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Title: Efficacy of a school-based obesity prevention intervention at reducing added sugar and sodium in children’s school lunches: the LA Health randomized controlled trial

Author
item HAWKINS, KEELY - Pennington Biomedical Research Center
item BURTON, JEFFERY - Pennington Biomedical Research Center
item APOLZAN, JOHN - Pennington Biomedical Research Center
item Thomson, Jessica
item WILLIAMSON, DONALD - Pennington Biomedical Research Center
item MARTIN, CORBY - Pennington Biomedical Research Center

Submitted to: International Journal of Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/29/2018
Publication Date: 11/1/2018
Citation: Hawkins, K.R., Burton, J.H., Apolzan, J.W., Thomson, J.L., Williamson, D.A., Martin, C.K. 2018. Efficacy of a school-based obesity prevention intervention at reducing added sugar and sodium in children’s school lunches: the LA Health randomized controlled trial. International Journal of Obesity. 42:1845-1852. https://doi.org/10.1038/s41366-018-0214-y.
DOI: https://doi.org/10.1038/s41366-018-0214-y

Interpretive Summary: The Healthy, Hunger-Free Kids Act of 2010 emphasizes the central role school nutrition plays in children’s health. The Act updated nutrition standards for the National School Lunch Program in response to concern about growing obesity trends in US children and adolescents. Using data from a previously conducted school-based obesity prevention intervention, the present study compared changes in added sugar and sodium consumption from baseline to follow-up between control and intervention students. Conducted in 2006-2009, the Louisiana (LA) Health intervention was a 28-month, school-based, obesity prevention intervention delivered to children in 4th-6th grade in 33 rural Louisiana schools. The intervention included environmental modifications to both the school classroom and cafeteria. Food selection and consumption during lunch in school cafeterias were measured using digital photography of children’s plates prior to eating (selection) and after eating (consumption based on plate waste). Results indicated that the LA Health intervention was effective at reducing the amounts of added sugar children in the intervention schools selected and consumed as compared to children in the control schools. Additionally, while the amounts of sodium children in the intervention schools selected and consumed did not change, the amounts selected and consumed by children in the control schools increased from baseline to follow-up. Suggestions for future research include focusing on further reductions of added sugar and sodium in school cafeteria foods as well as for foods consumed outside the school setting (i.e., the home).

Technical Abstract: Background: Decreasing selection and consumption of sodium and added sugars in the school cafeteria setting is important to provide optimal nutrition to children. Objective: The objective of this study is to determine whether Louisiana (LA) Health, a school-based obesity prevention intervention, could successfully reduce children's selection and consumption of sodium and added sugars during school lunches vs. the control group. Design: Food selection, consumption, and plate waste from student lunches (3 consecutive days) in 33 public schools in rural Louisiana were collected and analyzed using the digital photography of foods method at baseline and after a 28-month obesity prevention intervention (LA Health) beginning in 4th-6th grade (87% of children received free or reduced cost lunch). Selection and consumption of energy, added sugar, and sodium was objectively measured using digital photography of foods. Mixed models, including Race and BMI, were used to determine whether change in selection and consumption differed by group. Results: Sodium decreased for selection (-233.1 +/- 89.4 mg/lunch, p=0.04) and consumption (-206.3 +/- 65.9 mg/lunch) in the intervention (vs. control) by month 18, and in consumption by month 28 (-153.5 +/- 66.9 mg/lunch, p=0.03). Change in added sugar consumption decreased in the intervention (vs. control) at month 18 (-3.7 +/- 1.6, p=0.05) and at month 28 (-3.5 +/- 1.6 tsp/lunch, p=0.05). Conclusions: LA Health decreased the amount of added sugar and sodium selected and consumed, but not plate waste, by month 28. Results highlight the importance of long-term interventions and policies targeting provision and selection to improve dietary patterns in children, with less focus on plate waste.