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C
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[
1
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.
Ob
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Asi
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I
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b
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Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
2
4
3
-
1
2
5
5
1244
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.
Pre
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ls
[
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.
Als
o
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itiv
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ased
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r
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[
5
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.
I
t
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n
u
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itio
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liter
ac
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in
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v
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tio
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m
ig
h
t
h
elp
to
p
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itiv
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lu
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life
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ty
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d
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d
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ag
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t
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n
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v
ir
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m
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tal
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a
n
s
f
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m
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[
6
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.
E
q
u
ally
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d
if
f
e
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tem
atic
r
ev
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ca
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ter
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[
7
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Ho
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f
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u
ca
tio
n
p
r
o
g
r
a
m
s
o
n
n
u
tr
itio
n
al
s
tatu
s
,
ea
tin
g
p
atte
r
n
s
an
d
to
r
e
d
u
ce
t
h
e
weig
h
t o
f
ad
o
lescen
t g
ir
ls
[
8
]
.
T
h
e
h
ea
lth
o
u
tco
m
es
ass
o
ciate
d
with
weig
h
t
g
ai
n
a
n
d
o
b
esi
ty
ap
p
ea
r
to
in
cr
ea
s
e
th
e
r
is
k
o
f
ch
r
o
n
ic
d
is
ea
s
es
in
clu
d
in
g
d
iab
etes,
ca
r
d
io
v
ascu
lar
d
is
ea
s
es,
p
s
y
ch
o
s
o
cial
ab
n
o
r
m
alities
an
d
ev
en
th
e
r
is
k
o
f
ca
n
ce
r
[
9
]
.
I
t
h
as
b
ee
n
o
b
s
er
v
ed
th
at
n
u
tr
itio
n
ed
u
ca
tio
n
f
o
c
u
s
in
g
o
n
ca
r
b
o
h
y
d
r
ate
co
u
n
tin
g
h
elp
ed
to
r
ed
u
ce
g
ly
ce
m
ic
in
d
e
x
an
d
im
p
r
o
v
e
d
Hb
A1
C
in
d
iab
etic
p
atien
ts
[
1
0
]
.
Similar
ly
,
a
n
u
tr
itio
n
ed
u
ca
tio
n
p
r
o
g
r
am
o
f
1
2
wee
k
s
d
ec
r
ea
s
es
th
e
r
is
k
o
f
ca
r
d
io
v
ascu
lar
d
is
ea
s
es
in
Af
r
ican
Am
er
ican
s
[
1
1
]
.
Fo
llo
win
g
th
at,
a
6
-
y
ea
r
ed
u
ca
tio
n
al
in
ter
v
e
n
tio
n
p
r
o
g
r
am
was
co
m
p
leted
in
C
r
ete
to
ev
alu
ate
th
e
ch
an
g
e
i
n
ch
r
o
n
i
c
d
is
ea
s
e
p
atter
n
s
.
T
h
e
r
esu
lts
o
b
s
er
v
ed
a
s
ig
n
if
ican
t
im
p
r
o
v
e
m
en
t
in
b
io
ch
em
ical
p
ar
am
eter
s
,
to
tal
ch
o
lest
er
o
l
lev
els
an
d
an
th
r
o
p
o
m
etr
ic
in
d
icato
r
s
at
t
h
e
en
d
o
f
t
h
is
h
ea
lth
p
r
o
m
o
tio
n
p
r
o
g
r
am
[
1
2
]
.
Nev
e
r
th
eless
,
a
lim
ited
n
u
m
b
er
o
f
s
tu
d
ies f
o
cu
s
ed
o
n
t
h
e
im
p
ac
t
o
f
awa
r
en
ess
p
r
o
g
r
am
s
to
im
p
r
o
v
e
t
h
e
an
t
h
r
o
p
o
m
etr
ic
m
ea
s
u
r
es in
clu
d
in
g
b
o
d
y
m
ass
in
d
ex
(
B
MI
)
,
h
e
ig
h
t,
wei
g
h
t,
b
o
d
y
f
at,
an
d
th
in
n
ess
in
y
o
u
n
g
g
ir
ls
[
7
]
.
C
o
n
s
id
er
in
g
th
at,
o
u
r
s
co
p
in
g
r
ev
iew
s
u
m
m
ar
izes th
e
av
aila
b
le
liter
atu
r
e
e
v
alu
atin
g
th
e
ef
f
ec
tiv
en
ess
o
f
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
ed
u
ca
tio
n
in
ter
v
en
tio
n
s
o
n
an
t
h
r
o
p
o
m
etr
ic
m
ea
s
u
r
es
an
d
n
u
tr
itio
n
al
s
tat
u
s
o
f
ad
o
lescen
t
g
ir
ls
.
T
h
is
s
co
p
in
g
r
ev
iew
aim
ed
to
ev
alu
ate
th
e
ef
f
ec
ts
o
f
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
ed
u
ca
tio
n
in
ter
v
en
tio
n
s
o
n
B
MI
,
h
eig
h
t,
weig
h
t,
waist
cir
cu
m
f
er
e
n
ce
(
W
C
)
,
p
er
ce
n
tag
e
o
f
b
o
d
y
f
at
a
n
d
o
t
h
er
an
th
r
o
p
o
m
etr
ic
v
ar
ia
b
le
r
elate
d
to
n
u
tr
itio
n
al
s
t
atu
s
.
T
h
is
is
th
e
f
ir
s
t
s
co
p
in
g
r
ev
iew
th
at
w
ill
h
elp
to
m
ea
s
u
r
e
th
e
ef
f
icac
y
o
f
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
ed
u
ca
tio
n
f
o
cu
s
in
g
o
n
ad
o
lescen
t g
ir
ls
.
T
h
e
cu
r
r
e
n
t r
ev
iew
h
as p
o
ten
tial
to
p
r
o
v
i
d
e
g
u
i
d
elin
es
f
o
r
f
u
tu
r
e
p
o
licies
at
lo
ca
l
an
d
g
lo
b
al
lev
els
r
elate
d
to
th
e
p
u
b
lic
h
ea
l
th
in
ter
v
en
tio
n
s
an
d
s
ch
o
o
l
en
v
ir
o
n
m
e
n
t
to
im
p
r
o
v
e
th
e
n
u
tr
itio
n
al
s
tatu
s
o
f
ad
o
lescen
t
g
ir
ls
.
Fu
r
th
er
,
th
e
s
tu
d
y
f
in
d
in
g
s
will
h
elp
to
p
lan
f
u
tu
r
e
s
tu
d
ies,
b
r
in
g
in
g
to
g
eth
er
d
i
f
f
er
en
t
h
ea
lth
p
r
o
m
o
tio
n
s
tr
ateg
ies o
n
s
ch
o
o
l e
d
u
ca
tio
n
al
p
r
o
g
r
am
s
.
Ad
d
itio
n
ally
,
it
will
p
r
o
v
id
e
f
u
tu
r
is
tic
g
u
id
elin
es
to
m
o
d
if
y
th
e
ex
is
tin
g
cu
r
r
ic
u
lu
m
p
lan
s
an
d
h
ea
lth
attitu
d
e
s
at
in
d
iv
id
u
al,
c
o
m
m
u
n
ity
an
d
g
lo
b
al
lev
el
to
ac
h
iev
e
u
tm
o
s
t d
eter
m
in
ed
o
u
tp
u
t
f
r
o
m
th
ese
p
r
o
g
r
a
m
s
.
2.
M
E
T
H
O
D
T
h
is
s
co
p
in
g
r
ev
iew
ev
al
u
ated
th
e
ef
f
ec
ti
v
en
ess
o
f
s
ch
o
o
l
-
b
a
s
ed
n
u
tr
itio
n
ed
u
ca
tio
n
in
ter
v
e
n
tio
n
s
o
n
an
th
r
o
p
o
m
etr
ic
m
ea
s
u
r
es
an
d
n
u
tr
itio
n
al
s
tatu
s
o
f
ad
o
lescen
t
g
ir
ls
.
I
n
th
is
r
eg
ar
d
,
a
s
y
s
te
m
atic
ap
p
r
o
ac
h
was
ad
o
p
ted
an
d
two
s
cien
tific
r
eliab
le
d
atab
ases
,
i.e
.
,
Sco
p
u
s
an
d
Pu
b
Me
d
wer
e
s
elec
ted
to
r
etr
iev
e
th
e
ex
is
tin
g
liter
atu
r
e.
