The aim of this community-based, randomized- controlled prospective nutrition intervention study was to assess the impact of serving high-fiber snacks twice a day to a sample of school-age children on their dietary fiber intake and health-related quality of life (HRQOL) scores. Participants (n = 81) were children aged 7-11 years. Children were randomized to receive two high-fiber snacks per day for eight weeks (intervention) or to continue eating their regular snacks (control). At baseline and post-intervention, usual dietary intake data were collected via repeated 24-hour dietary recalls and HRQOL was as sessed using the PedsQL? Pediatric Quality of Life Inventory. Statistical analysis to assess significant changes in dietary intake as well as self-reported quality of life was conducted using two-sided student’s t-tests; significance level was set at p < 0.05. Dietary fiber intake increased significantly by 2.41 grams/day in the intervention group. The mean increase in the physical scale score of the PedsQL from baseline to post-intervention was significantly greater for the intervention as compared to control group. This study indicates that providing high-fiber snacks to elementary-school children can effectively increase dietary fiber consumption and may lead to an improved physical quality of life. Further research is needed regarding the impact of nutrition on health-related quality of life.
KeywordsQuality of LifeChildrenFiber IntakeSchool Snacks
[1] Varni, J.W., Limbers, C.A. and Burwinkle, T.M. (2007) Parent proxy-report of their children’s health-related quality of life: An analysis of 13,878 parents’ reliability and validity across age subgroups using the PedsQL 4.0 generic core scales. Health and Quality of Life Outcomes, 5, 2. http://dx.doi.org/10.1186/1477-7525-5-2
Hullmann, S.E., Ryan, J.L., Ramsey, R.R., Chaney, J.M. and Mullins L.L. (2011) Measures of general pediatric quality of life: Child Health Questionnaire (CHQ), DISABKIDS Chronic Generic Measure (DCGM), KINDL-R, Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales, and Quality of My Life Questionnaire (QoML). Arthritis Care & Research (Hoboken), 63, S420-S430. http://dx.doi.org/10.1002/acr.20637
Hamzaid, H., Talib, R.A., Azizi, N.H., Maamor, N., Reilly, J.J. and Wafa, S.W. (2011) Quality of life of obese children in Malaysia. International Journal of Pediatric Obesity, 6, 450-454. http://dx.doi.org/10.3109/17477166.2011.590206
Yackobovitch-Gavan, M., Nagelberg, N., Demol, S., Phillip, M. and Shalitin, S. (2008) Influence of weight-loss diets with different macronutrient compositions on health- related quality of life in obese youth. Appetite, 51, 697-703. http://dx.doi.org/10.1016/j.appet.2008.06.010
Yackobovitch-Gavan, M., Nagelberg, N., Phillip, M., Ashkenazi-Hoffnung, L., Hershkovitz, E. and Shalitin, S. (2009) The influence of diet and/or exercise and parental compliance on health-related quality of life in obese children. Nutrition Research, 29, 397-404. http://dx.doi.org/10.1016/j.nutres.2009.05.007
Boyle, S.E., Jones, G.L. and Walters, S.J. (2010) Physical activity, quality of life, weight status and diet in adolescents. Quality of Life Research, 19, 943-954. http://dx.doi.org/10.1007/s11136-010-9659-8
Schwimmer, J.B., Burwinkle, T.M. and Varni, J.W. (2003) Health-related quality of life of severely obese children and adolescents. Journal of the American Medical Association, 289, 1813-1819. http://dx.doi.org/10.1001/jama.289.14.1813
Tyler, C., Johnston, C.A., Fullerton, G. and Foreyt, J.P. (2007) Reduced quality of life in very over-weight Mexican American adolescents. Journal of Adolescent Health, 40, 366-368. http://dx.doi.org/10.1016/j.jadohealth.2006.10.015
Costarelli, V., Koretsi, E. and Georgitsogianni, E. (2013) Health-related quality of life of Greek adolescents: The role of the Mediterranean diet. Quality of Life Research, 22, 951-956. http://dx.doi.org/10.1007/s11136-012-0219-2
Carson, T.L., Hidalgo, B., Ard, J.D. and Affuso, O. (2013) Dietary interventions and quality of life: A systematic review of the literature. Journal of Nutrition Education and Behavior, 41, 56-60. http://dx.doi.org/10.1016/j.jneb.2013.09.005
