Luepker R V, Perry C L, McKinlay S M, Nader P R, Parcel G S, Stone E J, Webber L S, Elder J P, Feldman H A, Johnson C C
Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis 55455, USA.
JAMA. 1996 Mar 13;275(10):768-76. doi: 10.1001/jama.1996.03530340032026.
To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease.
A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994).
A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas.
Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education.
At the school level, two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychological factors, recall measures of eating and physical activity patterns, and other physiologic measures.
In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%)(P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed.
The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years.
评估以小学环境、课堂课程和家庭项目为重点的健康行为干预措施对心血管疾病一级预防的效果。
在四个地点进行的随机对照现场试验，有56所干预小学和40所对照小学。使用随机分组前的测量指标（1991年秋季）和随访测量指标（1994年春季）来评估结果。
来自加利福尼亚州、路易斯安那州、明尼苏达州和得克萨斯州公立学校的5106名最初为三年级的学生，他们具有不同的种族背景。
28所学校参与了从三年级到五年级的干预，包括学校餐饮服务调整、强化体育教育（PE）和课堂健康课程。另外28所学校除了这些内容外，还接受了家庭教育。
在学校层面，两个主要终点是餐饮服务午餐供应中的脂肪含量变化以及体育教育项目中中度至剧烈身体活动的量。在个体学生层面，血清胆固醇变化是主要终点，并用于该研究的效能计算。个体层面的次要终点包括心理因素、饮食和身体活动模式的回忆测量指标以及其他生理测量指标。
在干预学校的午餐中，脂肪能量摄入百分比下降幅度（从38.7%降至31.9%）显著大于对照午餐（从38.9%降至36.2%）（P<0.001）。与对照学校相比，在儿童和青少年心血管健康试验（CATCH）干预期间，干预学校体育课的身体活动强度显著增加（P<0.02）。与对照学校的学生（从32.6%降至32.2%）相比，干预学校学生自我报告的每日脂肪能量摄入显著降低（从32.7%降至30.3%）（P<0.001）。干预组学生报告的每日剧烈活动时间显著多于对照组（58.6分钟对46.5分钟；P<0.003）。治疗组之间的血压、身体尺寸和胆固醇测量指标没有显著差异。未观察到该干预对生长或发育有有害影响的证据。
CATCH干预能够在三个学年期间改变学校午餐的脂肪含量，增加体育课中的中度至剧烈身体活动，并改善儿童的饮食和身体活动行为。
