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Design and rationale for evaluating salad bars and students' fruit and vegetable consumption: A cluster randomized factorial trial with objective assessments.

ABSTRACT: Building healthy fruit and vegetable (FV) consumption habits early in life is critical for primary prevention. However, U.S. youth do not come close to meeting national recommendations for FV intake. School-lunch salad bars are one of the most heavily promoted ways to meet FV guidelines. Contrary to popular belief, no rigorous randomized trials have examined whether salad bars increase students' FV consumption. This paper describes the design and rationale of a federally funded trial to evaluate whether introducing salad bars in elementary, middle, and high schools affects students' FV consumption and waste during lunch. A cluster factorial randomized trial will test new salad bars against waitlist controls, with and without an additional marketing intervention (N?=?36 schools, N?=?6804 students: n?=?12 elementary, n?=?12 middle and n?=?12 high schools). Objective plate waste measurements of individual student's selection of FVs, consumption, and waste will be conducted using digital scales. Primary aim includes comparing FV consumption in schools without salad bars to those with new salad bars by grade level. Secondary aims include: a) whether FV marketing impacts the success of salad bars for FV consumption; b) whether salad bars differentially result in more FV waste compared to traditional serving methods; c) cost-benefit of using salad bars for consumption over traditional serving methods. When complete, this study stands to be one of the most definitive on the effectiveness of salad bars and contextual factors impacting their success. Findings will provide evidence for how to best spend limited federal dollars to improve FV intake in schools. Trial registration: ClinicalTrials.gov Identifier: NCT03283033 (date of registration: 9/14/2017).

SUBMITTER: Adams MA

PROVIDER: S-EPMC6392069 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Design and rationale for evaluating salad bars and students' fruit and vegetable consumption: A cluster randomized factorial trial with objective assessments.

Adams Marc A MA Ohri-Vachaspati Punam P Richards Timothy J TJ Todd Michael M Bruening Meg M

Contemporary clinical trials 20181218

Building healthy fruit and vegetable (FV) consumption habits early in life is critical for primary prevention. However, U.S. youth do not come close to meeting national recommendations for FV intake. School-lunch salad bars are one of the most heavily promoted ways to meet FV guidelines. Contrary to popular belief, no rigorous randomized trials have examined whether salad bars increase students' FV consumption. This paper describes the design and rationale of a federally funded trial to evaluate ...[more]

PMID: 30572161

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Project description:BackgroundMost children do not consume the recommended amount of fruit and vegetable (FV) servings. Changing the school food environment can be a cost-efficient, effective approach to improving children's dietary quality. There is great popular support for school salad bars as a means to increase children's FV intake within the National School Lunch Program (NSLP), yet empirical research is limited. Further, although FV consumption can facilitate healthy weight management if these foods replace high calorie items, there is a need to enhance understanding of salad bars' influence on children's diet quality and energy intake within the NSLP. This is particularly important to investigate in schools in communities characterized by high poverty, as students they serve are particularly likely to rely on school meals.MethodsThis report describes the design and rationale of a federally-funded investigation that uses validated methods to evaluate school salad bars. This district plans to install salad bars into 141 elementary schools over 5-years, facilitating the conduct of a waitlist control, cluster randomized controlled trial. Specifically, 12 pairs of matched schools will be randomly selected: half receiving a salad bar (Intervention) and half serving pre-portioned FVs only, standard under the NSLP (Control). Thus, groups will have different FV presentation methods; however, all schools will operate under a policy requiring students to take at least one FV serving. Schools will be matched on Title I status and percent of racial/ethnic minoritized students. Intake will be objectively assessed at lunch in each school pair, prior to (baseline), and 4-6 weeks after salad bars are installed (post), yielding ~ 14,160 lunch observations throughout the study duration. Cafeteria sales and NSLP participation data will be obtained to determine how salad bars impact revenues. Finally, implementation factors and cafeteria personnel's perspectives will be assessed, to identify barriers and facilitators to salad bars use and inform sustainability efforts. Proposed methods and current status of this investigation due to COVID-19 are described.DiscussionResults will have great potential to inform school nutrition policies and programs designed to improve dietary quality and reduce obesity.Trial registrationRetrospectively registered (10/28/22) in clinicaltrials.gov (NCT05605483).