A
s
ea
r
ch
ter
m
o
f
“n
u
tr
itio
n
”
OR
“
n
u
tr
itio
n
ed
u
ca
tio
n
”
OR
“h
ea
lth
ed
u
ca
tio
n
”
OR
“n
u
tr
itio
n
co
u
n
s
elin
g
”
OR
“n
u
tr
itio
n
a
war
en
ess
”
OR
“n
u
tr
itio
n
teac
h
in
g
”
AND
“a
n
th
r
o
p
o
m
etr
ic”
OR
“n
u
tr
itio
n
ass
es
s
m
en
t”
OR
“
B
o
d
y
Ma
s
s
in
d
ex
”
OR
“BMI
”
OR
“b
o
d
y
weig
h
ts
”
OR
“n
u
tr
itio
n
al
s
tat
u
s
”
OR
“b
o
d
y
f
at”
OR
“sk
in
f
o
ld
s
th
ick
n
ess
”
OR
“m
id
d
le
u
p
p
er
ar
m
cir
cu
m
f
er
en
ce
”
OR
“M
UAC” O
R
“stu
n
tin
g
”
OR
“wa
s
tin
g
”
OR
“m
aln
u
tr
itio
n
”
AND
“sch
o
o
ls
”
AND
“a
d
o
lescen
t g
ir
ls
”
was a
p
p
lied
f
o
r
i
n
itial d
at
a
ex
t
r
ac
tio
n
.
2
.
1
.
I
nclus
io
n/
ex
clus
io
n c
rit
er
ia
T
h
e
au
th
o
r
s
s
et
an
elig
ib
ilit
y
cr
iter
io
n
to
ex
tr
ac
t
p
r
ec
is
e,
r
eliab
le,
an
d
ac
cu
r
ate
in
f
o
r
m
atio
n
m
atch
in
g
th
e
s
tu
d
y
o
b
jectiv
es.
Stu
d
ies
wer
e
elig
ib
le
if
th
ey
m
et
th
e
f
o
llo
win
g
cr
iter
ia:
i)
s
ch
o
o
l
b
a
s
ed
in
ter
v
en
tio
n
;
ii)
p
ar
ticip
an
ts
wer
e
a
g
ed
b
etwe
en
1
0
to
1
8
y
ea
r
s
with
o
u
t
co
n
s
id
er
in
g
th
e
c
o
u
n
tr
y
,
eth
n
ic
g
r
o
u
p
,
s
o
cio
ec
o
n
o
m
ic
s
tatu
s
;
iii)
we
p
r
im
ar
ily
f
o
cu
s
ed
o
n
n
u
tr
itio
n
al
s
tatu
s
o
f
th
e
ad
o
lescen
ts
g
ir
ls
b
y
u
s
in
g
an
th
r
o
p
o
m
et
r
ic
m
ea
s
u
r
em
en
ts
th
er
ef
o
r
e,
th
e
s
tu
d
y
r
ep
o
r
ted
at
least
o
n
e
r
ela
ted
asp
ec
t
s
u
c
h
a
s
,
B
M
I
,
c
h
a
n
g
e
i
n
b
o
d
y
w
e
i
g
h
t
,
h
e
i
g
h
t
,
t
h
i
n
n
es
s
,
b
o
d
y
f
a
t
,
s
k
i
n
f
o
l
d
s
t
h
i
c
k
n
e
s
s
,
m
i
d
d
l
e
u
p
p
e
r
a
r
m
c
i
r
c
u
m
f
e
r
e
n
c
e
(
MU
AC
)
a
n
d
W
C
;
i
v
)
s
c
h
o
o
l
in
ter
v
en
tio
n
s
wer
e
b
ased
o
n
n
u
tr
itio
n
ed
u
ca
tio
n
p
r
o
g
r
am
s
o
r
in
ter
v
en
tio
n
s
,
d
ietar
y
m
o
d
if
ic
atio
n
,
h
ea
lth
y
d
iet,
n
u
tr
itio
n
al
awa
r
en
ess
p
r
o
g
r
am
s
,
s
ess
io
n
s
,
wo
r
k
s
h
o
p
a
n
d
s
em
in
ar
s
.
Sin
ce
o
u
r
f
o
c
u
s
was
to
e
v
alu
a
te
th
e
ef
f
ec
ts
o
f
n
u
tr
itio
n
ed
u
c
atio
n
o
n
n
u
tr
itio
n
al
s
tatu
s
o
f
a
d
o
lescen
t
g
ir
ls
,
s
tu
d
ies
wh
ich
co
m
b
in
ed
m
u
ltip
le
in
ter
v
en
tio
n
s
s
u
ch
a
s
n
u
tr
itio
n
al
ed
u
ca
tio
n
an
d
s
u
p
p
lem
en
tat
io
n
an
d
s
h
o
win
g
th
eir
ef
f
ec
ts
as
a
s
in
g
le
v
ar
iab
le
wer
e
ex
clu
d
ed
.
Ho
wev
er
,
if
th
is
s
u
p
p
lem
en
tatio
n
p
r
o
g
r
a
m
s
tu
d
ied
th
e
n
u
tr
itio
n
e
d
u
ca
tio
n
in
ter
v
e
n
tio
n
as
an
in
d
ep
e
n
d
en
t
v
ar
iab
le
w
as
in
clu
d
ed
t
o
s
h
o
w
th
e
ef
f
ec
tiv
en
ess
o
f
n
u
tr
itio
n
ed
u
ca
tio
n
p
r
o
g
r
am
s
.
Ad
o
le
s
ce
n
t
g
ir
ls
with
an
y
k
in
d
o
f
d
is
ab
ilit
y
o
r
v
ar
iab
les
s
u
ch
as
ea
tin
g
d
is
o
r
d
er
s
,
d
y
s
lip
id
em
ia,
m
en
tal
o
r
p
h
y
s
ical
d
is
ab
ilit
ies,
d
iab
etes,
o
r
an
em
ia
wer
e
n
o
t
in
cl
u
d
ed
[
1
0
]
.
Fu
r
th
er
m
o
r
e,
th
e
s
tu
d
ies
s
h
o
win
g
th
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
E
ffective
n
ess
o
f sch
o
o
l
-
b
a
s
ed
n
u
tr
itio
n
ed
u
ca
tio
n
o
n
o
b
esit
y
a
n
d
n
u
tr
itio
n
a
l sta
tu
s
…
(
S
eh
a
r
I
q
b
a
l
)
1245
p
s
y
ch
o
s
o
cial
m
ea
s
u
r
es
in
ter
m
s
o
f
im
p
r
o
v
in
g
n
u
tr
i
tio
n
al
k
n
o
wled
g
e,
s
elf
-
ef
f
icac
y
,
b
eh
a
v
io
r
al
ch
an
g
e
,
d
ietar
y
d
iv
er
s
ity
s
co
r
es
with
o
u
t
an
th
r
o
p
o
m
etr
ic
an
al
y
s
is
wer
e
ex
clu
d
ed
f
o
r
th
is
s
co
p
in
g
r
e
v
iew
[
1
3
]
.
T
h
e
s
tu
d
y
was
b
ased
o
n
s
ch
o
o
l
b
ased
n
u
tr
i
tio
n
al
in
ter
v
en
tio
n
wh
ile
ex
c
lu
d
in
g
r
e
p
r
o
d
u
ctiv
e
h
ea
lth
,
n
o
n
-
c
o
m
m
u
n
icab
le
d
is
ea
s
es,
m
en
s
tr
u
al
cy
cle
awa
r
en
ess
,
o
n
ly
p
ar
en
ts
’
ed
u
ca
tio
n
in
ter
v
en
tio
n
s
,
in
ter
v
en
tio
n
s
o
u
ts
id
e
th
e
s
ch
o
o
l,
f
o
o
d
f
o
r
tific
atio
n
,
s
u
p
p
ly
in
g
s
ch
o
o
l
lu
n
ch
an
d
b
r
ea
k
f
ast,
n
u
tr
itio
n
ed
u
ca
tio
n
f
o
r
p
r
e
v
en
tio
n
o
r
in
ter
v
e
n
tio
n
o
f
an
y
v
ir
al
o
r
ch
r
o
n
ic
d
is
ea
s
e.
2
.
2
.
