School-Based Cardiovascular Health Promotion: The Child and Adolescent Trial for Cardiovascular Health (CATCH)

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multisite intervention research study that builds on significant progress made in school health education research in the 1980s. The study has three phases: Phase I deals with study design, intervention, and measurement development, Phase II involves the main trial in 96 schools in four states, and Phase III focuses on analysis. The intervention program targets third-fifth grade students and focuses on multiple cardiovascular health behaviors, including eating habits, physical activity, and cigarette smoking. Classroom curricula, school environmental change, and family involvement programs are developed for each grade level and behavioral focus. This paper describes Phase II of CATCH with a rationale for cardiovascular health promotion with youth. The process of change that appears to be necessary for school-based health promotion and that will be tested in CATCH are presented as a framework to guide these efforts.     

Nutrition, Exercise, and Healthy Aging

Advancing age is associated with a remarkable number of changes in body composition, including reduction in lean body mass and increase in body fat, which have been well documented. Decreased lean body mass occurs primarily as a result of losses in skeletal muscle mass. This age-related loss in muscle mass has been termed “sarcopenia”. Loss in muscle mass accounts for the age-associated decreases in basal metabolic rate, muscle strength, and activity levels, which, in turn are the cause of the decreased energy requirements of the elderly. In sedentary persons, the main determinant of energy expenditure is fat-free mass, which declines by about 15% between the third and eighth decade of life. It also appears that declining energy needs are not matched by an appropriate decline in energy intake, with the ultimate result being increased body fat content. Increased body fatness and increased abdominal obesity are thought to be directly linked to the greatly increased incidence of non-insulin-dependent diabetes mellitus among the elderly. In this review we will discuss the extent to which regularly performed exercise can affect nutrition needs and functional capacity in the elderly. We will also discuss a variety of concerns when prescribing exercise in the elderly, such as planning for a wide variability in functional status, medical status, and training intensity and duration. Finally, we will attempt to provide some basic guidelines for beginning an exercise program for older men and women and establishing community-based programs.     

Nutrition and Health for Older Persons in Rural America: A Managed Care Model

Health care services and resources for older persons living in rural areas may be highly variable, and integrated service-delivery models are often lacking. This article presents a managed-care model of nutrition risk screening and intervention for older persons in rural areas. Nutrition risk screening was implemented by the Geisinger Health Care System, Danville, Pa, to target all eligible enrollees in a regional Medicare risk program. A single remote clinic site participating in the managed health care system was chosen for further study of a linked screening and case-management effort for undernourished persons. Screening and intervention at the clinic site selected for this study were guided by centralized expertise and resources. Individualized evaluation and intervention plans were developed with the aid of a dietitian and implemented by the clinic case manager. Of the 417 subjects who completed screening at the remote site, 68 met the risk criteria for undernutrition and were selected for case management. Many of the targeted persons received interventions that included evaluations by a physician or physician extender (eg, physician assistant, nurse practitioner) at the clinic and consultations with nutrition, mental health, or social services professionals. Twenty-six of the subjects who took part in the intervention completed a follow-up screening 6 months later. Ten of those persons no longer exhibited risk criteria. This demonstrates the feasibility of a linked screening and case management program for nutrition risk in the managed-care setting. J Am Diet Assoc. 1997; 97: 885-888.     

Body Fat Percentage of Children Varies According to Their Diet Composition

Objective To ascertain the association between diet composition and body fat percentage in 9- and 10-year-old children. Also, to examine the influence of gender, total energy intake, fitness, physical activity, and parental body mass on the relationship between diet composition and adiposity.Design Diet composition was assessed using the National Cancer Institute food frequency questionnaire, and adiposity was measured using the average of results determined using two skinfold equations. Fitness levels and physical activity were ascertained using the 1-mile run/walk test and a self-report 15-item scale, respectively.Subjects A sample of 262 children (162 boys and 100 girls, mean age=9.8±0.5 years) participated.Statistical analysis Regression analysis was used to determine the extent to which diet composition contributed to adiposity without statistical control for any potentially confounding variables. Partial correlations were calculated to assess the relationship between macronutrient intake and adiposity after potential confounders (gender, total energy intake, physical fitness, and parental body mass) were controlled statistically.Results Energy intake was positively related to adiposity. Fat intake, calculated as a percentage of total energy, was also positively related to adiposity, before and after control for potential confounding variables. Percentage of energy derived from carbohydrate was inversely related to adiposity, before and after controlling for potential confounders.Applications These findings indicate that the macronutrient intake of children, particularly dietary fat and carbohydrate intake, may play a role in adiposity, independent of the influence of total energy intake, gender, physical fitness, and parental body mass index.