Biannual cardiovascular health, muscular strength, balance and
flexibility measurements
Philadelphia Union 2 coach/player visits per year (90 minutes each)
Villanova
University
VioScreen accounts for all students in grade for parental completion
Focus group with 10 students per school per focus group
Partner Programs for Level 1 Schools
Vetri Foundation For
Children
No programming
Greener Partners 4 in-classroom Seed-2-Snack lessons
1 Farm Explorer visit per year
Fit Essentials One 45-minute fitness period per month, with one take-away fitness
assignment to complete outside of school
Biannual cardiovascular health, muscular strength, balance and
flexibility measurements
Philadelphia Union 1 coach/player visits per year (90 minutes each)
Villanova Unviersity No programming
Partner Programs for Control Schools
Vetri Foundation For
Children
No programming
Greener Partners No programming
Fit Essentials No programming
Philadelphia Union No programming
Villanova University No programming
Measurements
• Population analyzed
• Children in 5th grade
• During 2014 to 2015 school year
• Health behaviors
• Youth Behavior Survey Questionnaire
• 26-question multiple choice survey
• Beginning and end of school year
Example Questions fromYouth Behavior Survey Questionnaire
• During the past 7 days, on how many days did you eat breakfast?
• During the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day? (Add up all the time you spent in any kind of physical activity that increased your heart rate and made you breathe hard some of the time)
o 0 days
o 1 days
o 2 days
o 3 days
o 4 days
o 5 days
o 6 days
o 7 days
Statistical Analyses
• IBM SPSS standard edition 23 software
• Microsoft Excel 2015
• Descriptive Statistics
• Age
• Anthropometric Measures
• Matched paired t-tests
• From beginning to end of school year
• Change in number of days
• Breakfast consumed
• Participated in 60 minutes of physical activity
Variable Core
(n = 216)
Level 1
(n = 234)
Control
(n = 153)
Age (years) 10.3 ± 0.5 10.2 ± 0.5 10.2 ± 0.4
Body weight (kilograms [kg]) 41.5 ± 12.5 43.2 ± 11.6 41.5 ± 16.2
Height (centimeters [cm]) 144.1 ± 12.4 144.1 ± 7.0 144.7 ± 8.3
Body mass index (kg/m2) 19.6 ± 4.6 20.7 ± 4.7 20.7 ± 5.1
Waist circumference (cm) 66.7 ± 11.4 72.5 ± 13.4 68.2 ± 12.3
Values represent mean + standard deviation
Participant Characteristics ~ Baseline
Variable Core
(n = 213)
Level 1
(n = 244)
Control
(n = 141)
Age (years) 10.8 ± 0.5 10.8 ± 0.5 10.8 ± 0.6
Body weight (kilograms [kg]) 46.3 ± 13.9 47.2 ± 13.7 47.7 ± 15.6
Height (centimeters [cm]) 149.5 ± 7.7 152.2 ± 89.8 148.9 ± 8.1
Body mass index (kg/m2) 20.4 ± 4.8 23.3 ± 13.9 21.2 ± 5.2
Waist circumference (cm) 69.5 ± 11.8 70.5 ± 11.6 69.9 ± 12.6
Values represent mean + standard deviation
Participant Characteristics ~ Post-intervention
P>0.05; Values represent mean ± standard deviation
0
1
2
3
4
5
6
7
8
9
Core Level 1 Control
Num
ber
of
Days o
f C
onsum
ption
Change in Breakfast Consumption
Baseline Follow-Up
N=232N=211 N=204 N=245 N=141 N=154
0
1
2
3
4
5
6
7
8
Core Level 1 Control
Nu
mbe
r of
Da
ys o
f M
eeting 6
0 m
ins P
A
Change in Physical Activity Participation
Baseline Follow-Up
P>0.05; Values represent mean ± standard deviation
N=211 N=201 N=236 N=244 N=141 N=143
Conclusions
• No significant changes were observed in children in the 5th
grade, from the beginning to the end of the school year in
• Daily breakfast consumption
• Number of days engaged in 60 minutes of physical activity
• Although this school-based intervention may not have resulted in significant changes in healthy behaviors over one school year, the larger three-year intervention may result in positive changes
Independence Blue Cross Foundation