Nonsignificant Relationship between Participation in School-Provided Meals and Body Mass Index during the Fourth-Grade School Year

Abstract

Data from four cross-sectional studies involving fourth-grade children were analyzed to investigate the relationship between participation in school-provided meals and body mass index (BMI), and the effect observed energy intake has on that relationship. Participation and BMI data were available on 1,535 children (51% Black; 51% girls) for four school years (Fall 1999 to Spring 2003; one study per school year) at 13 schools total. Direct meal observations were available for a subset of 342 children (54% Black; 50% girls) for one to three breakfasts and one to three lunches per child for a total of 1,268 school meals (50% breakfast). Participation in breakfast, lunch, and combined (both meals on the same day) was determined from nametag records compiled for meal observations for each study. Weight and height were measured. A marginal regression model was fit with BMI as the dependent variable; independent variables were breakfast participation, lunch participation, combined participation, sex, age, race, and study. For the subset of children, observed energy intake at breakfast, lunch, and combined was included in additional analyses. Participation in breakfast, lunch, and combined was not significantly associated with BMI regardless of whether analyses included observed energy intake (P values > 0.181). The relationship between observed energy intake at breakfast and lunch, separately and combined, with BMI was positive (P values < 0.01). In conclusion, these results do not support a relationship between school-meal participation and BMI but do support a relationship between observed energy intake at school meals and BMI during fourth grade.

Energy Contribution and Nutrient Composition of Breakfast and Their Relations to Overweight in Free-living Individuals: A Systematic Review

“…Among the selected 19 studies (13-31) (Supplemental Table 1), 1 was a cohort study (13), 2 were intervention trials (14,15), and the remaining studies were cross-sectional studies or surveys (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). The studies were published between 1996 and 2013 (13)(14)(15)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), with the exception of 1 study that was published in 1988 (16).…”

“…The studies were published between 1996 and 2013 (13)(14)(15)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), with the exception of 1 study that was published in 1988 (16). The studies were mainly conducted in Europe, including Spain (17,19,20,23,28), the United Kingdom (13,15,18,31), France (16,25), and Finland (14), but some of the studies were conducted in the United States (22,24,26,27,29,30) and 1 study was conducted in Iran (21). The studies examined subjects of different ages: 10 studies enrolled children or adolescents (16, 19-21, 23, 25-28, 30), 8 recruited adults of different ages (13-15, 17, 22, 24, 29, 31), and 1 study enrolled 4 age-specific subgroups of subjects (18).…”

“…The studies examined subjects of different ages: 10 studies enrolled children or adolescents (16, 19-21, 23, 25-28, 30), 8 recruited adults of different ages (13-15, 17, 22, 24, 29, 31), and 1 study enrolled 4 age-specific subgroups of subjects (18). The sex of recruited subjects was not stated in 6 studies (13,16,25,27,28,30). Ten studies defined strict exclusion criteria (e.g., presence of chronic or endocrine diseases) (14, 15, 17, 19, 20, 22-24, 28, 29).…”

“…In 4 studies, the negative association was statistically significant (13,16,18,22), although in 1 study the result was significant for adolescents only (18). Two partially overlapping cross-sectional US studies adopted regression models for multilevel data to show a significant positive relation between energy intake at breakfast and BMI in children: a higher energy intake at breakfast was associated with a higher BMI (26,30). Two other studies, which included the only available trial on energy intake at breakfast (6 wk for each of the 2 trial periods), showed no significant association between energy intake at breakfast and obesity (14,24).…”

“…With regard to different age groups and the association between energy intake at breakfast and overweight/obesity, of the 7 cross-sectional/survey studies in children aged 2-13 y [of which 1 study reported both overall and separate results for children aged 3-6 and 7-11 y (25)], 1 study (14%) reported an inverse association (16), 2 partially overlapping studies (29%) reported a positive association (26,30), whereas the remaining 4 studies (57%) reported no significant associations (19,20,23,25). In particular, 2 studies (100%) in 2-to 6-y-old children found no significant association (19,25).…”