Healthful Diets Possible in Low-Income, Rural Communities

A team of investigators implemented a two-year intervention study in low-income, rural areas where a disproportionately higher risk of overweight and obesity habits among children persists, leading to an increased risk of diabetes and heart disease in adulthood. The study results were published in the Journal of the Academy of Nutrition and Dietetics.

To evaluate students’ diet quality at the beginning and after the study, researchers designed the Creating Healthy, Active and Nurturing Growing-up Environments (CHANGE) study, a two-year randomized, controlled, community- and school-based intervention to prevent unhealthful weight gain among rural school-aged children.

“Our primary objectives were to improve the diets, physical activity levels, and weight status of rural children based on the successful model developed by Tufts University researchers for the Shape Up Somerville study,” says lead investigator Christina Economos, PhD, of the Friedman School of Nutrition Science and Policy at Tufts University in Boston.

“The objective of our analysis was to examine changes in fruit, vegetable, legume, whole grain, and low-fat dairy consumption among rural elementary students who were exposed to the CHANGE study intervention compared with students in control schools,” says lead author Juliana F. W. Cohen, ScM, ScD, of the department of nutrition at Harvard School of Public Health in Boston. The team wanted to test its hypothesis that students involved with the study would improve their diet quality due to more healthful food environments.

Eight communities in rural California, Kentucky, Mississippi, and South Carolina participated in the study between 2007 and 2009. Two communities in each state were randomly assigned to either an intervention or control group. Students in the intervention sample were given daily access to more healthful school foods and weekly educational curriculum that incorporated the goals of the Shape Up Somerville model: at least five servings of fruits and vegetables, no more than two hours of television or other screen time, and at least one hour of physical activity. The mean age of the 1,230 participating students was 8.6, and about 85% to 95% were nonwhite.

A baseline analysis revealed that students in CHANGE schools ate similar amounts of fruits, vegetables, whole grains, dairy, potatoes/potato products, saturated fats, and sugars as students in control schools and consumed significantly more legumes.

As a result of the intervention, food consumption of students in CHANGE schools was significantly different than students in the control schools, with the following results:

• eating 0.08 cups of vegetables per 1,000 kcal more per day;

• eating 0.22 cups combined fruits and vegetables per 1,000 kcal more per day; and

• significantly lower glycemic index.

There was a trend toward more fruit consumption in the CHANGE study intervention, with 0.15 cups per 1,000 kcal per day.

“The outcomes of the CHANGE study provide evidence that a multicomponent intervention targeting low-income children living in rural communities in America can improve their diet quality,” Cohen says. “Overall, students consumed significantly more vegetables and combined fruits and vegetables after exposure to the CHANGE study intervention compared with students in control schools and communities.”

Source: Academy of Nutrition and Dietetics

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