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Lamps K, Muzaffar H, Prange N, Ann Patterson J, Hein A. Qualitative Evaluation of University Students' Experience Delivering an Obesity Prevention Programme in Elementary Schools. CAN J DIET PRACT RES 2023; 84:218-225. [PMID: 36971709 DOI: 10.3148/cjdpr-2023-009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The Coordinated Approach to Child Health (CATCH) programme is an accredited obesity prevention programme in the United States, teaching children about nutrition, physical activity, and screen time limits. This study aimed to evaluate the perceptions of undergraduate and graduate student leaders' about their experience delivering the CATCH programme in elementary schools in Northern Illinois school districts during the 2019-2020 school year and its impact on their personal and professional skills and on programme participants. An email questionnaire was sent to eligible students. Grounded theory was used to analyze the students' responses. Two researchers assigned codes to the data and identified themes. Twenty-one students responded (50% response rate). Six identified themes include "purpose of CATCH programme," "school facilities and resources," "university students experience with CATCH lessons and activities," "benefits to university student," "benefits to children and teachers," and "identified weaknesses and suggested improvements to CATCH." University students delivering the CATCH programme appreciated the opportunity to practice in a real-world setting, gained transferable professional skills, increased programme content knowledge, identified CATCH programme benefits/strengths, and planned to apply lessons learned to future practice.
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Affiliation(s)
- Katherine Lamps
- Nutrition and Dietetics, Northern Illinois University, LaSalle, IL, USA
| | - Henna Muzaffar
- Nutrition and Dietetics, Northern Illinois University, LaSalle, IL, USA
| | - Nancy Prange
- Nutrition and Dietetics, Northern Illinois University, LaSalle, IL, USA
| | | | - Andrea Hein
- Nutrition and Dietetics, Northern Illinois University, LaSalle, IL, USA
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Weber SJ, Mulvaney SA, Faiola A, Brown M, Koyama T, Sun L, Goggans SL, Hull PC. Commercially Available Mobile Apps With Family Behavioral Goal Setting and Tracking for Parents: Review and Quality Evaluation. JMIR Pediatr Parent 2023; 6:e41779. [PMID: 37831486 PMCID: PMC10612003 DOI: 10.2196/41779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Goal setting and tracking are well established behavior change techniques. Little is known about the extent to which commercially available mobile apps are designed to guide parents in using these strategies, their evidence base, and their quality. OBJECTIVE This study aims to review commercially available apps that target parents in relation to setting and tracking behavioral goals for their children. The objectives were to classify the apps' general characteristics, features, evidence base, and target behaviors and assess app quality overall and separately for apps that target health-related behaviors (HRBs) and apps without a health-related behavior (WHRB). METHODS Apps were identified using keyword searches in the Apple App Store and Google Play in the United States. Apps were included if their primary purpose was to assist with setting goals, tracking goals, tracking behaviors, or giving feedback pertaining to goals for children by parents. App characteristics and common features were documented and summarized. Two reviewers assessed app quality using the Mobile App Rating Scale (MARS). Descriptive statistics summarized the MARS total score, 4 quality subscales, and 6 app-specific items that reflect the perceived impact of the app on goal setting and tracking, overall and with subgroup analysis for HRB and WHRB apps. RESULTS Of the 21 apps identified, 16 (76%) met the review criteria. Overall, 9 apps defined and targeted the following HRBs: nutrition and mealtime (6/16, 38%), physical activity and screen time (5/16, 31%), sleep (7/16, 44%), and personal hygiene (6/16, 38%). Three apps targeted specific age groups (2 apps were for children aged 6-13 years and 1 app was for children aged ≥4 years). None of the apps provided tailored assessments or guidance for goal setting. None of the apps indicated that they were intended for the involvement of a health professional or had been tested for efficacy. The MARS total score indicated moderate app quality overall (mean 3.42, SD 0.49) and ranged from 2.5 to 4.2 out of 5 points. The Habitz app ranked highest on the MARS total score among HRB apps (score=4.2), whereas Thumsters ranked highest (score=3.9) among the WHRB apps. Subgroup analysis revealed a pattern of higher quality ratings in the HRB group than the WHRB group, including the mean MARS total score (mean 3.67, SD 0.34 vs mean 3.09, SD 0.46; P=.02); the engagement and information subscales; and the app-specific items about perceived impact on knowledge, attitudes, and behavior change. CONCLUSIONS Several high-quality commercially available apps target parents to facilitate goal setting and tracking for child behavior change related to both health and nonhealth behaviors. However, the apps lack evidence of efficacy. Future research should address this gap, particularly targeting parents of young children, and consider individually tailored guided goal setting and involvement of health professionals.
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Affiliation(s)
- Summer Joy Weber
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Shelagh A Mulvaney
- School of Nursing, Vanderbilt University, Nashville, TN, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anthony Faiola
- Department of Health and Clinical Sciences, University of Kentucky, Lexington, KY, United States
| | - Madeline Brown
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lili Sun
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Pamela Carmen Hull
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
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Beets MW, Weaver RG, Ioannidis JPA, Pfledderer CD, Jones A, von Klinggraeff L, Armstrong B. Influence of pilot and small trials in meta-analyses of behavioral interventions: a meta-epidemiological study. Syst Rev 2023; 12:21. [PMID: 36803891 PMCID: PMC9938611 DOI: 10.1186/s13643-023-02184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Pilot/feasibility or studies with small sample sizes may be associated with inflated effects. This study explores the vibration of effect sizes (VoE) in meta-analyses when considering different inclusion criteria based upon sample size or pilot/feasibility status. METHODS Searches were to identify systematic reviews that conducted meta-analyses of behavioral interventions on topics related to the prevention/treatment of childhood obesity from January 2016 to October 2019. The computed summary effect sizes (ES) were extracted from each meta-analysis. Individual studies included in the meta-analyses were classified into one of the following four categories: self-identified pilot/feasibility studies or based upon sample size but not a pilot/feasibility study (N ≤ 100, N > 100, and N > 370 the upper 75th of sample size). The VoE was defined as the absolute difference (ABS) between the re-estimations of summary ES restricted to study classifications compared to the originally reported summary ES. Concordance (kappa) of statistical significance of summary ES between the four categories of studies was assessed. Fixed and random effects models and meta-regressions were estimated. Three case studies are presented to illustrate the impact of including pilot/feasibility and N ≤ 100 studies on the estimated summary ES. RESULTS A total of 1602 effect sizes, representing 145 reported summary ES, were extracted from 48 meta-analyses containing 603 unique studies (avg. 22 studies per meta-analysis, range 2-108) and included 227,217 participants. Pilot/feasibility and N ≤ 100 studies comprised 22% (0-58%) and 21% (0-83%) of studies included in the meta-analyses. Meta-regression indicated the ABS between the re-estimated and original summary ES where summary ES ranged from 0.20 to 0.46 depending on the proportion of studies comprising the original ES were either mostly small (e.g., N ≤ 100) or mostly large (N > 370). Concordance was low when removing both pilot/feasibility and N ≤ 100 studies (kappa = 0.53) and restricting analyses only to the largest studies (N > 370, kappa = 0.35), with 20% and 26% of the originally reported statistically significant ES rendered non-significant. Reanalysis of the three case study meta-analyses resulted in the re-estimated ES rendered either non-significant or half of the originally reported ES. CONCLUSIONS When meta-analyses of behavioral interventions include a substantial proportion of both pilot/feasibility and N ≤ 100 studies, summary ES can be affected markedly and should be interpreted with caution.
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Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, SC, Columbia, USA.
