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Beresford SA, Rillamas-Sun E, Rudd K, Bishop SK, Deschenie D, Ornelas IJ, Bauer MC, Lombard KA. Development of an assessment tool to measure healthy eating in Navajo children and their families. Curr Dev Nutr 2023; 7:100074. [DOI: 10.1016/j.cdnut.2023.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
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Wahi G, de Souza RJ, Hartmann K, Giglia L, Jack SM, Anand SS. Effectiveness of programs aimed at obesity prevention among Indigenous children: A systematic review. Prev Med Rep 2021; 22:101347. [PMID: 33889482 PMCID: PMC8050026 DOI: 10.1016/j.pmedr.2021.101347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/30/2020] [Accepted: 02/20/2021] [Indexed: 01/03/2023] Open
Abstract
Given the significant health burden of childhood obesity, it is imperative that effective programs be better understood. When evaluating obesity prevention efforts, one must recognize the contextual factors which drive the disproportionate risk of obesity between populations. This systematic review sought to understand if programs aimed at obesity prevention and/or the promotion of healthy lifestyle behaviours for Indigenous children are effective. We conducted a search using Medline, EMBASE, PsychINFO, ERIC, CINAHL and iPORTAL databases from inception to August 13, 2019. We included experimental and quasi-experimental studies. The main outcomes of interest were change in anthropometrics, nutrition or physical activity. Our narrative synthesis included an assessment of study quality using the Effective Public Health Practice Project Quality assessment tool. A total of 34 studies met selection criteria. Most studies used a quasi-experimental design (n = 25) and were assessed as low to moderate quality (n = 32). Three studies showed a significant change in anthropometric measures, 14 studies demonstrated at least one significant nutrition-related behaviour or dietary-pattern change, and six studies demonstrated a significant impact on physical activity. This systematic review of programs to prevent obesity among Indigenous children finds a limited impact on anthropometric measurements. Future studies must prioritize Indigenous knowledge and ways of knowing to lead all phases of development, implementation, and evaluation of programs.
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Affiliation(s)
- Gita Wahi
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Katrina Hartmann
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
| | - Lucia Giglia
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
| | - Susan M. Jack
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
- School of Nursing, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Sonia S. Anand
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Canada
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Pineda E, Bascunan J, Sassi F. Improving the school food environment for the prevention of childhood obesity: What works and what doesn't. Obes Rev 2021; 22:e13176. [PMID: 33462933 DOI: 10.1111/obr.13176] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/30/2020] [Indexed: 12/18/2022]
Abstract
The food environment has a significant influence on dietary choices, and interventions designed to modify the food environment could contribute to the prevention of childhood obesity. Many interventions have been implemented at the school level, but effectiveness in addressing childhood obesity remains unclear. We undertook a systematic review, a meta-analysis, and meta-regression analyses to assess the effectiveness of interventions on the food environment within and around schools to improve dietary intake and prevent childhood obesity. Estimates were pooled in a random-effects meta-analysis with stratification by anthropometric or dietary intake outcome. Risk of bias was formally assessed. One hundred papers were included. Interventions had a significant and meaningful effect on adiposity (body mass index [BMI] z score, standard mean difference: -0.12, 95% confidence interval: 0.15, 0.10) and fruit consumption (portions per day, standard mean difference: +0.19, 95% confidence interval: 0.16, 0.22) but not on vegetable intake. Risk of bias assessment indicated that n = 43 (81%) of non-randomized controlled studies presented a high risk of bias in the study design by not accounting for a control. Attrition bias (n = 34, 79%) and low protection of potential contamination (n = 41, 95%) presented the highest risk of bias for randomized controlled trials. Changes in the school food environment could improve children's dietary behavior and BMI, but policy actions are needed to improve surrounding school food environments to sustain healthy dietary intake and BMI.
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Affiliation(s)
- Elisa Pineda
- Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, UK.,School of Public Health, Imperial College London, London, UK
| | - Josefina Bascunan
- Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, UK
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, London, UK
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Browne J, Lock M, Walker T, Egan M, Backholer K. Effects of food policy actions on Indigenous Peoples' nutrition-related outcomes: a systematic review. BMJ Glob Health 2020; 5:e002442. [PMID: 32816952 PMCID: PMC7437701 DOI: 10.1136/bmjgh-2020-002442] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Indigenous Peoples worldwide endure unacceptable health disparities with undernutrition and food insecurity often coexisting with obesity and chronic diseases. Policy-level actions are required to eliminate malnutrition in all its forms. However, there has been no systematic synthesis of the evidence of effectiveness of food and nutrition policies for Indigenous Peoples around the world. This review fills that gap. METHODS Eight databases were searched for peer-reviewed literature, published between 2000 and 2019. Relevant websites were searched for grey literature. Articles were included if they were original studies, published in English and included data from Indigenous Peoples from Western colonised countries, evaluated a food or nutrition policy (or intervention), and provided quantitative impact/outcome data. Study screening, data extraction and quality assessment were undertaken independently by two authors, at least one of whom was Indigenous. A narrative synthesis was undertaken with studies grouped according to the NOURISHING food policy framework. RESULTS We identified 78 studies from Canada, Australia, Aotearoa/New Zealand and the USA. Most studies evaluated targeted interventions, focused on rural or remote Indigenous communities. The most effective interventions combined educational strategies with policies targeting food price, composition and/or availability, particularly in retail and school environments. Interventions to reduce exposure to unhealthy food advertising was the only area of the NOURISHING framework not represented in the literature. Few studies examined the impact of universal food policies on Indigenous Peoples' diets, health or well-being. CONCLUSION Both targeted and universal policy action can be effective for Indigenous Peoples. Actions that modify the structures and systems governing food supply through improved availability, access and affordability of healthy foods should be prioritised. More high-quality evidence on the impact of universal food and nutrition policy actions for Indigenous Peoples is required, particularly in urban areas and in the area of food marketing.
