Protocol for a prospective, randomized, controlled trial of Mental Contrasting with Implementation Intentions (MCII) to enhance the effectiveness of VA's MOVE! weight management program: WOOP (Wish, Outcome, Obstacle, Plan) VA.

INTRODUCTION: Intensive weight management programs are effective but often have low enrollment and high attrition. Lack of motivation is a key psychological barrier to enrollment, engagement, and weight loss. Mental Contrasting with Implementation Intentions (MCII) is a unique imagery technique that increases motivation for behavior change. We describe our study protocol to assess the efficacy and implementation of MCII to enhance the effectiveness of VA's MOVE! or TeleMOVE! weight management programs using a procedure called "WOOP" (Wish, Outcome, Obstacle, Plan) for Veterans. We hypothesize that WOOP+MOVE! or TeleMOVE! (intervention) will lead to greater MOVE!/TeleMOVE! program engagment and consequently weight loss than MOVE!/TeleMOVE! alone (control). METHOD: Veterans are randomized to either the intervention or control. Both arms receive the either MOVE! or TeleMOVE! weight management programs. The intervention group receives an hour long WOOP training while the control group receives patient education. Both groups receive telephone follow up calls at 3 days, 4 weeks, and 2 months post-baseline. Eligible participants are Veterans (ages 18-70 years) with either obesity (BMI ≥ 30 kg/m2) or overweight (BMI ≥ 25 kg/m2) and an obesity-associated co-morbidity. At baseline, 6 and 12 months, we assess weight, diet, physical activity in both groups. The primary outcome is mean percent weight change at 6 months. Secondary outcomes include changes in waist circumference, diet, physical activity, and dieting self-efficacy and engagement in regular physical activity. We assess implementation using the RE-AIM framework. CONCLUSION: If WOOP VA is found to be efficacious, it will be an important tool to facilitate weight management and improve weight outcomes. CLINICAL TRIAL REGISTRATION: NCT05014984.

Ethnicity/race, parent educational attainment, and obesity associated with prediabetes in children.

BACKGROUND/OBJECTIVES: Obesity and other predictors of type 2 diabetes disproportionally affect Hispanic and Black children in the US compared to non-Hispanic White (NHW) children. Yet, the prevalence of prediabetes in children remains unestablished, and guidelines for screening young children are lacking. This study examined the relationships between demographic factors and prediabetes in vulnerable youth in central Texas. SUBJECTS/METHODS: This is a cross-sectional analysis of baseline data from 976 3rd-5th graders (7-12 years) who participated in TX Sprouts, a school-based gardening, nutrition, and cooking trial in 16 elementary schools serving mainly children from minority backgrounds and lower-income households. Measures collected included age, sex, ethnicity, free/reduced-priced school lunch (FRL) status, parent educational attainment (questionnaires), BMI from height (stadiometer) and weight (TANITA scale), and prediabetes status from fasting plasma glucose (FPG) and HbA1c. Regressions examined cross-sectional associations between demographics and FPG, HbA1c, and prediabetes. RESULTS: Children were 47% male, 67% Hispanic, and 10% Black, with a mean age of 9.3 years; 71% received FRL, 50% had overweight/obesity, and 26% had prediabetes. Prediabetes rates were 2.8 and 4.8 times higher in Hispanic and Black children compared to NHW children, respectively (p ≤ 0.001), and 1.5 times higher in children with obesity versus normal BMI (p = 0.02). Children of parents with only an 8th-grade education, some high school education, or a high school degree had 3.1, 2.7, and 2.2 times higher odds of having prediabetes compared to children of college graduates, respectively (p ≤ 0.004). Analyses with FPG and HbA1c yielded similar results. CONCLUSION: These findings suggest a potential need for earlier screening, more comprehensive testing guidelines, and prevention programs tailored toward minority children, children with obesity, and children of parents with low educational attainment. Future research should explore this finding in a larger, nationally representative sample.

Effects of a School-Based Gardening, Cooking, and Nutrition Cluster Randomized Controlled Trial on Unprocessed and Ultra-Processed Food Consumption.

BACKGROUND: School-based gardening and nutrition education interventions report improvements in dietary intake, notably through fruit and vegetables. However, gardening, cooking, and nutrition randomized controlled trials are limited in evaluating dietary quality, and none have examined processed food consumption to date. OBJECTIVES: The study examined the effects of Texas Sprouts (TX Sprouts), a gardening, cooking, and nutrition education intervention, compared with control on unprocessed and ultra-processed food (UPF) consumption in predominately low-income Hispanic children. METHODS: TX Sprouts was a school-based cluster randomized controlled trial that consisted of 16 elementary schools randomly assigned to either the TX Sprouts intervention (n = 8 schools) or control (delayed intervention; n = 8 schools) over 3 y (2016-2019). TX Sprouts schools received an outdoor teaching garden and 18 1-h lessons taught by trained educators throughout the school year. Dietary intake data via 2 24-h dietary recalls were collected on a random subsample (n = 468) at baseline and postintervention. All foods and beverages were categorized using the NOVA food classification system (e.g., unprocessed, processed, ultra-processed). Generalized linear mixed effects modeling tested changes in percent calories and grams of NOVA groups between the intervention and control estimates with schools as random clusters. RESULTS: Of the sample, 63% participated in the free and reduced-price lunch program, and 57% were Hispanic, followed by non-Hispanic White (21%) and non-Hispanic Black (12%). The intervention, compared to the control, resulted in an increase in consumption of unprocessed foods (2.3% compared with -1.8% g; P < 0.01) and a decrease in UPF (-2.4% compared with 1.4% g; P = 0.04). In addition, Hispanic children in the intervention group had an increase in unprocessed food consumption and a decrease in UPF consumption compared to non-Hispanic children (-3.4% compared with 1.5% g; P < 0.05). CONCLUSIONS: Study results suggest that school-based gardening, cooking, and nutrition education interventions can improve dietary intake, specifically increasing unprocessed food consumption and decreasing UPF consumption. This trial was registered at clinicaltrials.gov as NCT02668744.