Da
t
a
e
x
t
ra
ct
i
o
n
T
wo
in
d
ep
e
n
d
en
t
r
e
v
iewe
r
s
s
ca
n
n
ed
th
e
liter
atu
r
e
th
r
o
u
g
h
en
ter
in
g
th
e
s
elec
ted
s
ea
r
ch
ter
m
an
d
ap
p
ly
in
g
in
clu
s
io
n
/ex
clu
s
io
n
cr
iter
ia.
T
h
e
liter
atu
r
e
s
ea
r
ch
was
co
n
d
u
cted
o
n
Dec
em
b
e
r
15
th
,
2
0
2
3
with
2
0
y
ea
r
s
tem
p
o
r
al
r
estricti
o
n
(
2
0
0
3
-
2
0
2
3
)
to
r
etr
iev
e
m
o
r
e
r
ec
en
t,
co
m
p
r
eh
en
s
iv
e,
in
n
o
v
ativ
e
a
p
p
r
o
ac
h
es
an
d
d
ata
to
im
p
r
o
v
e
n
u
tr
itio
n
al
s
tatu
s
o
f
ad
o
lescen
t
g
i
r
ls
.
T
h
e
g
u
id
eli
n
es
f
r
o
m
p
r
ef
e
r
r
ed
r
ep
o
r
tin
g
it
em
s
f
o
r
s
y
s
tem
atic
r
ev
iews
an
d
m
eta
-
an
aly
s
es
(
PR
I
SMA)
wer
e
en
s
u
r
ed
d
u
r
in
g
th
e
en
tire
p
r
o
ce
s
s
[
1
4
]
.
W
e
en
th
r
alled
o
n
ly
E
n
g
lis
h
lan
g
u
ag
e
ar
ticles
o
r
s
tu
d
ies
d
u
r
in
g
o
u
r
liter
atu
r
e
s
ea
r
ch
ca
ter
in
g
th
e
m
ass
iv
e
r
ea
d
er
’
s
r
a
n
g
e
an
d
in
te
r
est.
An
y
ty
p
e
o
f
g
r
ey
liter
atu
r
e
was
ex
clu
d
ed
w
h
er
ea
s
all
r
esear
ch
s
t
u
d
ies
p
u
b
lis
h
ed
in
a
p
ee
r
r
ev
i
ew
r
e
liab
le
jo
u
r
n
al
wer
e
in
clu
d
ed
i
n
th
is
r
ev
iew.
3.
RE
SU
L
T
S
T
h
e
in
itial
s
ea
r
ch
o
n
Pu
b
Me
d
r
etr
iev
ed
2
0
0
ar
ticles,
wh
ile
Sco
p
u
s
r
esu
lted
in
2
0
3
s
tu
d
y
r
ec
o
r
d
s
.
I
n
itially
,
a
to
tal
o
f
1
1
0
a
r
ticles
wer
e
s
elec
ted
(
Pu
b
Me
d
=
3
8
;
Sco
p
u
s
=
7
2
)
af
ter
s
cr
ee
n
in
g
th
e
s
tu
d
y
ti
tles
an
d
s
elec
ted
f
o
r
ab
s
tr
ac
t
s
cr
ee
n
in
g
.
Fu
r
th
er
,
5
6
ab
s
tr
ac
ts
wer
e
s
elec
ted
f
o
r
th
e
n
ex
t
s
tep
af
te
r
r
em
o
v
in
g
th
e
d
u
p
licate
an
d
e
x
clu
d
in
g
th
e
ir
r
elev
a
n
t
s
tu
d
y
o
b
jectiv
es.
C
o
n
s
id
er
in
g
t
h
e
n
e
x
t
s
tag
e
o
f
ass
ess
m
en
t,
t
h
e
s
tu
d
ies
(
n
=
2
9
)
n
o
t
m
ee
tin
g
th
e
d
ef
in
e
d
in
clu
s
io
n
/ex
clu
s
io
n
cr
iter
ia
wer
e
ex
c
lu
d
ed
.
A
to
tal
o
f
2
7
ar
ticles
wer
e
s
elec
ted
f
o
r
f
u
ll
tex
t
p
u
r
s
u
al
an
d
f
in
ally
1
1
ar
ticles
wer
e
th
en
in
clu
d
ed
f
u
lf
illi
n
g
th
e
s
tu
d
y
aim
s
an
d
o
b
j
ec
tiv
es
as
s
h
o
wn
in
F
i
g
u
r
e
1
.
A
l
l
r
el
e
v
a
n
t
i
n
f
o
r
m
a
t
io
n
,
s
u
c
h
a
s
s
t
u
d
y
y
e
a
r
,
c
o
u
n
t
r
y
,
s
t
u
d
y
t
y
p
e
,
o
b
j
e
c
t
i
v
e
,
p
a
r
ti
c
i
p
a
n
t
s
c
h
a
r
a
ct
e
r
is
t
i
cs
,
i
n
t
e
r
v
e
n
t
i
o
n
d
e
ta
i
ls
,
s
t
u
d
y
d
u
r
a
t
i
o
n
,
s
t
u
d
i
e
d
v
a
r
i
a
b
l
e
s
,
r
e
s
u
l
ts
,
a
n
d
c
o
n
c
l
u
s
i
o
n
w
e
r
e
s
u
m
m
a
r
i
z
e
d
i
n
T
a
b
l
e
1
(
s
e
e
A
p
p
e
n
d
i
x
)
t
h
r
o
u
g
h
e
x
t
r
a
c
ti
o
n
.
A
n
y
d
i
s
c
r
e
p
a
n
c
i
es
we
r
e
r
es
o
l
v
e
d
b
y
t
h
e
c
o
n
s
e
n
s
u
s
o
f
t
h
e
r
e
v
i
e
w
e
r
s
.
Fig
u
r
e
1
.
Flo
w
ch
a
r
t o
f
s
cr
ee
n
in
g
p
r
o
ce
s
s
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
2
4
3
-
1
2
5
5
1246
-
E
f
f
ec
tiv
en
ess
o
f
s
ch
o
o
l
-
b
ase
d
n
u
tr
itio
n
ed
u
ca
tio
n
in
ter
v
e
n
t
io
n
s
o
n
an
t
h
r
o
p
o
m
etr
ic
m
ea
s
u
r
es
A
to
tal
o
f
1
1
s
tu
d
ies
wer
e
in
clu
d
ed
to
s
u
m
m
ar
ize
th
e
ef
f
e
cts
o
f
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
ed
u
ca
tio
n
in
ter
v
en
tio
n
s
o
n
an
th
r
o
p
o
m
etr
ic
m
ea
s
u
r
es
an
d
n
u
tr
itio
n
al
s
ta
tu
s
o
f
ad
o
lescen
t
g
ir
ls
.
A
to
tal
o
f
5
s
tu
d
ies
f
o
cu
s
ed
o
n
o
b
esit
y
p
r
ev
e
n
tio
n
am
o
n
g
ad
o
lescen
t
g
ir
ls
th
r
o
u
g
h
im
p
lem
en
tin
g
n
u
tr
itio
n
al
awa
r
en
ess
p
r
o
g
r
am
s
.
A
s
tu
d
y
fro
m
I
r
an
en
r
o
lled
1
7
2
ad
o
les
ce
n
t
g
ir
ls
an
d
d
eliv
e
r
ed
n
u
tr
iti
o
n
ed
u
ca
tio
n
f
o
r
7
m
o
n
t
h
s
to
f
in
d
o
u
t
th
e
ch
an
g
es
in
B
MI
,
W
C
,
an
d
d
ietar
y
in
ta
k
e.
T
h
e
s
tu
d
y
f
in
d
in
g
s
s
ee
n
s
i
g
n
if
ican
t
ef
f
ec
ts
o
f
n
u
tr
itio
n
e
d
u
ca
tio
n
i
n
r
e
d
u
cin
g
B
MI
an
d
W
C
b
ef
o
r
e
i
n
ter
v
en
t
io
n
(
B
MI
=
2
9
.
2
±
3
.
9
;
W
C
=
8
9
.
6
±
2
.
9
)
to
af
ter
in
ter
v
e
n
tio
n
(
B
MI
=
2
8
.
5
±
4
.
3
;
WC
=
8
6
.
5
±
9
.
8
)
[
1
5
]
.