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Affiliation(s)
- Jennifer Browne
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Mark Lock
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Troy Walker
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation, Melbourne, Victoria, Australia
| | - Kathryn Backholer
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
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Redmond LC, Jock B, Gadhoke P, Chiu DT, Christiansen K, Pardilla M, Swartz J, Platero H, Caulfield LE, Gittelsohn J. OPREVENT (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans): Design of a Multilevel, Multicomponent Obesity Intervention for Native American Adults and Households. Curr Dev Nutr 2019; 3:81-93. [PMID: 31453430 PMCID: PMC6700458 DOI: 10.1093/cdn/nzz009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/10/2018] [Accepted: 01/29/2019] [Indexed: 11/25/2022] Open
Abstract
Obesity prevalence is high in Native American (NA) adults, and there is a critical need to establish and implement evidence-based social, behavioral, and policy interventions that are theoretically informed. The use of multilevel, multicomponent (MLMC) interventions has been shown to be an effective strategy for comprehensive health behavior change; however, there is little guidance available in the literature to facilitate implementation in this underserved and understudied population. To decrease obesity and related comorbidities in NA adults, an MLMC intervention called OPREVENT (Obesity Prevention and Evaluation of InterVention Effectiveness in NaTive North Americans) was implemented in 5 rural NA communities to modify the food-purchasing environment, improve diet, and increase physical activity (PA). Five NA communities across the Upper Midwest and Southwest United States were randomly assigned to Immediate (n = 3) or Delayed (n = 2) Intervention. OPREVENT was implemented in Immediate Intervention community food stores, worksites, schools, and media over 1 y. A community-randomized controlled trial was used to evaluate intervention impact in adults at the individual and institutional levels, with individual-level data being collected on diet, PA, and psychosocial variables at baseline and follow-up; and institutional-level data being collected on food stores, worksites, and schools, media, and process measures. The OPREVENT intervention was one of the first MLMC obesity interventions in this population and provides evidence-based practices for future program development. The purpose of this article is to describe the design, implementation, and evaluation of OPREVENT. This trial was registered at isrctn.com as ISRCTN76144389.
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Affiliation(s)
- Leslie C Redmond
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- University of Alaska Anchorage, School of Allied Health, Dietetics and Nutrition Department, Anchorage, AK
| | - Brittany Jock
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Preety Gadhoke
- St. John's University, Department of Pharmacy Administration & Public Health, Fresh Meadows, NY
| | - Dorothy T Chiu
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Marla Pardilla
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jacqueline Swartz
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Harrison Platero
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Laura E Caulfield
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Joel Gittelsohn
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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Banna J, Bersamin A. Community involvement in design, implementation and evaluation of nutrition interventions to reduce chronic diseases in indigenous populations in the U.S.: a systematic review. Int J Equity Health 2018; 17:116. [PMID: 30103753 PMCID: PMC6090789 DOI: 10.1186/s12939-018-0829-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/24/2018] [Indexed: 11/19/2022] Open
Abstract
Background Indigenous peoples of the United States disproportionately experience chronic diseases associated with poor nutrition, including obesity and diabetes. While chronic disease related health disparities among Indigenous people are well documented, it is unknown whether interventions adequately address these health disparities. In addition, it is unknown whether and to what extent interventions are culturally adapted or tailored to the unique culture, worldview and nutrition environments of Indigenous people. The aim of this review was to identify and characterize nutrition interventions conducted with Indigenous populations in the US, and to determine whether and to what degree communities are involved in intervention design, implementation and evaluation. Methods Peer-reviewed articles were identified using MEDLINE. Articles included were published in English in a refereed journal between 2000 and 2015, reported on a diet-related intervention in Indigenous populations in the US, and reported outcome data. Data extracted were program objectives and activities, target population, geographic region, formative research to inform design and evaluation, partnership, capacity building, involvement of the local food system, and outcomes. Narrative synthesis of intervention characteristics and the degree and type of community involvement was performed. Results Of 1060 records identified, 49 studies were included. Overall, interventions were successful in producing changes in knowledge, behavior or health (79%). Interventions mostly targeted adults in the Western region and used a pre-test, post-test design. Involvement of communities in intervention design, implementation, and evaluation varied from not at all to involvement at all stages. Of programs reporting significant changes in outcomes, more than half used at least three strategies to engage communities. However, formative research to inform the evaluation was not performed to a great degree, and fewer than half of the programs identified described involvement of the local food system. Conclusions The extent of use of strategies to promote community engagement in programs reporting significant outcomes is notable. In planning interventions in Indigenous groups, researchers should consider ways to involve the community in intervention design, execution and evaluation. There is a particular need for studies focused on Indigenous youth in diverse regions of the US to further address diet-related chronic conditions.
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Affiliation(s)
- Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences at the University of Hawai'i at Mānoa, Honolulu, USA.
