Effects of a Free School Breakfast Programme on Children‟s Nutrient Intake. Results from a Stepped-Wedge, Cluster Randomised Controlled Trial.

Abstract

Background There is an increased interest in the role of breakfast programmes in improving children‟s food and nutrient intake. However, in New Zealand breakfast programmes are a relatively new development and there are no government funded programmes. The impacts of the breakfast programmes are only just beginning to be researched. The Breakfast in Schools Intervention Trial (BISkIT) was a 10 month stepped-wedge, cluster randomised, controlled trial. BISkIT evaluated the effect of a free school breakfast programme on children‟s school attendance, academic achievement and short-term hunger. The piece of work in this thesis is a sub-study of BISkIT. Aim The aim of the sub-study was to research the impact of a free breakfast in schools programme on energy and nutrient intake of primary aged children at low decile schools in New Zealand. The objective was to assess change from baseline in daily macro nutrients including protein, saturated fat, and sugar, and micro nutrients including iron, calcium, zinc, sodium and fiber. The main outcome of interest was change in absolute daily energy intake. Method Fourteen low decile New Zealand schools were recruited to participate in BISkIT. Schools were randomised to cross over from control to intervention at different time points. The substudy was undertaken in six of the 14 schools. The intervention was the establishment of a breakfast programme provided by New Zealand Red Cross or Fonterra Cooperative Group Limited and Sanitarium Health Food Company. A four day estimated food diary was used to collect dietary data. An intention to treat analysis was used. Results Forty students participated in the sub-study. The average age was 11.3years ± 1.1 years, 60 percent were female, 30 percent Māori, 30 percent Pacific, the rest New Zealand European or other ethnicities. The median was reported: energy (pre 7628kJ, post 7319kJ; p=0.688), saturated fat (pre 31g, post 28g; p=0.766), total protein (pre 64g, post 65g; p=0.673), sugar (pre 86g post 78g; p=0.082), calcium (pre 567mg, post 570mg; p=0.544), iron (pre 9mg, post 10mg; p=0.572), zinc (pre 9mg, post 8mg; p=0.572), sodium (pre 2290mg, post 2106mg; p=0.910), and fibre (pre and post 16g; p=0.254). There were no statistically significant effects of the breakfast programme on children‟s nutrient intake. Conclusion This sub-study suggests that a free school breakfast programme did not have a significant effect on children‟s daily nutrient intakes. However a number of limitations such as low numbers of participants, dietary data collection method, pragmatic intervention, may have influenced the ability of the sub-study to find significant findings.