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An intervention study showed that promoting water consumption in schoolchildren prevented overweight, but a mechanism linking water consumption to overweight was not substantiated. We investigated whether increased water consumption replaced sugar-containing beverages and whether changes in water or sugar-containing beverages influenced body weight outcomes. In a secondary analysis of the intervention study in Germany, we analysed combined longitudinal data from the intervention and control groups. Body weight and height were measured and beverage consumption was self-reported by a 24-h recall questionnaire at the beginning and end of the school year 2006/2007. The effect of a change in water consumption on change in sugar-containing beverage (soft drinks and juices) consumption, change in BMI (kg/m2) and prevalence of overweight and obesity at follow-up was analysed using regression analyses. Of 3220 enroled children, 1987 children (mean age 8·3 (sd 0·7) years) from thirty-two schools were analysed. Increased water consumption by 1 glass/d was associated with a reduced consumption of sugar-containing beverages by 0·12 glasses/d (95 % CI −0·16, −0·08) but was not associated with changes in BMI (P=0·63). Increased consumption of sugar-containing beverages by 1 glass/d was associated with an increased BMI by 0·02 (95 % CI 0·00, 0·03) kg/m2 and increased prevalence of obesity (OR 1·22; 95 % CI 1·04, 1·44) but not with overweight (P=0·83). In conclusion, an increase in water consumption can replace sugar-containing beverages. As sugar-containing beverages were associated with weight gain, this replacement might explain the prevention of obesity through the promotion of water consumption.

Im Bereich der Ubergewichtspravention bei Kindern fehlt es immer noch an nachweislich wirksamen Masnahmen. Bislang beinhalteten Programme oft nur Masnahmen der Verhaltenspravention, obwohl die Kombination mit der Verhaltnispravention, die am adipogenen Umfeld ansetzt, bedeutsam fur nachhaltige Erfolge scheint. Ein modifizierbarer Faktor bei der Gewichtsentwicklung ist das Trinkverhalten von Kindern. Hier anzusetzen gilt als vielversprechend zur Ubergewichtspravention. Diese Praventionsansatze wurden in der „trinkfit“-Studie kombiniert und auf ihre Wirksamkeit sowie Umsetzbarkeit in einer kontrollierten Interventionsstudie uberpruft. Die Intervention zur Ubergewichtspravention zielte allein auf die Erhohung des Wasserverzehrs bei Grundschulkindern und beinhaltete eine Unterrichtsreihe zum Thema „Wasser“ (Verhaltenspravention) sowie die Bereitstellung von Wasserspendern und Trinkflaschen (Verhaltnispravention). Nach einem Schuljahr war das Risiko fur Ubergewicht in der Interventionsgruppe reduziert. Dieser praventive Effekt war allerdings bei Kindern mit Migrationshintergrund nicht nachweisbar. Die Prozessevaluation deutet darauf hin, dass die kombinierten Masnahmen zur Erhohung des Wasserverzehrs zudem auch nachhaltig und umsetzbar im Setting Schule waren.

OBJECTIVE. The study tested whether a combined environmental and educational intervention solely promoting water consumption was effective in preventing overweight among children in elementary school.METHODS. The participants in this randomized, controlled cluster trial were second- and third-graders from 32 elementary schools in socially deprived areas of 2 German cities. Water fountains were installed and teachers presented 4 prepared classroom lessons in the intervention group schools (N = 17) to promote water consumption. Control group schools (N = 15) did not receive any intervention. The prevalence of overweight (defined according to the International Obesity Task Force criteria), BMI SD scores, and beverage consumption (in glasses per day; 1 glass was defined as 200 mL) self-reported in 24-hour recall questionnaires, were determined before (baseline) and after the intervention. In addition, the water flow of the fountains was measured during the intervention period of 1 school year (August 2006 to June 2007).RESULTS. Data on 2950 children (intervention group: N = 1641; control group: N = 1309; age, mean ± SD: 8.3 ± 0.7 years) were analyzed. After the intervention, the risk of overweight was reduced by 31% in the intervention group, compared with the control group, with adjustment for baseline prevalence of overweight and clustering according to school. Changes in BMI SD scores did not differ between the intervention group and the control group. Water consumption after the intervention was 1.1 glasses per day greater in the intervention group. No intervention effect on juice and soft drink consumption was found. Daily water flow of the fountains indicated lasting use during the entire intervention period, but to varying extent.CONCLUSION. Our environmental and educational, school-based intervention proved to be effective in the prevention of overweight among children in elementary school, even in a population from socially deprived areas.

OBJECTIVE: The study analyzed the effect of a combined environmental and educational intervention solely promoting water consumption on the incidence of overweight among school children. METHODS: 2,950 second and third graders of 32 elementary schools in socially deprived neighborhoods of two German cities participated in a randomized controlled intervention trial (August 2006-June 2007). In intervention schools (N = 17), water fountains were installed, each child received a water bottle, and teachers performed classroom lessons to promote water consumption. Control schools (N = 15) did not receive any intervention. Body heights and weights were measured at baseline and follow-up to assess the incidence and remission of overweight and obesity during follow-up. The water flow of the fountains was measured regularly during follow-up. Children's beverage consumption was self-reported in 24-hour recall questionnaires before and after intervention. METHODS: After the intervention, the incidence of overweight was significantly lower in the intervention group (3.8%) than in the control group (6.0%, p = 0.018). Remission of overweight and obesity did not differ between the groups. Measured water flow of the fountains indicated a sustained use. CONCLUSION: A simple dietary intervention with the sole focus on the promotion of drinking water effectively reduced the incidence of overweight among school children.