| | - Andrea Bersamin
- Center for Alaska Native Health Research, Institute of Arctic Biology at the University of Alaska Fairbanks, Fairbanks, USA
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Naude CE, Visser ME, Nguyen KA, Durao S, Schoonees A. Effects of total fat intake on bodyweight in children. Cochrane Database Syst Rev 2018; 7:CD012960. [PMID: 29974953 PMCID: PMC6513603 DOI: 10.1002/14651858.cd012960.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND As part of efforts to prevent childhood overweight and obesity, we need to understand the relationship between total fat intake and body fatness in generally healthy children. OBJECTIVES To assess the effects and associations of total fat intake on measures of weight and body fatness in children and young people not aiming to lose weight. SEARCH METHODS For this update we revised the previous search strategy and ran it over all years in the Cochrane Library, MEDLINE (Ovid), MEDLINE (PubMed), and Embase (Ovid) (current to 23 May 2017). No language and publication status limits were applied. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing and unpublished studies (5 June 2017). SELECTION CRITERIA We included randomised controlled trials (RCTs) in children aged 24 months to 18 years, with or without risk factors for cardiovascular disease, randomised to a lower fat (30% or less of total energy (TE)) versus usual or moderate-fat diet (greater than 30%TE), without the intention to reduce weight, and assessed a measure of weight or body fatness after at least six months. We included prospective cohort studies if they related baseline total fat intake to weight or body fatness at least 12 months later. DATA COLLECTION AND ANALYSIS We extracted data on participants, interventions or exposures, controls and outcomes, and trial or cohort quality characteristics, as well as data on potential effect modifiers, and assessed risk of bias for all included studies. We extracted body weight and blood lipid levels outcomes at six months, six to 12 months, one to two years, two to five years and more than five years for RCTs; and for cohort studies, at baseline to one year, one to two years, two to five years, five to 10 years and more than 10 years. We planned to perform random-effects meta-analyses with relevant subgrouping, and sensitivity and funnel plot analyses where data allowed. MAIN RESULTS We included 24 studies comprising three parallel-group RCTs (n = 1054 randomised) and 21 prospective analytical cohort studies (about 25,059 children completed). Twenty-three studies were conducted in high-income countries. No meta-analyses were possible, since only one RCT reported the same outcome at each time point range for all outcomes, and cohort studies were too heterogeneous to combine.Effects of dietary counselling to reduce total fat intake from RCTsTwo studies recruited children aged between 4 and 11 years and a third recruited children aged 12 to 13 years. Interventions were combinations of individual and group counselling, and education sessions in clinics, schools and homes, delivered by dieticians, nutritionists, behaviourists or trained, supervised teachers. Concerns about imprecision and poor reporting limited our confidence in our findings. In addition, the inclusion of hypercholesteraemic children in two trials raised concerns about applicability.One study of dietary counselling to lower total fat intake found that the intervention may make little or no difference to weight compared with usual diet at 12 months (mean difference (MD) -0.50 kg, 95% confidence interval (CI) -1.78 to 0.78; n = 620; low-quality evidence) and at three years (MD -0.60 kg, 95% CI -2.39 to 1.19; n = 612; low-quality evidence). Education delivered as a classroom curriculum probably decreased BMI in children at 17 months (MD -1.5 kg/m2, 95% CI -2.45 to -0.55; 1 RCT; n = 191; moderate-quality evidence). The effects were smaller at longer term follow-up (five years: MD 0 kg/m2, 95% CI -0.63 to 0.63; n = 541; seven years; MD -0.10 kg/m2, 95% CI -0.75 to 0.55; n = 576; low-quality evidence).Dietary counselling probably slightly reduced total cholesterol at 12 months compared to controls (MD -0.15 mmol/L, 95% CI -0.24 to -0.06; 1 RCT; n = 618; moderate-quality evidence), but may make little or no difference over longer time periods. Dietary counselling probably slightly decreased low-density lipoprotein (LDL) cholesterol at 12 months (MD -0.12 mmol/L, 95% CI -0.20 to -0.04; 1 RCT; n = 618, moderate-quality evidence) and at five years (MD -0.09, 95% CI -0.17 to -0.01; 1 RCT; n = 623; moderate-quality evidence), compared to controls. Dietary counselling probably made little or no difference to HDL-C at 12 months (MD -0.03 mmol/L, 95% CI -0.08 to 0.02; 1 RCT; n = 618; moderate-quality evidence), and at five years (MD -0.01 mmol/L, 95% CI -0.06 to 0.04; 1 RCT; n = 522; moderate-quality evidence). Likewise, counselling probably made little or no difference to triglycerides in children at 12 months (MD -0.01 mmol/L, 95% CI -0.08 to 0.06; 1 RCT; n = 618; moderate-quality evidence). Lower versus usual or modified fat intake may make little or no difference to height at seven years (MD -0.60 cm, 95% CI -2.06 to 0.86; 1 RCT; n = 577; low-quality evidence).Associations between total fat intake, weight and body fatness from cohort studiesOver half the cohort analyses that reported on primary outcomes suggested that as total fat intake increases, body fatness measures may move in the same direction. However, heterogeneous methods and reporting across cohort studies, and predominantly very low-quality evidence, made it difficult to draw firm conclusions and true relationships may be substantially different. AUTHORS' CONCLUSIONS We were unable to reach firm conclusions. Limited evidence from three trials that randomised children to dietary counselling or education to lower total fat intake (30% or less TE) versus usual or modified fat intake, but with no intention to reduce weight, showed small reductions in body mass index, total- and LDL-cholesterol at some time points with lower fat intake compared to controls. There were no consistent effects on weight, high-density lipoprotein (HDL) cholesterol or height. Associations in cohort studies that related total fat intake to later measures of body fatness in children were inconsistent and the quality of this evidence was mostly very low. Most studies were conducted in high-income countries, and may not be applicable in low- and middle-income settings. High-quality, longer-term studies are needed, that include low- and middle-income settings to look at both possible benefits and harms.
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Affiliation(s)
- Celeste E Naude
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
| | - Marianne E Visser
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
- South African Medical Research CouncilCochrane South AfricaCape TownSouth Africa
| | - Kim A Nguyen
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
| | - Solange Durao
- South African Medical Research CouncilCochrane South AfricaCape TownSouth Africa
| | - Anel Schoonees
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