Dietary Psychosocial Mediators of Vegetable Intake in Schoolchildren From Low-Income and Racial and Ethnic Minority US Families: Findings From the Texas Sprouts Intervention.

BACKGROUND: Numerous school-based interventions have used cooking and gardening approaches to improve dietary intake; however, research is limited on the mediation effect of dietary psychosocial factors on the link between the intervention and increased vegetable intake, particularly in children from low-income and racial and ethnic minority US families. OBJECTIVE: Our aim was to examine the effects of the Texas Sprouts intervention on dietary psychosocial factors related to intake of vegetables, and whether these psychosocial factors mediate the link between the intervention and increased intake of vegetables in schoolchildren from low-income and racial and ethnic minority US families. DESIGN: This was an analysis of data on secondary outcomes from the Texas Sprouts program, a 1-year school-based gardening, nutrition, and cooking cluster randomized controlled trial consisting of elementary schools that were randomly assigned to either the Texas Sprouts intervention or to control. PARTICIPANTS/SETTING: Participants were 2,414 third- through fifth-grade students from low-income and racial and ethnic minority US families from 16 schools (8 intervention and 8 control) in Austin, TX. INTERVENTION: The intervention group received eighteen 60-minute gardening, nutrition, and cooking student lessons in an outdoor teaching garden and 9 monthly parent lessons throughout the academic year. MAIN OUTCOME MEASURES: Child psychosocial and dietary measures were collected at baseline and post intervention via validated questionnaires. STATISTICAL ANALYSES PERFORMED: Generalized linear mixed models assessed the intervention effects on dietary psychosocial factors. Mediation analyses examined whether these psychosocial factors mediated the link between the intervention and increased child vegetable intake. RESULTS: Children in Texas Sprouts, compared with controls, showed significant increases in the mean scores of gardening attitudes, cooking self-efficacy, gardening self-efficacy, nutrition and gardening knowledge, and preferences for fruit and vegetables (all, P < .001). Each of the dietary psychosocial factors mediated the association between the Texas Sprouts intervention and child vegetable intake. CONCLUSIONS: Besides targeting dietary behaviors, future school-based interventions should also focus on understanding the mechanisms through which teaching children to cook and garden influence dietary psychosocial factors as mediators of change in healthy eating behaviors.

Effects of a School-Based Nutrition, Gardening, and Cooking Intervention on Metabolic Parameters in High-risk Youth: A Secondary Analysis of a Cluster Randomized Clinical Trial.

Importance: Although school-based gardening programs for children have consistently been shown to improve dietary behaviors, no cluster randomized clinical trial (RCT) has evaluated the effects of a school-based gardening intervention on metabolic outcomes. Objective: To evaluate the effects of a school-based gardening, nutrition, and cooking intervention (Texas Sprouts) on changes in metabolic outcomes in elementary schoolchildren. Design, Setting, and Participants: This study was a secondary analysis of a cluster RCT, conducted over 3 years from 2016 to 2019, at low-income elementary schools with majority Hispanic students in the greater Austin, Texas, area. Data were analyzed from January to August 2022. Interventions: Texas Sprouts was 1 school year long (9 months) and consisted of (1) Garden Leadership Committee formation; (2) a 0.25-acre outdoor teaching garden; (3) 18 student gardening, nutrition, and cooking lessons taught by trained educators throughout the school year; and (4) 9 monthly parent lessons. The delayed intervention was implemented the following academic year and received an identical intervention. Main Outcomes and Measures: The following measures were obtained at baseline and postintervention (9 months): demographics via survey; measured height, weight, and body mass index parameters; and glucose, insulin, homeostatic model assessment of insulin resistance, and a lipid panel via an optional fasting blood draw. Results: Sixteen elementary schools were randomly assigned to either Texas Sprouts intervention (8 schools) or to delayed intervention (control, 8 schools). A total of 3302 children (aged 7-12 years) were enrolled in Texas Sprouts, and fasting blood samples were obtained from 1104 children (or 33% of those enrolled) at baseline. The final analytic sample included 695 children (307 boys [44.17%]; mean [SE] age, 9.28 [0.04] years; 480 Hispanic children [69.02%]; 452 [65.03%] eligible for free or reduced lunch) with complete demographic data and baseline and postintervention (9-month) fasting blood draws. Compared with control schools, children from Texas Sprouts schools had a 0.02% reduction in mean hemoglobin A1c (95% CI, 0.03%-0.14%; P = .005) and a 6.40 mg/dL reduction in mean low-density lipoprotein cholesterol (95% CI, 3.82-8.97 mg/dL; P = .048). There were no intervention effects on glucose, insulin, homeostatic model assessment of insulin resistance, or other lipid parameters. Conclusions and Relevance: In this cluster RCT, Texas Sprouts improved glucose control and reduced low-density lipoprotein cholesterol in high-risk youth. These findings suggest that elementary schools should incorporate garden-based interventions as a way to improve metabolic parameters in children. Trial Registration: ClinicalTrials.gov Identifier: NCT02668744.

