[The effectiveness of primary prevention interventions promoting physical activity and healthy eating in preschool children: A review of reviews]

Impact of "JolinchenKids-Fit and Healthy in Daycare" on Children's Objectively Measured Physical Activity: A Cluster-Controlled Study

BACKGROUND

To evaluate a multicomponent health promotion program targeting preschoolers' physical activity (PA).

METHODS

PA of children from 23 German daycare facilities (DFs; 13 intervention DFs, 10 control DFs) was measured via accelerometry at baseline and after 12 months. Children's sedentary time, light PA, and moderate to vigorous PA were estimated. Adherence was tracked with paper-and-pencil calendars. Mixed-model regression analyses were used to assess intervention effects.

RESULTS

PA data were analyzed from 183 (4.2 [0.8] y, 48.1% boys) children. At follow-up, children in DF groups with more than 50% adherence to PA intervention components showed an increase of 9 minutes of moderate to vigorous PA per day (β = 9.28; 95% confidence interval [CI], -0.16 to 18.72) and a 19-minute decrease in sedentary time (β = -19.25; 95% CI, -43.66 to 5.16) compared with the control group, whereas children's PA of those who were exposed to no or less than 50% adherence remained unchanged (moderate to vigorous PA: β = 0.34; 95% CI, -13.73 to 14.41; sedentary time: β = 1.78; 95% CI, -26.54 to 30.09). Notable effects were found in children with migration background.

CONCLUSIONS

Only small benefits in PA outcomes were observed after 1 year. A minimum of 50% adherence to the intervention seems to be crucial for facilitating intervention effects.

[Body mass index among children and adolescents: prevalences and distribution considering underweight and extreme obesity : Results of KiGGS Wave 2 and trends]

BACKGROUND

The current results of the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS Wave 2, 2014-2017) indicate that the prevalence of overweight and obesity among children and adolescents in Germany has hardly changed during this period.

OBJECTIVES

What are the current prevalences for the other categories of the BMI distribution (severe underweight, underweight, and extreme obesity) and what changes have occurred between the KiGGS baseline survey (2003-2006) and KiGGS Wave 2 with regard to the BMI categories and the distribution of BMI values?

MATERIALS AND METHODS

KiGGS Wave 2 analyses are based on data from 1762 boys and 1799 girls aged 3 to 17 years with valid measurements of height and weight. The KiGGS baseline survey provides information on 7531 boys and 7215 girls for trend evaluations.

RESULTS

For underweight prevalence as well as for the prevalence of extreme obesity no change over time can be observed. The BMI percentiles also show only minor differences between the two survey periods with a marginal shift of the upper BMI percentiles downwards before puberty and a slight increase after puberty. There is no clear shift in the BMI distribution towards lower BMI values.

DISCUSSION

There are now many activities at the national, regional, and local level that focus on prevention and intervention to reduce overweight and obesity. The marginal shifts in the upper BMI percentiles in the upper BMI percentiles before puberty observed here suggest that some success may have been achieved in obesity prevention among children in Germany.

Effectiveness of Teacher-Led Nutritional Lessons in Altering Dietary Habits and Nutritional Status in Preschool Children: Adoption of a NASA Mission X-Based Program

The preschool years are a sensitive period for the development of food preferences that will affect physical growth and life-long health. The promotion of healthy eating and nutritional status was achieved by adapting the US National Aeronautics and Space Administration (NASA) Mission X (MX) Program among young children in South Korea. The intervention program was delivered by nutritional experts and class teachers over 10 weeks. Children from 37 school classes (n = 534) from 7 daycares and kindergartens were randomized into a control group (CG, n = 280) and an intervention group (IG, n = 254). Parents were surveyed for their children’s characteristics and nutrition quotient (NQ) at baseline and at the 10-week follow-up. At baseline, 18.8% (boys: 18.9%; girls: 18.8%) of the subjects were overweight or obese (body mass index ≥ 85th percentile). After the intervention, the mean differences in various anthropometric measures did not differ significantly between the groups in a linear regression model adjusted for age, sex, and type of school. The NQ grades were significantly higher in the IG than the CG after the intervention (p = 0.000). In summary, the 10-week South Korean MX program improved the eating behaviors and nutrition status of young children. A further multisector prevention program is needed to prevent childhood obesity in young children.

How Can Physical Activity Be Promoted Among Children and Adolescents? A Systematic Review of Reviews Across Settings

Introduction: A vast majority of children and adolescents are physically inactive. As a result, high obesity rates and related diseases have made physical activity promotion a politically relevant topic. In order to form the basis for political decision making, evidence is required regarding the efficacy and effectiveness of interventions for physical activity promotion. In contrast to previous research, this systematic review of reviews targets three key settings (family and home, childcare, school), and is among the largest to have been conducted. Methods: A systematic review of reviews was conducted as part of a large-scale project to develop national recommendations for physical activity promotion in Germany. Six electronic databases were searched and inclusion criteria were defined. Two independent reviewers screened the titles and abstracts of potentially relevant literature. 213 reviews were identified and categorised by target group. A total of 74 reviews were identified dealing with children and adolescents. Each review underwent a quality assessment. Results: 39 reviews with the highest quality and relevance were analysed. Three reviews focused on the family and home setting, 4 on the childcare setting, 28 on the school setting and 4 on other settings. Evidence revealed the key role played by parents in promoting physical activity in children within each setting. Furthermore, evidence pointed toward the efficacy of multi-component interventions in the childcare and school setting. Several evidence-based intervention strategies were identified for childcare facilities and schools. Discussion: The review of reviews identified a number of promising strategies for PA promotion among children and adolescents. Among reviews, multi-component interventions in childcare facilities and schools stand out prominently. At the same time, the review of reviews indicated that there is still a lack of studies on the efficacy of interventions that go beyond the individual level. We recommend that future research should also target community and policy level interventions and interventions other than the school setting. In order to make more specific recommendations regarding the scale-up of promising intervention strategies, further knowledge about the effectiveness, health equity and cost effectiveness of interventions is needed.