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Naude CE, Visser ME, Nguyen KA, Durao S, Schoonees A. Effects of total fat intake on bodyweight in children. Cochrane Database Syst Rev 2018; 2:CD012960. [PMID: 29446437 PMCID: PMC6491333 DOI: 10.1002/14651858.cd012960] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND As part of efforts to prevent childhood overweight and obesity, we need to understand the relationship between total fat intake and body fatness in generally healthy children. OBJECTIVES To assess the effects of total fat intake on measures of weight and body fatness in children and young people not aiming to lose weight. SEARCH METHODS For this update we revised the previous search strategy and ran it over all years in the Cochrane Library, MEDLINE (Ovid), MEDLINE (PubMed), and Embase (Ovid) (current to 23 May 2017). No language and publication status limits were applied. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing and unpublished studies (5 June 2017). SELECTION CRITERIA We included randomised controlled trials (RCTs) in children aged 24 months to 18 years, with or without risk factors for cardiovascular disease, randomised to a lower fat (30% or less of total energy (TE)) versus usual or moderate-fat diet (greater than 30%TE), without the intention to reduce weight, and assessed a measure of weight or body fatness after at least six months. We included prospective analytical cohort studies in these children if they related baseline total fat intake to weight or body fatness at least 12 months later. We duplicated inclusion decisions and resolved disagreement by discussion with other authors. DATA COLLECTION AND ANALYSIS We extracted data on participants, interventions or exposures, controls and outcomes, and trial or cohort quality characteristics, as well as data on potential effect modifiers, and assessed risk of bias for all included studies. We extracted outcome data using the following time point ranges, when available: RCTs: baseline to six months, six to 12 months, one to two years, two to five years and more than five years; cohort studies: baseline to one year, one to two years, two to five years, five to 10 years and more than 10 years. We planned to perform random-effects meta-analyses with relevant subgrouping, and sensitivity and funnel plot analyses where data allowed. MAIN RESULTS We included 24 studies comprising three parallel-group RCTs (n = 1054 randomised) and 21 prospective analytical cohort studies (about 25,059 children completed). Twenty-three were conducted in high-income countries. No meta-analyses were possible, since only one RCT reported the same outcome at each time point range for all outcomes, and cohort studies were too heterogeneous.For the RCTs, concerns about imprecision and poor reporting limited our confidence in our findings. In addition, the inclusion of hypercholesteraemic children in two trials raised concerns about applicability. Lower versus usual or modified total fat intake may have made little or no difference to weight over a six- to twelve month period (mean difference (MD) -0.50 kg, 95% confidence interval (CI) -1.78 to 0.78; 1 RCT; n = 620; low-quality evidence), nor a two- to five-year period (MD -0.60 kg, 95% CI -2.39 to 1.19; 1 RCT; n = 612; low-quality evidence). Compared to controls, lower total fat intake (30% or less TE) probably decreased BMI in children over a one- to two-year period (MD -1.5 kg/m2, 95% CI -2.45 to -0.55; 1 RCT; n = 191; moderate-quality evidence), with no other differences evident across the other time points (two to five years: MD 0.00 kg/m2, 95% CI -0.63 to 0.63; 1 RCT; n = 541; greater than five years; MD -0.10 kg/m2, 95% CI -0.75 to 0.55; 1 RCT; n = 576; low-quality evidence). Lower fat intake probably slightly reduced total cholesterol over six to 12 months compared to controls (MD -0.15 mmol/L, 95% CI -0.24 to -0.06; 1 RCT; n = 618; moderate-quality evidence), but may make little or no difference over longer time periods. Lower fat intake probably slightly decreased low-density lipoprotein (LDL) cholesterol over six to 12 months (MD -0.12 mmol/L, 95% CI -0.20 to -0.04; 1 RCT; n = 618, moderate-quality evidence) and over two to five years (MD -0.09, 95% CI -0.17 to -0.01; 1 RCT; n = 623; moderate-quality evidence), compared to controls. However, lower total fat intake probably made little or no difference to HDL-C over a six- to 12-month period (MD -0.03 mmol/L, 95% CI -0.08 to 0.02; 1 RCT; n = 618; moderate-quality evidence), nor a two- to five-year period (MD -0.01 mmol/L, 95% CI -0.06 to 0.04; 1 RCT; n = 522; moderate-quality evidence). Likewise, lower total fat intake probably made little or no difference to triglycerides in children over a six- to 12-month period (MD -0.01 mmol/L, 95% CI -0.08 to 0.06; 1 RCT; n = 618; moderate-quality evidence). Lower versus usual or modified fat intake may make little or no difference to height over more than five years (MD -0.60 cm, 95% CI -2.06 to 0.86; 1 RCT; n = 577; low-quality evidence).Over half the cohort analyses that reported on primary outcomes suggested that as total fat intake increases, body fatness measures may move in the same direction. However, heterogeneous methods and reporting across cohort studies, and predominantly very low-quality evidence, made it difficult to draw firm conclusions and true relationships may be substantially different. AUTHORS' CONCLUSIONS We were unable to reach firm conclusions. Limited evidence from three trials that randomised children to a lower total fat intake (30% or less TE) versus usual or modified fat intake, but with no intention to reduce weight, showed small reductions in body mass index, total- and LDL-cholesterol at some time points with lower fat intake compared to controls, and no consistent differences in effects on weight, high-density lipoprotein (HDL) cholesterol or height. Associations in cohort studies that related total fat intake to later measures of body fatness in children were inconsistent and the quality of this evidence was mostly very low. Twenty-three out of 24 included studies were conducted in high-income countries, and may not be applicable in low- and middle-income settings. High-quality, longer-term studies are needed, that include low- and middle-income settings and look at both possible benefits and risks.
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Affiliation(s)
- Celeste E Naude
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
| | | | - Kim A Nguyen
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
| | - Solange Durao
- South African Medical Research CouncilCochrane South AfricaCape TownSouth Africa
| | - Anel Schoonees
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa
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Black AP, D'Onise K, McDermott R, Vally H, O'Dea K. How effective are family-based and institutional nutrition interventions in improving children's diet and health? A systematic review. BMC Public Health 2017; 17:818. [PMID: 29041899 PMCID: PMC5645887 DOI: 10.1186/s12889-017-4795-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/21/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Effective strategies to improve dietary intake in young children are a priority to reduce the high prevalence of chronic non-communicable diseases in adulthood. This study aimed to assess the impact of family-based and school/preschool nutrition programs on the health of children aged 12 or younger, including the sustainability of these impacts and the relevance to socio-economic inequalities. METHODS A systematic review of literature published from 1980 to December 2014 was undertaken. Randomised controlled trials involving families with children aged up to 12 years in high income countries were included. The primary outcomes were dietary intake and health status. Results were presented in a narrative synthesis due to the heterogeneity of the interventions and outcomes. RESULTS The systematic search and assessment identified 39 eligible studies. 82% of these studies were set in school/preschools. Only one school study assessed the impact of involving parents systematically. The family-based programs which provided simple positive dietary advice to parents and regular follow-up reduced fat intake significantly. School and family-based studies, if designed and implemented well, increased F&V intake, particularly fruit. Effective school-based programs have incorporated role-models including peers, teachers and heroic figures, rewards and increased access to healthy foods. School nutrition programs in disadvantaged communities were as effective as programs in other communities. CONCLUSIONS Family and school nutrition programs can improve dietary intake, however evidence of the long-term sustainability of these impacts is limited. The modest overall impact of even these successful programs suggest complementary nutrition interventions are needed to build a supportive environment for healthy eating generally.