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, SC, Columbia, USA
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, CA, USA.,Department of Health Research and Policy, Stanford University, Stanford, CA, USA.,Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.,Department of Statistics, Stanford University, Stanford, CA, USA.,Departments of Medicine, of Health Research and Policy, of Biomedical Data Science, and of Statistics, Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | | | - Alexis Jones
- Arnold School of Public Health, University of South Carolina, SC, Columbia, USA
| | | | - Bridget Armstrong
- Arnold School of Public Health, University of South Carolina, SC, Columbia, USA
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Okonya O, Siddiqui B, George D, Fugate C, Hartwell M, Vassar M. Use of behavioural change taxonomies in systematic reviews and meta-analyses regarding obesity management. Clin Obes 2023; 13:e12574. [PMID: 36515291 DOI: 10.1111/cob.12574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/15/2022] [Accepted: 11/13/2022] [Indexed: 12/15/2022]
Abstract
We investigated the prevalence of behavioural change taxonomies in systematic reviews and meta-analyses related to obesity management. In addition, we analysed the funding sources, author conflicts of interest statements, risk of bias, and favorability of the results in such studies to determine if there was a relationship between methodological quality and taxonomy use. We searched several databases including MEDLINE, Epistemonikos, Cochrane EDSR, Pubmed and Embase for systematic reviews and meta-analyses regarding the behavioural treatment of obesity. Screening and data extraction was performed in a masked, duplicate fashion. We performed statistical analyses to determine any significant association between use of taxonomy and study characteristics. Fifteen (of 186; 8.06%) systematic reviews used a taxonomy-nine used the BCTTv1, three used OXFAB, two used the CALO-RE and one used "Taxonomy of choice architecture techniques." Most interventions that referenced a taxonomy were self-mediated (6/60, 10%). Behavioural change taxonomies were mentioned in 10 (of 87, 11.49%) studies with a public funding source. Of the studies with favourable results, 14 studies (of 181, 7.73%) referred to a taxonomy. We found no statistically significant relationships between use of taxonomy and study characteristics. We found that systematic reviews regarding the management of obesity rarely mention a behavioural change taxonomy. Given the global burden of obesity, it is crucial that behavioural change techniques are reproducible and translatable. We recommend that researchers look further into how taxonomies affect the quality and reproducibility of behavioural interventions in an effort to improve patient outcomes.
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Affiliation(s)
- Ochije Okonya
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Bilal Siddiqui
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - David George
- Department of Pediatrics, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Colony Fugate
- Department of Pediatrics, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Cardozo NDO, Crisp AH, Pinheiro Fernandes AC, Trude ACB, Araneda-Flores J, Oliveira MRMD. Ambiente alimentar e excesso de peso em escolares: uma revisão sistemática sul-americana. Rev Panam Salud Publica 2022; 46:e164. [PMID: 36320205 PMCID: PMC9595220 DOI: 10.26633/rpsp.2022.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Objetivo. Identificar e compilar os achados de estudos observacionais que analisaram a relação de fatores do ambiente alimentar escolar e individuais de consumo na escola com excesso de peso em escolares da América do Sul no período de 2011 a 2021. Métodos. A pesquisa foi realizada em cinco bases de dados (PubMed, Web of Science, SciELO, Scopus e LILACS) e no Google Scholar, além de consulta a especialistas. Foram selecionados estudos observacionais com escolares de 5 a 19 anos, realizados na América do Sul, que usaram medidas objetivas para avaliar excesso de peso, como o índice de massa corporal (Organização Mundial da Saúde e/ou International Obesity Task Force), em associação a fatores do ambiente alimentar escolar e individuais de consumo na escola. O protocolo foi registrado na plataforma PROSPERO (CRD42020212383). Resultados. Dos 906 registros identificados, 13 estudos transversais (um da Argentina, um do Equador e 11 do Brasil) foram incluídos na revisão. As prevalências variaram de 7,5% a 32,5% para sobrepeso e 1,7% a 28,0% para obesidade. Fatores do ambiente alimentar escolar, dos domínios político e físico (como educação alimentar e nutricional insatisfatória e indisponibilidade de refeições preparadas na escola) se associaram com maiores prevalências de excesso de peso. Fatores individuais relacionados à adesão ao programa de alimentação escolar (como consumo da alimentação oferecida pela escola ao invés de lanche trazido de casa) se associaram a menores prevalências de excesso de peso. Conclusões. São escassos os estudos sul-americanos enfocando a associação entre fatores do ambiente alimentar escolar e/ou individuais e excesso de peso em escolares. As evidências restritas a contextos locais ou regionais incentivam novos estudos de abrangência nacional.
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Affiliation(s)
- Najla de Oliveira Cardozo
- Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas, Programa de Pós-Graduação de Alimentos e Nutrição, Araraquara (SP), Brasil
| | - Alex Harley Crisp
- Universidade Metodista de Piracicaba, Programa de Pós-Graduação em Ciências do Movimento Humano, Piracicaba (SP), Brasil
| | | | | | | | - Maria Rita Marques de Oliveira
- Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas, Programa de Pós-Graduação de Alimentos e Nutrição, Araraquara (SP), Brasil
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Seneviratne SN, Rajindrajith S. Fetal programming of obesity and type 2 diabetes. World J Diabetes 2022; 13:482-497. [PMID: 36051425 PMCID: PMC9329845 DOI: 10.4239/wjd.v13.i7.482] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/18/2021] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
The prevalence of obesity and type 2 diabetes mellitus has increased rapidly over the past few decades, and prevention efforts have not been successful. Fetal programming involves the earliest stage of obesity development, and provides a novel concept to complement other strategies for lifelong prevention of obesity and type 2 diabetes mellitus. The World Health Organization now advocates a life-course approach to prevent/control obesity, starting with pre-conceptional and antenatal maternal health. Maternal overnutrition, gestational diabetes mellitus and excessive gestational weight gain lead to fetal overgrowth, and “programs” the offspring with an increased risk of obesity and type 2 diabetes mellitus in childhood and adulthood. This review summarizes current data on fetal programming of obesity and type 2 diabetes mellitus including potential causative factors, mechanisms and interventions to reduce its impact.
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Affiliation(s)
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 08, Sri Lanka
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Reschke F, Galuschka L, Landsberg S, Weiner C, Guntermann C, Sadeghian E, Lange K, Danne T. Successful telehealth transformation of a pediatric outpatient obesity teaching program due to the COVID-19 pandemic - the "Video KiCK" program. J Pediatr Endocrinol Metab 2022; 35:803-812. [PMID: 35575788 DOI: 10.1515/jpem-2022-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate if digital approaches can ameliorate the known consequences of social-distancing restrictions in the context of the global COVID-19 pandemic for adolescent participants originally registered for a face-to-face outpatient weight regulation program and whether video-based multiprofessional outpatient obesity therapy is successful for a group of adolescents with preexisting obesity. METHODS The certified KiCK outpatient training program for children and adolescents with overweight and obesity was remodeled as a consequence of the lockdown traditional face-to-face program to a completely digital and video-based format on short notice. The virtual approach was compared with the results of the conventional program regarding metabolic parameters, body mass index standard deviation score (BMI SDS), well-being, and physical fitness. RESULTS Sixty-nine of 77 enrolled participants for KiCK (age 8 to 17 years, BMI z score >2.0) were able and willing to participate virtually. After the first lockdown significant improvements of BMI SDS (mean 0.18; p=0.02), homeostasis model assessment (HOMA) index (mean 1.4; p=0.016), triglycerides (mean 0.18 mmol/dL; p=0.021), 6 minute-walk-test (mean 97.0 m; p=0.030, and well-being according to the World Health Organization 5 (WHO-5) questionnaire (mean 2.5; p=0.002) were found after the virtual intervention, which was comparable to the results observed previously in matched pairs data from the program during the pre-COVID period. After the end of the second lockdown weight SDS, BMI SDS, HOMA INDEX, and cholesterol were also measured reduced compared to baseline parameters measured before program initiation. Walking distance in the 6 MWT and improvement in general well-being in the WHO-5 questionnaire also persisted. CONCLUSIONS These results indicate good acceptance and efficacy of the video-intervention for youth with overweight and obesity during the lockdown, supporting the use of virtual modules in future programs after the pandemic.
