Using skin carotenoids to assess dietary changes in students after one academic year of participating in the shaping healthy choices program

Authors: NGUYEN, LORI - University Of California; SCHERR, RACHEL - University Of California; DHARMAR, MADAN - University Of California; ERMAKOV, IGOR - Consultant; GELLERMAN, WERNER - Consultant; Jahns, Lisa; KEEN, CARL - University Of California Agriculture And Natural Resources (UCANR); STEINBERG, FRANCENE - University Of California Agriculture And Natural Resources (UCANR); YOUNG, HEATHER - University Of California; ZIDENBERG-CHERR, SHERI - University Of California Agriculture And Natural Resources (UCANR)

Submitted to: Journal of Nutrition Education and Behavior
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/16/2016
Publication Date: 1/4/2017
Publication URL: https://handle.nal.usda.gov/10113/5575809
Citation: Nguyen, L.M., Scherr, R.E., Dharmar, M., Ermakov, I.V., Gellerman, W., Jahns, L.A., Keen, C.L., Steinberg, F.M., Young, H.M., Zidenberg-Cherr, S. 2017. Using skin carotenoids to assess dietary changes in students after one academic year of participating in the shaping healthy choices program. Journal of Nutrition Education and Behavior. 49(1):73-78.e1.

Interpretive Summary: School aged children do not consume enough vegetables and fruits. As children spend a large part of their day in school, the school setting is often a place where interventions to get children to increase intake of vegetables and fruits occur. However, it is difficult to know if the intervention works because it is difficult to measure changes in intake. Most studies use self-reported vegetables and fruits to assess change, but self-report has problems such as children forgetting how much they ate or saying what they think the researcher wants to hear. Carotenoids are substances found in brightly-colored vegetables and fruits and can be measured in the blood and in the skin. As it is invasive to take blood from children and expensive to analyze, skin carotenoid measurements are a noninvasive and quick way to assess vegetable and fruit intake. We conducted this study to see if 4th grade students participating in a school-based nutrition intervention changed their vegetable intake as measured by skin carotenoids. The intervention was called the Shaping Healthy Choices Program. It included garden-enhanced education, family and community partnerships, increased regionally procured produce in the lunchroom, and school-site wellness committees and lasted one academic-year (nine months). To assess change in vegetable and fruit consumption, researchers asked for self-reported intake and measured skin carotenoids before and after the intervention. After the intervention, dietary intake of carotenoids decreased by 19% and skin carotenoids decreased by 9%, suggesting that the children consumed fewer vegetables and fruits after the intervention than before. While the reported decrease in dietary carotenoid intake was unanticipated, the skin carotenoid measurements confirmed this. Skin carotenoid data can help evaluate changes in vegetable and fruit intake.

Technical Abstract: Objective: To determine whether 4th-grade students participating in the Shaping Healthy Choices Program (SHCP), a school-based nutrition intervention, change vegetable intake Design: quasi-experimental single group pre-test, post-test with a self-selected, convenience sample of students recruited at the school Participants: representative of the school population. 93/160 (58%) had dietary intake data, 82/102 (80%) had skin carotenoid data, and 30 had both dietary intake and skin carotenoid data pre-and post-intervention. Intervention(s): included garden-enhanced education, family and community partnerships, increased regionally procured produce in the lunchroom, and school-site wellness committees. Lasted one academic-year (nine months) Main Outcome Measure(s): Dietary intake of fruits, vegetables, and carotenoids, and skin carotenoids. Block Food Frequency Questionnaire measured dietary intake and resonance Raman spectroscopy (RRS) measured skin carotenoids. Analysis: ANOVA, paired t-tests, Pearson’s correlation, and linear regression analyses were used. Statistical significance at a=0.05. Results: Dietary intake of carotenoids decreased by 19% (1.47mg, n=093, P=0.05) and skin carotenoids decreased by 9% (2882 RRS intensity units, n=82, P<0.01). Change in reported intake correlated with change in skin carotenoids (r=0.43, n=30, P=0.02). Conclusions and Implications: While the reported decrease in carotenoid intake was unanticipated, the RRS measurements confirmed this. RRS data can help evaluate changes in fruit and vegetable intake.