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Affiliation(s)
- Andrew P Black
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
- Bulgarr Ngaru Medical Aboriginal Corporation, PO Box 170, South Grafton, NSW, 2460, Australia.
| | - Katina D'Onise
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Robyn McDermott
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, Australia
| | - Hassan Vally
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Kerin O'Dea
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Fleischhacker S, Roberts E, Camplain R, Evenson KR, Gittelsohn J. Promoting Physical Activity Among Native American Youth: a Systematic Review of the Methodology and Current Evidence of Physical Activity Interventions and Community-wide Initiatives. J Racial Ethn Health Disparities 2016; 3:608-624. [PMID: 27294756 PMCID: PMC4911341 DOI: 10.1007/s40615-015-0180-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/13/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
Promoting physical activity using environmental, policy, and systems approaches could potentially address persistent health disparities faced by American Indian and Alaska Native children and adolescents. To address research gaps and help inform tribally led community changes that promote physical activity, this review examined the methodology and current evidence of physical activity interventions and community-wide initiatives among Native youth. A keyword-guided search was conducted in multiple databases to identify peer-reviewed research articles that reported on physical activity among Native youth. Ultimately, 20 unique interventions (described in 76 articles) and 13 unique community-wide initiatives (described in 16 articles) met the study criteria. Four interventions noted positive changes in knowledge and attitude relating to physical activity but none of the interventions examined reported statistically significant improvements on weight-related outcomes. Only six interventions reported implementing environmental, policy, and system approaches relating to promoting physical activity and generally only shared anecdotal information about the approaches tried. Using community-based participatory research or tribally driven research models strengthened the tribal-research partnerships and improved the cultural and contextual sensitivity of the intervention or community-wide initiative. Few interventions or community-wide initiatives examined multi-level, multi-sector interventions to promote physical activity among Native youth, families, and communities. More research is needed to measure and monitor physical activity within this understudied, high risk group. Future research could also focus on the unique authority and opportunity of tribal leaders and other key stakeholders to use environmental, policy, and systems approaches to raise a healthier generation of Native youth.
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Affiliation(s)
- Sheila Fleischhacker
- Senior Public Health & Science Policy Advisor, Office of Nutrition Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Two Democracy Plaza, Room 635, 6707 Democracy Boulevard MSC 5461, Bethesda, Maryland 20892-5461, – office 301-594-7440, mobile – 301-640-1396, fax – 301-480-3768
| | - Erica Roberts
- Doctoral Candidate, University of Maryland School of Public Health, Department of Behavioral and Community Health, 7923 Eastern Ave, Apt 1001, Silver Spring, MD 20910, voice – 410-236-7016
| | - Ricky Camplain
- Doctoral Student, University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, 137 East Franklin Street, Suite 303A, Chapel Hill, NC 27514, voice – 505-658-5262
| | - Kelly R. Evenson
- Research Professor of Epidemiology, University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, 137 E Franklin Street, Suite 306, Chapel Hill, NC 27514, voice – 919-966-4187
| | - Joel Gittelsohn
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Center for Human Nutrition, 615 N. Wolfe Street, Rm W2041, Baltimore, MD 21205, voice – 410-955-3927
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Fleischhacker S. Emerging Opportunities for Registered Dietitian Nutritionists to Help Raise a Healthier Generation of Native American Youth. J Acad Nutr Diet 2016; 116:219-225. [PMID: 26680608 PMCID: PMC4733391 DOI: 10.1016/j.jand.2015.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sheila Fleischhacker
- Corresponding Author and Reprint Contact, Sheila Fleischhacker, PhD, JD, Senior Public Health & Science Policy Advisor, Office of Nutrition Research, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Department of Health and Human Services, Two Democracy Plaza, Room 635, 6707 Democracy Boulevard MSC 5461, Bethesda, Maryland 20892-5461, voice – 301-594-7440, blackberry – 301-640-1396, fax – 301-480-3768,
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Evans CEL, Albar SA, Vargas-Garcia EJ, Xu F. School-Based Interventions to Reduce Obesity Risk in Children in High- and Middle-Income Countries. ADVANCES IN FOOD AND NUTRITION RESEARCH 2015; 76:29-77. [PMID: 26602571 DOI: 10.1016/bs.afnr.2015.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
School-based interventions are relatively new and were first introduced in the United States in the 1990s. Early programs were mainly education based with many of the findings now embedded in school policy in the form of a healthy eating curriculum. More recent school programs have taken education outside the classroom and attempted to engage parents as well as teachers. Environmental changes such as improving the quality of foods available at lunchtime and at other times during the school day are now common. Reviews of evaluations of school-based programs have demonstrated that they are effective and successfully improve dietary quality such as increasing fruit and vegetable intake and decreasing sweet and savory snacks and sweetened drinks; not just in school but over the whole day and particularly in younger school children. School-based interventions are also effective at reducing obesity if components to increase physical activity and reduce sedentary behaviors are also targeted but not if only dietary behaviors are tackled. Most of the high-quality evaluation studies using randomized controlled trials have been carried out in high-income countries as they are costly to run. However, middle-income countries have benefitted from the information available from these evaluation studies and many are now starting to fund and evaluate school-based programs themselves, resulting in unique problems such as concomitant under- and overnutrition being addressed. Action for the future demands more focus on populations most at risk of poor dietary quality and obesity in order to reduce inequalities in health and on adolescents who have not benefited as much as younger children from school-based interventions. This will involve innovative solutions within schools as well as targeting the food environment outside schools such as reducing the density of fast-food outlets and marketing of sweet and savory snacks and drinks.