Do Appetite Traits Mediate the Link Between Birth Weight and Later Child Weight in Low-Income Hispanic Families?

Background: Birth weight and appetite traits (ATs) are important early life determinants of child weight and obesity. Objectives: The aim of this study is to examine whether (1) birth weight-for-gestational age z-scores (BWGAzs) were associated with ATs at child age 2 years and (2) ATs mediated the link between BWGAzs and weight-for-age z-scores (WFAzs) at child ages 3 and 4 years among Hispanic children. Methods: We conducted a secondary longitudinal analysis of data from the Starting Early Program of low-income, Hispanic mother-child pairs. ATs were assessed using the Child Eating Behavior Questionnaire at age 2 years. Child birth weight was obtained from medical records. Birth weight, sex, and gestational age were used to generate BWGAzs with Fenton growth curves. WFAz was calculated based on the CDC 2000 growth charts. Regression and mediation analyses were used to explore associations between BWGAzs, ATs, and WFAzs. Results: Infants with higher BWGAzs had significantly lower Satiety Responsiveness (B = -0.10) and Food Fussiness (B = -0.13) scores at age 2 years and higher WFAzs at ages 3 (B = 0.44) and 4 (B = 0.34) years. Lower Satiety Responsiveness at age 2 years was associated with higher WFAzs at ages 3 (B = -0.11) and 4 (B = -0.34; all p < 0.01) years. Lower Satiety Responsiveness partially mediated the positive relationship between birth weight and child WFAzs at ages 3 and 4 years. Conclusions: Children with higher birth weight and lower Satiety Responsiveness scores may be at higher risk of developing obesity in childhood. Further research is needed to understand the mechanisms through which birth weight influences child appetite. Clinical Trial Registration: ClinicalTrials.gov: NCT01541761.

Effects of a School-Based Garden Program on Academic Performance: A Cluster Randomized Controlled Trial.

BACKGROUND: School gardening programs have consistently been found to improve dietary behaviors in children. Although several quasi-experimental studies have also reported that school gardens can enhance academic performance, to date, no randomized controlled trial has been conducted to substantiate this. OBJECTIVE: The objective of the study was to examine the effects of Texas Sprouts (TX Sprouts), a gardening, nutrition, and cooking program vs control on academic performance in primarily low-income, Hispanic children. DESIGN: This is a secondary analysis of the grade-level academic scores from schools that participated in the TX Sprouts program, a school-based cluster randomized controlled trial, consisting of 16 elementary schools that were randomly assigned to either the TX Sprouts intervention (n = 8 schools) or control (delayed intervention; n = 8 schools). PARTICIPANTS/SETTING: Analysis included 16 schools with students in fourth and fifth grade in Austin, TX from 2016 to 2019 that had a majority Hispanic population and a majority of children participating in the free and reduced lunch program. INTERVENTION: The intervention consisted of 18 one-hour gardening, nutrition, and cooking lessons taught in an outdoor teaching garden by trained educators throughout the academic year. MAIN OUTCOME MEASURES: Texas Education Agency grade-level data for the State of Texas Assessments of Academic Readiness were obtained via the Texas Education Agency website for the corresponding year of the intervention or control condition. STATISTICAL ANALYSIS PERFORMED: Repeated measures general linear models with pre- and post-intervention State of Texas Assessments of Academic Readiness scores as the dependent variable were run, adjusting for the percent of free and reduced lunch and school district as covariates. RESULTS: Schools that received the TX Sprouts intervention had a 6.5-percentage-point increase in fourth-grade reading State of Texas Assessments of Academic Readiness scores compared with control schools (P = .047). There were no significant differences in reading scores for fifth grade students or math scores for either fourth- or fifth-grade students between groups. CONCLUSIONS: Study findings provide evidence that school gardening programs may have some modest effects on academic achievement.

School-based intervention impacts availability of vegetables and beverages in participants' homes.

