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Open Access Highly Accessed Research

Children's body mass index, participation in school meals, and observed energy intake at school meals

Suzanne Domel Baxter1*, James W Hardin2, Caroline H Guinn1, Julie A Royer1, Alyssa J Mackelprang1 and Christina M Devlin1

Author Affiliations

1 Institute for Families in Society, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, SC 29208 USA

2 Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208 USA

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International Journal of Behavioral Nutrition and Physical Activity 2010, 7:24  doi:10.1186/1479-5868-7-24

Published: 24 March 2010

Abstract

Background

Data from a dietary-reporting validation study with fourth-grade children were analyzed to investigate a possible relationship of body mass index (BMI) with daily participation in school meals and observed energy intake at school meals, and whether the relationships differed by breakfast location (classroom; cafeteria).

Methods

Data were collected in 17, 17, and 8 schools during three school years. For the three years, six, six, and seven of the schools had breakfast in the classroom; all other schools had breakfast in the cafeteria. Information about 180 days of school breakfast and school lunch participation during fourth grade for each of 1,571 children (90% Black; 53% girls) was available in electronic administrative records from the school district. Children were weighed and measured, and BMI was calculated. Each of a subset of 465 children (95% Black; 49% girls) was observed eating school breakfast and school lunch on the same day. Mixed-effects regression was conducted with BMI as the dependent variable and school as the random effect; independent variables were breakfast participation, lunch participation, combined participation (breakfast and lunch on the same day), average observed energy intake for breakfast, average observed energy intake for lunch, sex, age, breakfast location, and school year. Analyses were repeated for BMI category (underweight/healthy weight; overweight; obese; severely obese) using pooled ordered logistic regression models that excluded sex and age.

Results

Breakfast participation, lunch participation, and combined participation were not significantly associated with BMI or BMI category irrespective of whether the model included observed energy intake at school meals. Observed energy intake at school meals was significantly and positively associated with BMI and BMI category. For the total sample and subset, breakfast location was significantly associated with BMI; average BMI was larger for children with breakfast in the classroom than in the cafeteria. Significantly more kilocalories were observed eaten at breakfast in the classroom than in the cafeteria.

Conclusions

For fourth-grade children, results provide evidence of a positive relationship between BMI and observed energy intake at school meals, and between BMI and school breakfast in the classroom; however, BMI and participation in school meals were not significantly associated.