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Affiliation(s)
- Charlotte E L Evans
- Lecturer in Public Health Nutrition, Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK.
| | - Salwa Ali Albar
- School of Food Science and Nutrition, King Abdul-Aziz University, PO Box 42807, 21551 Jeddah, Saudi Arabia; Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Elisa J Vargas-Garcia
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Fei Xu
- Nanjing Municipal Center for Disease Control and Prevention 2, Zizhulin, Nanjing 210003, China
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Rationale and design of a comparative effectiveness trial to prevent type 2 diabetes in mothers and children: The ENCOURAGE healthy families study. Contemp Clin Trials 2015; 40:105-11. [DOI: 10.1016/j.cct.2014.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 01/22/2023]
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Pakseresht M, Kolahdooz F, Gittelsohn J, Roache C, Corriveau A, Sharma S. Improving vitamin A and D intake among Inuit and Inuvialuit in Arctic Canada: evidence from the Healthy Foods North study. J Epidemiol Community Health 2014; 69:453-9. [PMID: 25527784 DOI: 10.1136/jech-2014-204623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/02/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND People in Arctic Canada are undergoing a nutritional transition and increased prevalence of chronic disease. The Healthy Foods North diet and physical activity intervention was developed in 2007-2008 while working with populations in six communities in Nunavut and the Northwest Territories, Canada. METHODS Four communities received the 1-year intervention (eg, conducting workshops, cooking classes and walking clubs) and two communities served as controls. Among the 263 adult evaluation participants, food frequency questionnaires were used to assess dietary intake at baseline and postintervention. Changes in mean nutrient intakes, nutrient density and dietary adequacy from baseline to postintervention were determined. The intervention impact on nutrient intakes was assessed through multivariate linear regression analysis. RESULTS Post-intervention assessment showed a reductions in total fat, saturated, monounsaturated and polyunsaturated fatty acids, and increases in iron intake, only in the intervention group. More than a 4%-increase in the percentage of adherence to vitamins A and D recommendations was observed in the intervention group. After adjusting the regression models, respondents in the intervention communities significantly reduced their energy intake and increased their vitamins A and D intake. CONCLUSIONS The Healthy Foods North is an effective programme to improve dietary quality among populations of the Canadian Arctic. Long-term interventions are expected to be important factors in the prevention of diet-related chronic diseases in these communities.
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Affiliation(s)
- Mohammadreza Pakseresht
- Department of Medicine, University of Alberta, University Terrace, Edmonton, Alberta, Canada
| | - Fariba Kolahdooz
- Department of Medicine, University of Alberta, University Terrace, Edmonton, Alberta, Canada
| | - Joel Gittelsohn
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cindy Roache
- Department of Medicine, University of Alberta, University Terrace, Edmonton, Alberta, Canada
| | - André Corriveau
- Department of Health and Social Services, Government of the Northwest Territories, Centre Square Tower, Yellowknife, Northwest Territories, Canada
| | - Sangita Sharma
- Department of Medicine, University of Alberta, University Terrace, Edmonton, Alberta, Canada
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Towns C, Cooke M, Rysdale L, Wilk P. Healthy Weights Interventions in Aboriginal Children and Youth: A Review of the Literature. CAN J DIET PRACT RES 2014; 75:125-31. [DOI: 10.3148/cjdpr-2014-006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is evidence that Aboriginal children and youth in Canada and elsewhere are at higher risk of obesity and overweight than other children. However, there has been no review of healthy weights interventions specifically aimed at Aboriginal children. A structured search for peer-reviewed articles presenting and evaluating healthy weights interventions for Aboriginal children and youth was conducted. Seventeen articles, representing seven interventions, were reviewed to identify their main characteristics, evaluation design, and evaluation outcomes. Interventions included several large community-based programs as well as several more focused programs that all targeted First Nations or American Indians, rather than Métis or Inuit. Only 1 program served an urban Aboriginal population. None of the published evaluations reported significant reductions in obesity or overweight or sustained increases in physical activity, although some evaluations presented evidence of positive effects on children's diets or on nutrition knowledge or intentions. We conclude that broader structural factors affecting the health of Aboriginal children may limit the effectiveness of these interventions, and that more evidence is required regarding interventions for Aboriginal children in various geographic and cultural contexts in Canada including Inuit and Métis communities.
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Affiliation(s)
- Claire Towns
- Northern Ontario Dietetic Internship Program, Barrie, ON
| | - Martin Cooke
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Lee Rysdale
- Northern Ontario Dietetic Internship Program, Sudbury, ON
| | - Piotr Wilk
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON
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Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, Komro KA, Gibbs LF, Magnus D, Campbell R. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst Rev 2014; 2014:CD008958. [PMID: 24737131 PMCID: PMC11214127 DOI: 10.1002/14651858.cd008958.pub2] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. OBJECTIVES To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. SEARCH METHODS We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. SELECTION CRITERIA We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. DATA COLLECTION AND ANALYSIS At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. MAIN RESULTS We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement. AUTHORS' CONCLUSIONS The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.
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Affiliation(s)
- Rebecca Langford
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Christopher P Bonell
- Institute of Education, University of LondonSocial Science Research Unit18 Woburn SquareLondonLondonUKWC1H 0NR
| | - Hayley E Jones
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Theodora Pouliou
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Simon M Murphy
- Cardiff UniversityCardiff School of Social Sciences1‐3 Museum PlaceCardiffSouth GlamorganUKCF10 3BD
| | - Elizabeth Waters
- The University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthLevel 5/207 Bouverie StParkvilleVICAustralia3052
| | - Kelli A Komro
- University of FloridaHealth Outcomes and Policy and Institute for Child Health PolicyPO Box 100177GainesvilleFloridaUSA32610‐0177
| | - Lisa F Gibbs
- The University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthLevel 5/207 Bouverie StParkvilleVICAustralia3052
| | - Daniel Magnus
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Rona Campbell
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
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Ronsley R, Lee AS, Kuzeljevic B, Panagiotopoulos C. Healthy Buddies™ reduces body mass index z-score and waist circumference in Aboriginal children living in remote coastal communities. THE JOURNAL OF SCHOOL HEALTH 2013; 83:605-613. [PMID: 23879779 DOI: 10.1111/josh.12072] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 03/15/2013] [Accepted: 04/30/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Aboriginal children are at increased risk for obesity and type 2 diabetes. Healthy Buddies™-First Nations (HB) is a curriculum-based, peer-led program promoting healthy eating, physical activity, and self-esteem. METHODS Although originally designed as a pilot pre-/post-analysis of 3 remote Aboriginal schools that requested and received HB training, one school did not implement the program and was used as a control group. Outcomes included changes in body mass index z-score (zBMI), waist circumference (WC), blood pressure (BP), self-esteem, health behavior, and knowledge over 1 school year in kindergarten to grade 12 children. RESULTS There was a significant decrease in zBMI (1.10 to 1.04, p = .028) and WC (77.1 to 75.0 cm, p < .0001) in the HB group (N = 118) compared with an increase in zBMI (1.14 to 1.23, p = .046) and a minimal WC change in the control group (N = 61). Prevalence of elevated BP did not change in the HB group, but increased from 16.7% to 31.7% in the control group (p = .026). General linear model analysis revealed a significant interaction between time, group, and zBMI (p = .001), weight status (p = .014), nutritious beverage knowledge (p = .018), and healthy living and self-esteem score (p = .005). CONCLUSIONS The HB program is a promising school-based strategy for addressing obesity and self-esteem in Aboriginal children.