An
o
th
e
r
s
tu
d
y
f
r
o
m
I
r
an
ev
alu
ated
th
e
ef
f
ec
tiv
en
ess
o
f
n
u
tr
itio
n
al
ed
u
ca
tio
n
b
ased
o
n
h
ea
lth
b
elief
m
o
d
el
o
n
o
v
er
wei
g
h
t
an
d
at
-
r
is
k
-
of
-
o
v
er
weig
h
t
ad
o
lescen
t
g
ir
ls
an
d
f
o
u
n
d
a
d
e
cr
ea
s
e
in
B
MI
ev
en
af
ter
2
an
d
3
m
o
n
th
s
o
f
in
ter
v
en
tio
n
[
1
6
]
.
Pre
v
io
u
s
ly
,
in
2
0
1
3
,
th
e
ef
f
ec
t
o
f
2
4
-
m
o
n
th
s
ch
o
o
l
-
b
ased
o
b
esit
y
p
r
ev
en
tio
n
p
r
o
g
r
am
r
ep
o
r
te
d
a
ch
an
g
e
in
p
er
ce
n
tag
e
o
f
b
o
d
y
f
at
am
o
n
g
a
d
o
lescen
t
g
ir
l
s
af
ter
in
ter
v
en
tio
n
[
B
o
d
y
f
at
=
-
1
.
9
6
(
-
3
.
0
2
,
-
0
.
8
9
)
]
[
1
7
]
.
On
th
e
s
am
e
lin
es,
Sar
v
estan
i
an
d
co
lleag
u
es
ass
ess
ed
th
e
ef
f
ec
t
o
f
d
ietar
y
b
eh
av
io
r
m
o
d
if
icatio
n
o
n
an
t
h
r
o
p
o
m
etr
ic
in
d
ices
an
d
ea
tin
g
b
eh
av
i
o
r
in
o
b
ese
ad
o
lesc
en
t
g
ir
ls
an
d
f
o
u
n
d
p
o
s
itiv
e
s
ig
n
if
ican
t
ef
f
ec
ts
o
f
b
eh
av
io
r
al
m
o
d
if
icatio
n
p
r
o
g
r
am
o
n
B
MI
(
b
e
f
o
r
e
in
ter
v
en
ti
o
n
=
2
9
.
0
7
)
r
ed
u
ce
d
to
(
af
ter
in
ter
v
en
tio
n
s
=
2
8
.
4
8
)
[
1
8
]
.
A
s
tu
d
y
f
r
o
m
USA
ev
alu
ated
th
e
s
ch
o
o
l
-
b
ased
in
ter
v
en
tio
n
f
o
r
o
b
esit
y
p
r
ev
en
tio
n
an
d
f
o
u
n
d
a
d
ec
r
ea
s
e
in
B
MI
am
o
n
g
g
ir
ls
af
ter
in
t
er
v
en
tio
n
(
2
7
.
6
to
2
6
.
6
)
as
co
m
p
a
r
ed
to
th
e
co
n
tr
o
l
g
r
o
u
p
(
2
5
.
9
to
2
6
.
6
)
[
1
9
]
.
Ad
d
in
g
th
at,
2
s
tu
d
ies
r
ep
o
r
te
d
th
at
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
i
n
ter
v
en
tio
n
s
m
ig
h
t
h
elp
to
im
p
r
o
v
e
th
e
n
u
tr
itio
n
al
s
tatu
s
o
f
u
n
d
e
r
n
o
u
r
is
h
ed
g
ir
ls
.
Su
c
h
as
th
e
ef
f
ec
ts
o
f
a
m
u
ltico
m
p
o
n
e
n
t
s
ch
o
o
l
-
b
ased
in
ter
v
en
tio
n
p
r
o
g
r
a
m
o
n
an
t
h
r
o
p
o
m
etr
ic
o
u
tco
m
es
wer
e
in
v
esti
g
ated
b
y
Gr
y
d
elan
d
an
d
co
llea
g
u
e
s
in
No
r
way
.
T
h
is
in
ter
v
en
tio
n
i
n
clu
d
ed
m
u
ltip
le
in
ter
v
en
tio
n
ef
f
o
r
ts
to
p
r
o
m
o
t
e
a
h
ea
lth
y
d
iet
a
n
d
d
eli
v
er
ed
th
e
s
ess
io
n
s
ab
o
u
t
awa
r
en
ess
o
f
h
ea
lth
y
f
o
o
d
c
h
o
ices.
T
h
e
r
esu
lts
o
f
th
e
s
tu
d
y
s
h
o
wed
th
at
m
u
ltico
m
p
o
n
en
t
s
ch
o
o
l
-
b
ased
in
ter
v
en
tio
n
p
r
o
g
r
am
s
h
elp
ed
to
im
p
r
o
v
e
n
u
tr
itio
n
al
s
tatu
s
with
an
in
cr
ea
s
e
in
B
MI
f
r
o
m
(
1
8
.
0
to
1
9
.
0
)
a
n
d
W
C
in
cr
ea
s
ed
f
r
o
m
(
6
2
.
2
to
6
5
.
7
)
af
ter
2
0
-
m
o
n
th
n
u
tr
itio
n
ed
u
ca
tio
n
p
r
o
g
r
am
[
2
0
]
.
A
n
o
th
er
e
x
p
er
im
e
n
tal
s
tu
d
y
im
p
lem
en
te
d
a
6
-
m
o
n
th
n
u
tr
itio
n
e
d
u
ca
tio
n
in
ter
v
e
n
tio
n
b
ased
o
n
th
e
h
ea
lth
b
elief
m
o
d
el
in
E
th
io
p
ia
t
o
im
p
r
o
v
e
p
u
ls
e
co
n
s
u
m
p
tio
n
a
n
d
weig
h
t
s
tatu
s
o
f
1
3
2
ad
o
le
s
ce
n
t
g
ir
ls
an
d
f
o
u
n
d
th
at
n
u
tr
itio
n
awa
r
en
ess
an
d
co
u
n
s
elin
g
im
p
r
o
v
e
d
th
e
B
MI
an
d
h
eig
h
t o
f
t
h
e
g
ir
ls
af
ter
in
t
er
v
en
tio
n
[
2
1
]
.
Ho
wev
er
,
4
s
tu
d
ies r
ep
o
r
ted
with
non
-
s
ig
n
if
ica
n
t
o
r
s
lig
h
t
p
o
s
itiv
e
ef
f
ec
ts
o
f
n
u
tr
itio
n
e
d
u
ca
tio
n
p
r
o
g
r
am
s
o
n
n
u
tr
itio
n
al
s
tatu
s
am
o
n
g
ad
o
lescen
t
g
ir
ls
.
R
ec
en
tly
,
Patim
ah
an
d
c
o
lleag
u
es
d
eter
m
in
e
d
th
e
ef
f
i
ca
cy
o
f
n
u
t
r
itio
n
awa
r
e
n
ess
f
o
cu
s
in
g
o
n
MU
AC
,
B
MI
an
d
Heig
h
t
-
f
o
r
-
Ag
e
in
d
ex
(
HAZ
)
.
T
h
e
s
tu
d
y
f
o
u
n
d
th
at
n
u
tr
itio
n
in
ter
v
en
tio
n
d
o
es
n
o
t
im
p
r
o
v
e
th
e
MU
AC
,
B
MI
an
d
HAZ
o
f
th
e
g
ir
ls
as
c
o
m
p
ar
e
d
t
o
th
e
co
n
t
r
o
l
g
r
o
u
p
[
2
2
]
.
An
o
th
er
r
an
d
o
m
ized
co
n
tr
o
l
tr
ial
co
n
d
u
cte
d
in
E
th
io
p
ia
in
tr
o
d
u
ce
d
th
e
p
u
ls
es
-
b
ased
n
u
tr
itio
n
ed
u
ca
tio
n
in
s
ch
o
o
ls
to
r
ed
u
c
e
th
e
p
r
o
p
o
r
tio
n
o
f
th
in
n
ess
am
o
n
g
a
d
o
lescen
t
g
ir
l
s
an
d
d
id
n
o
t
o
b
s
er
v
e
an
y
ch
a
n
g
es
in
th
e
r
ed
u
ctio
n
o
f
th
in
n
ess
(
R
R
;9
5
%C
I
,
1
.
3
2
;
0
.
6
0
-
2
.
9
2
)
[
2
3
]
.