Die Anzahl an Ganztagsschulen in Deutschland nimmt stetig zu: 2004 gab es davon 6.800 mit etwa einer Million Schulern. 2007 waren es schon 10.000 Schulen mehr (Clausen/Kersting 2007b). In 2006 hat die Kultusministerkonferenz festgelegt, dass an Tagen mit Ganztagsschulbetrieb ein Mittagessen anzubieten ist. Allerdings gab es bis dahin keine verbindlichen Regelungen zur Qualitat der Schulverpflegung. Die Deutsche Gesellschaft fur Ernahrung (DGE) hat 2007 die ersten bundesweiten „Qualitatsstandards fur die Schulverpflegung“ veroffentlicht und 2009 uberarbeitet. Diese enthalten neben padagogisch-didaktischen Aspekten auch Checklisten fur Speiseplane und Nahrwertkriterien, die jedoch unverbindlich sind (siehe auch Pelz in diesem Band).

Background The epidemic increase in childhood overweight demands effective and also feasible prevention programmes. A school-based environmental and educational intervention focusing on the promotion of water consumption was found to be effective for overweight prevention in children. Process evaluation and long-term surveillance are necessary to evaluate the feasibility and sustainability of the intervention programme in a school setting. Methods Process evaluation was conducted during the intervention period (one school year) and a 19-month follow-up after the intervention trial on the prevention of overweight in 17 elementary schools. Data were collected through measuring the water flow of water fountains installed in schools, and questionnaires and interviews were administered to teachers and headmasters of intervention schools. Main outcomes were implementation of the intervention components, behavioural modification of the children concerning water consumption, and teacher and headmaster attitudes towards the intervention. Results Eleven out of 17 intervention schools maintained the water fountains until 19-month follow-up. The mean water flow of the fountains decreased initially, but remained stable after the during the follow-up period. The implementation rate of the educational units by teachers varied between the units from 13% to 84%. Teachers graded the overall concept of the intervention as good, continuously during the intervention and follow-up period. The majority of teachers organized the water supply of the fountains on the class level during the intervention period but not during the follow-up. Conclusions The long-term process evaluation showed that the combined educational and environmental intervention has potential for sustained modifications in the beverage consumption habits of children. It also identified barriers and promoting factors of a sustainable and feasible implementation of the preventive programme in a school setting.

Die Moglichkeiten, sich gesund zu ernahren, sollten allen Familien in gleicher Weise offen stehen, unabhangig von ihrem soziookonomischen Hintergrund. Die Optimierte Mischkost zeigt, dass selbst eine preisbewusst konzipierte, gesunde Ernahrung mit dem derzeitigen Betrag, der im Arbeitslosengeld II fur Ernahrung bei Kindern und Jugendlichen veranschlagt wurde, bei gangigem Einkaufsverhalten ab dem Schulalter nicht zu realisieren ist. Vor diesem Hintergrund konnen die Tafeln mit ihrem Lebensmittelangebot Familien mit geringem Einkommen eine Erganzung bieten. Kinder-Tafeln oder die Belieferung von Schulen durch die Tafeln ermoglichen auch Kindern aus sozial schwachen Familien gesunde Mahlzeiten. Wenn offentliche Kampagnen fur eine bessere Ernahrung alle Bevolkerungsgruppen in gleicher Weise erreichen sollen, muss die derzeitige soziale Chancenungleichheit von Kindern und Jugendlichen beim Zugang zu einer gesunden Ernahrung mehr als bisher berucksichtigt werden.

OBJECTIVE: To apply for the first time FAO/WHO standards for Food Based Dietary Guidelines (FBDG) to develop a total diet concept named Optimized Mixed Diet (OMD) for children and adolescents in a European country. METHODS: Exact 7-day menus were composed for sample age groups of children (4-6 years) and adolescents (13-14 years), taking into account the German meal patterns, common non-fortified foods, and sensory preferences of children (practical criteria). Food amounts and food selection within the menus were optimized so far as to achieve a total of reference intakes for 22 nutrients (scientific criteria). Simple food based messages were deduced. RESULTS: Compared to the existing high-fat, low plant food diet reported from the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study), the OMD is lower in fat and saturated fatty acids and contains ample amounts of plant foods. Reference nutrient densities for age groups between 1 and 18 years were achieved or exceeded, except folate. Foods from the optimized menus were summarized into 11 food groups based on nutritional and practical considerations. Proportions of food groups by weight are independent of age and can be used to recalculate food amounts for various age groups or energy requirements, respectively. For simplification, "recommended" foods were distinguished from "tolerated" foods by their nutrient densities; based on food amounts, 3 simple rules for food consumption were deduced, i.e. beverages and plant foods: ample; animal foods: moderate; high-fat, high-sugar foods: sparingly. CONCLUSIONS: Exact menus and food amounts are a prerequisite to ascertain nutrient adequacy of FBDG. The OMD demonstrates that a single diet concept with a core of quantified food groups can be adequate for age groups between 1 and 18 years within a country, such as Germany.