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BackgroundThis pragmatic evaluation investigated the effectiveness of the Children’s Health, Activity and Nutrition: Get Educated! (CHANGE!) Project, a cluster randomised intervention to promote healthy weight using an educational focus on physical activity and healthy eating.MethodsParticipants (n = 318, aged 10–11 years) from 6 Intervention and 6 Comparison schools took part in the 20 weeks intervention between November 2010 and March/April 2011. This consisted of a teacher-led curriculum, learning resources, and homework tasks. Primary outcome measures were waist circumference, body mass index (BMI), and BMI z-scores. Secondary outcomes were objectively-assessed physical activity and sedentary time, and food intake. Outcomes were assessed at baseline, at post-intervention (20 weeks), and at follow-up (30 weeks). Data were analysed using 2-level multi-level modelling (levels: school, student) and adjusted for baseline values of the outcomes and potential confounders. Differences in intervention effect by subgroup (sex, weight status, socio-economic status) were explored using statistical interaction.ResultsSignificant between-group effects were observed for waist circumference at post-intervention (β for intervention effect =−1.63 (95% CI = −2.20, -1.07) cm, p<0.001) and for BMI z-score at follow-up (β=−0.24 (95% CI = −0.48, -0.003), p=0.04). At follow-up there was also a significant intervention effect for light intensity physical activity (β=25.97 (95% CI = 8.04, 43.89) min, p=0.01). Interaction analyses revealed that the intervention was most effective for overweight/obese participants (waist circumference: β=−2.82 (95% CI = −4.06, -1.58) cm, p<0.001), girls (BMI: β=−0.39 (95% CI = −0.81, 0.03) kg/m2, p=0.07), and participants with higher family socioeconomic status (breakfast consumption: β=8.82 (95% CI = 6.47, 11.16), p=0.07).ConclusionsThe CHANGE! intervention positively influenced body size outcomes and light physical activity, and most effectively influenced body size outcomes among overweight and obese children and girls. The findings add support for the effectiveness of combined school-based physical activity and nutrition interventions. Additional work is required to test intervention fidelity and the sustained effectiveness of this intervention in the medium and long term.Trial registrationCurrent Controlled Trials ISRCTN03863885.

Objective: To examine the changes over time in cardiorespiratory fitness and body mass index (BMI) of children. Design: Serial cross-sectional, population-based study. Setting: Primary schools in Liverpool, UK. Participants: A total of 15 621 children (50% boys), representing 74% of eligible 9-11-year olds in the annual school cohorts between 1998/9 and 2003/4, who took part in a 20m multi-stage shuttle run test (20mMST). Main outcome measures: Weight, height, BMI (kg/m 2 ) and obesity using the International Obesity Taskforce definition. Results: Median (95% confidence interval) 20mMST score (number of runs) fell in boys from 48.9 (47.9-49.9) in 1998/9 to 38.1 (36.8-39.4) in 2003/4, and in girls from 35.8 (35.0-36.6) to 28.1 (27.2-29.1) over the same period. Fitness scores fell across all strata of BMI (Po0.001). Moreover, BMI increased over the same 6-year period even among children in fittest third of 20mMST. Conclusion: In a series of uniform cross-sectional assessments of school-aged children, BMI increased whereas cardiorespiratory fitness levels decreased within a 6-year period. Even among lean children, fitness scores decreased. Public health measures to reduce obesity, such as increasing physical activity, may help raise fitness levels among all children -not just the overweight or obese.

Relatively more lower SES children spent time in sedentary behaviours than sport participation. Weight status was not consistently associated with sedentary behaviours. Proportionately more boys than girls watched TV, played video games, and participated in sport, suggesting that boys find time for sedentary behaviours and physical activity. Efforts should be made to address inequalities in the prevalence of sedentary behaviours and sport participation for all children regardless of SES, weight status, or sex.

