José A Menezes-Filho, Chrissie F Carvalho, Juliana L G Rodrigues, Cecília F S Araújo, Nathália R Dos Santos, Cássio S Lima, Matheus J Bandeira, Breno L de S Marques, Ana Laura S Anjos, Homegnon A F Bah, Neander Abreu, Alline Philibert, Donna Mergler
Environmental Co-Exposure to Lead and Manganese and Intellectual Deficit in School-Aged Children
International journal of environmental research and public health
school free fruit vegetable ffv policies used promote healthy dietary habits tackle obesity however understanding effects weight outcomes limited assess effect nationwide ffv policy childhood adolescent weight status explore heterogeneity sex socioeconomic position study used quasinatural experimental design 2007 2014 norwegian combined schools grades 110 age 6 16 years obligated provide ffvs elementary schools grades 17 used 4 nationwide studies n 11215 children norwegian growth cohort longitudinal crosssectional anthropometric data age 85 13 years capture variation ffv exposure outcomes body mass index standard deviation score bmisds overweight obesity owob waist circumference wc weight height ratio wthr age 85 years bmisds owob age 13 years analyses included longitudinal models pre postexposure trajectories estimate policy effect participation rate cohort 80 analyses 4 excluded due missing data estimates adjusted region population density parental education pooled models additionally adjusted preexposure bmisds little evidence benefit unintended consequence 125 years exposure ffv policy bmisds owob wc wthr either sex example boys exposed ffv policy 005 higher bmisds 95 ci 004 014 120fold higher odds owob 95 ci 086 166 03 cm bigger wc 95 ci 03 08 exposed girls 004 higher bmisds 95 ci 004 013 103 fold higher odds owob 95 ci 075 139 0cm difference wc 95 ci 06 06 evidence heterogeneity policy effect estimates 85 years across cohorts socioeconomic position however results inconsistent comparisons analysis age 13 years 4 years policy exposure also showed little evidence effect bmisds owob main limitations study potential residual confounding exposure misclassification despite efforts minimize impact conclusions study observed little evidence norwegian nationwide ffv policy notable beneficial effect unintended consequence weight status among norwegian children adolescents