L
ik
ewise,
D
u
n
k
er
an
d
C
lau
d
in
o
[
2
4
]
aim
ed
to
in
v
esti
g
ate
th
e
ef
f
ec
ts
o
f
Ne
w
Mo
v
es
p
r
o
g
r
am
(
NM
P)
th
at
co
n
s
is
t
o
f
s
p
o
r
ts
,
n
u
tr
itio
n
al
s
u
p
p
o
r
t,
ed
u
ca
tio
n
al
s
ess
io
n
s
,
m
o
tiv
atio
n
al
in
t
er
v
iews,
co
llectiv
e
lu
n
ch
,
p
ar
e
n
tal
in
f
o
r
m
atio
n
m
ater
ials
an
d
co
u
n
s
elin
g
.
Ho
we
v
er
,
th
e
r
e
s
u
lts
h
av
e
n
o
t
co
n
f
ir
m
ed
an
y
s
ig
n
if
ican
t
ch
an
g
e
in
th
e
weig
h
t
o
f
a
d
o
le
s
ce
n
t
g
ir
ls
[
2
4
]
.
T
h
e
s
tu
d
y
f
r
o
m
L
u
b
an
s
a
n
d
co
-
wo
r
k
er
s
in
t
r
o
d
u
ce
d
a
1
2
-
m
o
n
t
h
m
u
ltico
m
p
o
n
en
t
s
ch
o
o
l
-
b
ased
o
b
esit
y
p
r
ev
e
n
tio
n
p
r
o
g
r
a
m
(
NE
AT
)
am
o
n
g
a
d
o
lescen
t
g
ir
l
s
an
d
co
n
clu
d
e
d
th
at
NE
AT
p
r
o
g
r
am
d
id
n
o
t
h
elp
to
ch
an
g
e
B
MI
in
ex
p
er
im
en
tal
g
r
o
u
p
(
B
MI
=
2
3
.
3
0
±
4
.
7
1
)
as
co
m
p
ar
ed
to
co
n
tr
o
l
g
r
o
u
p
(
B
MI
=
2
3
.
3
7
±
4
.
6
8
)
[
2
5
]
.
4.
DIS
CU
SS
I
O
N
Ou
r
r
esu
lts
f
o
u
n
d
th
at
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
ed
u
ca
tio
n
p
r
o
g
r
am
s
m
ig
h
t
h
elp
to
r
ed
u
ce
B
MI
,
W
C
an
d
p
er
ce
n
tag
e
o
f
b
o
d
y
f
at
in
o
v
er
weig
h
t
ad
o
lescen
t
g
ir
ls
wh
ile
n
o
s
ig
n
if
ican
t
ef
f
ec
t
was
o
b
s
er
v
ed
to
im
p
r
o
v
e
th
e
h
eig
h
t,
W
C
,
an
d
t
h
in
n
ess
in
d
ic
ato
r
s
am
o
n
g
u
n
d
er
n
o
u
r
is
h
ed
a
d
o
lescen
ts
’
g
ir
ls
.
E
m
p
h
asizin
g
n
u
tr
itio
n
ed
u
ca
tio
n
in
s
ch
o
o
ls
ap
p
ea
r
s
to
c
r
ea
te
a
war
en
ess
r
eg
ar
d
in
g
h
ea
lth
y
f
o
o
d
ch
o
ices,
m
ai
n
ten
an
ce
o
f
w
eig
h
t,
p
r
e
v
en
tio
n
o
f
o
b
esit
y
an
d
to
r
ed
u
ce
th
e
f
u
tu
r
is
tic
r
is
k
o
f
co
m
m
u
n
icab
le
an
d
n
o
n
-
co
m
m
u
n
icab
le
d
is
ea
s
es
[
2
6
]
.
Ou
r
f
in
d
in
g
s
o
b
s
er
v
ed
th
at
s
ch
o
o
l
b
ased
n
u
tr
itio
n
al
awa
r
en
ess
p
r
o
g
r
am
s
h
elp
to
co
n
tr
o
l
ex
ce
s
s
iv
e
weig
h
t
g
a
in
a
n
d
o
b
esit
y
p
r
ev
e
n
tio
n
in
g
ir
ls
.
I
n
ag
r
ee
m
en
t
to
o
u
r
r
esu
lts
,
a
r
ec
en
t
s
tu
d
y
f
o
u
n
d
th
at
s
ch
o
o
l
-
b
ased
ex
er
cise
an
d
n
u
tr
itio
n
in
ter
v
e
n
tio
n
r
ed
u
ce
B
MI
an
d
b
o
d
y
f
at
in
o
v
er
weig
h
t
ad
o
lescen
t
g
ir
ls
[
2
7
]
.
Similar
ly
,
an
o
th
er
s
tu
d
y
f
o
u
n
d
th
at
n
u
tr
it
io
n
al
an
d
lif
esty
le
in
ter
v
en
tio
n
s
in
th
e
s
ch
o
o
l
en
v
ir
o
n
m
en
t
ca
n
ch
an
g
e
s
tu
d
en
ts
’
b
eh
av
io
r
c
h
an
g
es
an
d
o
b
esit
y
p
r
ev
en
tio
n
in
ad
o
lescen
ts
[
2
8
]
.
Similar
to
m
an
y
s
tu
d
ies,
we
u
s
ed
an
th
r
o
p
o
m
etr
ic
m
ea
s
u
r
es
as
a
p
r
im
ar
y
v
ar
iab
l
e
to
p
r
o
v
id
e
th
e
b
est
s
u
itab
le
in
d
icato
r
f
o
r
n
u
tr
i
tio
n
al
s
tatu
s
o
f
ad
o
lescen
t
g
ir
ls
.
B
ein
g
th
e
f
r
eq
u
e
n
tly
u
s
ed
in
d
i
ca
to
r
f
o
r
n
u
tr
itio
n
al
s
tatu
s
,
an
t
h
r
o
p
o
m
etr
ic
m
ea
s
u
r
es
m
ig
h
t
h
elp
to
p
r
ev
e
n
t
b
iased
r
esu
lts
in
v
esti
g
ated
b
y
o
b
s
e
r
v
er
s
,
in
s
tr
u
m
en
ts
,
an
d
i
n
f
o
r
m
an
ts
[
2
9
]
.
I
n
co
n
co
m
itan
t
,
B
MI
an
d
o
th
er
an
th
r
o
p
o
m
etr
ic
m
ea
s
u
r
es
ca
n
h
elp
to
p
r
o
v
i
d
e
a
th
o
r
o
u
g
h
p
o
r
t
r
ay
al
o
f
th
e
ef
f
ec
tiv
en
ess
o
f
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
p
r
o
g
r
a
m
s
[
3
0
]
.
B
MI
is
th
e
m
o
s
t
f
r
eq
u
e
n
tly
u
s
ed
p
r
ed
icto
r
t
o
ev
alu
ate
th
e
ef
f
ec
ts
o
f
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
al
p
r
o
g
r
a
m
s
[
3
1
]
.
B
MI
is
a
s
tan
d
a
r
d
ized
ass
ess
m
en
t
m
eth
o
d
m
ea
s
u
r
ed
as
in
d
iv
id
u
al
weig
h
t
(
k
g
)
d
iv
id
ed
b
y
h
is
/h
e
r
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
E
ffective
n
ess
o
f sch
o
o
l
-
b
a
s
ed
n
u
tr
itio
n
ed
u
ca
tio
n
o
n
o
b
esit
y
a
n
d
n
u
tr
itio
n
a
l sta
tu
s
…
(
S
eh
a
r
I
q
b
a
l
)
1247
h
eig
h
t
(
m
)
.
Acc
o
r
d
in
g
to
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
(
W
HO)
B
MI
v
alu
es
(
>
+
1
SD)
ar
e
co
n
s
id
er
ed
as
o
v
er
weig
h
t w
h
ile
(
>
+
2
SD)
a
r
e
m
ea
s
u
r
ed
as o
b
esit
y
co
n
s
id
er
in
g
th
e
s
p
ec
if
ic
ag
e
an
d
g
en
d
e
r
[
3
2
]
.
Mo
r
eo
v
er
,
s
k
in
-
f
o
ld
th
ick
n
ess
o
f
ad
o
lescen
ts
is
an
o
th
er
im
p
o
r
tan
t
p
r
e
d
icto
r
to
ev
alu
ate
b
o
d
y
f
itn
ess
.
T
h
o
u
g
h
we
f
in
d
a
lim
ited
n
u
m
b
er
o
f
s
tu
d
ies in
t
h
is
r
eg
ar
d
.