As rates of metabolic syndrome rise, children consume too few vegetables and too much added sugar. Because children tend to eat what is available at home, the home environment plays a key role in shaping dietary habits. This secondary analysis evaluated the effects of a school-based gardening, cooking, and nutrition education intervention (TX Sprouts) compared to control on the availability of vegetables, fruit juice, and sugar-sweetened beverages (SSBs) at home. In the TX Sprouts cluster-randomized trial, 16 schools were randomized to TX Sprouts (n = 8 schools) or control (n = 8 schools) for one academic year. All schools served predominately Hispanic families with low incomes. TX Sprouts built school gardens and taught 18 lessons to all 3rd-5th grade students at intervention schools. TX Sprouts also offered monthly caregiver lessons before and/or after school. Caregivers completed questionnaires pre and post, providing demographics and information about home availability of vegetables, fruit juice, and SSBs. Summary statistics were used to describe the sociodemographic characteristics of participants. Linear regression assessed the change in scores (pre to post) for the food/ beverage availability question. The model was adjusted for the caregiver's education, employment status, child's grade, and free or reduced-price lunch eligibility. The analytic sample included 895 participants. Compared to control, the intervention positively changed the home availability of targeted foods and beverages, largely by improving the availability of vegetables and vegetable juice. This study showed that a school gardening, nutrition, and cooking program delivered to elementary children may positively influence the home food environment.

Breakfast Consumption May Improve Fasting Insulin, HOMA-IR, and HbA1c Levels in Predominately Low-Income, Hispanic Children 7-12 Years of Age.

Children from low-income households and minority families have high cardiometabolic risk. Although breakfast consumption is known to improve cardiometabolic health in children, limited randomized control trials (RCT) have explored this association in low-income and racial/ethnic U.S. minority families. This study conducted secondary analyses from TX Sprouts, a school-based gardening, cooking, and nutrition education RCT, to examine the intervention effect on breakfast consumption and how changes in breakfast consumption impact cardiometabolic risk in predominately low-income, multi-ethnic children. TX Sprouts consisted of 16 schools (8 intervention; 8 control) in greater Austin, TX. A total of 18 lessons were taught, including topics on breakfast consumption benefits and choosing healthy food options at school. Children completed clinical measures (e.g., anthropometrics, body composition via bioelectrical impedance), and the number of breakfast occasions (BO) per week (at home and school) was captured via validated survey at baseline and post-intervention. Post-study­Baseline changes in breakfast consumption were used to categorize students as: maintainers (BO −1 to 1 day/week), decreasers (BO ≤−2 day/week), and increasers (BO ≥2 day/week). Optional fasting blood draws were performed on a subsample. Generalized weighted linear mixed modeling tested differences between intervention and control, with schools as random clusters. Analysis of covariance and linear regression examined changes in breakfast consumption on cardiometabolic outcomes, controlling for age, sex, race/ethnicity, free and reduced-price school meal participation (FRL), school site, breakfast location, physical activity, baseline cardiometabolic measures, and BMI z-score. This study included 1417 children (mean age 9 years; 53% male; 58% Hispanic, 63% FRL; breakfast consumption patterns: 63% maintainers, 16% decreasers, and 21% increasers). There was no intervention effect on changes in breakfast consumption. Compared to decreasers, increasers had an increase in insulin (−0.3 µIU/mL vs. +4.1 µIU/mL; p = 0.01) and a larger increase in HOMA-IR (+0.4 vs. +1.5; p < 0.01). Every one-day increase in breakfast consumption decreased fasting insulin by 0.44 µIU/mL, HOMA-IR by 0.11, and hemoglobin A1c by 0.01% (p ≤ 0.03). Increased breakfast consumption was linked to improved glucose control, suggesting breakfast can mitigate risk in a high-risk population. To better understand underlying mechanisms linking breakfast consumption to improved metabolic health, RCTs focusing on breakfast quality and timing are warranted.

Distinct racial and ethnic metabolic syndrome characteristics: A comparative assessment in low-income children 7-10 years of age.

BACKGROUND: Pediatric MetS prevalence varies due to lack of consensus on evaluative criteria and associated thresholds, with most not recommending a diagnosis <10 years. However, MetS risk components are becoming evident earlier in life and affect races and ethnicities disproportionately. OBJECTIVES: To compare the prevalence of MetS based on existing definitions and elucidate racial- and ethnic-specific characteristics associated with MetS prevalence. METHODS: The baseline and follow-up samples included 900 and 557 children 7-10 years, respectively. Waist circumference, BMI percentile, blood pressure, fasting plasma glucose (FPG), insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C) were measured. Agreement between MetS definitions was quantified via kappa statistics. MetS and risk factor prevalence and the predictability of metabolic parameters on MetS eight months later was evaluated via logistic regression. McFadden pseudo-R2 was reported as a measure of predictive ability, and the Akaike information criterion evaluated fit of each model. RESULTS: The baseline sample was 55.0% male and 71.6% Hispanic, followed by non-Hispanic White (NHW) (17.3%) and non-Hispanic Black (NHB) (11.1%), with an average age of 9.2 years. MetS prevalence ranged from 7.6% to 21.4%, highest in Hispanic (9.0%-24.0%) and lowest in NHB children (4.0%-14.0%). Highest agreement was between Ford et al. and Cook et al. definitions (K = 0.88) and lowest agreements were consistently with the International Diabetes Federation criteria (K ≤ 0.57). Compared to NHW children, Hispanic children had higher odds for MetS (OR: 1.7; p = 0.03) and waist circumference, HDL-C, and FPG risk factors (p < 0.05), while NHB children had higher odds for the FPG risk factor (p ≤ 0.007) and lower odds for the plasma triglycerides risk factor (p = 0.002), across multiple MetS definitions. In longitudinal analyses, HDL-C was the strongest independent predictor of MetS in Hispanic and NHW children (p < 0.001 and p < 0.01, respectively), while plasma triglycerides was the strongest independent predictor of MetS in NHB children (p < 0.05). CONCLUSIONS: MetS prevalence was high in children ≤10 years, and proposed criteria are susceptible to racial and ethnic bias, diagnosing some populations more than other populations with high cardiovascular risk. Earlier preventative measures should be imposed in clinical settings, accounting for racial and ethnic differences, to mitigate disease onset.