Characteristics of Effective Interventions Promoting Healthy Eating for Pre-Schoolers in Childcare Settings: An Umbrella Review

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.

[Promoting a balanced diet and physical activity among children : Conditions for the successful implementation and maintenance of multi-level interventions and policies: Results of two qualitative case studies]

BACKGROUND

To date, conditions for successfully implementing and maintaining multi-level interventions and policies for the promotion of a balanced diet and physical activity are not well understood from the perspective of stakeholders.

OBJECTIVE

The aim of this article is to examine which factors are regarded as facilitating or impeding introduction, implementation and maintenance of multi-level interventions and policies from the standpoint of stakeholders.

MATERIALS AND METHODS

Semi-structured face-to-face interviews with stakeholders of one multi-level intervention (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS [IDEFICS] for the prevention of childhood obesity, n = 4) and one policy (Federal state offices coordinating networks for the provision of healthy food options in schools, n = 3) were analysed using qualitative content analysis.

RESULTS

In both cases, the use of existing structures facilitated introduction, implementation and maintenance. Additionally, training of staff for implementation according to standardised protocols or concepts and taking structures and work conditions of settings into account during implementation were considered essential. In both cases, conflicting interests in interdisciplinary stakeholder teams regarding intervention content and implementation were identified as a barrier. A lack of political support and insecure long-term funding only played a role in regard to the implementation and maintenance of policies. On the other hand, target groups of the multi-level intervention were not sufficiently involved in the development of intervention materials which resulted in a lack of tailoring and acceptance in the target groups.

CONCLUSIONS

The results provide important insights into the long-term implementation of multi-level interventions and policies in different settings.

[What are the determinants of childhood obesity? : A literature review as part of the project "Nationwide Monitoring of Childhood Obesity Determinants"]

BACKGROUND

Obesity can impair health even in childhood and unfold negative health consequences through an individual's lifespan. In Germany, to date, a systematic and periodically updated synopsis of the multifaceted determinants of childhood obesity is lacking. In this paper, we present the results of a systematic literature review on childhood obesity determinants, which was conducted over the course of the implementation of nationwide monitoring.

METHODS

The review was carried out in three steps. Initially, a search for etiological models of childhood obesity was conducted. Based on these results, a systematic review of reviews on childhood obesity determinants was carried out. Finally, the results were verified by taking international guidelines on childhood obesity into account.

RESULTS

In total, 21 etiological models, 75 reviews and 7 guidelines were identified. Over 60 determinants were extracted from these publications and were summarized into the following categories: nutritional behavior, physical activity behavior, sleeping pattern, biological determinants and diseases, prenatal and early childhood determinants, psycho-social determinants, food environment, moveability/walkability, setting and social environment, health promotion and prevention, socioeconomic, demographic, and sociocultural determinants.

CONCLUSION

This review demonstrates the complex patterns of childhood obesity determinants in correspondence with a socio-ecological approach. The review will form the basis for the monitoring-system "Nationwide Monitoring of Childhood Obesity Determinants", which will be implemented at the Robert Koch Institute by the end of 2017.

[Overweight in primary school-age children. Prevalence and risk factors]

BACKGROUND

Various studies show that pre-school age is a sensitive period for the development of overweight and obesity. During a longitudinal study between 2010 and 2013, the municipal health authority (city of Frankfurt) in cooperation with the university children's hospital investigated the development of weight in children aged 5 to 8.

MATERIALS AND METHODS

The weight and height of a collective of 5720 children were measured (2010/11). In addition, nutritional and exercise habits, as well as media consumption was documented for 4758 children through a questionnaire during the school enrolment procedure. The weight and height of 3481 children were measured again in the second grade (2012/13).

RESULTS

Over a period of 24 months, the percentage of overweight (not obese) children increased from 7.5 to 9.4 % and that of obese children from 4.5 to 5.0 %. 164 of 2818 children with a normal initial weight (5.8 %) changed to percentile class overweight or obese. 79 of 260 children who were initially overweight, not obese (30 %), changed to the group of normal weight, but only 4 out of 156 obese children (3 %). Increased TV consumption (> 1 h per day), availability of their own television, lack of physical activity, and consumption of high-calorie drinks were risk factors for the development of overweight during the primary school age. 72 % of parents of overweight children and 22 % of obese children falsely classified their children as normal weight.

CONCLUSIONS

Targeted education about the risk of obesity in the primary school age and offers for early intervention should be established in the healthcare services concerned.