Dwyer Johanna T, Michell Paul, Cosentino Claire, Webber Larry, Seed Julienne M, Hoelscher Deanna, Snyder M Patricia, Stevens Mary, Nader Philip
Tufts University Schools of Medicine and Nutrition Science and Policy, and Frances Stern Nutrition Center, New England Medical Center, 750 Washington Street, Box 783, Boston, Massachusetts 02111, USA.
J Adolesc Health. 2003 Jun;32(6):428-35. doi: 10.1016/s1054-139x(03)00053-3.
To determine the long-term effects of a low fat intervention on sugar content in school lunches
We calculated contributions of total sugars, 6 specific sugars, and selected nutrients in National School Lunch Program meals served in 56 former intervention, 20 randomly selected control schools that had participated 3 years before in a low fat intervention, and 12 additional schools from neighboring school districts that had never been exposed to the intervention, whose goal was the lowering of total fat to under 30% of calories and saturated fat to under 10% calories. Analysis of variance adjusted for region was used to compare treatment groups. Pearson partial correlations controlling for the effects of region and treatment group were used to assess the strength of sugar and fat relationships.
Three years after the low fat intervention, former intervention, control and unexposed schools lunches were similar in mean total sugars (25% of calories), and "added" sugars (e.g. sucrose, glucose, galactose, and maltose) at 15% of calories; and differed only in their lactose content. As percent of calories from fat or saturated fat in lunches decreased, that from sugars increased. Lunches that met reduced saturated fat goals were significantly higher than those not meeting goals in percent of calories from sugars both in meals as offered (27.6 +/- 0.3% vs. 26.2 +/- 0.3 SE p =.004) and as served (26.5 +/- 0.4 vs. 23.9 +/- 0.4 p =.009). Lunches meeting reduced total fat goals were significantly higher only in percent of calories from sugars as served. Seventy-five percent of total sugar in lunches offered was from chocolate milk, fruit/fruit juices, and white milk. More "added" sugar came from high micronutrient foods, such as fruit, fruit juices, and chocolate milk than from desserts and entrees.
The existence of a fat-sugar "see-saw" makes it important to emphasize substitutions of fat and saturated fat with starches and fiber in school lunches.
确定低脂干预对学校午餐糖分含量的长期影响
我们计算了56所曾参与干预的学校、20所随机挑选的3年前参与过低脂干预的对照学校以及12所来自周边学区且从未接触过该干预措施（目标是将总脂肪含量降至卡路里的30%以下，饱和脂肪含量降至卡路里的10%以下）的学校所提供的全国学校午餐计划餐食中总糖、6种特定糖类和选定营养素的贡献。使用经区域调整的方差分析来比较各治疗组。控制区域和治疗组影响的Pearson偏相关用于评估糖与脂肪关系的强度。
低脂干预三年后，曾参与干预的学校、对照学校和未接触过干预的学校午餐的平均总糖含量（占卡路里的25%）以及“添加”糖（如蔗糖、葡萄糖、半乳糖和麦芽糖）含量（占卡路里的15%）相似；仅乳糖含量有所不同。随着午餐中脂肪或饱和脂肪的卡路里百分比下降，糖的卡路里百分比上升。达到降低饱和脂肪目标的午餐在提供的餐食（27.6 +/- 0.3%对26.2 +/- 0.3 SE，p =.004）和实际供应的餐食（26.5 +/- 0.4对23.9 +/- 0.4，p =.009）中糖的卡路里百分比显著高于未达到目标的午餐。达到降低总脂肪目标的午餐仅在实际供应的餐食中糖的卡路里百分比显著更高。提供的午餐中75%的总糖来自巧克力牛奶、水果/果汁和白牛奶。更多的“添加”糖来自高营养素食物，如水果、果汁和巧克力牛奶，而非甜点和主菜。
脂肪 - 糖“跷跷板”的存在使得在学校午餐中强调用淀粉和纤维替代脂肪和饱和脂肪很重要。
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