Project description:BackgroundThere is evidence of a clustering of healthy dietary patterns and physical activity among young people and also of unhealthy behaviours. The identification of influences on children's health behaviors, particularly clustered health behaviors, at the time at which they develop is imperative for the design of interventions. This study examines associations between parental modelling and support and children's physical activity (PA) and consumption of fruit and vegetables (FV), and combinations of these behaviours.MethodsIn 2002/3 parents of 775 Australian children aged 10-12 years reported how frequently their child ate a variety of fruits and vegetables in the last week. Children wore accelerometers for eight days during waking hours. Parental modelling and parental support (financial and transport) were self-reported. Binary logistic and multinomial logistic regression analyses examined the likelihood of achieving >/= 2 hours of PA per day (high PA) and of consuming >/= 5 portions of FV per day (high FV) and combinations of these behaviors (e.g. high PA/low FV), according to parental modelling and support.ResultsItems of parental modelling and support were differentially associated with child behaviours. For example, girls whose parents reported high PA modelling had higher odds of consuming >/= 5 portions of FV/day (OR = 1.95, 95% CI = 1.32-2.87, p < 0.001). Boys whose parents reported high financial support for snacks/fast foods had higher odds of having 'high PA/low FV' (OR = 2.0, 95% CI = 1.1-3.7).ConclusionParental modelling of and support for physical activity and fruit and vegetable consumption were differentially associated with these behaviours in children across behavioural domains and with combinations of these behaviours. Promoting parents' own healthy eating and physical activity behaviours as well encouraging parental modelling and support of these behaviours in their children may be important strategies to test in future research.

Project description:Background:Mitochondrial dysfunction is an important component of the aging process and has been implicated in the development of many human diseases. Mitochondrial DNA copy number (mtDNAcn), an indirect biomarker of mitochondrial function, is sensitive to oxidative damage. Few population-based studies have investigated the impact of fruit and vegetable consumption and cigarette smoke (2 major sources of exogenous antioxidants and oxidants) on leukocyte mtDNAcn. Objectives:We investigated the association between fruit and vegetable consumption, cigarette smoke, and leukocyte mtDNAcn based on data from the Nurses' Health Study (NHS). Methods:Data from 2769 disease-free women in the NHS were used to examine the cross-sectional associations between dietary sources of antioxidants, cigarette smoke, and leukocyte mtDNAcn. In vitro cell-based experiments were conducted to support the findings from the population-based study. Results:In the multivariable-adjusted model, both whole-fruit consumption and intake of flavanones (a group of antioxidants abundant in fruit) were positively associated with leukocyte mtDNAcn (P-trend = 0.005 and 0.02, respectively), whereas pack-years of smoking and smoking duration were inversely associated with leukocyte mtDNAcn (P-trend = 0.01 and 0.007, respectively). These findings are supported by in vitro cell-based experiments showing that the administration of naringin, a major flavanone in fruit, led to a substantial increase in mtDNAcn in human leukocytes, whereas exposure to nicotine-derived nitrosamine ketone, a key carcinogenic ingredient of cigarette smoke, resulted in a significant decrease in mtDNAcn of cells (all P < 0.05). Further in vitro studies showed that alterations in leukocyte mtDNAcn were functionally linked to the modulation of mitochondrial biogenesis and function. Conclusions:Fruit consumption and intake of dietary flavanones were associated with increased leukocyte mtDNAcn, whereas cigarette smoking was associated with decreased leukocyte mtDNAcn, which is a promising biomarker for oxidative stress-related health outcomes.

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Design and rationale for evaluating salad bars and students' fruit and vegetable consumption: A cluster randomized factorial trial with objective assessments.

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Design and rationale for evaluating salad bars and students' fruit and vegetable consumption: A cluster randomized factorial trial with objective assessments.

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