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Affiliation(s)
- Felix Reschke
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Laura Galuschka
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Sarah Landsberg
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Chantal Weiner
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Cathrin Guntermann
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Evelin Sadeghian
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Karin Lange
- Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Thomas Danne
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
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Jensterle M, Janež A. Glucagon-Like Peptide-1 Receptor Agonists in the Treatment of Obesity. Horm Res Paediatr 2021; 96:599-608. [PMID: 34852347 DOI: 10.1159/000521264] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity treatment based on glucagon-like peptide-1 receptor agonists (GLP-1 RAs) proved to limit morbidity and mortality in adult population. In children, optimizing lifestyle intervention (LSI) and reducing culpable environmental exposures represent the mainstay strategy for obesity prevention and management. However, there remains a subset of children and adolescents whose obesity is resistant to lifestyle approach. For these poor responders, the need for safe and effective weight-reducing agents is apparent. The purpose of this review is to provide an overview of the efficacy and safety of approved GLP-1 RA in the management of adult and pediatric obesity. SUMMARY We presented the main outcomes of clinical trial programs called SCALE and STEP that supported a market authorization approval for liraglutide and semaglutide for the treatment of obesity in adult population. Then, we summarized the studies on the efficacy of GLP-1 RA in pediatric obesity that have been accumulating from 2 larger studies with liraglutide and few other smaller studies with exenatide and liraglutide. The results indicate that GLP-1 RA is safe, tolerable, and effective in reducing weight and also in improving cardiometabolic profile in children with obesity and poor response to LSI alone. At present, liraglutide is the first and so far the only GLP-1 RA that received FDA approval in 2020 for use in children aged 12-17 years with obesity. New trials including semaglutide for pediatric obesity are ongoing. KEY MESSAGES There is a strong interest in current use and further development of obesity treatments based on glucagon-like peptide-1 (GLP-1) agonism. In adolescents with obesity, who are poor responders to lifestyle approach, the use of GLP-1 RA as an adjunct to LSI is effective and safe. Due to limited experience, a general recommendation is to prioritize long acting over short acting GLP-1 RA because they are approved for the treatment of obesity and have better tolerability, safety, and treatment response effect. In the future research, more high-grade evidence including novel iterations of GLP-1 agonism and long-term follow-ups are needed in pediatric population.
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Affiliation(s)
- Mojca Jensterle
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Janež
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Parent Involvement in Diet or Physical Activity Interventions to Treat or Prevent Childhood Obesity: An Umbrella Review. Nutrients 2021; 13:nu13093227. [PMID: 34579099 PMCID: PMC8464903 DOI: 10.3390/nu13093227] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/17/2022] Open
Abstract
Parents substantially influence children’s diet and physical activity behaviors, which consequently impact childhood obesity risk. Given this influence of parents, the objective of this umbrella review was to synthesize evidence on effects of parent involvement in diet and physical activity treatment and prevention interventions on obesity risk among children aged 3–12 years old. Ovid/MEDLINE, Elsevier/Embase, Wiley/Cochrane Library, Clarivate/Web of Science, EBSCO/CINAHL, EBSCO/PsycInfo, and Epistemonikos.org were searched from their inception through January 2020. Abstract screening, full-text review, quality assessment, and data extraction were conducted independently by at least two authors. Systematic reviews and meta-analyses of diet and physical activity interventions that described parent involvement, included a comparator/control, and measured child weight/weight status as a primary outcome among children aged 3–12 years old were included. Data were extracted at the level of the systematic review/meta-analysis, and findings were narratively synthesized. Of 4158 references identified, 14 systematic reviews and/or meta-analyses (eight treatment focused and six prevention focused) were included and ranged in quality from very low to very high. Our findings support the inclusion of a parent component in both treatment and prevention interventions to improve child weight/weight status outcomes. Of note, all prevention-focused reviews included a school-based component. Evidence to define optimal parent involvement type and duration and to define the best methods of involving parents across multiple environments (e.g., home, preschool, school) was inadequate and warrants further research. PROSPERO registration: CRD42018095360.
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Elinder LS, Wiklund CA, Norman Å, Stattin NS, Andermo S, Patterson E, Hemmingsson E, Cook C, Raposo S, Kwak L. IMplementation and evaluation of the school-based family support PRogram a Healthy School Start to promote child health and prevent OVErweight and obesity (IMPROVE) - study protocol for a cluster-randomized trial. BMC Public Health 2021; 21:1630. [PMID: 34488691 PMCID: PMC8419825 DOI: 10.1186/s12889-021-11663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background IMPROVE aims to conduct a hybrid type 3 evaluation design to test the effectiveness of bundled implementation strategies on intervention fidelity of the Healthy School Start (HSS) program, while simultaneously monitoring effects on health outcomes of children and parents. The HSS is a 4-component family support program for children starting school (5–7 years of age) promoting healthy dietary habits and physical activity in the home environment to prevent childhood obesity and parents’ risk of developing type 2 diabetes. Methods IMPROVE is a cluster-randomized controlled trial with two arms to evaluate and compare the effects of two different bundles of implementation strategies on intervention fidelity expressed as adherence and responsiveness at 12 and 24 months (primary outcomes). Thirty schools in two municipalities will participate in the study reaching about 1400 families per school year. In stakeholder workshops, key implementation determinants were identified according to the domains of the Consolidated Framework for Implementation Research. Through a consensus process with stakeholders, two bundles of implementation strategies were tailored to address context-specific determinants. Schools randomly assigned to group 1 will receive bundle 1 (Basic) and group 2 will receive bundle 1 + 2 (Enhanced). Bundle 2 consists of external facilitation, fidelity monitoring and feedback strategies. Secondary outcomes will include change in acceptability, appropriateness, feasibility, and organisational readiness as perceived by school staff. In addition, child weight status and diet, and parents’ feeding practices and risk of type 2 diabetes will be monitored. Linear and ordinal regression analysis will be used to test the effect on the primary and secondary outcomes, taking clustering and covariates into consideration where needed. Process evaluation will be conducted through key stakeholder interviews to investigate experiences of the program and perceptions on sustainability. Discussion This systematic approach to investigating the effectiveness of two different bundles of implementation strategies tailored to context-specific determinants on the fidelity of the HSS intervention will provide new insight into feasible implementation strategies and external support needed for the HSS to be effective and sustainable. Results will help inform how to bridge the gap between the research on school-based health programs and routine practice in schools. Trial registration Registered prospectively at ClinicalTrials.gov ID: NCT04984421, registered July 30, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11663-2.
