Effectiveness of a diet and physical activity promotion strategy on the prevention of obesity in Mexican school children

BMC Public Health

Ignacio Méndez Gómez Humarán²  Alejandra Jiménez Aguilar¹  Araceli Salazar Coronel¹  Claudia Amaya Castellanos¹  Carmen Morales Ruán¹  Teresa Shamah Levy¹ 

[1] National Institute of Public Health, Av. Universidad # 655, Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Morelos, Mexico 62100 C.P;Center for Research in Mathematics, AC, Aguascalientes, Mexico

关键词: Physical activity;    Eating;    Mexico;    Effectiveness;    Scholars;    Obesity;   

Others  :  1163823
DOI  :  10.1186/1471-2458-12-152

 received in 2011-10-09, accepted in 2012-03-01,  发布年份 2012

【 摘 要 】

Background

Overweight and obesity in children in Mexico was among the countries with the highest prevalence's in the world. Mexico currently has few innovative and comprehensive experiences to help curb the growth of this serious public health problem. Therefore, the aim of this study is to assess the effectiveness of a nutrition and physical activity strategy, called "Nutrition on the Go" ("nutrición en movimiento") in maintaining the BMI values of school children in the State of Mexico.

Methods

A two-stage cluster trial was carried out. Sixty schools were selected in the State of Mexico, of which 30 were randomly assigned to the intervention group (IG) and 30 to the control group (CG). A total of 1020 fifth grade school children participated. The intervention strategy aimed to decrease the energy content of school breakfasts and include fruits and vegetables, as well as increase physical activity and the consumption of water during the time spent at school. The strategy was implemented over a 6-month period.

Results

The estimated probability (EP) of obesity between baseline and the final stage for the IG decreased 1% (Initial EP = 11.8%, 95%CI 9.0, 15.2, final EP = 10.8, 95%CI 8.4, 13.) For the CG, the probability increased 0.9% (baseline EP = 10.6%; 95%CI 8.1, 13.7; final EP = 11.5, 95%CI 9.0, 14.6). The interaction between the intervention and the stage is the average odd time corrected treatment effect, which is statistically significant (p = 0.01) (OR = 0.68, 95%CI 0.52, 091).

This represents the interaction between intervention and stage, which is highly significant (p = 0.01) (OR = 0.68; 95%CI 0.52, 091). In addition, girls had a protective effect on obesity (OR = 0.56; 95%CI 0.39, 0.80).

Conclusions

The intervention strategy is effective in maintaining the BMI of school children.

