ABSTRACTA COMPARISON OF RURAL VERSUS URBAN CHILDREN’S CARDIOVASCULAR DISEASE RISK FACTOR STATUS AND NUTRITION BEHAVIORS: BASELINE AND INTERVENTION EFFECTS ByTyler Brian BeckerIMPORTANCE: The prevalence of obesity and other cardiovascular disease (CVD) risk factors has increased among children within the United States (US) over the past 40 years. Overall, national data indicates rural (RU) vs urban (UR) populations have a greater prevalence of obesity and levels of other CVD risk factors, due in part to lower socioeconomic status, less access to healthcare, decreased access to nutrient dense foods (eg, fruits, vegetables), recreational areas, and exercise facilities. Most cross-sectional research comparing RU and UR obesity rates and nutrition behaviors have used large, national data sets, which may not be representative of smaller regions within the US. Few studies have compared RU and UR’s children’s nutrition behaviors and CVD risk factors, with most studies addressing obesity prevalence. Fewer studies have compared the effects of school-based nutrition and physical activity (PA) interventions on RU and UR children’s nutrition behavior and CVD risk status. OBJECTIVE: In a sample of Michigan (MI) children, determine if: 1) mean levels and prevalence of obesity and other CVD risk factors are greater in RU vs UR children; 2a) mean levels of nutrition behaviors and nutrient intakes are more favorable in UR vs RU children, b) fewer % of RU vs UR participants meeting nutrition recommendations, c) relationship of nutrition behaviors and nutrient intakes with CVD risk factors; 3) improvements to nutrition behaviors and CVD risk factors after a school-based nutrition and PA intervention are equivocal between RU and UR participants. DESIGN, SETTING, AND PARTICIPANTS: Objectives 1 and 2: cross-sectional; objective 3: quasi-experimental (RU vs UR comparison). Participants included 995 Michigan (MI) fifth graders (mean age, 10.6 years) (RU: n=307; UR: n=688) from 2008-2013 who participated in (S)Partners for Heart Health, a school- and web-based nutrition and PA intervention (8 lessons and web modules, and mentors). RU and UR classification was determined by the Rural-Urban Commuting Area Codes. MAIN OUTCOMES AND MEASURES: Baseline and post measures were assessed 4-5 months apart. Nutrition behaviors were quantified with a Food Frequency Questionnaire and included food groups, selected macro- and micronutrients, and dietary indices related to cardiovascular health. CVD risk factors included: anthropometry, blood cholesterol, and resting blood pressure (BP). Mixed-model ANOVAs evaluated between-group differences adjusted for confounders with school as the random effect. (P < .05). RESULTS: Significant findings included Objective 1: The prevalence of elevated diastolic BP was higher in RU vs UR children. Objective 2: UR vs RU children had higher mean intakes of fruit, dietary fiber per 1000 kilocalories, and vitamin C; no difference for RU and UR children meeting recommendations; observed some anticipated relationships for nutrition variables with CVD risk factors, but also a number of unanticipated results. Objective 3: Pre to post intervention intakes of dairy and vitamin D increased more in RU vs UR children, and vitamin E increased more in UR vs RU children. Risk factors: %BF and prevalence of elevated diastolic BP decreased more in RU vs UR children. CONCLUSIONS AND RELEVANCE: MI RU children are at greater risk for CVD risk factors and consume less nutrient-dense diets vs UR children. Overall, the prevalence of CVD risk factors was higher in both groups vs national average. (S)Partners improved selected nutrition behaviors and CVD risk factors in both RU and UR children, suggesting this intervention or similar are viable school-based options.
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