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Affiliation(s)
- Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Centre for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Sweden.
| | - Camilla A Wiklund
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Åsa Norman
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Clinical Neurosciences, Karolinska Institutet, SE-171 65, Solna, Sweden
| | - Nouha Saleh Stattin
- Academic Primary Healthcare Centre, Region Stockholm, SE-113 65, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| | - Susanne Andermo
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 83, Huddinge, Sweden
| | - Emma Patterson
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Erik Hemmingsson
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences, SE-114 68, Stockholm, Sweden
| | - Clayton Cook
- Department of Organizational Leadership and Policy Development, University of Minnesota, Minneapolis, MN, 55, USA
| | - Sara Raposo
- Department of Global Public Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Sweden
| | - Lydia Kwak
- Institute for Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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11
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Ryan PM, Seltzer S, Hayward NE, Rodriguez DA, Sless RT, Hawkes CP. Safety and Efficacy of Glucagon-Like Peptide-1 Receptor Agonists in Children and Adolescents with Obesity: A Meta-Analysis. J Pediatr 2021; 236:137-147.e13. [PMID: 33984333 DOI: 10.1016/j.jpeds.2021.05.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To determine the weight, body mass index (BMI), cardiometabolic, and gastrointestinal effects of glucagon-like peptide-1 (GLP-1) receptor agonists in children with obesity. STUDY DESIGN Web of Science, PubMed/MEDLINE, and Scopus databases from 01/01/1994-01/01/2021 for randomized control trials examining the weight, BMI, cardiometabolic, or gastrointestinal effects of GLP-1 receptor agonists in children and adolescents with obesity. Data were extracted by 2 independent surveyors and a random effects model was applied to meta-analyze generic inverse variance outcomes. Primary outcomes were related to weight and cardiometabolic profile, and secondary outcomes of interest were gastrointestinal-related treatment-emergent adverse events. RESULTS Nine studies involving 574 participants were identified, of which 3 involved exenatide and 6 involved liraglutide. GLP-1 receptor agonists use caused a modest reduction in body weight (mean difference [MD] -1.50 [-2.50,-0.50] kg, I2 64%), BMI (MD -1.24 [-1.71,-0.77] kg/m2, I2 0%), and BMI z score (MD -0.14 [-0.23,-0.06], I2 43%). Glycemic control was improved in children with proven insulin resistance (glycated hemoglobin A1c MD -1.05 [-1.93,-0.18] %, I2 76%). Although no lipid profile improvements were noted, a modest decrease in systolic blood pressure was detected (MD -2.30 [-4.11,-0.49] mm Hg; I2 0%). Finally, analysis of gastrointestinal-related treatment-emergent adverse events revealed an increased risk of nausea (risk ratio 2.11 [1.44, 3.09]; I2 0%), without significant increases in other gastrointestinal symptoms. CONCLUSIONS This meta-analysis indicates that GLP-1 receptor agonists are safe and effective in modestly reducing weight, BMI, glycated hemoglobin A1c, and systolic blood pressure in children and adolescents with obesity in a clinical setting, albeit with increased rates of nausea. PROSPERO ID CRD42020195869.
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Affiliation(s)
- Paul M Ryan
- Department of Pediatrics and Child Health, University College Cork, Cork, Ireland.
| | - Sean Seltzer
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | | | | | - Ryan T Sless
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colin P Hawkes
- Department of Pediatrics and Child Health, University College Cork, Cork, Ireland; Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, PA
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12
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Calcaterra V, Verduci E, Pascuzzi MC, Magenes VC, Fiore G, Di Profio E, Tenuta E, Bosetti A, Todisco CF, D'Auria E, Zuccotti G. Metabolic Derangement in Pediatric Patient with Obesity: The Role of Ketogenic Diet as Therapeutic Tool. Nutrients 2021; 13:2805. [PMID: 34444964 PMCID: PMC8400548 DOI: 10.3390/nu13082805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/22/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
Obesity is defined as a condition characterized by an excessive fat accumulation that has negative health consequences. Pediatric obesity is associated with an increased risk for many diseases, including impaired glycemic and lipidic control that may lead to the development of chronic, and potentially disabling, pathologies, such as type 2 diabetes mellitus (T2DM) and cardiovascular events, in adult life. The therapeutic strategy initially starts with interventions that are aimed at changing lifestyle and eating behavior, to prevent, manage, and potentially reverse metabolic disorders. Recently, the ketogenic diet (KD) has been proposed as a promising dietary intervention for the treatment of metabolic and cardiovascular risk factors related to obesity in adults, and a possible beneficial role has also been proposed in children. KD is very low in carbohydrate, high in fat, and moderate to high in protein that may have the potential to promote weight loss and improve lipidic derangement, glycemic control, and insulin sensitivity. In this review, we present metabolic disorders on glycemic and lipidic control in children and adolescents with obesity and indication of KD in pediatrics, discussing the role of KD as a therapeutic tool for metabolic derangement. The results of this review may suggest the validity of KD and the need to further research its potential to address metabolic risk factors in pediatric obesity.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Elvira Verduci
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Health Sciences, University of Milano, 20142 Milano, Italy
| | - Martina Chiara Pascuzzi
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Vittoria Carlotta Magenes
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Giulia Fiore
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Health Sciences, University of Milano, 20142 Milano, Italy
| | - Elisabetta Di Profio
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Elisavietta Tenuta
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Alessandra Bosetti
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
| | - Carolina Federica Todisco
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Enza D'Auria
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, "Vittore Buzzi" Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science "L. Sacco", University of Milan, 20157 Milan, Italy
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13
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Allender S, Orellana L, Crooks N, Bolton KA, Fraser P, Brown AD, Le H, Lowe J, de la Haye K, Millar L, Moodie M, Swinburn B, Bell C, Strugnell C. Four-Year Behavioral, Health-Related Quality of Life, and BMI Outcomes from a Cluster Randomized Whole of Systems Trial of Prevention Strategies for Childhood Obesity. Obesity (Silver Spring) 2021; 29:1022-1035. [PMID: 33950583 PMCID: PMC8251751 DOI: 10.1002/oby.23130] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to test the effectiveness of the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS Childhood Obesity) for behavioral, health-related quality of life (HRQoL), and BMI outcomes. METHODS This was a cluster randomized trial of 10 communities randomly allocated (1:1) to start intervention in 2015 (step 1) or in 2019 (after 4 years) in South West Victoria, Australia. Data were collected from participating primary schools in April to June of 2015 (73% school participation rate), 2017 (69%), and 2019 (63%). Student participation rates were 80% in 2015 (1,792/2,516 invited), 81% in 2017 (2,411/2,963), and 79% in 2019 (2,177/2,720). Repeat cross-sectional analyses of measured height and weight (grades two, four, and six [aged approximately 7 to 12 years]), self-reported behavior, and HRQoL (grades four and six) were conducted. RESULTS There was an intervention by time interaction in BMI z scores (P = 0.031) and obesity/overweight prevalence (P = 0.006). BMI z score and overweight/obesity prevalence decreased between 2015 and 2017 and increased between 2017 and 2019 in intervention communities. The intervention significantly reduced takeaway food consumption (P = 0.034) and improved physical (P = 0.019), psychosocial (P = 0.026), and global (P = 0.012) HRQoL. Water consumption increased among girls (P = 0.033) in the intervention communities, as did energy-dense, nutrient-poor snack consumption among boys (P = 0.006). CONCLUSIONS WHO STOPS had a positive impact on takeaway food intake and HRQoL.
