Clinical Trial: OPUS School Meal Study - Cross Sectional Analyses From Baseline Investigations

Study Status: Completed
Recruit Status: Completed
Study Type: Observational

Official Title: OPUS(Optimal Well-being, Development and Health for Danish Children Through a Healthy New Nordic Diet) School Meal Study - - Cross Sectional Analyses From Baseline Investigations

Brief Summary: The present study is based on cross-sectional data from the baseline investigations carried out in OPUS School Meal Study - a randomized crossover study carried out in 9 primary schools in Denmark 2011-2012. Approximately 800 Danish school children from 3rd and 4th grades (8-12 year olds) took part in these baseline investigations of socioeconomic status, pubertal status, growth status, learning abilities, well-being, sleep, physical activity and risk markers of Cardiovascular Disease (CVD), type II diabetes and osteoporosis.

Detailed Summary:
Sponsor: Arne Astrup

Current Primary Outcome:

  • Metabolic syndrome score [ Time Frame: Baseline (Cross-sectional) ]
    The metabolic syndrome score is a continuous z-score based on individual z-scores for Waist Circumference (WC), Mean Arterial Pressure (MAP), serum High Density Lipoprotein (HDL), serum Triglyceride (TG) and Homeostasis Model Assessment (HOMA) index. It´s an internal score meaning that the basis for the score is the distribution of values in this study population.
  • Body composition [ Time Frame: Baseline (Cross-sectional) ]
    Body composition will be determined by Dual energy X-ray Absorptiometry (DXA) scanning. The parameters included are total body Fat Free Mass Index (FFMI in kg/m2), total body Fat Mass Index (FMI in kg/m2), total body fat percentage and the ratio between android and gynoid fat mass in kg.
  • Concentration Performance [ Time Frame: Baseline (Cross-sectional) ]
    Concentration Performance is assessed by means of a concentration test called the D2-test of Attention. Concentration Performance is derived from the number of correctly crossed out relevant items minus the errors of commission (confused).
  • Fatty acid composition in whole-blood [ Time Frame: Baseline (cross-sectional) ]
    Content of saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, total n-3 and n-6 polyunsaturated fatty acids, eicosapentaenoic acid, docosahexaenoic acid, and the n-6:n-3 ratio in whole-blood measured as weight% relative to the weight of total fatty acids.


Original Primary Outcome:

  • Metabolic syndrome score [ Time Frame: Baseline (Cross-sectional) ]
    The metabolic syndrome score is a continuous z-score based on individual z-scores for Waist Circumference (WC), Mean Arterial Pressure (MAP), serum High Density Lipoprotein (HDL), serum Triglyceride (TG) and Homeostasis Model Assessment (HOMA) index. It´s an internal score meaning that the basis for the score is the distribution of values in this study population.
  • Body composition [ Time Frame: Baseline (Cross-sectional) ]
    Body composition will be determined by Dual energy X-ray Absorptiometry (DXA) scanning. The parameters included are total body lean mass index (LMI in kg/m2), total body fat mass index (FMI in kg/m2), total body fat percentage and the ratio between android and gynoid fat mass in kg.
  • Concentration Performance [ Time Frame: Baseline (Cross-sectional) ]
    Concentration Performance is assessed by means of a concentration test called the D2-test of Attention. Concentration Performance is derived from the number of correctly crossed out relevant items minus the errors of commission (confused).
  • Fatty acid composition in whole-blood [ Time Frame: Baseline (cross-sectional) ]
    Content of saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, total n-3 and n-6 polyunsaturated fatty acids, eicosapentaenoic acid, docosahexaenoic acid, and the n-6:n-3 ratio in whole-blood measured as weight% relative to the weight of total fatty acids.


Current Secondary Outcome:

  • Body weight, Body Mass Index (BMI) [ Time Frame: Baseline (Cross-sectional) ]

    Body weight (in kg),BMI, BMI z-score calculated on the basis of the current references from WHO and body weight status (underweight/normal weight/overweight and obese) based on the age and gender specific iso BMI´s defined by Cole et al.

