Changes in water and sugar-containing beverage consumption and body weight outcomes in children.

An intervention study showed that promoting water consumption in schoolchildren prevented overweight, but a mechanism linking water consumption to overweight was not substantiated. We investigated whether increased water consumption replaced sugar-containing beverages and whether changes in water or sugar-containing beverages influenced body weight outcomes. In a secondary analysis of the intervention study in Germany, we analysed combined longitudinal data from the intervention and control groups. Body weight and height were measured and beverage consumption was self-reported by a 24-h recall questionnaire at the beginning and end of the school year 2006/2007. The effect of a change in water consumption on change in sugar-containing beverage (soft drinks and juices) consumption, change in BMI (kg/m2) and prevalence of overweight and obesity at follow-up was analysed using regression analyses. Of 3220 enroled children, 1987 children (mean age 8·3 (sd 0·7) years) from thirty-two schools were analysed. Increased water consumption by 1 glass/d was associated with a reduced consumption of sugar-containing beverages by 0·12 glasses/d (95 % CI -0·16, -0·08) but was not associated with changes in BMI (P=0·63). Increased consumption of sugar-containing beverages by 1 glass/d was associated with an increased BMI by 0·02 (95 % CI 0·00, 0·03) kg/m2 and increased prevalence of obesity (OR 1·22; 95 % CI 1·04, 1·44) but not with overweight (P=0·83). In conclusion, an increase in water consumption can replace sugar-containing beverages. As sugar-containing beverages were associated with weight gain, this replacement might explain the prevention of obesity through the promotion of water consumption.

Immigrational background affects the effectiveness of a school-based overweight prevention program promoting water consumption.

We tested whether a simple overweight prevention program promoting water consumption in elementary schools is equally effective in children with an immigrational background (MIG) and in those without (non-MIG). Thus, a secondary analysis of a controlled cluster trial, lasting one school year, was conducted. Thirty-two elementary schools located in low socioeconomic districts in two German cities were included. Of the 2,950 school children analyzed, 1,306 were MIG children. Water fountains were installed in the schools of the intervention group (IG) and teachers held lessons to promote water consumption. Control schools (control group (CG)) did not receive any intervention. Before and after intervention, body weight and height was measured. Overweight was defined by age- and sex-specific BMI cutoffs that are linked to an adult BMI of 25 kg/m(2). Beverage consumption was assessed in questionnaires. Modification of intervention effects by immigrational background was tested by interaction terms. The immigrational background modified the intervention effect on prevalence and remission of overweight (interaction term: P = 0.03 and P = 0.02), but not on the incidence of overweight (P = 0.06). After intervention, the risk of being overweight was reduced in the IG compared to the CG among non-MIG (odds ratio = 0.51, 95% confidence interval (CI): 0.31-0.83), but not among MIG children (odds ratio = 1.02, 95% CI: 0.63-1.65). After intervention, water consumption significantly increased in the IG equally among both, non-MIG and MIG, by ~1 glass/day. A simple school-based intervention promoting water consumption prevented overweight in non-MIG children, but failed in MIG children. Different beverage consumption, among other lifestyle factors, may account for this effect but scientific discussion remains open.

Promotion and provision of drinking water in schools for overweight prevention: randomized, controlled cluster trial.

OBJECTIVE: The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school. METHODS: The participants in this randomized, controlled cluster trial were second- and third-graders from 32 elementary schools in socially deprived areas of 2 German cities. Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools (N = 17) to promote water consumption. Control group schools (N = 15) did not receive any intervention. The prevalence of overweight (defined according to the International Obesity Task Force criteria), BMI SD scores, and beverage consumption (in glasses per day; 1 glass was defined as 200 mL) self-reported in 24-hour recall questionnaires, were determined before (baseline) and after the intervention. In addition, the water flow of the fountains was measured during the intervention period of 1 school year (August 2006 to June 2007). RESULTS: Data on 2950 children (intervention group: N = 1641; control group: N = 1309; age, mean +/- SD: 8.3 +/- 0.7 years) were analyzed. After the intervention, the risk of overweight was reduced by 31% in the intervention group, compared with the control group, with adjustment for baseline prevalence of overweight and clustering according to school. Changes in BMI SD scores did not differ between the intervention group and the control group. Water consumption after the intervention was 1.1 glasses per day greater in the intervention group. No intervention effect on juice and soft drink consumption was found. Daily water flow of the fountains indicated lasting use during the entire intervention period, but to varying extent. CONCLUSION: Our environmental and educational, school-based intervention proved to be effective in the prevention of overweight among children in elementary school, even in a population from socially deprived areas.

A simple dietary intervention in the school setting decreased incidence of overweight in children.

OBJECTIVE: The study analyzed the effect of a combined environmental and educational intervention solely promoting water consumption on the incidence of overweight among school children. METHODS: 2,950 second and third graders of 32 elementary schools in socially deprived neighborhoods of two German cities participated in a randomized controlled intervention trial (August 2006-June 2007). In intervention schools (N = 17), water fountains were installed, each child received a water bottle, and teachers performed classroom lessons to promote water consumption. Control schools (N = 15) did not receive any intervention. Body heights and weights were measured at baseline and follow-up to assess the incidence and remission of overweight and obesity during follow-up. The water flow of the fountains was measured regularly during follow-up. Children's beverage consumption was self-reported in 24-hour recall questionnaires before and after intervention. RESULTS: After the intervention, the incidence of overweight was significantly lower in the intervention group (3.8%) than in the control group (6.0%, p = 0.018). Remission of overweight and obesity did not differ between the groups. Measured water flow of the fountains indicated a sustained use. CONCLUSION: A simple dietary intervention with the sole focus on the promotion of drinking water effectively reduced the incidence of overweight among school children.

Using the concept of Food Based Dietary Guidelines to Develop an Optimized Mixed Diet (OMD) for German children and adolescents.

OBJECTIVE: To apply for the first time FAO/WHO standards for Food Based Dietary Guidelines (FBDG) to develop a total diet concept named Optimized Mixed Diet (OMD) for children and adolescents in a European country. METHODS: Exact 7-day menus were composed for sample age groups of children (4-6 years) and adolescents (13-14 years), taking into account the German meal patterns, common non-fortified foods, and sensory preferences of children (practical criteria). Food amounts and food selection within the menus were optimized so far as to achieve a total of reference intakes for 22 nutrients (scientific criteria). Simple food based messages were deduced. RESULTS: Compared to the existing high-fat, low plant food diet reported from the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study), the OMD is lower in fat and saturated fatty acids and contains ample amounts of plant foods. Reference nutrient densities for age groups between 1 and 18 years were achieved or exceeded, except folate. Foods from the optimized menus were summarized into 11 food groups based on nutritional and practical considerations. Proportions of food groups by weight are independent of age and can be used to recalculate food amounts for various age groups or energy requirements, respectively. For simplification, "recommended" foods were distinguished from "tolerated" foods by their nutrient densities; based on food amounts, 3 simple rules for food consumption were deduced, i.e. beverages and plant foods: ample; animal foods: moderate; high-fat, high-sugar foods: sparingly. CONCLUSIONS: Exact menus and food amounts are a prerequisite to ascertain nutrient adequacy of FBDG. The OMD demonstrates that a single diet concept with a core of quantified food groups can be adequate for age groups between 1 and 18 years within a country, such as Germany.