【 授权许可】

   
2012 Levy et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]WHO: Diet, nutrition and the prevention of chronic diseases. In Report of a Joint FAO/WHO Expert consultation. WHO Technical report series 916.WHO: Geneva; 2003.
• [2]Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, Tough SC: Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations. Obes Rev 2006, 7(Suppl 1):7-66.
• [3]Sassi F, et al.: Obesity and the Economic of Prevention: Fit not Fat, OECD. 2010. 2/OECD Health Data 2010
• [4]Freedman DS, Khan LK, Serdula MK, et al.: The relation of childhood BMI to adult adiposity: the Bogalusa heart study. Pediatrics 2005, 115:22-27.
• [5]Venn AJ, Thomson RJ, Schmidt MD, Cleland VJ, Curry BA, Gennat HC, Dwyer T: Overweight and obesity from childhood to adulthood: a follow-up of participants in the 1985 Australian schools health and fitness survey. Med J Aust 2007, 186:458-460.
• [6]Juonala M, Magnussen CG, Berenson GS, Venn A, Burns TL, Sabin MA, Srinivasan SR, Daniels SR, Davis PH, Chen W, Sun C, Cheung M, Viikari JS, Dwyer T, Raitakari OT: Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med 2011, 365:1876-1885.
• [7]OECD Family database: OECD - Social Policy Division - Directorate of Employment, Labour and Social Affairs. CO1.7: Overweight and obesity at age 15 by gender. (Consultado el 13 de abril de 2011). [http://www.oecd.org/els/social/family/database] webcite
• [8]Olaiz G, Rivera J, Shamah T, Rojas R, Villalpando S, Hernández M, Sepúlveda J: Encuesta Nacional de Salud y Nutrición. México: Instituto Nacional de Salud Pública; 2007.
• [9]Rivera Dommarco J, Shamah Levy T, Villalpando Hernández S, Rivera Pasquel M, Cuevas Nasu L, Mejía Rodríguez F, Barquera Cervera S, Capítulo II: Preescolares de la Encuesta Nacional de Nutrición 1999: Estado de nutrición de niños y mujeres en México. 29-68. Editorial INSP Vol. 1 Diciembre de 2001. ISBN 968-6502-54-8
• [10]Cuevas Nasu L, Shamah Levy T, Rivera Dommarco J, Ávila Arcos MA, Mendoza Ramírez AJ: Capítulo: Estado Nutricio. Encuesta Nacional de Salud y Nutrición 2006. Resultados por entidad Federativa, Estado de México. Secretaría de Salud: Instituto Nacional de Salud Pública; 2006:73-83. ISBN 978-970-9874-36-6
• [11]Shamah Levy T (Ed): Encuesta Nacional de Salud en Escolares. 2008 Cuernavaca (México): Instituto Nacional de Salud Pública (MX); 2010.
• [12]Walley AJ, Asher JE, Froguel P: The genetic contribution to non-syndromic human obesity. NatureReviews July 2009, 10:431-434.
• [13]Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T, Campbell KJ: Intervenciones para prevenir la obesidad infantil (Revisión Cochrane traducida). En. Oxford: Update Software Ltd; 2008. Número 4. Disponible en: http://www.update-software.com webcite
• [14]Brown T, Summerbell C: Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for health and clinical excellence. Obesity reviews 2009, 10:110-114.
• [15]Katz L: School-based interventions for health promotion and weight control: not just waiting on the world to change. Annu Rev Public Health 2009, 30:253-272.
• [16]Caballero B, et al.: Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian Schoolchildren. Am J Clin Nutr 2003, 78:1030-1038.
• [17]Collins E, Warren J, Neve M, McCoy P, Stokes B: Measuring effectiveness of dietetic interventions in child obesity. A systematic review of randomized trials. Arch Pediatr Adolesc Med 2006, 160:906-922.
• [18]Gortmaker S, Petrson K, Wiecha J, Sobol A, Dixit S, Fox MK, Laird N: Reducing obesity via a school-based interdisciplinary intervention among youth. Arch Pediatr Adolesc Med 1999, 153:409-418.
• [19]Bere E, Veierød MB, Bjelland M, Klepp K-I: Free school fruit sustained effect 1 year later. Health Educ Res 2006, 21(2):268-275.
• [20]Bere E, Veierød MB, Bjelland M, Klepp K-I: Outcome and process evaluation of a Norwegian school-randomized fruit and vegetable intervention: Fruits and Vegetables Make the Marks (FVMM). Health Educ Res 2006, 21(2):258-267.
• [21]Pérez-Morales E, Bacardi-Gascón M, Jiménez Cruz A, et al.: Intervenciones aleatorias controladas basadas en las escuelas para prevenir la obesidad infantil: revisión sistemática de 2006 a 2009. ALAN 2009, 59(3):253-259.
• [22]Kropski JA, Keckley PH, Jensen GL: School-based obesity prevention programs: an evidence-based review. Obesity 2008, 16:1009-1018.
• [23]Plachta-Danielzik S, Pust S, Asbeck I, Czerwinski-Mast M, Langnaäse K, Fischer C, et al.: Four-year follow-up of school-based intervention on overweight children: the kops study. Obesity 2007, 15(12):3159-3169.
• [24]James J, Thomas P, Kerr D: Preventing childhood obesity: two-year follow-up results from the Christchurch obesity prevention program in schools (CHOPPS). BMJ 2007, 335(7623):762.