Few
s
tu
d
ies in
clu
d
ed
in
th
is
s
c
o
p
in
g
r
e
v
iew
h
av
e
r
ep
o
r
ted
n
o
n
-
s
ig
n
if
ican
t e
f
f
ec
ts
o
f
h
e
alth
ed
u
ca
tio
n
p
r
o
g
r
a
m
s
to
im
p
r
o
v
e
th
e
n
u
tr
itio
n
al
s
tatu
s
o
r
c
h
an
g
e
in
B
MI
o
f
th
e
g
ir
ls
.
Few
o
th
e
r
s
tu
d
ies
s
h
o
wed
t
h
e
v
a
r
ied
r
esu
lts
ac
co
r
d
in
g
to
g
en
d
e
r
d
i
f
f
er
en
ce
s
,
a
g
e
o
r
weig
h
t
s
tatu
s
an
d
eth
n
icity
o
f
th
e
ch
ild
r
e
n
[
2
0
]
.
I
n
c
o
n
tr
ast
to
o
u
r
f
in
d
in
g
s
,
a
s
t
u
d
y
co
n
s
id
er
i
n
g
th
e
m
u
ltip
le
co
m
p
o
n
e
n
t
h
ea
lth
ed
u
ca
tio
n
p
r
o
g
r
am
f
o
u
n
d
th
e
b
en
e
f
icial
ef
f
ec
ts
o
f
n
u
tr
itio
n
ed
u
ca
tio
n
to
im
p
r
o
v
e
n
u
tr
itio
n
al
s
tatu
s
d
u
r
i
n
g
ad
o
lescen
ce
[
3
3
]
.
T
h
e
in
clu
d
e
d
s
tu
d
ies
in
o
u
r
s
co
p
in
g
r
ev
iew
d
id
n
o
t
p
ar
tic
u
lar
ly
co
n
s
id
er
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
t
h
at
m
ig
h
t
b
e
co
n
s
id
er
e
d
a
m
ajo
r
r
ea
s
o
n
f
o
r
th
ese
non
-
s
ig
n
if
ica
n
t
ef
f
ec
ts
[
3
0
]
.
Fam
ily
en
v
ir
o
n
m
en
t,
p
a
r
en
ts
’
k
n
o
wled
g
e,
ec
o
n
o
m
ic
s
tatu
s
ar
e
im
p
o
r
tan
t
p
ar
am
eter
s
,
an
d
co
n
f
o
u
n
d
in
g
f
ac
to
r
s
m
ig
h
t
a
f
f
ec
t
th
e
r
esu
lts
o
u
tco
m
es
[
3
4
]
.
Su
ch
as
B
er
e
an
d
c
o
l
leag
u
e
s
p
r
ev
io
u
s
ly
f
o
u
n
d
th
at
ad
o
lescen
ts
liv
in
g
with
e
d
u
ca
ted
p
ar
e
n
t
s
h
av
e
b
etter
n
u
tr
itio
n
al
s
tatu
s
an
d
h
ea
lth
y
ea
tin
g
h
ab
its
as
co
m
p
ar
ed
to
th
e
co
n
t
r
o
l
g
r
o
u
p
liv
in
g
with
less
ed
u
ca
ted
p
ar
e
n
ts
[
3
5
]
.
Als
o
,
m
a
n
y
o
th
e
r
s
tu
d
ies
h
av
e
r
ep
o
r
ted
th
e
p
o
s
itiv
e
ef
f
ec
ts
o
f
p
ar
en
t’
s
ed
u
ca
tio
n
in
im
p
r
o
v
in
g
d
ietar
y
d
iv
er
s
ity
,
in
tak
e
o
f
f
r
u
its
an
d
v
eg
etab
les
an
d
n
u
t
r
itio
n
al
b
eh
a
v
io
r
i
n
ad
o
lescen
t c
h
ild
r
en
[
3
6
]
-
[
3
8
]
.
I
n
s
u
m
m
ar
y
,
we
f
o
u
n
d
t
h
at
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
al
p
r
o
g
r
am
s
ca
n
h
elp
to
im
p
r
o
v
e
th
e
n
u
tr
itio
n
al
s
tatu
s
o
f
ad
o
lescen
t
g
ir
ls
.
Sin
ce
,
th
e
class
r
o
o
m
ac
tiv
ities
a
n
d
ed
u
ca
tio
n
ar
e
r
eg
u
lar
l
y
ac
ce
n
tu
ated
o
n
co
u
r
s
e
lear
n
in
g
o
u
tco
m
es,
tr
ad
itio
n
al
cu
r
r
icu
lu
m
,
an
d
f
o
r
m
al
ed
u
ca
t
io
n
.
Nu
tr
itio
n
al
ed
u
ca
tio
n
in
s
ch
o
o
ls
will
h
elp
to
in
cr
ea
s
e
n
u
tr
itio
n
al
awa
r
en
ess
,
h
ea
lth
y
ea
tin
g
an
d
o
b
esit
y
p
r
ev
en
tio
n
in
ad
o
lescen
t
g
ir
ls
.
Als
o
,
s
ch
o
o
l
b
ased
n
u
tr
itio
n
i
n
ter
v
en
tio
n
in
cl
u
d
i
n
g
s
elf
-
ef
f
icac
y
/p
er
ce
iv
e
d
c
o
n
tr
o
l,
o
u
tco
m
e
ex
p
ec
tatio
n
s
/attitu
d
e,
h
ab
it,
an
d
b
eh
av
io
r
al
in
ten
tio
n
m
ig
h
t
h
e
lp
to
c
h
an
g
e
d
ietar
y
h
a
b
its
lead
in
g
t
o
b
etter
n
u
t
r
itio
n
al
s
tatu
s
[
3
9
]
.
A
h
o
lis
tic
ap
p
r
o
ac
h
with
m
o
r
e
p
r
o
f
ess
io
n
al
tr
ain
in
g
f
o
r
teac
h
er
s
b
ased
o
n
h
ea
lth
p
r
o
m
o
tio
n
s
tr
ateg
ies,
f
u
tu
r
e
q
u
an
titativ
e
an
d
q
u
alitativ
e
s
tu
d
ies,
lo
n
g
er
d
u
r
atio
n
o
f
in
ter
v
en
tio
n
s
,
c
o
m
p
r
eh
en
s
iv
e
f
o
llo
w
-
u
p
an
d
e
v
al
u
atio
n
s
ar
e
n
ee
d
e
d
to
im
p
lem
en
t
ef
f
icien
t
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
ed
u
ca
tio
n
p
r
o
g
r
am
s
an
d
h
ea
lth
p
r
o
m
o
tio
n
.
Fu
r
th
er
s
tu
d
ies
an
d
in
ter
v
en
tio
n
al
tr
ials
will
p
r
o
v
id
e
f
u
tu
r
is
tic
g
u
i
d
elin
es
in
o
r
d
er
to
m
o
d
if
y
th
e
ex
is
tin
g
ed
u
c
atio
n
p
r
o
g
r
am
s
an
d
h
ea
lth
attitu
d
es a
t in
d
iv
id
u
al,
co
m
m
u
n
ity
,
an
d
p
o
licy
le
v
el
to
ac
h
iev
e
d
eter
m
in
ed
h
ea
lth
o
u
tco
m
es.
T
h
is
is
th
e
f
ir
s
t
co
m
p
r
eh
en
s
iv
e
s
co
p
in
g
r
ev
iew
f
o
cu
s
in
g
o
n
th
e
ef
f
icac
y
o
f
s
ch
o
o
l
-
b
ase
d
n
u
tr
itio
n
ed
u
ca
tio
n
o
n
an
t
h
r
o
p
o
m
etr
ic
v
ar
iab
les
in
clu
d
in
g
B
MI
,
f
a
t
ch
an
g
es,
h
eig
h
t,
weig
h
t,
MU
AC
,
W
C
am
o
n
g
ad
o
le
s
ce
n
t
g
ir
ls
,
h
o
wev
er
,
lim
ited
n
u
m
b
er
o
f
s
tu
d
ies
an
d
lack
o
f
en
o
u
g
h
in
ter
v
en
tio
n
al
tr
ia
ls
was
a
lim
itatio
n
wh
ile
co
n
d
u
ctin
g
th
is
s
co
p
i
n
g
r
e
v
iew.
Similar
ly
,
m
o
s
t
o
f
th
e
in
clu
d
e
d
s
tu
d
ies
p
r
o
v
id
ed
lim
ited
an
d
h
eter
o
g
en
o
u
s
d
ata
in
ter
m
s
o
f
in
ter
v
en
tio
n
,
m
et
h
o
d
o
l
o
g
y
an
d
o
u
tco
m
es.
