January 2014

The CHANGE Study: A Healthy-Lifestyles Intervention to Improve Rural Children’s Diet Quality

In the United States, children typically have inadequate intakes of fruits, vegetables, and whole grains, and have excessive intakes of added sugars and solid fats.

Interventions targeting low-income, rural areas have been limited, despite children in these areas having a disproportionately higher risk for overweight and obesity and less-healthy dietary habits compared with their peers in urban and suburban settings.

To address this lack of attention to a vulnerable population, the Creating Healthy, Active and Nurturing Growing-Up Environments (CHANGE) study was designed with the following primary objectives: to improve the diets, physical activity levels, and weight status of rural children.

The objective of this analysis was to examine changes in fruit, vegetable, legume, whole-grain, and low-fat dairy consumption among rural elementary students who were exposed to the CHANGE study intervention compared with students in control schools. Secondary aims were to examine changes in energy from saturated fats, added sugars, fiber, potato products, and glycemic index among CHANGE and control children.

Overall, students consumed significantly more vegetables and combined fruits and vegetables after exposure to the CHANGE study intervention compared with students in control schools and communities. For a typical child consuming a 2,000-calorie diet, this translates to more than an additional cup of vegetables per week, and an additional 3 cups of fruits and vegetables combined per week. There were no significant differences in their whole grain, legume, or dairy consumption, but there was a trend toward more fruit consumption. Although there were also no differences when examining potatoes/potato products, added sugars, fiber, or saturated fats, the analysis revealed a significant reduction in the GI of students in the CHANGE study schools compared with students in the control schools, which could have important implications for obesity prevention in this at-risk population.

The CHANGE study enhanced some aspects of rural students’ dietary intake. Implementing similar interventions in rural America can be promising to support vegetable consumption.

Cohen, J. F., Kraak, V. I., Choumenkovitch, S. F., Hyatt, R. R., & Economos, C.D. (2014). The CHANGE study: a healthy-lifestyles intervention to improve rural children’s diet quality. J Acad Nutr Diet.  114: 48-53.

Supplemental Article:

Gutschall, M., & Settle, J. (2013). Changes in food choices of rural preadolescent and adolescent children following a theory-based after-school nutrition intervention. Topics In Clinical Nutrition, 28(4), 356-363. doi:10.1097/01.TIN.0000437412.51317.1a