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Affiliation(s)
- Steven Allender
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Liliana Orellana
- Faculty of HealthBiostatistics UnitDeakin UniversityGeelongVictoriaAustralia
| | - Nic Crooks
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Kristy A. Bolton
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Penny Fraser
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Andrew Dwight Brown
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Ha Le
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
- Faculty of Health, Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Janette Lowe
- Southern Grampians and Glenelg Primary Care PartnershipHamiltonVictoriaAustralia
| | - Kayla de la Haye
- Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Lynne Millar
- School of Public HealthCurtin UniversityPerthWestern AustraliaAustralia
| | - Marjorie Moodie
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
- Faculty of Health, Deakin Health EconomicsInstitute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Boyd Swinburn
- School of Population HealthUniversity of AucklandAucklandNew Zealand
| | - Colin Bell
- Faculty of Health, School of MedicineDeakin UniversityGeelongVictoriaAustralia
| | - Claudia Strugnell
- Faculty of Health, Global Obesity Centre (GLOBE)Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
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Nury E, Morze J, Grummich K, Rücker G, Hoffmann G, Angele CM, Steinacker JM, Conrad J, Schmid D, Meerpohl JJ, Schwingshackl L. Effects of nutrition intervention strategies in the primary prevention of overweight and obesity in school settings: a protocol for a systematic review and network meta-analysis. Syst Rev 2021; 10:122. [PMID: 33888162 PMCID: PMC8063346 DOI: 10.1186/s13643-021-01661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Overweight and obesity in children and adolescents are major public health challenges affecting quality of life and representing important risk factors in the development of non-communicable diseases. School environments provide great possibilities for the primary prevention of overweight and obesity and different school-based nutrition interventions are available. However, existing research on school-based nutrition interventions has important limitations and no network meta-analysis (NMA) has been performed yet to compare all available interventions. Therefore, the present research project aims to investigate the impact of different nutrition interventions in the school setting by comparing and ranking them using NMA methodology. METHODS/DESIGN A systematic literature search will be performed in 11 electronic databases (PubMed, the Cochrane Library, Web of Science, ERIC, PsycINFO, CAB Abstracts, Campbell Library, BiblioMap EPPI, Australian Education Index, Joanna Briggs Institute Evidence-Based Practice Database and Practice-based Evidence in Nutrition Database). Parallel or cluster randomized controlled trials (RCTs) meeting the following criteria will be included: (1) generally healthy school students aged 4-18 years, (2) school-based intervention with ≥ 1 nutrition component, and (3) assessed anthropometric (overweight/obesity risk, body weight change, weight Z-score, [standardized] body mass index, body fat, waist circumference) and/or diet-quality measures (daily intake of fruits and vegetables, fat, and sugar-sweetened beverages). Random effects pairwise and NMA will be performed for these outcomes and surface under the cumulative ranking curve (SUCRA) estimated (P-score). Where possible, component NMA (CNMA) will be used additionally. Subgroup analyses are carried out for intervention duration, gender, age of school students, socioeconomic status, and geographical location, and sensitivity analyses by excluding high risk of bias RCTs. DISCUSSION This systematic review and NMA will be the first to both directly and indirectly compare and rank different school-based nutrition interventions for the primary prevention of overweight and obesity in childhood and adolescence. Our analyses will provide important insights about the effects of the different interventions and show which are the most promising. The results of our study can help inform the design of new studies and will be of value to anyone interested in developing successful, evidence-based nutrition interventions in school settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020220451 .
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Affiliation(s)
- Edris Nury
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakub Morze
- Department of Cardiology and Internal Diseases, University of Warmia and Mazury, Olsztyn, Poland
- Department of Human Nutrition, University of Warmia and Mazury, Olsztyn, Poland
| | - Kathrin Grummich
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany Foundation, Cochrane Germany, Freiburg, Germany
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Hoffmann
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - Claudia M. Angele
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
- Centre for Teacher Education, University of Vienna, Vienna, Austria
| | - Jürgen M. Steinacker
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Johanna Conrad
- Science Department, German Nutrition Society, Bonn, Germany
| | - Daniela Schmid
- Division for Quantitative Methods in Public Health and Health Services Research, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Jörg J. Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany Foundation, Cochrane Germany, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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15
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Rozga M, Handu D. Current Systems-Level Evidence on Nutrition Interventions to Prevent and Treat Cardiometabolic Risk in the Pediatric Population: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2021; 121:2501-2523. [PMID: 33495106 DOI: 10.1016/j.jand.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
Improving and maintaining cardiometabolic health remains a major focus of health efforts for the pediatric population. Recent research contributes understanding of the systems-level nutrition factors influencing cardiometabolic health in pediatric individuals. This scoping review examines current evidence on interventions and exposures influencing pediatric cardiometabolic health to inform registered dietitian nutritionists working at each systems level, ranging from individual counseling to public policy. A literature search of MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, and other databases was conducted to identify evidence-based practice guidelines, systematic reviews, and position statements published in English from January 2017 until April 2020. Included studies addressed nutrition interventions or longitudinal exposures for participants 2 to 17 years of age who were healthy or had cardiometabolic risk factors. Studies were categorized according level of the social-ecological framework addressed. The databases and hand searches identified 2614 individual articles, and 169 articles were included in this scoping review, including 6 evidence-based practice guidelines, 141 systematic reviews, and 22 organization position statements. The highest density of systematic reviews focused on the effects of dietary intake (n = 58) and interventions with an individual child or family through counseling or education (n = 54). The least frequently examined levels of interventions or exposures were at the policy level (n = 12). Registered dietitian nutritionists can leverage this considerable body of recent systematic reviews to inform a systems-level, collaborative approach to prevention and treatment of pediatric cardiometabolic risk factors.
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16
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Chau S, Oldman S, Smith SR, Lin CA, Ali S, Duffy VB. Online Behavioral Screener with Tailored Obesity Prevention Messages: Application to a Pediatric Clinical Setting. Nutrients 2021; 13:nu13010223. [PMID: 33466705 PMCID: PMC7828782 DOI: 10.3390/nu13010223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/18/2022] Open
Abstract
Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children’s health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated. Each reported the child’s activity and behaviors using the online PALS and received two to three messages tailored to the responses (aligned with elaboration likelihood and transtheoretical models) to motivate behavioral improvements or reinforce healthy behaviors. Most children and parents (>90%) agreed the PALS was easy to complete, encouraging thought about their own/child’s behaviors. The child’s PALS responses appeared reasonable (fair-to-good child–parent intraclass correlations). Most children and parents (≥75%) reported the tailored messages to be helpful and favorable for improving or maintaining the targeted behavior. Neither message type (motivating/reinforcing) nor favorability responses varied significantly by the child’s weight or family’s food security status. In summary, children and parents found the PALS with tailored messages acceptable and useful. The message types and responses could help focus brief clinical encounters.
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Affiliation(s)
- Sarah Chau
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Samantha Oldman
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Sharon R. Smith
- CT Children’s Medical Center, University of CT School of Medicine, Hartford, CT 06269-1101, USA;
| | - Carolyn A. Lin
- Communications Department, University of CT, Storrs, CT 06269-1101, USA;
| | - Saba Ali
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
| | - Valerie B. Duffy
- Department of Allied Health Sciences, University of CT, Storrs, CT 06269-1101, USA; (S.C.); (S.O.); (S.A.)