The effect of nigella sativa supplementation on cardiometabolic outcomes in patients with non-alcoholic fatty liver: A randomized double-blind, placebo-controlled trial.

BACKGROUND AND PURPOSE: Non-alcoholic fatty liver disease (NAFLD) is one of the metabolic disturbances associated with liver cell inflammation. Nigella sativa (N.sativa) is a widely used medicinal plant known for its anti-inflammatory, antimicrobial, antioxidant, and hepato-protective properties. This study aimed to assess the effect of supplementation of N. sativa oil on plasma levels of adiponectin, leptin, and blood pressure (BP) in patients diagnosed with NAFLD. MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled clinical trial was conducted on 44 NAFLD patients. Participants were randomly assigned to two groups (n = 22/group); the experimental group received 1000 mg of N. sativa oil per day, while the control group received a placebo for eight weeks. The primary outcome measures were serum levels of adiponectin, leptin, and systolic and diastolic blood pressure measured at the baseline and the end of the intervention. RESULTS: After eight weeks of supplementation with N. sativa oil, no statistically significant differences were found in serum levels of adiponectin (p = 0.40), leptin (p = 0.89), systolic BP (p = 0.13), and diastolic BP (p = 0.09) between the two groups. Furthermore, after supplementation with N. sativa, no significant changes were observed in leptin (p = 0.07), adiponectin (p = 0.13), systolic BP (p = 0.82), and diastolic BP (p = 0.38) within the two groups. CONCLUSION: These results indicate that administration of N. sativa oil 1000 mg/day for 8 weeks has no favorable effect on cardiometabolic measures in NAFLD patients. Further studies with higher dosage over a longer period are needed to investigate whether this effect is dose- and time-dependent.

Infant appetite traits, feeding practices and child obesity in low-income Hispanic families.

BACKGROUND: Appetite traits and feeding practices are important determinants of child weight and obesity. OBJECTIVES: This study examined whether: (1) infant appetite traits were associated with feeding practices and (2) feeding practices mediated the link between appetite traits and weight-for-age z-scores at age 3 years. METHODS: We conducted a secondary data analysis from the 'Starting Early Program' of low-income, Hispanic mother-child pairs. Appetite traits were assessed using the Baby Eating Behaviour Questionnaire. Infant feeding practices were collected using 24-h dietary recalls and surveys: (1) breastfeeding exclusivity, intensity and duration; (2) early introduction to complementary foods/liquids and (3) any 100% fruit juice consumption at age 10 months. Regression and mediation analyses were used to explore associations between appetite, feeding and weight. RESULTS: Higher infant Slowness in Eating scores were associated with greater breastfeeding exclusivity, intensity and duration, compared to lower Slowness in Eating. Infants with higher Slowness in Eating and Satiety Responsiveness had lower odds of early introduction to complementary foods/liquids. Infants with higher Enjoyment of Food had greater odds of 100% juice consumption. Breastfeeding duration mediated the relationship between higher infant Slowness in Eating and lower weight-for-age z-scores. CONCLUSIONS: Appetite traits represent potential targets for early life infant feeding interventions.

Comparison of School vs Home Breakfast Consumption with Cardiometabolic and Dietary Parameters in Low-Income, Multiracial/Ethnic Elementary School-Aged Children.

BACKGROUND: Breakfast consumption is often associated with improving cardiometabolic parameters and diet quality. However, literature evaluating breakfast consumption with these outcomes between the school and home environments is limited. OBJECTIVE: This study examined relationships between breakfast consumption locations (school vs home) and cardiometabolic parameters, breakfast dietary intake, and daily dietary intake. DESIGN: This cross-sectional study used baseline data from TX Sprouts, a 1-year school-based gardening, nutrition, and cooking cluster-randomized trial, implemented in 16 elementary schools in Austin, TX, during 2016 to 2019. PARTICIPANTS/SETTING: Analyses included 383 low-income, multiracial/ethnic elementary school-aged children (mean age = 9.2 years; 60.6% Hispanic; 70.5% free/reduced lunch; 58.5% home breakfast consumers). MAIN OUTCOME MEASURES: Cardiometabolic parameters were obtained via fasting blood draws, and dietary intake was assessed using one 24-hour dietary recall conducted on a random, unannounced weekday. Cardiometabolic and dietary parameters (ie, energy intake, macronutrients, and food group servings) for breakfast and for the day were evaluated. STATISTICAL ANALYSES PERFORMED: Multivariate analysis of covariance was performed to examine cardiometabolic parameters and dietary intake between school and home breakfasts. RESULTS: School breakfast consumers (SBC) had lower fasting triglyceride levels than home breakfast consumers (HBC) (89.0 mg/dL vs 95.7 mg/dL; P = 0.03) (to convert to mmol/L, multiply by 0.0113). SBC had lower total fat for the day (P = 0.02) and lower total and saturated fat, sodium, and refined grains at breakfast (P ≤ 0.01) than HBC. However, SBC had lower protein at breakfast (P = 0.01) and higher carbohydrates, total sugar, and added sugar for the day and at breakfast (P ≤ 0.03) than HBC. CONCLUSIONS: SBC compared with HBC had lower fat intake, which may have contributed to the lower triglyceride level observed in SBC, but also had lower protein intake at breakfast and higher added sugar intake for the day and at breakfast. These results suggest dietary intake differed between HBC and SBC; that is, the home and school environments, but more research is needed to evaluate if such differences are due to School Breakfast Program guidelines.