• [25]Jiang J, Xia X, Greiner T, Wu G, Lian G, Rosenqvist U: The effects of a 3-year obesity intervention in schoolchildren in Beijing. Child Care Health Dev 2007, 33(5):641-646.
• [26]Sichieri R, Trotte AP, Souza RA, Veiga GV: School randomized trial on prevention of excessive weight gain by discouraging students from drinking sodas. Public Health Nutr 2009, 12(2):197-202.
• [27]Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J, et al.: A policy-based school intervention to prevent overweight and obesity. Pediatrics 2008, 121(4):e794-e802.
• [28]Sallis JF, McKenzie TL, Conway TL, Elder JP, Prochaska JJ, Brown M, Zive MMS, Marshall SJ, Alcaraz JE: Environmental interventions for eating and physical activity. A randomized controlled trial in middle schools. Am J Prev Med 2003, 24(3):209-217.
• [29]Kain J, Leyton B, Cerda R, Vio F, Uauy R: Two-year controlled effectiveness trial of a school-based intervention to prevent obesity in Chilean children. Public Health Nutrition 2008, 12(9):1451-1461.
• [30]Shamah Levy T, Morales Ruán MC, Ambrocio Hernández R (Eds): Contribución de los desayunos escolares del DIF Estado de México en el estado de nutrición. México In 2010, 64.
• [31]Murray DM: Design and Analysis of Group-Randomized Trials. New York: Oxford University Press, Inc; 1998.
• [32]SEP - CONADE: Guía de actividad física. In Escolar primaria. México. D.F. Comisión Nacional de Cultura Física y Deporte; 2008.
• [33]Ziemendorff S, Krause A: Guía de Validación de Materiales Educativos (con enfoque en materiales de educación sanitaria). Primera edición. Programa de Agua y Saneamiento PROAGUA/GTP. Perú: Chiclayo; 2003:74.
• [34]Lohman T, Roche A, Martorell R: Anthropometric standarization reference manual. IL: Champlaign; 1988.
• [35]Habicht JP: Standardization of quantitative epidemiological methods in the field]. Bol Oficina Sanit Panam 1974, 76:375-384.
• [36]Fleiss JL: Statistical methods for rates and proportions. New York: John Wiley & Sons; 1981.
• [37]Bandura A: Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall; 1977.
• [38]Cole T, Bellizzi M: Establishing a Standard definition for child overweight and obesity worldwide: international survey. BMJ 2000, 320:1-6.
• [39]Rodríguez S, Mundo V, Jiménez A, Shamah T: Methodology for the analysis of dietary data from the Mexican National health and nutrition survey 2006. Salud Pública de México 2009, 51(Sup. 4):S523-S529.
• [40]Hernández B, Gortmarker S, Larid N, Colditz G, Parra-Cabrera S, Peterson K: Validez y reproductibilidad de un cuestionario de actividad e inactividad física para escolares de la ciudad de México. Salud Pública Mex 2000, 42:315-323.
• [41]Aedo A, Ávila H: Nuevo cuestionario para evaluar la autoeficacia hacia la actividad física en niños. Rev Panam Salud Publica 2009, 26(4):324-329.
• [42]Norman GJ, Carlson JA, Sallis JF, Wagner N, Calfas KJ, Patrick K: Reliability and validity of brief psychosocial measures related to dietary behaviors. International Journal of Behavioral Nutrition and Physical Activity 2010, 7:56. BioMed Central Full Text
• [43][http://famprevmed.ucsd.edu/pacedocs/PAS.pdf] webcitePACE, University of San Diego, California; 2001. Consulted on the 25th of July 2011
• [44]Ruiz V, Berrocal López A, Rivas T: Autoeficacia en el control de la conducta de ingesta. Adaptación al castellano de la eating self-efficacy scale. Psicothema 2003, 15(1):36-40.
• [45]Murray DM: Design and analysis of Group-Randomized Trials. New York: Oxford University Press; 1998.
• [46]Williams R: Generalized ordered logit/partial proportional odds models for ordinal dependent variables. The Stata Journal 2006, 6(1):58-82.
• [47]Lobstein T, Baur L, Uauy R: for the IASO International Obesity Task Force. Obesity in children and young people: a crisis in public health. Obesity reviews 2004, 5(Suppl. 1):4-85.
• [48]Wang Y, Ge K, Popkin BM: Tracking of body mass index from childhood to adolescence: a 6-y follow-up study in China. Am J Clin Nutr 2000, 72:1018-1024.
• [49]Salazar CAA: Diseño y validación de material didáctico, para promover una estrategia de alimentación saludable y la actividad física en escuelas primarias mexicanas. In Comunicación personal. Cuernavaca, Mor., México; 2011.
• [50]Sonia Olivares C, Nelly Bustos Z, Ximena Moreno H, Lydia Lera M, Silvana Cortez F: Actitudes y prácticas sobre alimentación y actividad física en niños obesos y sus madres en Santiago, Chile. Rev Chil Nutr 2006, 33(2):70-179.
• [51]Trost S, Kerr L, Pate R: Physical activity in obese and non-obese children. IJOB 2001, 25(6):822-829.
• [52]Kalakanis L, Moulton B: Facts at a Glance. School-Based Interventions for Childhood Obesity: TLC Research Division. [http://www.tlc.state.tx.us/pubspol/childobesity.pdf] webcite 2006. Access: Jan, 6 2012
• [53]Keith Haddock C, et al.: Treatments for childhood and adolescent obesity. Annals of Behavioral Medicine 1994, 16:235-244.