    Cole et al. (2000) BMJ 320 (7244): 1240-1243. Cole et al. (2007) BMJ 335 (7612): 194-197.

  • Physical activity [ Time Frame: Baseline (Cross-sectional) ]
    Physical activity is measured using waist-worn ActiGraph GT3X and GT3X+. Outcome measures will be counts/min, time spent in sedentary, light, moderate and vigorous activities. The participant are asked to note down non-wear periods in a logbook - mainly to increase compliance - and to note the amount of bicycling and if the child was sick within the measurement period. Questions regarding TV-watching, playing with videogames and physical activity, will help identify activity-pattern.
  • Sleep [ Time Frame: Baseline (Cross-sectional) ]
    Sleep is measured using ActiGraph GT3X and GT3X+ with the monitor placed on the right hip for all students and on the non-dominant wrist for a sub-sample. Using a sleep diary, total sleep time and sleep quality will be derived from these actigraphy measurements. In addition, the abbreviated version of the Children's Sleep Habits Questionnaire (CSHQ) is used to identify sleep problems.
  • Cardio-respiratory fitness [ Time Frame: Baseline (Cross-sectional) ]
    Cardio-respiratory fitness is measured using the Andersen test, which is a 10-min intermittent running test to estimate maximal oxygen uptake (mL*min-1*kg-1).
  • Dietary intake [ Time Frame: Baseline (Cross-sectional) ]
    Dietary intake is measured as micro-and macronutrients as well as food groups (e.g. fish and fruit/vegetables) by means of a 7-day dietary survey, which is a web based recall record method developed especially for children. Families without internet access can use a paper version of a 7-day dietary survey. The meal time perception is measured as well.
  • Appetite-regulating hormones [ Time Frame: Baseline (cross-sectional) ]
    Leptin and ghrelin. If resources are available at the end of the study period, ghrelin will be separated in acylated and deacylated ghrelin, and both the effect of the intervention on total, acylated, deacylated and the ratio between acylated:deacylated ghrelin will be assessed. If the resources are too tight at the end of the study, only total ghrelin will be used.
  • Vitamin D status [ Time Frame: Baseline (Cross-sectional) ]
    Serum concentrations of 25-hydroxyvitamin D [25(OH)D] will be used as marker of vitamin D status, related to food intake and time of season.
  • Bone Health [ Time Frame: Baseline (Cross-sectional) ]
    Bone Health will be evaluated by DXA scanning (total body and spine Bone Mineral Content (BMC), Bone Mineral Density (BMD), and Bone Area (BA). Osteocalcin and serum Parathyreoideahormon (PTH) are also included as markers of bone health.
  • Iron status [ Time Frame: Baseline (Cross-sectional) ]
    Whole-blood hemoglobin and serum ferritin will be used as measures of iron status
  • Attention - other measures [ Time Frame: Baseline (Cross-sectional) ]

    The following five measures from the attention test D2 will be used:

    TN=Total Number of items processed E%=Percentage of errors

  • Wellness [ Time Frame: Baseline (Cross-sectional) ]
    Student wellness is assessed by means of the Danish WRS Wellness Rating Scale filled out by students. The scale contains five subscales and one combined scale (sum score) adding the five subscales. The subscales cover: Living environment, school, school mates, family, and self concept.
  • Learning [ Time Frame: Baseline (Cross-sectional) ]
    Student learning is assessed by means of the Danish LRS Learning Rating Scale filled out by students. The scale contains four subscales and one combined scale (sum score) adding the four subscales. The subscales cover: Academic learning, social situation in school, teaching style appropriateness, and school expectations.
  • Mathematics proficiency [ Time Frame: Baseline (Cross-sectional) ]
    Mathematics proficiency is assessed by means of the Danish MG test for 3rd And 4th grade. They each have one measure: Number of correct results within 45 minutes.
  • Reading proficiency [ Time Frame: Baseline (Cross-sectional) ]
  • Body weight, Body Mass Index (BMI) [ Time Frame: Baseline (Cross-sectional) ]

    Body weight (in kg), BMI z-score calculated on the basis of the current references from WHO and body weight status (underweight/normal weight/overweight and obese) based on the age and gender specific iso BMI´s defined by Cole et al.

