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Browsing AUT Affiliated Research by Author "Graham, D"

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    Increasing Activity and Improving Nutrition Through a Schools-based Programme: Project Energize. 1. Design, Programme, Randomisation and Evaluation Methodology
    (Cambridge University Press, 2008) Graham, D; Appleton, S; Rush, E; McLennan, S; Reed, P; Simmons, D
    Project Energize is a through-school nutrition and activity programme that is being evaluated in a 2-year, cluster-randomised, longitudinal study. The present paper describes the background of the programme and study, the programme development and delivery, the study methodology including randomisation, measurement and analysis tools and techniques, and the mix of the study population. The programme is being delivered to sixty-two primary schools with sixty-two control schools, each limb containing about 11,000 students. The children in the evaluation cohort are 5 or 10 years old at enrolment; the randomisation protocol has achieved post-consent enrolment of 3,000 evaluation participants, who are comparable by age, sex and school decile. End-point measures include body composition and associated physical characteristics, fitness, home and school environment and practice.
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    Project Energize: Whole-region Primary School Nutrition and Physical Activity Programme; Evaluation of Body Size and Fitness 5 Years After the Randomised Controlled Trial
    (Cambridge University Press, 2014) Rush, E; McLennan, S; Obolonkin, V; Vandal, AC; Hamlin, M; Simmons, D; Graham, D
    Project Energize, a region-wide whole-school nutrition and physical activity programme, commenced as a randomised controlled trial (RCT) in the period 2004-6 in 124 schools in Waikato, New Zealand. In 2007, sixty-two control schools were engaged in the programme, and by 2011, all but two of the 235 schools in the region were engaged. Energizers (trained nutrition and physical activity specialists) work with eight to twelve schools each to achieve the goals of the programme, which are based on healthier eating and enhanced physical activity. In 2011, indices of obesity and physical fitness of 2474 younger (7·58 (sd 0·57) years) and 2330 older (10·30 (sd 0·51) years) children attending 193 of the 235 primary schools were compared with historical measurements. After adjusting for age, sex, ethnicity, socio-economic status (SES) and school cluster effects, the combined prevalence of obesity and overweight among younger and older children in 2011 was lower by 31 and 15 %, respectively, than that among 'unEnergized' children in the 2004 to 2006 RCT. Similarly, BMI was lower by 3·0 % (95 % CI - 5·8, - 1·3) and 2·4 % (95 % CI - 4·3, - 0·5). Physical fitness (time taken to complete a 550 m run) was significantly higher in the Energized children (13·7 and 11·3 %, respectively) than in a group of similarly aged children from another region. These effects were observed for boys and girls, both indigenous Māori and non-Māori children, and across SES. The long-term regional commitment to the Energize programme in schools may potentially lead to a secular reduction in the prevalence of overweight and obesity and gains in physical fitness, which may reduce the risk of developing obesity and type 2 diabetes.
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    A School-based Obesity Control Programme: Project Energize. Two-year Outcomes
    (Cambridge University Press, 2012) Rush, E; Reed, P; McLennan, S; Coppinger, T; Simmons, D; Graham, D
    Through-school nutrition and physical activity interventions are designed to help reduce excess weight gain and risk of chronic disease. From 2004 to 2006, Project Energize was delivered in the Waikato Region of New Zealand as a longitudinal randomised controlled study of 124 schools (year 1-6), stratified by rurality and social deprivation, and randomly assigned to intervention or control. Children (686 boys and 662 girls) aged 5 (1926) and 10 (1426) years (692 interventions and 660 controls) had height, weight, body fat (by bioimpedance) and resting blood pressure (BP) measured at baseline and 2 years later. Each intervention school was assigned an 'Energizer'; a trained physical activity and nutrition change agent, who worked with the school to achieve goals based on healthier eating and quality physical activity. After adjustment for baseline measures, rurality and social deprivation, the intervention was associated with a reduced accumulation of body fat in younger children and a reduced rate of rise in systolic BP in older children. There was some evidence that the pattern of change within an age group varied with rurality, ethnicity and sex. We conclude that the introduction of an 'Energizer led' through-school programme may be associated with health benefits over 2 years, but the trajectory of this change needs to be measured over a longer period. Attention should also be paid to the differing response by ethnicity, sex, age group and the effect of rurality and social deprivation.
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    Vitamin D Status of Year 3 Children and Supplementation Through Schools With Fortified Milk
    (Cambridge University Press, 2009) Graham, D; Kira, G; Conaglen, J; McLennan, S; Rush, E
    Objective: To evaluate levels of vitamin D3 and HDL-cholesterol (HDL-C), and the ratio of HDL-C to LDL-cholesterol (LDL-C), in schoolchildren receiving vitamin-D-fortified, fat-depleted, high-Ca milk in schools. Design: Cross-sectional study of previously randomised schools receiving supplemental milk, compared with a matched control group. Setting: Low-decile Year 1-6 schools in the Waikato region of New Zealand. Subjects: Year 3 children from either milk schools or control schools, consenting to blood sampling. Results: For eighty-nine children receiving supplementary daily milk, vitamin D3 levels were significantly higher than in eighty-three control children matched for age, sex, body composition and ethnicity (mean (sd): 49.6 (15.8) v. 43.8 (14.7) nmol/l, P = 0.011), as were HDL-C levels (mean (sd): 1.47 (0.35) v. 1.35 (0.29) mmol/l, P = 0.024) and HDL-C:LDL-C (median: 0.79 v. 0.71, P = 0.026). LDL-C levels were similar in both groups (mean (sd): 2.07 (0.55) v. 2.16 (0.60) mmol/l, P = 0.31). Of control children, 32/83 (20.2 %) of the milk group (Pearson's chi2 = 7.00, P = 0.008). Mean 25-hydroxyvitamin D (vitamin D3) levels in the milk group were still below the lower end of the recommended normal range (60 nmol/l). Conclusions: Vitamin D3 levels are low in low-decile Year 3 children in midwinter. Levels are improved with vitamin-D-fortified milk but still below the recommended range. HDL-C and HDL-C:LDL-C levels are improved in the milk-supplemented group. This supports the supply of vitamin-D-fortified, fat-reduced milk to schools.
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