Youssef, N.N., Langseder, A.L., Verga, B.J., Mones, R.L. and Rosh, J.R. (2005) Chronic childhood constipation is associated with impaired quality of life: A case-controlled study. Journal of Pediatric Gastroenterology and Nutrition, 41, 56-60. http://dx.doi.org/10.1097/01.mpg.0000167500.34236.6a
Stewart, M.L. and Schroeder, N.M. (2013) Dietary treatments for childhood constipation: Efficacy of dietary fiber and whole grains. Nutrition Reviews, 71, 98-109. http://dx.doi.org/10.1111/nure.12010
Costabile, A., Klinder, A., Fava, F., Napolitano, A., Fogliano, V., Leonard, C., Gibson, G.R. and Tuohy, K.M. (2008) Whole-grain wheat breakfast cereal has a prebiotic effect on the human gut microbiota: A double-blind, placebo-controlled, crossover study. British Journal of Nutrition, 99, 110-120. http://dx.doi.org/10.1017/S0007114507793923
Lee, S., Harnack, L., Jacobs Jr., D.R., Steffen, L.M., Luepker, R.V. and Arnett, D.K. (2007) Trends in diet quality for coronary heart disease prevention between 1980-1982 and 2000-2002: The minnesota heart survey. Journal of the American Dietetic Association, 107, 213-222. http://dx.doi.org/10.1016/j.jada.2006.11.003
Oza-Frank, R., Cheng, Y.J., Narayan, K.M. and Gregg, E.W. (2009) Trends in nutrient intake among adults with diabetes in the United States: 1988-2004. Journal of the American Dietetic Association, 109, 1173-1178. http://dx.doi.org/10.1016/j.jada.2009.04.007
Cavadini, C., Siega-Riz, A.M. and Popkin, B.M. (2000) US adolescent food intake trends from 1965 to 1996. Western Journal of Medicine, 173, 378-383. http://dx.doi.org/10.1136/ewjm.173.6.378
Saldanha, L.G. (1995) Fiber in the diet of US children: Results of national surveys. Pediatrics, 96, 994-997.
King, D.E., Mainous III, A.G. and Lambourne, C.A. (2012) Trends in dietary fiber intake in the United States, 1999-2008. Journal of the Academy of Nutrition and Dietetics, 112, 642-648. http://dx.doi.org/10.1016/j.jand.2012.01.019
Moshfegh, A., Goldman, J. and Cleveland, L. (2005). What we eat in America, NHANES 2001-2002: Usual nutrient intakes from food compared to dietary reference intakes. http://www.ars.usda.gov/Services/docs.htm?docid=22659
Trumbo, P., Schlicker, S., Yates, A.A. and Poos, M. (2002) Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. Journal of the American Dietetic Association, 102, 1621-1630. http://dx.doi.org/10.1016/S0002-8223(02)90346-9
Varni, J.W., Seid, M. and Kurtin, P.S. (2001) PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Medical Care, 39, 800-812. http://dx.doi.org/10.1097/00005650-200108000-00006
Varni, J.W., Burwinkle, T.M. and Seid, M. (2006) The PedsQL 4.0 as a school population health measure: Feasibility, reliability, and validity. Quality of Life Research, 15, 203-215. http://dx.doi.org/10.1007/s11136-005-1388-z
United States Department of Agriculture, Department of Health and Human Services (2000) Nutrition and your health: dietary guidelines for Americans: Aim for fitness, build a healthy base, choose sensibly for good health. http://www.health.gov/dietaryguidelines/dga2000/DIETGD.PDF
United States Department of Agriculture (2011) ChooseMyPlate. www.choosemyplate.gov
Keast, D.R., Fulgoni III, V.L., Nicklas, T.A. and O’Neil, C.E. (2013) Food sources of energy and nutrients among children in the United States: National Health and Nutrition Examination Survey 2003-2006. Nutrients, 5, 283-301. http://dx.doi.org/10.3390/nu5010283
Zhou, S.S., Li, D., Zhou, Y.M., Sun, W.P. and Liu, Q.G. (2010) B-vitamin consumption and the prevalence of diabetes and obesity among the US adults: Population based ecological study. BMC Public Health, 10, 746. http://dx.doi.org/10.1186/1471-2458-10-746
Kranz, S., Mitchell, D.C., Siega-Riz, A.M. and Smiciklas-Wright, H. (2005) Dietary fiber intake by American preschoolers is associated with more nutrient-dense diets. Journal of the American Dietetic Association, 105, 221-225. http://dx.doi.org/10.1016/j.jada.2004.11.005
Kranz, S., Smiciklas-Wright, H. and Francis, L.A. (2006) Diet quality, added sugar, and dietary fiber intakes in American preschoolers. Pediatric Dentistry, 28, 164-171.