    Cole et al. (2000) BMJ 320 (7244): 1240-1243. Cole et al. (2007) BMJ 335 (7612): 194-197.

  • Physical activity [ Time Frame: Baseline (Cross-sectional) ]
    Physical activity is measured using waist-worn ActiGraph GT3X and GT3X+. Outcome measures will be counts/min, time spent in sedentary, light, moderate and vigorous activities. The participant are asked to note down non-wear periods in a logbook - mainly to increase compliance - and to note the amount of bicycling and if the child was sick within the measurement period. Questions regarding TV-watching, playing with videogames and physical activity, will help identify activity-pattern.
  • Sleep [ Time Frame: Baseline (Cross-sectional) ]
    Sleep is measured using ActiGraph GT3X and GT3X+ with the monitor placed on the right hip for all students and on the non-dominant wrist for a sub-sample. Using a sleep diary, total sleep time and sleep quality will be derived from these actigraphy measurements. In addition, the abbreviated version of the Children's Sleep Habits Questionnaire (CSHQ) is used to identify sleep problems.
  • Cardio-respiratory fitness [ Time Frame: Baseline (Cross-sectional) ]
    Cardio-respiratory fitness is measured using the Andersen test, which is a 10-min intermittent running test to estimate maximal oxygen uptake (mL*min-1*kg-1).
  • Dietary intake [ Time Frame: Baseline (Cross-sectional) ]
    Dietary intake is measured as micro-and macronutrients as well as food groups (e.g. fish and fruit/vegetables) by means of a 7-day dietary survey, which is a web based recall record method developed especially for children. Families without internet access can use a paper version of a 7-day dietary survey. The meal time perception is measured as well.
  • Appetite-regulating hormones [ Time Frame: Baseline (cross-sectional) ]
    Leptin and ghrelin. If resources are available at the end of the study period, ghrelin will be separated in acylated and deacylated ghrelin, and both the effect of the intervention on total, acylated, deacylated and the ratio between acylated:deacylated ghrelin will be assessed. If the resources are too tight at the end of the study, only total ghrelin will be used.
  • Vitamin D status [ Time Frame: Baseline (Cross-sectional) ]
    Serum concentrations of 25-hydroxyvitamin D [25(OH)D] will be used as marker of vitamin D status, related to food intake and time of season.
  • Bone Health [ Time Frame: Baseline (Cross-sectional) ]
    Bone Health will be evaluated by DXA scanning (total body and spine Bone Mineral Content (BMC), Bone Mineral Density (BMD), and Bone Area (BA). Osteocalcin and serum Parathyreoideahormon (PTH) are also included as markers of bone health.
  • Iron status [ Time Frame: Baseline (Cross-sectional) ]
    Whole-blood hemoglobin and serum ferritin will be used as measures of iron status
  • Attention - other measures [ Time Frame: Baseline (Cross-sectional) ]

    The following five measures from the attention test D2 will be used:

    TN=Total Number of items processed E%=Percentage of errors

  • Wellness [ Time Frame: Baseline (Cross-sectional) ]
    Student wellness is assessed by means of the Danish WRS Wellness Rating Scale filled out by students. The scale contains five subscales and one combined scale (sum score) adding the five subscales. The subscales cover: Living environment, school, school mates, family, and self concept.
  • Learning [ Time Frame: Baseline (Cross-sectional) ]
    Student learning is assessed by means of the Danish LRS Learning Rating Scale filled out by students. The scale contains four subscales and one combined scale (sum score) adding the four subscales. The subscales cover: Academic learning, social situation in school, teaching style appropriateness, and school expectations.
  • Mathematics proficiency [ Time Frame: Baseline (Cross-sectional) ]
    Mathematics proficiency is assessed by means of the Danish MG test for 3rd And 4th grade. They each have one measure: Number of correct results within 45 minutes.
  • Reading proficiency [ Time Frame: Baseline (Cross-sectional) ]