PORTLAND, OR — If US elementary, middle, and high schools provided students with fresh fruits and vegetables and restricted the availability of sugar-sweetened beverages, this would reduce deaths from coronary heart disease, stroke, and diabetes (cardiometabolic deaths) in the general population many years later, according to a new study[1].

"Specific US school food environment policies involving fruit and vegetable provision and sugar-sweetened beverage restriction would modestly improve diet and BMI in children and could prevent up to 0.7% of all cardiometabolic deaths," researchers estimate.

Studies suggest that "students consume over one-third of their daily food intake when they are in school, so this is a great intervention setting, because we can implement policies to directly affect diet," Katherine L Rosettie (Tufts University, Boston, MA) told heartwire from Medscape, after presenting the study at the EPI|LIFESTYLE 2017 Scientific Sessions.

"Rather than addressing diet and obesity later in life, I think we can make a really big impact by targeting these kids when they are young," she said.


Session comoderator Dr Lawrence J Appel (Johns Hopkins University, Baltimore, MD) agrees.

"Physicians often focus on the individual patient, and for heart doctors and internists this is mostly adults, but the diseases we are managing really reflect adverse behaviors that begin in childhood," he noted to heartwire . This study shows that "policies aimed at improving diet in children have beneficial effects that impact children but also have a persistent effect in adults."

Suboptimal diets and obesity in childhood tend to persist in adulthood, Rosettie agreed.

How Schools Can Counter Lifelong Impact of Suboptimal Childhood Diet

The researchers developed a comparative risk-assessment model to estimate how national health policies requiring that schools provide healthy fruits and vegetables and restrict sugary drinks would affect the students' daily intake of these foods and beverages, their BMI, and their likelihood of death from cardiometabolic disease as adults.

The researchers identified 4165 children and adolescents who were 5 to 18 years old when they participated in the 2009–10 or 2011–2012 National Health and Nutrition Examination Survey (NHANES) who had data for fruit, vegetable, and sugar-sweetened beverage intake.

At baseline, on average, the children and adolescents in elementary, middle, and high school were eating 1.6, 1.2, and 1.1 servings of fruit a day, respectively, and 1.1, 1.3, and 1.5 servings of vegetables a day, respectively. The vegetables excluded any type of potatoes, including fries, Rosettie noted.

The model predicted that a policy of providing fresh fruits and vegetables in elementary, middle, and high school would increase the students' daily fruit intake by about 14%, 19%, and 21%, respectively, but their vegetable intake would stay about the same.

On average, the children and adolescents in elementary, middle, and high school were consuming 1.0, 1.4, and 1.9 servings of sugar-sweetened beverages a day, respectively, but this would drop by 11%, 8%, and 6%, respectively, if schools restricted access to these beverages.

The researchers estimated that a policy to make sugary drinks less available in schools would lower BMI by about 0.2 kg/m2 for children in elementary, middle, or high school.

They further assumed that the children and adolescents would keep 35% of the improvements in their diet as they grew older.

Based on National Center of Health Statistics data  showing that there were 702,308 deaths from cardiometabolic disease in 2012, the model predicted that 4703 deaths/year (or 0.67% of deaths/year) would have been averted if these adults had been exposed to policies that provided students with fruit and vegetables and restricted access to sugary drinks in schools.

Specifically, the model predicted that restricting sugary drinks in schools would avert an estimated 2418 cardiometabolic deaths/year (0.34% of deaths/year) and providing fruit would avert a similar number of cardiometabolic deaths (2121 deaths/year or 0.30% of deaths/year).

However, providing students with healthy vegetables would avert only 165 such deaths a year (0.02% of deaths/year),

School policies for serving healthy food and beverages to students "is just one piece of the puzzle" to tackle childhood obesity and subsequent cardiometabolic deaths, since children and teenagers also drink sugary beverages in the home or in fast-food restaurants, Rosettie acknowledged.

Nevertheless, this model suggests that food policies in schools could have an important impact on cardiometabolic health in adulthood.

The authors have no relevant financial relationships.  

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