Du
e
to
lim
ited
n
u
m
b
er
o
f
s
tu
d
ies an
d
h
eter
o
g
en
eity
am
o
n
g
th
e
r
esu
l
ts
v
ar
iab
les,
it wa
s
n
o
t p
o
s
s
ib
le
to
co
n
d
u
ct
a
m
eta
-
an
aly
s
is
an
d
to
g
en
er
alize
th
e
r
esu
lts
o
n
d
if
f
er
en
t
p
o
p
u
lati
o
n
s
.
W
e
d
id
n
o
t
in
clu
d
e
s
tu
d
ies
with
p
ar
en
tal
in
v
o
lv
em
en
t,
ed
u
ca
tio
n
an
d
awa
r
en
ess
in
th
e
co
n
tex
t
o
f
h
ea
lth
y
d
ietar
y
p
atter
n
s
.
Als
o
,
th
e
lev
el
an
d
ef
f
ec
ts
o
f
teac
h
er
n
u
tr
itio
n
al
awa
r
en
ess
wer
e
n
o
t
r
ev
iewe
d
.
I
t
ca
n
b
e
co
n
s
id
er
ed
an
o
th
er
s
tu
d
y
lim
itatio
n
.
Mo
r
e
s
tu
d
ies
with
lo
n
g
ter
m
in
ter
v
en
tio
n
s
ar
e
n
ee
d
e
d
to
ap
p
l
y
a
c
o
m
p
r
eh
en
s
iv
e
ap
p
r
o
ac
h
to
m
o
d
if
y
th
e
ex
is
tin
g
s
ch
o
o
l
-
b
ased
h
ea
lth
p
r
o
g
r
am
s
.
I
n
co
n
co
m
itan
t,
lar
g
e
s
ca
le
n
u
tr
it
io
n
al
in
ter
v
en
tio
n
p
r
o
g
r
am
s
o
n
co
m
m
u
n
ity
lev
el
b
o
t
h
in
h
ig
h
-
an
d
lo
w
-
i
n
co
m
e
co
u
n
tr
ies ca
n
h
elp
to
h
alt
d
o
u
b
le
b
u
r
d
en
o
f
m
aln
u
tr
itio
n
.
5.
CO
NCLU
S
I
O
N
Ou
r
r
ev
iew
r
ep
o
r
ted
th
e
b
en
ef
icial
ef
f
ec
t
s
o
f
s
ch
o
o
l
-
b
ased
n
u
tr
itio
n
ed
u
ca
tio
n
to
im
p
r
o
v
e
h
ea
lth
an
d
to
r
ed
u
ce
o
b
esit
y
in
ad
o
lescen
t
g
ir
ls
.
Sin
ce
n
u
tr
itio
n
al
in
te
r
v
en
tio
n
p
r
o
g
r
am
s
ca
n
im
p
r
o
v
e
n
u
tr
itio
n
al
h
a
b
its
th
r
o
u
g
h
f
u
n
ac
tiv
ities
an
d
in
ter
ac
tiv
e
s
e
s
s
io
n
.
Sch
o
o
l
-
b
ased
n
u
tr
itio
n
p
r
o
g
r
am
s
ca
n
b
e
a
v
ital
an
d
co
s
t
-
ef
f
ec
tiv
e
s
tr
ateg
y
to
in
cr
ea
s
e
n
u
tr
itio
n
al
awa
r
en
ess
,
h
ea
lth
y
life
s
ty
le,
ea
tin
g
b
eh
av
io
r
s
an
d
to
ad
d
r
ess
n
u
tr
itio
n
al
d
ef
icien
cies
am
o
n
g
a
d
o
lescen
t
g
ir
ls
.
T
h
e
in
t
r
o
d
u
ctio
n
o
f
n
u
tr
itio
n
ed
u
ca
tio
n
in
to
th
e
s
tu
d
y
cu
r
r
ic
u
lu
m
co
n
tin
u
es
s
u
p
p
o
r
t
f
r
o
m
teac
h
e
r
s
,
ef
f
ec
tiv
e
p
ar
en
ts
’
ed
u
ca
tio
n
,
co
u
n
s
elin
g
o
f
th
e
s
tu
d
en
ts
,
in
tr
o
d
u
ctio
n
o
f
d
aily
p
h
y
s
ical
ac
tiv
ity
,
an
d
p
r
o
v
is
io
n
o
f
f
r
u
its
an
d
v
eg
etab
les
b
y
s
ch
o
o
l
f
o
o
d
s
er
v
ices
m
ig
h
t
h
e
lp
to
ac
q
u
ir
e
wid
e
-
r
an
g
in
g
h
ea
lth
b
e
n
ef
its
to
ad
o
l
escen
t
g
ir
ls
.
Als
o
,
n
u
tr
itio
n
ed
u
ca
tio
n
p
r
o
g
r
am
s
th
r
o
u
g
h
o
t
h
e
r
p
latf
o
r
m
s
s
u
ch
as
co
m
m
u
n
ity
en
g
ag
em
en
t,
p
a
r
e
n
ts
’
awa
r
en
ess
,
p
ee
r
s
’
in
v
o
lv
e
m
en
t,
h
ea
lth
y
m
ess
ag
es
o
n
s
o
cial
m
ed
ia
an
d
web
-
b
ased
ed
u
ca
tio
n
m
ig
h
t
h
elp
to
im
p
r
o
v
e
o
u
tco
m
es.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
th
er
e
is
n
o
f
u
n
d
i
n
g
in
v
o
lv
ed
f
o
r
t
h
is
ar
ticle.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
2
4
3
-
1
2
5
5
1248
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
Seh
ar
I
q
b
al
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Sair
a
Z
af
ar
✓
✓
✓
✓
✓
✓
Sy
ed
Hass
an
Usma
n
Sh
ah
✓
✓
✓
✓
Ab
d
u
l
Mo
m
in
R
izwa
n
Ah
m
ad
✓
✓
✓
✓
✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
ftwa
re
Va
:
Va
li
d
a
ti
o
n
Fo
:
Fo
rm
a
l
a
n
a
ly
sis
I
:
I
n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
c
e
s
D
:
D
a
t
a
C
u
r
a
t
i
o
n
O
:
W
r
i
t
i
n
g
-
O
r
i
g
i
n
a
l
D
r
a
f
t
E
:
W
r
i
t
i
n
g
-
R
e
v
i
e
w
&
E
d
i
t
i
n
g
Vi
:
Vi
su
a
li
z
a
ti
o
n
Su
:
Su
p
e
rv
isio
n
P
:
P
ro
jec
t
a
d
m
in
istrati
o
n
Fu
:
Fu
n
d
in
g
a
c
q
u
isit
i
o
n
CO
NF
L
I
C
T
O
F
I
N
T
E
R
E
S
T
ST
A
T
E
M
E
NT
T
h
e
au
th
o
r
s
d
ec
lar
e
n
o
co
n
f
lict o
f
in
ter
est.
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
au
th
o
r
s
co
n
f
ir
m
t
h
at
th
e
d
ata
s
u
p
p
o
r
tin
g
th
e
f
in
d
i
n
g
s
o
f
t
h
is
s
tu
d
y
ar
e
av
ailab
le
with
in
th
e
ar
ticle.
RE
F
E
R
E
NC
E
S
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1
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T
ab
le
1
.
E
f
f
ec
tiv
en
ess
o
f
s
ch
o
o
l
-
b
ased
n
u
t
r
itio
n
ed
u
ca
tio
n
in
ter
v
en
tio
n
s
o
n
b
o
d
y
m
ass
in
d
e
x
an
d
n
u
tr
itio
n
al
s
tatu
s
o
f
ad
o
lescen
ts
g
ir
ls
(
co
n
tin
u
ed
)
R
e
f
e
r
e
n
c
e
/
c
o
u
n
t
r
y
S
t
u
d
y
t
y
p
e
a
n
d
o
b
j
e
c
t
i
v
e
P
a
r
t
i
c
i
p
a
n
t
s
I
n
t
e
r
v
e
n
t
i
o
n
I
n
c
l
u
d
e
d
v
a
r
i
a
b
l
e
s
R
e
s
u
l
t
s
R
e
mar
k
s
[
1
5
]
/
I
r
a
n
C
l
u
st
e
r
r
a
n
d
o
m
i
z
e
d
c
o
mm
u
n
i
t
y
t
r
i
a
l
Th
e
st
u
d
y
e
v
a
l
u
a
t
e
d
t
h
e
e
f
f
e
c
t
s
o
f
n
u
t
r
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t
i
o
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d
u
c
a
t
i
o
n
f
o
c
u
si
n
g
o
n
so
c
i
a
l
c
o
g
n
i
t
i
v
e
t
h
e
o
r
y
t
o
i
mp
r
o
v
e
d
i
e
t
a
r
y
h
a
b
i
t
s a
n
d
t
o
r
e
d
u
c
e
B
M
I
a
n
d
W
C
s
a
mo
n
g
o
v
e
r
w
e
i
g
h
t
a
n
d
o
b
e
se
g
i
r
l
st
u
d
e
n
t
s
.