There is little age-specific information on changes in dietary intake over time in this country, yet this is valuable in assessing the effectiveness of health education programmes particularly in vulnerable groups such as adolescents. In 1990, 379 children aged 12 years completed two 3 d dietary records. They were interviewed by one dietitian on the day after completion of each diary to verify and enlarge on the information provided and, with the aid of food models, obtain a quantitative record of food intake. Nutrient intake was calculated using computerized food tables. These children attended the same seven Middle schools in Northumberland as 405 children of the same age who recorded their diet using the same method, 10 years previously. Heights and weights were also recorded in both studies in the same manner.Comparing the nutrient intakes in 1990 with 1980, energy intake fell in the boys (to 8.6 MJ) but not in the girls (8.3 MJ). The contribution of fat to energy intake was unchanged a t about 40% (about 90 g/d). Likewise, intake of sugars was unchanged at about 22% of energy (about 118 g/d). Calcium intake remained the same in the girls (763 mg/d in 1990) but fell in the boys (786 mg/d in 1990). Iron, vitamin C and unavailable carbohydrate intakes increased in both sexes, and the nutrient density of the diet improved in all sex and social-class groups. However, a social trend evident in 1980 still existed in 1990 with low social groups having the poorest-quality diet. It is concluded that there is tittle evidence of substantial progress towards improving the diet of adolescents in this country.

There is a lack of information concerning the diet of vegetarian children. The present study compared the dietary intake of fifty vegetarian children, aged 7-11 years, with fifty matched omnivores. Three 3 d food records were completed by each child at intervals of 6 months. The day after completing the record each child was interviewed to clarify food items and assess portion sizes. Food records were analysed using Microdiet (University of Salford). Finger-prick cholesterol and haemoglobin measurements were taken from a subsample of the group. Only one child's family was a member of the Vegetarian Society and almost one-third of vegetarian children had omnivorous parents (seventeen of fifty subjects). The energy intake (MJ) of the vegetarians was significantly lower than that of the omnivores, 7.6 (SD 1-05) and 8-0 (SD 1.36) respectively; there were no significant differences in Fe or fat intakes. For the vegetarians po1yunsatnrated:saturated fat ratio (P:S 0.7 (SD 004)) and NSP intake (13-8 (SD 0.7) g/d) were significantly higher than those of the omnivores (P:S 0 5 (SD 002), NSP 10.3 (SD 0.4) g/d). There was no significant difference in cholesterol measurements (mmol/l) between the two groups: vegetarian 3.5 (SD 0.12), omnivores 3.7 (SD 0.15). The haemoglobin level (gp) of the vegetarians (11.8 (SD 0.2)) was significantly below that of the omnivores (12.4 (SD 0.2)

Objective: Dietary surveys of 11-to 12-year-old Northumbrian children in 1980 and 1990 revealed that consumption of non-milk extrinsic sugars (NMES) was 16 -17% of energy intake. This study reports dietary sugars consumption in 2000 and compares it with data collected in 1980 and 1990, using identical methods. Design: A repeat cross-sectional dietary survey of children aged 11 -12 years attending the same schools as in the 1980 and 1990 surveys. Setting: Seven middle schools in south Northumberland. Subjects: All children aged 11-12 years old attending the seven schools. Method: Food consumption was recorded using two 3-day diet diaries. Food composition tables were used to calculate energy and nutrient intakes. NMES, and milk and intrinsic sugars were calculated using previously described methods. , and from breakfast cereals increased from 2 to 7 g day 21 over the 20 years. Confectionery and soft drinks provided 61% of NMES. Over 20 years, the proportion of energy from fat decreased by 5% and from starch increased by 4%, creating a welcome tilt in the fat -starch see-saw, without an adverse effect on sugars intake. Conclusions: Consumption of NMES in 2000 was substantially higher than recommended, and there has been little change over 20 years. Continued and coordinated efforts are required at a national, community and individual level to reduce the intake of NMES.

Implementing routine nutritional screening on such units would assist in identifying at risk patients, enabling referral for dietetic intervention to be made. Providing nutrition education for staff might help to improve knowledge and awareness of malnutrition for this patient group.