- Correspondence: ; Tel.: +1-860-486-1997
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17
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Gallardo-Escribano C, Vargas-Candela A, Vilches-Perez A, Muñoz-Melero M, Ruiz-Moreno MI, Benitez-Porres J, Romance-Garcia AR, Rodriguez-Ortega R, Rosa-López A, Rosales-Jaime A, Diaz-Ruiz J, Tinahones FJ, Gómez-Huelgas R, Bernal-Lopez MR. Lifestyle Modification Improves Insulin Resistance and Carotid Intima-Media Thickness in a Metabolically Healthy Obese Prepubescent Population. J Pediatr Gastroenterol Nutr 2021; 72:127-134. [PMID: 32804905 DOI: 10.1097/mpg.0000000000002901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of this study was to analyze effects of a 12-month lifestyle modification that involved a Mediterranean diet (MedDiet) and physical activity (PA) program in a population of metabolically healthy obese children (MHOCh). METHODS We included a population of MHOCh with ≤1 of the following criteria: waist circumference and blood pressure ≥90 percentile, triglycerides >150 mg/dL, high-density lipoprotein-cholesterol (HDL-c) <40 mg/dL, or impaired fasting glucose. After 12 months of intensive lifestyle modification, anthropometric measurements, glycemic and lipid profiles, adherence to the MedDiet, energy intake, PA, body composition, and carotid intima-media thickness (cIMT) were analyzed. RESULTS One hundred thirty-one MHOCh (70 boys and 61 girls; P = 0.65, age: 7.9 ± 1.3 years, body mass index [BMI]: 24.7 ± 3.5 kg/m2) were included. After 12 months of intervention, a significant decrease in standard deviation (SD) units of body weight (-0.5 ± 0.1; P < 0.001) and BMI (-0.5 ± 0.1; P < 0.001) were observed in the total population. A significant improvement in adherence to the MedDiet (+2 points) and a significant reduction in protein, fatty acids, total fat, and cholesterol intake in the entire population were observed. All participants did more moderate-vigorous PA, which led to a significant increase in lean and total mass and decrease in total fat. Significant improvements in the glycemic profile (insulin levels [-6.6 μIU/mL, P < 0.001] and HOMA index [-1.2, P < 0.001]) were observed. Participants with pathological cIMT values reduced this cardiovascular predictor to normal values. CONCLUSIONS A 12-month lifestyle modification intervention involving weight loss with MedDiet and PA in MHOCh yielded improvements in MedDiet adherence, lipid intake, moderate-vigorous PA, body composition, insulin resistance, and cIMT.
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Affiliation(s)
| | - Antonio Vargas-Candela
- Internal Medicine Department, Instituto de Investigacion Biomedica de Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga
| | - Alberto Vilches-Perez
- Endocrinology and Nutrition Department, Instituto de Investigacion Biomedica de Malaga (IBIMA), University Hospital Virgen de la Victoria
| | - Maite Muñoz-Melero
- Internal Medicine Department, Instituto de Investigacion Biomedica de Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga
| | - M Isabel Ruiz-Moreno
- Internal Medicine Department, Instituto de Investigacion Biomedica de Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga
| | - Javier Benitez-Porres
- Department of Human Physiology, Physical Education and Sports, Faculty of Medicine, University of Malaga
| | - Angel Ramon Romance-Garcia
- Biodynamic and Body Composition Laboratory, Department of Didactics of Language, Arts, and Sport, University of Malaga
| | | | - Andrés Rosa-López
- Pediatric Radiology Department, Regional University Hospital of Malaga, Spain
| | | | | | - Francisco J Tinahones
- Endocrinology and Nutrition Department, Instituto de Investigacion Biomedica de Malaga (IBIMA), University Hospital Virgen de la Victoria
- Cartama Estacion Health Center, Malaga
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Instituto de Investigacion Biomedica de Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga
- CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain
| | - M Rosa Bernal-Lopez
- Internal Medicine Department, Instituto de Investigacion Biomedica de Malaga (IBIMA), Regional University Hospital of Malaga, University of Malaga
- CIBER Pathophysiology of Obesity and Nutrition, Carlos III Health Institute, Madrid, Spain
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18
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Shorey S, Chan V. Effectiveness of healthy eating interventions among children: A quantitative systematic review. J Adv Nurs 2020; 77:583-594. [PMID: 33068061 DOI: 10.1111/jan.14606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Abstract
AIMS This review aimed to evaluate the effectiveness of healthy eating interventions among normal-weight children. DESIGN A systematic review of randomized controlled trials. DATA SOURCES Seven databases were searched from the inception of each database until September 2019. REVIEW METHODS A systematic review of quantitative studies was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA extension for reporting a synthesis without a meta-analysis. RESULTS Fifteen studies were included in this review. A meta-analysis could not be conducted because of the observed heterogeneity across studies. There were mixed effects of the included interventions on healthy eating habits, ranging from effective to not effective. Only a few studies found behavioural determinants effective in enhancing healthy eating. CONCLUSION Because of the observed heterogeneity and varied outcome variables, a meta-analysis could not be conducted, and the overall effectiveness of the included interventions could not be verified. Interventions that were theory based, parent focused, and delivered through the multimodal interactive approach were found to be effective in enhancing healthy eating habits among children. More studies involving peers that are institution based need to be conducted.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Valerie Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
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Anselma M, Chinapaw MJM, Kornet-van der Aa DA, Altenburg TM. Effectiveness and promising behavior change techniques of interventions targeting energy balance related behaviors in children from lower socioeconomic environments: A systematic review. PLoS One 2020; 15:e0237969. [PMID: 32870928 PMCID: PMC7462275 DOI: 10.1371/journal.pone.0237969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/06/2020] [Indexed: 01/22/2023] Open
Abstract
This systematic review aims to summarize the evidence regarding the effectiveness of interventions targeting energy balance-related behaviors in children from lower socioeconomic environments and the applied behavior change techniques. The literature search was conducted in Cochrane, Embase, Psycinfo and Pubmed. Articles had to be published between January 2000 and September 2019. Studies were included that i) targeted dietary behavior, physical activity and/or sedentary behavior; ii) had a controlled trial design; iii) included children aged 9–12 years old; iv) focused on lower socioeconomic environments; and v) took place in upper-middle or high income countries. Two independent researchers extracted data, identified behavior change techniques using the Behavior Change Technique Taxonomy v1, and performed a methodological quality assessment using the quality assessment tool of the Effective Public Health Practice Project. We included 24 studies, of which one received a high and three a moderate quality rating. Demonstration, practice and providing instructions on how to perform a behavior were the most commonly applied behavior change techniques. Seven studies reported significant beneficial intervention effects: five on physical activity, one on physical activity and sedentary behavior and one on dietary behavior. When comparing effective versus non-effective interventions, and comparing our review to previous reviews focusing on children from the general population, similar behavior change techniques were applied. More high quality research is needed to evaluate the effectiveness of interventions and their behavior change techniques targeting children of low socioeconomic environments. PROSPERO registration number: CRD42016052599
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Affiliation(s)
- Manou Anselma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Mai J. M. Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniëlle A. Kornet-van der Aa
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Teatske M. Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Jurado-Castro JM, Gil-Campos M, Gonzalez-Gonzalez H, Llorente-Cantarero FJ. Evaluation of Physical Activity and Lifestyle Interventions Focused on School Children with Obesity Using Accelerometry: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176031. [PMID: 32825085 PMCID: PMC7503305 DOI: 10.3390/ijerph17176031] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 01/11/2023]
Abstract
Despite the existence of global recommendations for physical activity and lifestyle to avoid childhood obesity, there are no specific recommendations for school-age children. The aim of this meta-analysis was to measure the effects of current interventions with a physical activity component on body mass index (BMI) Z-score and on the moderate and vigorous physical activity (MVPA) time, measured by accelerometry, and focused on children with obesity. Randomized controlled trial studies (RCTs) based on physical activity interventions focused on children with obesity (6 to 12 years old) from January 1991 to August 2018 were included. The post-intervention mean and standard deviation of the BMI Z-score and MVPA engaged time were extracted to calculate the results using random effects models. Of a total of 229 studies considered potentially eligible, only 10 RCTs met the inclusion criteria. There were improvements in the BMI Z-score for physical activity intervention groups, compared with non-intervention children in addition to a significant increase in time engaged in MVPA. In conclusion, interventions with a physical activity component in school-children with obesity seem to be effective at reducing BMI and producing an increase in time spent engaged in physical activity. Therefore, interventions based on physical activity should be considered one of the main strategies in treating childhood obesity.
