Trials | |
A primary-school-based study to reduce the prevalence of childhood obesity – the EdAl (Educació en Alimentació) study: a randomized controlled trial | |
Montse Giralt2  Rosa Solà5  Victoria Arija3  David Moriña1  Rosa Albaladejo4  Elisabet Llauradó4  Lucia Tarro4  | |
[1] Unitat de Bioestadística, Facultat de Medicina, Universitat Autònoma de Barcelona, Avda de Can Domènech, Cerdanyola del Vallès 08193, Barcelona, Spain;Unit of Farmacobiology, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç 21, Reus 43201, Spain;Unit of Nutritional Epidemiology, IISPV, Institut d’Investigació en Atenció Primària, Jordi Gol i Gorina, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç 21, Reus 43201, Spain;Health Education and Promotion, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç 21, Reus 43201, Spain;Unit of Lipids and Arteriosclerosis Research, CIBERDEM, Hospital Universitari Sant Joan, IISPV, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, C/Sant Llorenç 21, Reus 43201, Spain | |
关键词: Health promoting agent; Intervention program; Obesity prevention; Healthy lifestyle; Childhood obesity; | |
Others : 807458 DOI : 10.1186/1745-6215-15-58 |
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received in 2013-04-11, accepted in 2014-01-27, 发布年份 2014 | |
【 摘 要 】
Background
Obesity is one of the main determinants of avoidable disease burden.
To implement a program by university students acting as “health promoting agents” (HPAs) and to evaluate the effects on obesity prevalence of the primary-school-based program that promotes healthy lifestyle, including dietary and physical activity recommendations over 28 months.
Methods
Two school clusters were randomly assigned to intervention (24 schools, 1,222 pupils) or control (14 schools, 717 pupils); 78% of pupils were Western European. Mean age (±SD) was 8.4 ± 0.6 years (49.9% females) at baseline. Generalized linear mixed models were used to analyze differences in primary outcome between both groups. Data collected included body mass index (BMI) every year. Dietary habits and lifestyle questionnaires were filled in by the parents at baseline and at the end of the study. The interventions focused on eight lifestyle topics covered in 12 activities (1 hour/activity/session) implemented by HPAs over 3 school academic years.
Results
At 28 months, obesity prevalence in boys was decreased −2.36% in the intervention group (from 9.59% to 7.23%) and increased 2.03% (from 7.40% to 9.43%) in the control group; the difference was 4.39% (95% CI 3.48 to 5.30; P = 0.01). The boys in the intervention group had an effective reduction of −0.24 units in the change of BMI z-score (from 0.01 to −0.04), compared to control (from −0.10 to 0.09); 5.1% more intervention pupils undertook physical activity >5 hours/week than control pupils (P = 0.02).
Fish consumption was a protector (odds ratio 0.39; 95% CI 0.23 to 0.67) while “fast-food” consumption was a risk factor for childhood obesity (odds ratio: 2.27; 95% CI 1.08 to 4.77).
Conclusions
Our school-based program, conducted by HPA students, successfully reduced childhood obesity prevalence in boys.
Trial registration
International Standard Randomized Controlled Trial Number: ISRCTN29247645.
【 授权许可】
2014 Tarro et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
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20140708111231966.pdf | 368KB | download | |
Figure 2. | 40KB | Image | download |
Figure 1. | 45KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
【 参考文献 】
- [1]Nadeau KJ, Maahs DM, Daniels SR, Eckel RH: Childhood obesity and cardiovascular disease: links and prevention strategies. Nat Rev Cardiol 2011, 8:513-525.
- [2]Wojcicki JM, Heyman MB: Let’s move – childhood obesity prevention from pregnancy and infancy onward. N Engl J Med 2010, 362:1457-1459.
- [3]Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker H: Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 2010, 362:485-493.
- [4]Reinehr T, Wabitsch M: Childhood obesity. Curr Opin Lipidol 2011, 22:21-25.
- [5]van der Horst K, Oenema A, van de Looij-Jansen P, Brug J: The ENDORSE study: research into environmental determinants of obesity related behaviors in Rotterdam schoolchildren. BMC Public Health 2008, 8:142. BioMed Central Full Text
- [6]Dehghan M, Akhtar-Danesh N, Merchant AT: Childhood obesity, prevalence and prevention. Nutr J 2005, 4:24. BioMed Central Full Text
- [7]The WHO Global InfoBase: BMI-for-age (5–19 years). Expanded tables for constructing national health cards. http://www.who.int/growthref/who2007_bmi_for_age/en/index.html webcite
- [8]Garaulet M, Ortega FB, Ruiz JR, Rey-López JP, Béghin L, Manios Y, Cuenca-García M, Plada M, Diethelm K, Kafatos A, Molnár D, Al-Tahan J, Moreno LA: Short sleep duration is associated with increased obesity markers in European adolescents: effect of physical activity and dietary habits. The HELENA study. Int J Obes (Lond) 2011, 35:1308-1317.
- [9]Burke V, Beilin LJ, Durkin K, Stritzke WG, Houghton S, Cameron CA: Television, computer use, physical activity, diet and fatness in Australian adolescents. Int J Pediatr Obes 2006, 1:248-255.
- [10]Sisson SB, Broyles ST, Baker BL, Katzmarzyk PT: Television, reading, and computer time: correlates of school-day leisure-time sedentary behavior and relationship with overweight in children in the U.S. J Phys Act Health 2011, 8:188-197.
- [11]Rey-López JP, Vicente-Rodríguez G, Biosca M, Moreno LA: Sedentary behaviour and obesity development in children and adolescents. Nutr Metab Cardiovasc Dis 2008, 18:242-251.
- [12]Bucher Della Torre S, Akré C, Suris JC: Obesity prevention opinions of school stakeholders: a qualitative study. J Sch Health 2010, 80(Suppl 5):233-239.