Impact of a School-Based Gardening, Cooking, Nutrition Intervention on Diet Intake and Quality: The TX Sprouts Randomized Controlled Trial.

School gardens have become common school-based health promotion strategies to enhance dietary behaviors in the United States. The goal of this study was to examine the effects of TX Sprouts, a one-year school-based gardening, cooking, and nutrition cluster randomized controlled trial, on students' dietary intake and quality. Eight schools were randomly assigned to the TX Sprouts intervention and eight schools to control (i.e., delayed intervention) over three years (2016-2019). The intervention arm received: formation and training of Garden Leadership Committees; a 0.25-acre outdoor teaching garden; 18 student lessons including gardening, nutrition, and cooking activities, taught weekly in the teaching garden during school hours; and nine parent lessons, taught monthly. Dietary intake data via two 24 h dietary recalls (24 hDR) were collected on a random subsample (n = 468). Dietary quality was calculated using the Healthy Eating Index 2015 (HEI-2015). The intervention group compared to control resulted in a modest increase in protein intake as a percentage of total energy (0.4% vs. -0.3%, p = 0.021) and in HEI-2015 total vegetables component scores (+4% vs. -2%, p = 0.003). When stratified by ethnicity/race, non-Hispanic children had a significant increase in HEI-2015 total vegetable scores in the intervention group compared to the control group (+4% vs. -8%, p = 0.026). Both the intervention and control groups increased added sugar intake; however, to a lesser extent within the intervention group (0.3 vs. 2.6 g/day, p = 0.050). School-based gardening, cooking, and nutrition interventions can result in significant improvements in dietary intake. Further research on ways to scale and sustain nutrition education programs in schools is warranted. The trial is registered at ClinicalTrials.gov (NCT02668744).

Infant and Early Child Appetite Traits and Child Weight and Obesity Risk in Low-Income Hispanic Families.

BACKGROUND: Child appetite traits (ATs) are associated with later child weight and obesity risk. Less research has focused on ATs in low-income Hispanic children or included longitudinal associations with infant weight. OBJECTIVE: To determine stability of ATs during infancy and childhood and their relationship with subsequent weight and obesity risk at age 3 years among low-income Hispanic children. DESIGN: A secondary longitudinal analysis of data from the Starting Early Program randomized controlled obesity prevention trial. PARTICIPANTS/SETTING: Three hundred twenty-two low-income, Hispanic mother-child pairs enrolled between 2012 and 2014 in a public hospital in New York City. MAIN OUTCOME MEASURES: ATs, including Slowness in Eating, Satiety Responsiveness, Food Responsiveness, and Enjoyment of Food were assessed using the Baby and Child Eating Behavior Questionnaires at ages 3 months, 2 years, and 3 years. Main outcome measures were child standardized weight-for-age z score (WFAz) and obesity risk (WFA≥95th percentile) at age 3 years. STATISTICAL ANALYSES PERFORMED: AT stability was assessed using correlations and multilevel modeling. Linear and logistic regression analyses examined associations between ATs and child WFAz and obesity risk at age 3 years. RESULTS: There was limited stability for all ATs measured over time. During infancy, Slowness in Eating was associated with lower 3-year WFAz (B = -0.18, 95% CI -0.33 to -0.04; P = 0.01). At age 2 years, Slowness in Eating and Satiety Responsiveness were associated with lower WFAz (B = -0.29, 95% CI -0.47 to -0.12; P < 0.01; B = -0.36, 95% CI -0.55 to -0.17; P < 0.01) and obesity risk (adjusted odds ratio 0.49, 95% CI 0.28 to 0.85; adjusted odds ratio 0.61, 95% CI 0.38 to 0.99) at 3 years. Increased Slowness in Eating and Satiety Responsiveness over time were associated with lower 3-year WFAz (B = -0.74, 95% CI -1.18 to -0.2 [Slowness in Eating]; B = -1.19, 95% CI -1.87 to -0.52 [Satiety Responsiveness], both P values = 0.001). Higher Enjoyment of Food over time was associated with higher 3-year WFAz (B = 0.62, 95% CI 0.24 to 1.01; P = 0.002). CONCLUSIONS: Infants with lower Slowness in Eating and Satiety Responsiveness may have higher levels of obesity risk and need more tailored approaches to nutrition counseling and obesity prevention.

Barriers, Strategies, and Resources to Thriving School Gardens.