To
t
a
l
(
n
=
1
7
2
)
I
n
t
e
r
v
e
n
t
i
o
n
g
r
o
u
p
(
n
=
8
7
)
C
o
n
t
r
o
l
g
r
o
u
p
(
n
=
8
5
)
A
g
e
=
1
2
-
1
6
y
e
a
r
s
D
u
r
a
t
i
o
n
:
7
-
m
o
n
t
h
Th
e
i
n
t
e
r
v
e
n
t
i
o
n
w
a
s b
a
se
d
o
n
t
h
e
f
o
l
l
o
w
i
n
g
c
o
m
p
o
n
e
n
t
s.
1)
P
r
a
c
t
i
c
a
l
n
u
t
r
i
t
i
o
n
w
o
r
k
s
h
o
p
s
a
n
d
i
n
t
e
r
a
c
t
i
v
e
semi
n
a
r
s
2)
V
i
si
t
i
n
g
i
n
d
u
st
r
i
a
l
f
o
o
d
c
o
m
p
a
n
i
e
s
.
To
g
e
t
m
o
r
e
f
a
mi
l
i
a
r
a
n
d
t
o
mak
e
a
p
o
s
i
t
i
v
e
a
t
t
i
t
u
d
e
f
o
r
h
e
a
l
t
h
y
f
o
o
d
.
3)
H
e
a
l
t
h
y
c
o
o
k
i
n
g
w
o
r
k
s
h
o
p
s
.
Ta
r
g
e
t
e
d
o
n
h
e
a
l
t
h
y
c
o
o
k
i
n
g
o
p
t
i
o
n
s.
4)
Te
x
t
m
e
ssa
g
e
s
f
o
r
st
u
d
e
n
t
s
a
n
d
p
a
r
e
n
t
s
t
o
c
r
e
a
t
e
a
n
d
m
a
i
n
t
a
i
n
h
e
a
l
t
h
y
n
u
t
r
i
t
i
o
n
a
l
b
e
h
a
v
i
o
r
s.
5)
P
a
r
e
n
t
s’
n
e
w
sl
e
t
t
e
r
s
6)
C
a
l
l
s
t
o
st
u
d
e
n
t
s
t
o
i
m
p
r
o
v
e
se
l
f
-
e
f
f
i
c
a
c
y
a
n
d
t
o
su
p
p
o
r
t
c
h
i
l
d
r
e
n
f
o
r
h
e
a
l
t
h
y
d
i
e
t
.
7)
M
o
n
t
h
l
y
n
u
t
r
i
t
i
o
n
a
l
c
o
n
su
l
t
i
n
g
p
r
i
v
a
t
e
sessi
o
n
s
−
B
M
I
−
W
C
s
−
D
i
e
t
a
r
y
i
n
t
a
k
e
B
a
se
l
i
n
e
R
e
s
u
l
t
s
(
M
e
a
n
±
S
d
)
C
o
n
t
r
o
l
G
r
o
u
p
B
M
I
=
2
7
.
2
±
2
.
9
W
C
=
8
4
.
4
±
6
.
7
I
n
t
e
r
v
e
n
t
i
o
n
g
r
o
u
p
B
M
I
=
2
9
.
2
±
3
.
9
W
C
=
8
9
.
6
±
2
.
9
A
f
t
e
r
i
n
t
e
r
v
e
n
t
i
o
n
(
M
e
a
n
±
S
d
)
C
o
n
t
r
o
l
G
r
o
u
p
B
M
I
=
2
7
.
6
±
2
.
9
W
C
=
8
4
.
9
±
6
.
4
I
n
t
e
r
v
e
n
t
i
o
n
g
r
o
u
p
B
M
I
=
2
8
.
5
±
4
.
3
W
C
=
8
6
.
5
±
9
.
8
Th
e
st
u
d
y
sh
o
w
e
d
t
h
a
t
n
u
t
r
i
t
i
o
n
e
d
u
c
a
t
i
o
n
may
h
e
l
p
t
o
r
e
d
u
c
e
B
M
I
a
n
d
W
C
.
[
1
6
]
/
I
r
a
n
A
n
e
x
p
e
r
i
me
n
t
a
l
st
u
d
y
Th
e
st
u
d
y
a
i
me
d
t
o
a
ss
e
ss
t
h
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f
f
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f
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d
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c
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b
a
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d
o
n
h
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a
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t
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b
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l
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f
mo
d
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l
o
n
sel
f
-
e
st
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e
m
a
n
d
B
M
I
o
f
o
v
e
r
w
e
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g
h
t
a
n
d
a
t
r
i
sk
o
f
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v
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r
w
e
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g
h
t
a
d
o
l
e
sce
n
t
g
i
r
l
s
.
To
t
a
l
(
n
=
1
4
0
)
I
n
t
e
r
v
e
n
t
i
o
n
g
r
o
u
p
(
n
=
7
0
)
C
o
n
t
r
o
l
g
r
o
u
p
(
n
=
7
0
)
D
u
r
a
t
i
o
n
:
3
m
o
n
t
h
s
Ed
u
c
a
t
i
o
n
b
a
s
e
d
p
r
o
g
r
a
m w
a
s
b
a
s
e
d
o
n
a
h
e
a
l
t
h
b
e
l
i
e
f
mo
d
e
l
f
o
r
i
m
p
r
o
v
i
n
g
n
u
t
r
i
t
i
o
n
a
l
st
a
t
u
s.
Th
e
si
x
6
0
-
mi
n
u
t
e
sessi
o
n
s
w
e
r
e
c
o
n
d
u
c
t
e
d
b
a
s
e
d
o
n
h
e
a
l
t
h
b
e
l
i
e
f
m
o
d
e
l
a
n
d
e
mp
h
a
s
i
z
i
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d
i
e
t
t
o
c
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n
t
r
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l
w
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i
g
h
t
i
n
o
v
e
r
w
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g
h
t
a
n
d
a
t
-
r
i
sk
a
d
o
l
e
sc
e
n
t
s’
g
i
r
l
s
.
−
B
M
I
R
e
s
u
l
t
s
(
M
e
a
n
±
Sd
)
C
o
n
t
r
o
l
g
r
o
u
p
B
M
I
=
2
7
.
1
1
±
1
.
2
7
2
m
o
n
t
h
s a
f
t
e
r
i
n
t
e
r
v
e
n
t
i
o
n
B
M
I
=
2
7
.
1
9
±
1
.
5
5
3
M
o
n
t
h
s
a
f
t
e
r
i
n
t
e
r
v
e
n
t
i
o
n
B
M
I
=
2
7
.
1
3
±
1
.
5
6
I
n
t
e
r
v
e
n
t
i
o
n
g
r
o
u
p
B
M
I
=
2
7
.
1
5
±
1
.
2
1
)
2
m
o
n
t
h
s a
f
t
e
r
i
n
t
e
r
v
e
n
t
i
o
n
B
M
I
=
2
6
.
8
2
±
1
.
4
2
3
M
o
n
t
h
s
a
f
t
e
r
i
n
t
e
r
v
e
n
t
i
o
n
B
M
I
=
2
6
.
7
0
±
1
.
3
8
Th
e
st
u
d
y
f
o
u
n
d
t
h
a
t
n
u
t
r
i
t
i
o
n
e
d
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c
a
t
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o
n
h
a
s
a
p
r
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v
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n
t
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v
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a
n
d
c
o
n
t
r
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l
l
i
n
g
e
f
f
e
c
t
s
o
n
w
e
i
g
h
t
a
n
d
B
M
I
.
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