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Affiliation(s)
- Jose Manuel Jurado-Castro
- Metabolism and Investigation Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain; (J.M.J.-C.); (F.J.L.-C.)
| | - Mercedes Gil-Campos
- Metabolism and Investigation Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain; (J.M.J.-C.); (F.J.L.-C.)
- CIBEROBN, (Physiopathology of Obesity and Nutrition), Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- Unit of Metabolism and Pediatric Research, Reina Sofia University Hospital, 14004 Córdoba, Spain
- Correspondence: ; Tel.: +34-9577-36467
| | | | - Francisco Jesus Llorente-Cantarero
- Metabolism and Investigation Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain; (J.M.J.-C.); (F.J.L.-C.)
- CIBEROBN, (Physiopathology of Obesity and Nutrition), Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- Department of Specific Didactics, Faculty of Education, University of Cordoba, 14071 Córdoba, Spain
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21
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Pan HJ, Hung LJ, Chen CY. Effect of class-based lifestyle intervention on the management of childhood obesity. Obes Res Clin Pract 2020; 14:184-190. [PMID: 32381350 DOI: 10.1016/j.orcp.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/31/2019] [Accepted: 03/24/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Childhood obesity is prevalent in southern Taiwan and lifestyle interventions for the management of childhood obesity are challenging. How to overcome the barriers of implementation programs is crucial. We offered lunchtime education and integrated it into education programs. Finally, we evaluated whether such an intervention could change unhealthy behaviors and reduce obesity tendency among elementary students. METHODS This was a prospective cohort study, conducted at an elementary school from September 2015 to July 2018. We distributed a lifestyle questionnaire to assess the students' dietary habits and physical activities before our intervention. We offered class-based interactive nutrition programs and record the behavior and weight change each semester. The body mass index (BMI) of the students were obtained each semester, and they were categorized as underweight, normal, overweight, and obese according to the age-specific BMI. RESULTS In total, 279 students were followed for 3 consecutive years. The most prevalent unhealthy dietary habit was the consumption of sweetened beverages in approximately 76% of the students. At the end of the study, the percentage of normal weight increased and the overall percentage of overweight/obesity decreased in both groups. At the end of the study, the BMI-time curve became flatter than that of Kaohsiung (regional) city and approached the national standard. It indicates that the increase in average BMI was effectively delayed with our intervention. CONCLUSIONS Lunchtime education is an innovative way to provide class-based education programs in school that yielded behavior changes and are effective approaches for delaying childhood obesity.
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Affiliation(s)
- Hsiang Ju Pan
- Department of Family Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan; Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City 83102, Taiwan.
| | - Li Ju Hung
- Department of Family Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan; National Kaohsiung University of Science and Technology, No. 415, Jiangong Rd., Sanmin Dist., Kaohsiung City 80778, Taiwan
| | - Chieh Yu Chen
- Department of Family Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan
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22
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Rochira A, Tedesco D, Ubiali A, Fantini MP, Gori D. School Gardening Activities Aimed at Obesity Prevention Improve Body Mass Index and Waist Circumference Parameters in School-Aged Children: A Systematic Review and Meta-Analysis. Child Obes 2020; 16:154-173. [PMID: 32091934 DOI: 10.1089/chi.2019.0253] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Childhood obesity, due to its increasing prevalence, is one of the most challenging problems in public health and prevention. Recent strategies have been implemented to tackle this trend, including school gardening projects. This systematic review analyzes the main elements of school gardening with a specific meta-analysis about its impact on anthropometric parameters. Materials and Methods: We searched studies in PubMed, EMBASE, and Cochrane Library on school gardening projects carried out until February 2019 and addressed to children aged 6 to 13 years. Results: Thirty-three studies passed the screening selection. Outcomes analyzed were fruits and vegetables consumption/knowledge, nutritional attitudes and behavior, anthropometric outcomes (i.e., BMI, waist circumference-WC) and other outcomes (i.e., blood pressure, science achievement, and physical activity). We performed descriptive analyses of these outcomes and found a general benefit from school gardening projects. We subsequently performed a meta-analysis on anthropometric outcomes, highlighting a significant reduction of both BMI percentile (%) (-1.37%) and WC (-1.30 cm). Conclusions: Although more high-quality studies are needed on this topic, along with a greater homogeneity of anthropometric measurements, the results of our article show a modest but positive impact of school gardening projects on anthropometric measures and more generally on children's health.
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Affiliation(s)
- Andrea Rochira
- School of Hygiene and Preventive Medicine, University of Bologna, Bologna, Italy
| | - Dario Tedesco
- IRCCS Rizzoli Orthopedic Institute Hospital Health Direction, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Andrea Ubiali
- School of Hygiene and Preventive Medicine, University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- School of Hygiene and Preventive Medicine, University of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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23
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Venturelli F, Ferrari F, Broccoli S, Bonvicini L, Mancuso P, Bargellini A, Giorgi Rossi P. The effect of Public Health/Pediatric Obesity interventions on socioeconomic inequalities in childhood obesity: A scoping review. Obes Rev 2019; 20:1720-1739. [PMID: 31468647 PMCID: PMC6899709 DOI: 10.1111/obr.12931] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 01/16/2023]
Abstract
Childhood obesity has a strong social gradient. This scoping review aims to synthesize the evidence on the impact on inequalities of non-targeted interventions to reduce the prevalence of childhood and adolescent obesity in high-income countries. We updated a review by Hillier-Brown, searching up to 31 December 2017 on MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO, with no limitations on study design. Fifty-eight studies describing 51 interventions were included: 31 randomized clinical trials and 27 non-randomized trials, with sample sizes from 67 to 2,700,880 subjects. The majority were implemented in the school setting at a community level; the others were in health services or general population setting and targeting individuals or the system. Twenty-nine interventions proved to be effective overall; seven others had an effect only in a subgroup, while 15 proved not to be effective. All types of included interventions can increase inequalities. Moreover, some interventions had opposite effects based on the socioeconomic characteristics. Any kind of intervention can reduce equity. Consequences are difficult to predict based on intervention construct. Complex interventions acting on multiple targets, settings, and risk factors are more effective and have a lower risk of increasing inequalities.
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Affiliation(s)
- Francesco Venturelli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Ferrari
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Serena Broccoli
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Laura Bonvicini
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pamela Mancuso
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annalisa Bargellini
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, Section of Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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24
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Vosburgh K, Smith SR, Oldman S, Huedo-Medina T, Duffy VB. Pediatric-Adapted Liking Survey (PALS): A Diet and Activity Screener in Pediatric Care. Nutrients 2019; 11:nu11071641. [PMID: 31323759 PMCID: PMC6683261 DOI: 10.3390/nu11071641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022] Open
Abstract
Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey (PALS) to assess the reliability and validity of a Healthy Behavior Index (HBI) generated from the PALS responses. The PALS was completed by 925 children (average age = 11 ± 4 years, 55% publicly insured, 37% overweight/obese by Body Mass Index Percentile, BMI-P) and 925 parents. Child–parent dyads differed most in liking of vegetables, sweets, sweet drinks, and screen time. Across the sample, child and parent HBIs were variable, normally distributed with adequate internal reliability and construct validity, revealing two dimensions (less healthy—sweet drinks, sweets, sedentary behaviors; healthy—vegetables, fruits, proteins). The HBI showed criterion validity, detecting healthier indexes in parents vs. children, females vs. males, privately- vs. publicly-health insured, and residence in higher- vs. lower-income communities. Parent’s HBI explained some variability in child BMI percentile. Greater liking of sweets/carbohydrates partially mediated the association between low family income and higher BMI percentile. These findings support the utility of PALS as a dietary behavior and activity screener for children and their parents in a clinical setting.