OBJECTIVE: To identify school garden attributes and practices that most strongly contribute to garden use and sustainability and translate them into recommendations for improving garden-based nutrition education. DESIGN: Surveys were developed and administered to school stakeholders to assess the barriers, strategies, and resources for successful school garden-based nutrition education. A panel of school garden experts identified thriving school gardens. Logistic regression was used to identify which attributes predicted thriving school garden programs. SETTING: Approximately 109 schools across Greater Austin, TX. PARTICIPANTS: A total of 523 school teachers and 174 administrators. OUTCOMES: Barriers, strategies, and resources relevant to successful school gardening nutrition programs. RESULTS: Thriving school gardens were 3-fold more likely to have funding and community partner use (P = 0.022 and P = 0.024), 4 times more likely to have active garden committees (P = 0.021), available garden curriculum (P = 0.003), teacher training (P = 0.045), ≥ 100 students who used the garden annually (P = 0.047), and 12 times more likely to have adequate district and administrator support (P = 0.018). CONCLUSIONS AND IMPLICATIONS: Adequate administrative and district support is fundamental when implementing a school garden. Schools may benefit from finding additional funding, providing teacher garden training, providing garden curriculum, forming garden leadership committees, and partnering with local community organizations to improve garden-based nutrition education.

School-based gardening, cooking and nutrition intervention increased vegetable intake but did not reduce BMI: Texas sprouts - a cluster randomized controlled trial.

BACKGROUND: Although school garden programs have been shown to improve dietary behaviors, there has not been a cluster-randomized controlled trial (RCT) conducted to examine the effects of school garden programs on obesity or other health outcomes. The goal of this study was to evaluate the effects of a one-year school-based gardening, nutrition, and cooking intervention (called Texas Sprouts) on dietary intake, obesity outcomes, and blood pressure in elementary school children. METHODS: This study was a school-based cluster RCT with 16 elementary schools that were randomly assigned to either the Texas Sprouts intervention (n = 8 schools) or to control (delayed intervention, n = 8 schools). The intervention was one school year long (9 months) and consisted of: a) Garden Leadership Committee formation; b) a 0.25-acre outdoor teaching garden; c) 18 student gardening, nutrition, and cooking lessons taught by trained educators throughout the school-year; and d) nine monthly parent lessons. The delayed intervention was implemented the following academic year and received the same protocol as the intervention arm. Child outcomes measured were anthropometrics (i.e., BMI parameters, waist circumference, and body fat percentage via bioelectrical impedance), blood pressure, and dietary intake (i.e., vegetable, fruit, and sugar sweetened beverages) via survey. Data were analyzed with complete cases and with imputations at random. Generalized weighted linear mixed models were used to test the intervention effects and to account for clustering effect of sampling by school. RESULTS: A total of 3135 children were enrolled in the study (intervention n = 1412, 45%). Average age was 9.2 years, 64% Hispanic, 47% male, and 69% eligible for free and reduced lunch. The intervention compared to control resulted in increased vegetable intake (+ 0.48 vs. + 0.04 frequency/day, p = 0.02). There were no effects of the intervention compared to control on fruit intake, sugar sweetened beverages, any of the obesity measures or blood pressure. CONCLUSION: While this school-based gardening, nutrition, and cooking program did not reduce obesity markers or blood pressure, it did result in increased vegetable intake. It is possible that a longer and more sustained effect of increased vegetable intake is needed to lead to reductions in obesity markers and blood pressure. CLINICAL TRIALS NUMBER: NCT02668744 .

Association of infant diet with subsequent obesity at 2-5 years among children exposed to gestational diabetes: the SWIFT study.

AIMS/HYPOTHESES: This longitudinal analysis evaluated the independent and joint associations of any breastfeeding (BF) or exclusive BF (EBF) and intake of sugar-sweetened beverages (SSBs) and 100% fruit juice from birth to 1 year with subsequent overweight and obesity among young children exposed to gestational diabetes (GDM). METHODS: The analysis utilised prospectively collected data from participants enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes after GDM (SWIFT); 1035 pregnant women (20-45 years) diagnosed with GDM, of whom 75% were of Black, Hispanic or Asian race and ethnicity. Mother-infant dyad characteristics and infant dietary intake were assessed via research protocols at in-person examinations, telephone interviews and monthly mailed surveys from birth to 1 year. Child weight, length and height were obtained from electronic health records at birth (2008-2011) and ages 2-5 years (2010-2016) to classify BMI percentile groups (n = 835). RESULTS: Adequate BF (≥6 months), adequate EBF duration (≥6 months), and SSB and 100% fruit juice intake in the first year were independently associated with child obesity at ages 2-5 years (all p < 0.05). Compared with children with adequate EBF and no intake of SSB or 100% fruit juice, those with adequate EBF and intake of 100% fruit juice and/or SSBs had a four- to fivefold higher odds of obesity (aOR 4.2, 95% CI:1.6, 11.2 for 100% fruit juice; aOR 4.5, 95% CI:1.4, 8.5 for fruit juice or SSBs; and aOR 4.7, 95% CI:1.4, 15 for SSBs; all p < 0.01), while those with inadequate EBF (<6 months) and intake of 100% fruit juice and/or SSBs had a six- to 12-fold higher odds of obesity (aOR 6.4, 95% CI:2.4, 17.2 for fruit juice; aOR 6.6, 95% CI:2.7, 14.8 for fruit juice or SSBs; and aOR 12.2, 95% CI:4.3, 25 for SSBs; all p < 0.001). Compared with children with adequate BF and no intake of SSB or 100% fruit juice, those with adequate BF and intake of 100% fruit juice and/or SSBs had a threefold higher odds of obesity (aOR 3.1, 95% CI:1.1, 7.3 for fruit juice; aOR 3.3, 95% CI:1.3, 8.3 for fruit juice or SSBs; and aOR 3.4, 95% CI:1.3, 8.5 for SSBs; all p < 0.05), while those with inadequate BF (<6 months) and intake of 100% fruit juice and/or SSB were associated with five- to tenfold higher odds of obesity (aOR 4.8, 95% CI:2.3, 12.2 for fruit juice; aOR 6.0, 95% CI:2.5, 12.8 for fruit juice or SSBs; aOR 9.5, 95% CI:3.7, 15.1 for SSBs; all p < 0.05). CONCLUSIONS/INTERPRETATION: This is the first study to prospectively evaluate the relation of BF or EBF duration and intake of SSB and 100% fruit juice during the first year of life with subsequent obesity in children exposed to GDM. Adequate BF or EBF combined with avoidance of SSB and 100% fruit juice during early infancy may ameliorate future child obesity in this high-risk population.