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Affiliation(s)
- Rebecca Ronsley
- Faculty of Medicine, University of Toronto, 77 Gerrard Street West, Toronto, Ontario M5G2A1, Canada.
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18
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Bains A, Pakseresht M, Roache C, Beck L, Sheehy T, Gittelsohn J, Corriveau A, Sharma S. Healthy Foods North improves diet among Inuit and Inuvialuit women of childbearing age in Arctic Canada. J Hum Nutr Diet 2013; 27 Suppl 2:175-85. [PMID: 23808787 DOI: 10.1111/jhn.12134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Healthy Foods North (HFN) is a community-based intervention designed to promote a healthy diet and lifestyle of Inuit and Inuvialuit populations in Arctic Canada. The objective of the present study was to determine the effects of HFN on the nutrient intake of women of childbearing age. METHODS Six communities in Nunavut (n = 3) and the Northwest Territories (n = 3) were selected for programme implementation; four received a 12-month intervention and two served as controls. Quantitative food frequency questionnaires were used to assess dietary intake at baseline and 1 year post-intervention. Among women participants aged 19-44 years (n = 136), 79 were exposed to the intervention and 57 were not. Mean daily energy and nutrient intake and density were determined. Dietary adequacy was assessed by comparing the women's daily nutrient intakes with dietary reference intakes (DRI). RESULTS Main outcomes were the pre- to post-intervention changes between intervention and control groups for energy and selected nutrient intakes, nutrient density and dietary adequacy. Among the participants, the intervention had a beneficial effect on vitamin A and D intake. The percentage of individuals with nutrient intakes below the DRI increased from pre- to post-intervention for vitamin A and D in the control group but only for vitamin A in the intervention group. The programme did not have a significant impact on calorie, sugar, or fat consumption. CONCLUSIONS The HFN programme is effective in mitigating some of the negative impacts of the nutrition transition on dietary adequacy among Inuit and Inuvialuit women of childbearing age.
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Affiliation(s)
- A Bains
- Aboriginal and Global Health Research Group, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Guinn CH, Baxter SD, Royer JA, Hitchcock DB. Explaining the positive relationship between fourth-grade children's body mass index and energy intake at school-provided meals (breakfast and lunch). THE JOURNAL OF SCHOOL HEALTH 2013; 83:328-334. [PMID: 23517000 PMCID: PMC3607456 DOI: 10.1111/josh.12035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 06/10/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND A 2010 publication showed a positive relationship between children's body mass index (BMI) and energy intake at school-provided meals (as assessed by direct meal observations). To help explain that relationship, we investigated 7 outcome variables concerning aspects of school-provided meals: energy content of items selected, number of meal components selected, number of meal components eaten, amounts eaten of standardized school-meal portions, energy intake from flavored milk, energy intake received in trades, and energy content given in trades. METHODS Fourth-grade children (N = 465) from Columbia, SC, were observed eating school-provided breakfast and lunch on 1 to 4 days per child. Researchers measured children's weight and height. For daily values at school meals, a generalized linear model was fit with BMI (dependent variable) and the 7 outcome variables, sex, and age (independent variables). RESULTS BMI was positively related to amounts eaten of standardized school-meal portions (p < .0001) and increased 8.45 kg/m(2) per serving, controlling for other variables in the model. BMI was positively related to energy intake from flavored milk (p = .0041) and increased 0.347 kg/m(2) for every 100 kcal consumed. BMI was negatively related to energy intake received in trades (p = .0003) and decreased 0.468 kg/m(2) for every 100 kcal received. BMI was not significantly related to 4 outcome variables. CONCLUSIONS Knowing that relationships between BMI and actual consumption, not selection, at school-provided meals explained the (previously found) positive relationship between BMI and energy intake at school-provided meals is helpful for school-based obesity interventions.
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Affiliation(s)
- Caroline H. Guinn
- University of South Carolina, Institute for Families in Society, 1600 Hampton Street, Suite 507, Columbia, SC 29208, Phone: 803-777-1824 ext. 24
| | - Suzanne Domel Baxter
- University of South Carolina, Institute for Families in Society, 1600 Hampton Street, Suite 507, Columbia, SC 29208, Phone: 803-777-1824 ext. 12
| | - Julie A. Royer
- University of South Carolina, Institute for Families in Society, 1600 Hampton Street, Suite 507, Columbia, SC 29208, Phone: 803-777-1824 ext. 23
| | - David B. Hitchcock
- University of South Carolina, Department of Statistics, 216 LeConte College, Columbia, SC 29208, Phone: 803-774-5346
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Cohen JFW, Richardson S, Austin SB, Economos CD, Rimm EB. School lunch waste among middle school students: nutrients consumed and costs. Am J Prev Med 2013; 44:114-21. [PMID: 23332326 PMCID: PMC3788640 DOI: 10.1016/j.amepre.2012.09.060] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/30/2012] [Accepted: 09/27/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The National School Lunch Program has been guided by modest nutrient standards, and the palatability of meals, which drives consumption, receives inadequate attention. School food waste can have important nutritional and cost implications for policymakers, students, and their families. PURPOSE Nutrient losses and economic costs associated with school meal waste were examined. The study also assessed if school foods served were valid proxies for foods consumed by students. METHODS Plate waste measurements were collected from middle school students in Boston attending two Chef Initiative schools (n=1609) and two control schools (n=1440) during a 2-year pilot study (2007-2009) in which a professional chef trained cafeteria staff to make healthier school meals. The costs associated with food waste were calculated and the percentage of foods consumed was compared with a gold standard of 85% consumption. Analyses were conducted in 2010-2011. RESULTS Overall, students consumed less than the required/recommended levels of nutrients. An estimated $432,349 of food (26.1% of the total food budget) was discarded by middle school students annually at lunch in these Boston middle schools. For most meal components, substantially less than 85% was consumed. CONCLUSIONS There is substantial food waste among middle school students in Boston. Overall, students' nutrient consumption levels were below school meal standards, and foods served were not valid proxies for foods consumed. The costs associated with discarded foods are high; if translated nationally for school lunches, roughly $1,238,846,400 annually is wasted. Students might benefit if additional focus were given to the quality and palatability of school meals.