- [13]Lautenschlager L, Smith C: Understanding gardening and dietary habits among youth garden program participants using the Theory of Planned Behavior. Appetite 2007, 49:122-130.
- [14]Müller MJ, Asbeck I, Mast M, Langnäse K, Grund A: Prevention of obesity - more than an intention. Concept and first results of the Kiel obesity prevention study (KOPS). Int J Obes Relat Metab Disord 2001, 251:S66-S74.
- [15]Foster GD, Sherman S, Borradaile KE, Grundy KM, Vander Veur SS, Nachmani J, Karpyn A, Kumanyika S, Shults J: A policy-based school intervention to prevent overweight and obesity. Pediatrics 2008, 121(Suppl 4):e794-e802.
- [16]Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD: Interventions for preventing obesity in children. Cochrane Database Syst Rev 2011, 7(Suppl 12):CD001871.
- [17]Harris KC, Kuramoto LK, Schulzer M, Retallack JE: Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ 2009, 180:719-726.
- [18]Brug J, te Velde SJ, Chinapaw MJ, Bere E, Bourdeaudhuij I, Moore H, Maes L, Jensen J, Manios Y, Lien N, Kleep KI, Lobstein T, Martens M, Salmon J, Singh AS: Evidence-based development of school-based and family-involved prevention of overweight across Europe: the ENERGY-project’s design and conceptual framework. BMC Public Health 2010, 10:276. BioMed Central Full Text
- [19]Giralt M, Albaladejo R, Tarro L, Moriña D, Arija V, Solà R: A primary-school-based study to reduce prevalence of childhood obesity in Catalunya (Spain) – EDAL- Educació en Alimentació: study protocol for a randomized controlled trial. Trials 2011, 12:54. BioMed Central Full Text
- [20]Wang Y, Wu Y, Wilson RF, Bleich S, Cheskin L, Weston C, Showell N, Fawole O, Lau B, Segal J: Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis [Internet]. Agency for Healthcare Research and Quality: US; 2013.
- [21]Serra Majem L, Ribas Barba L, Aranceta Bartrina J, Pérez Rodrigo C, Saavedra Santana P, Peña Quintana L: Childhood and adolescent obesity in Spain. Results of the EnKid study (1998–2000). Med Clin (Barc) 2003, 12:725-732.
- [22]Llargués E, Franco R, Recasens A, Nadal A, Vila M, Pérez JM, Martínez-Mateo F, Recasens I, Salvador G, Serra J, Castells C: Weight, dietary patterns and exercise habits in first-year primary school children: the AVall study. Endocrinol Nutr 2009, 56:287-292.
- [23]Gidding SS, Dennison BA, Birch LL, Daniels SR, Gillman MW, Lichtenstein AH, Rattay KT, Steinberger J, Stettler N, Van Horn L, American Heart Association; American Academy of Pediatrics: Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation 2006, 113(Suppl 23):e857.
- [24]Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000, 320(Suppl 7244):1240-1243.
- [25]Cole TJ, Flegal KM, Nicholls D, Jackson AA: Body mass index cut-offs to define thinness in children and adolescents: international survey. BMJ 2007, 335(Suppl 7612):194.
- [26]World Health Organization: Child Growth Standards. [http://www.who.int/childgrowth/standards/chts_wfa_boys_z/en/index.html webcite]
- [27]Llargués E, Franco R, Recasens A, Nadal A, Vila M, Pérez JM, Manresa JM, Recasens I, Salvador G, Serra J, Roure E, Castells C: Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study. J Epidemiol Community Health 2011, 65:896-901.
- [28]Jansen W, Borsboom G, Meima A, Zwanenburg EJ, Mackenbach JP, Raat H, Brug J: Effectiveness of a primary school-based intervention to reduce overweight. Int J Pediatr Obes 2011, 6(Suppl 2–2):e70-e77.
- [29]Kriemler S, Zahner L, Schindler C, Meyer U, Hartmann T, Hebestreit H, Brunner-La Rocca HP, van Mechelen W, Puder JJ: Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. BMJ 2010, 23:c785.
- [30]Wang Y, Lobstein T: Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006, 1:11-25.
- [31]Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, Laird N: Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med 1999, 153:409-418.
- [32]He C, Zhang C, Hunter DJ, Hankinson SE, Buck Louis GM, Hediger ML, Hu FB: Age at menarche and risk of type 2 diabetes: results from 2 large prospective cohort studies. Am J Epidemiol 2010, 171:334-344.
- [33]Sánchez-Cruz JJ, Jiménez-Moleón JJ, Fernández-Quesada F, Sánchez MJ: Prevalence of child and youth obesity in Spain in 2012. Rev Esp Cardiol 2013, 66(Suppl 5):371-376.
- [34]Matthews V, Wien M, Sabaté J: The risk of child and adolescent overweight is related to types of food consumed. Nutr J 2011, 10:71. BioMed Central Full Text
- [35]Yi X, Yin C, Chang M, Xiao Y: Prevalence and risk factors of obesity among school-aged children in Xi’an, China. Eur J Pediatr 2012, 171(Suppl 2):389-394.
- [36]Plachta-Danielzik S, Landsberg B, Lange D, Seiberl J, Muller MJ: Eight-year follow-up of school-based intervention on childhood overweight – the Kiel Obesity Prevention Study. Obes Facts 2011, 4:35-43.
- [37]Antonogeorgos G, Panagiotakos DB, Grigoropoulou D, Papadimitriou A, Anthracopoulos M, Nicolaidou P, Priftis KN: The mediating effect of parent’s educational status on the association between adherence to the Mediterranean diet and childhood obesity: the PANACEA study. Int J Public Health 2013, 58:401-408.