Persistent organic pollutants exposure in newborn dried blood spots and infant weight status: A case-control study of low-income Hispanic mother-infant pairs.

Persistent organic pollutants (POPs) are believed to alter metabolic homeostasis during fetal development, leading to childhood obesity. However, limited studies have explored how fetal chemical exposures relate to birth and infant weight outcomes in low-income Hispanic families at the highest risk of obesity. Therefore, we sought to determine associations between neonatal POPs exposure measured in newborn dried blood spots (DBS) and prenatal diet quality, birth weight, and overweight status at 18 months old. We conducted a case-control study nested within the Starting Early Program randomized controlled trial comparing POPs concentrations in infants with healthy weight (n = 46) and overweight status (n = 52) at age 18 months. Three categories of POPs, organochlorine pesticides (OCPs), polybrominated diphenyl ethers (PBDEs) and perfluoroalkyl substances (PFASs) were measured in archived newborn DBS. We assessed correlations between prenatal diet quality and neonatal POPs concentrations. Multivariable regression analyses examined associations between POPs (dichotomized at the mean) and birth weight z-score and weight status at 18 months, controlling for confounders. Seven of eight chemicals had detectable levels in greater than 94% of the sample. Higher protein, sodium and refined grain intake during pregnancy were correlated with lower POPs in newborn DBS. We found that high concentrations of perfluorooctanesulfonate (unstandardized coefficient [B]: -0.62, 95% confidence interval [CI]: -0.96 to -0.29) and perfluorohexanesulfate (B: -0.65, 95% CI: -0.99 to -0.31) were related to lower birth weight z-scores compared to those with low concentrations. We did not find associations between PBDEs, OCPs, and the other PFASs with birth weight z-scores, or between any POPs and weight status at 18 months. In conclusion, two PFASs were associated with lower birth weight, an important indicator of child health and growth, although direct associations with infant overweight status were not found. Whether neonatal POPs exposures contribute to economic and ethnic disparities in early obesity remains unclear.

Prenatal and Pediatric Primary Care-Based Child Obesity Prevention Program: A Randomized Trial.

OBJECTIVES: To determine impact of a primary care-based child obesity prevention intervention beginning during pregnancy on early childhood weight outcomes in low-income Hispanic families. METHODS: A randomized controlled trial comparing mother-infant pairs receiving either standard care or the Starting Early Program providing prenatal and postpartum nutrition counseling and nutrition parenting support groups targeting key obesity-related feeding practices in low-income groups. Primary outcomes were reduction in weight-for-age z-scores (WFAzs) from clinical anthropometric measures, obesity prevalence (weight for age ≥95th percentile), and excess weight gain (WFAz trajectory) from birth to age 3 years. Secondary outcomes included dose effects. RESULTS: Pregnant women (n = 566) were enrolled in the third trimester; 533 randomized to intervention (n = 266) or control (n = 267). Also, 358 children had their weight measured at age 2 years; 285 children had weight measured at age 3 years. Intervention infants had lower mean WFAz at 18 months (0.49 vs 0.73, P = .04) and 2 years (0.56 vs 0.81, P = .03) but not at 3 years (0.63 vs 0.59, P = .76). No group differences in obesity prevalence were found. When generalized estimating equations were used, significant average treatment effects were detected between 10-26 months (B = -0.19, P = .047), although not through age 3 years. In within group dose analyses at 3 years, obesity rates (26.4%, 22.5%, 8.0%, P = .02) decreased as attendance increased with low, medium, and high attendance. CONCLUSIONS: Mean WFAz and growth trajectories were lower for the intervention group through age 2 years, but there were no group differences at age 3. Further study is needed to enhance sustainability of effects beyond age 2.