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Affiliation(s)
- Kayla Vosburgh
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Sharon R Smith
- CT Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT 06106 2, USA
| | - Samantha Oldman
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Tania Huedo-Medina
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Valerie B Duffy
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT 06269, USA.
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25
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Elinder LS, Patterson E, Nyberg G, Norman Å. A Healthy School Start Plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial. BMC Public Health 2018; 18:459. [PMID: 29625599 PMCID: PMC5889522 DOI: 10.1186/s12889-018-5354-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/21/2018] [Indexed: 01/12/2023] Open
Abstract
Background Systematic reviews conclude that interventions to prevent overweight and obesity in children obtain stronger effects when parents are involved. Parenting practices and parent-child interactions shape children’s health-related behaviours. The Healthy School Start Plus intervention aims to promote healthy dietary habits and physical activity and prevent obesity in children through parental support in disadvantaged areas with increased health needs, delivered by teachers and school nurses. This protocol describes the design, outcome and process evaluation of the study. Methods Effectiveness of the intervention is compared to standard care within school health services. The 6-month programme, based on Social Cognitive Theory, consists of four components: 1) Health information to parents regarding the child; 2) Motivational Interviewing with the parents by the school nurse concerning the child; 3) classroom activities for the children by teachers; and 4) a web-based self-test of type-2 diabetes risk by parents. Effects will be studied in a cluster randomised trial including 17 schools and 352 six-year old children. The primary outcome is dietary intake of indicator foods, and secondary outcomes are physical activity, sedentary behaviour and BMI. Outcomes will be measured at baseline, at 6 months directly after the intervention, and at follow-up 18 months post baseline. Statistical analysis will be by mixed-effect regression analysis according to intention to treat and per protocol. Mediation analysis will be performed with parental self-efficacy and parenting practices. Quantitative and qualitative methods will be used to study implementation in terms of dose, fidelity, feasibility and acceptability. The hypothesis is that the programme will be more effective than standard care and feasible to perform in the school context. Discussion The programme is in line with the cumulated evidence regarding the prevention of childhood obesity: That schools should be a focal point of prevention efforts, interventions should involve multiple components, and include the home environment. If effective, it will fill a knowledge gap concerning evidence-based health promotion practice within school health services to prevent obesity, and in the long term reduce social inequalities in health. Trial registration The trial was retrospectively registered on January 4, 2018 and available online at ClinicalTrials.gov: No. NCT03390725.
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Affiliation(s)
- Liselotte Schäfer Elinder
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. .,Centre for Epidemiology and Community Medicine, Solnavägen 1E, 113 65, Stockholm, Sweden.
| | - Emma Patterson
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Solnavägen 1E, 113 65, Stockholm, Sweden
| | - Gisela Nyberg
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Solnavägen 1E, 113 65, Stockholm, Sweden
| | - Åsa Norman
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
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26
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Matwiejczyk L, Mehta K, Scott J, Tonkin E, Coveney J. Characteristics of Effective Interventions Promoting Healthy Eating for Pre-Schoolers in Childcare Settings: An Umbrella Review. Nutrients 2018; 10:nu10030293. [PMID: 29494537 PMCID: PMC5872711 DOI: 10.3390/nu10030293] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/18/2018] [Accepted: 02/25/2018] [Indexed: 12/13/2022] Open
Abstract
Early Childhood Education and Care (ECEC) settings have a pivotal role in shaping children’s dietary food habits by providing the contextual environment within which they develop these behaviours. This study examines systematic reviews for (1) the effectiveness of interventions to promote healthy eating in children aged 2–5 years attending centre-based childcare; (2) intervention characteristics which are associated with promoting healthy eating and; (3) recommendations for child-health policies and practices. An Umbrella review of systematic reviews was undertaken using a standardized search strategy in ten databases. Twelve systematic reviews were examined using validated critical appraisal and data extraction tools. Children’s dietary food intake and food choices were significantly influenced. Interventions to prevent obesity did not significantly change children’s anthropometric measures or had mixed results. Evidence was more convincing if interventions were multi-component, addressed physical activity and diet, targeted individual-level and environmental-level determinants and engaged parents. Positive outcomes were mostly facilitated by researchers/external experts and these results were not replicated when implemented in centres by ECEC providers without this support. The translation of expert-led interventions into practice warrants further exploration of implementation drivers and barriers. Based on the evidence reviewed, recommendations are made to inform child-health directed practices and policies.
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Affiliation(s)
- Louisa Matwiejczyk
- College Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia.
| | - Kaye Mehta
- College Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia.
| | - Jane Scott
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Emma Tonkin
- College Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia.
| | - John Coveney
- College Nursing and Health Sciences, Flinders University, Adelaide, SA 5000, Australia.
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27
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Gori D, Guaraldi F, Cinocca S, Moser G, Rucci P, Fantini MP. Effectiveness of educational and lifestyle interventions to prevent paediatric obesity: systematic review and meta-analyses of randomized and non-randomized controlled trials. Obes Sci Pract 2017; 3:235-248. [PMID: 29071100 PMCID: PMC5649699 DOI: 10.1002/osp4.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE This review and meta-analysis aim at updating a previous meta-analysis carried out by Waters et al. on the efficacy of interventions aimed at preventing childhood obesity and at identifying predictors of outcome. METHODS Using an ad-hoc search string, PubMed database was searched for studies assessing body mass index reduction associated with programmes lasting ≥12 weeks in overweight and obese children aged 2-18 years. Studies designed for children with eating disorders or relevant comorbidities were excluded. Studies meeting inclusion criteria were classified according to patient age (<6, 6-12 and 13-18 years), and intervention type (physical activity, diet or both), setting (educational, family or both) and duration (≤1 or >1 year). The search was also extended to other databases. Hand-searching techniques were also applied. The Cochrane 'risk of bias' was applied for quality assessment. RESULTS Seventy-two studies were meta-analysed. Overall, the best results were achieved by programmes combining diet and physical activity (n = 39). With regard to the setting, programmes involving both school and family and lasting ≤1 year were the most efficacious for 6- to 12-year-old children (n = 26); family-based-only interventions were also effective in children <6 years old (n = 2), although results have to be interpreted cautiously because of the small number of patients enrolled and the high study heterogeneity. In 13- to 18-year-old patients, interventions delivered at school (n = 8) were substantially unsuccessful. CONCLUSIONS Interventions for childhood obesity prevention should include both diet and physical activity, be preferentially targeted towards school age children and involve both the school and family setting. However, because of the important methodological limitations associated with currently available literature, additional studies are needed to draw definite conclusions.
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Affiliation(s)
- D Gori
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
| | - F Guaraldi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences University of Turin Turin Italy
| | - S Cinocca
- School of Hygiene and Preventive Medicine University of Bologna Bologna Italy
| | - G Moser
- School of Hygiene and Preventive Medicine University of Bologna Bologna Italy
| | - P Rucci
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
| | - M P Fantini
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
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