Sumera Ehsan, Ayesha Ayub, Ayesha Sadiq
Medical students' knowledge about curriculum development and implementation in public and private medical institutes
Pakistan journal of medical sciences
implemented 2012 healthy hungerfree kids act 2010 hhfka increased nutritional requirements national school lunch program nslp reverse potential role nslp childhood obesity evaluate whether associations free reducedprice nslp body mass growth differed implementation hhfka cohort study used data 2 nationally representative cohorts us kindergarteners sampled 1998 1999 2010 2011 followed 6 years grade 5 early childhood longitudinal study kindergarten class 19981999 eclsk1999 20032004 kindergarten class 20102011 eclsk2011 20152016 total 5958 children selected analysis lowincome families eligible free reducedprice nslp household income 185 federal poverty level attended public schools missing data free reducedprice nslp participation body mass index bmi calculated weight kilograms divided height meters squared kindergarten grades 1 5 data analyzed january 1 september 7 2021 crosscohort comparison vs implementation hhfka free reducedprice nslp participation kindergarten grades 1 5 body mass index difference bmid obesity threshold difference bmi units age sexspecific obesity thresholds 95th percentile sensitive change high bmi multigroup models cohort included weights balance distribution 2 cohorts across wide range covariates wald test used assess whether associations differed cohorts final analysis 3388 children eclsk1999 1696 girls 501 mean sd age baseline 746 43 months 2570 children eclsk2011 1348 males 525 mean sd age baseline 736 42 months included best fitting model bmid change free reducedprice nslp participation across cohorts included fixed timevarying associations hhfka implementation grade 5 free reducedprice nslp participants higher bmid adjusted prior bmid trajectory nonparticipants 054 95 ci 027081 hhfka implementation association attenuated 007 95 ci 058 045 grade 5 associations different across cohorts 21 429 p 04 cohort study using crosscohort comparisons children lowincome families participated free reducedprice nslp higher likelihood progression high bmi longer observed hhfka implementation finding suggests hhfka may attenuated previous association nslp child obesity disparities