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Affiliation(s)
- Juliana F W Cohen
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Improved dietary intake among overweight and obese children followed from 8 to 12 years of age in a randomised controlled trial. J Nutr Sci 2012; 1:e16. [PMID: 25191545 PMCID: PMC4153323 DOI: 10.1017/jns.2012.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 08/24/2012] [Accepted: 08/24/2012] [Indexed: 12/13/2022] Open
Abstract
More knowledge about improving dietary intake in secondary preventive actions against
childhood overweight and obesity is needed. The objective was to evaluate the impact of a
2-year intervention on energy, macronutrient and food intake of overweight and obese
children participating in a randomised controlled trial. Children (8–12 years old) living
in Sweden were recruited to participate for 2 years between 2006 and 2009. The children
were randomised into either an intervention group (n 58), participating
in an intervention concerning food habits, physical activity and behavioural change, or a
control group (n 47). Dietary intake at baseline and the 2-year
measurement were assessed with a diet history interview covering 14 d. Energy intake (EI)
of the intervention and control groups was underestimated by 28 and 21 %, respectively,
after 2 years, but with no difference between the groups (P = 0·51).
After 2 years of intervention, the intervention group, compared with the control group,
had a lower intake of sugar-sweetened beverages (P = 0·015) as well as a
higher intake of foods high in fibre, low in saturated fat, sugar and salt
(P = 0·031). Further, a lower EI in relation to BMR, lower total fat,
MUFA and cholesterol was seen in the intervention group compared with the control group.
In conclusion, the food and nutrient intake of overweight and obese children was improved
after participating in a 2-year intervention programme. Dietary counselling should be
included in secondary preventive actions against childhood overweight and obesity to
promote healthy food habits.
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Story M, Hannan PJ, Fulkerson JA, Rock BH, Smyth M, Arcan C, Himes JH. Bright Start: Description and main outcomes from a group-randomized obesity prevention trial in American Indian children. Obesity (Silver Spring) 2012; 20:2241-9. [PMID: 22513491 PMCID: PMC3407274 DOI: 10.1038/oby.2012.89] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first-grade American Indian children. Bright Start was a group-randomized, school-based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. Although the intervention was not associated with statistically significant change in mean levels of BMI, BMI-Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, whereas the control children experienced a corresponding incidence of 24.8%; a difference of -11.4% (P = 0.033). The intervention significantly reduced parent-reported mean child intakes of sugar-sweetened beverages, whole milk, and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.
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Affiliation(s)
- Mary Story
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
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Osei-Assibey G, Dick S, Macdiarmid J, Semple S, Reilly JJ, Ellaway A, Cowie H, McNeill G. The influence of the food environment on overweight and obesity in young children: a systematic review. BMJ Open 2012; 2:bmjopen-2012-001538. [PMID: 23253872 PMCID: PMC3532982 DOI: 10.1136/bmjopen-2012-001538] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The increasing prevalence of childhood obesity has led to interest in its prevention, particularly through school-based and family-based interventions in the early years. Most evidence reviews, to date, have focused on individual behaviour change rather than the 'obesogenic environment'. OBJECTIVE This paper reviews the evidence on the influence of the food environment on overweight and obesity in children up to 8 years. DATA SOURCES Electronic databases (including MEDLINE, EMBASE, Cochrane Controlled Trials Register (CCTR), DARE, CINAHL and Psycho-Info) and reference lists of original studies and reviews were searched for all papers published up to 31 August 2011. STUDY SELECTION Study designs included were either population-based intervention studies or a longitudinal study. Studies were included if the majority of the children studied were under 9 years, if they related to diet and if they focused on prevention rather than treatment in clinical settings. DATA EXTRACTION Data included in the tables were characteristics of participants, aim, and key outcome results. Quality assessment of the selected studies was carried out to identify potential bias and an evidence ranking exercise carried out to prioritise areas for future public health interventions. DATA SYNTHESIS Thirty-five studies (twenty-five intervention studies and ten longitudinal studies) were selected for the review. There was moderately strong evidence to support interventions on food promotion, large portion sizes and sugar-sweetened soft drinks. CONCLUSIONS Reducing food promotion to young children, increasing the availability of smaller portions and providing alternatives to sugar-sweetened soft drinks should be considered in obesity prevention programmes aimed at younger children. These environment-level interventions would support individual and family-level behaviour change.
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Affiliation(s)
- George Osei-Assibey
- Public Health Nutrition Research Group, University of Aberdeen, Aberdeen, UK
| | - Smita Dick
- Public Health Nutrition Research Group, University of Aberdeen, Aberdeen, UK
| | - Jennie Macdiarmid
- Public Health Nutrition Research Group, University of Aberdeen, Aberdeen, UK
- Rowett Institute of Nutrition and Health, Aberdeen, UK
| | - Sean Semple
- Environmental and Occupational Medicine Group, University of Aberdeen, Aberdeen, UK
| | - John J Reilly
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Anne Ellaway
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Hilary Cowie
- Institute of Occupational Medicine, Research Avenue North, Riccarton, Edinburgh, UK
| | - Geraldine McNeill
- Public Health Nutrition Research Group, University of Aberdeen, Aberdeen, UK
- Rowett Institute of Nutrition and Health, Aberdeen, UK
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Greening L, Harrell KT, Low AK, Fielder CE. Efficacy of a school-based childhood obesity intervention program in a rural southern community: TEAM Mississippi Project. Obesity (Silver Spring) 2011; 19:1213-9. [PMID: 21233806 DOI: 10.1038/oby.2010.329] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A healthy lifestyle school-based obesity intervention was evaluated in a rural southern community where the rate of obesity ranks as the highest. School-age children (N = 450) ranging from 6 to 10 years of age (Mage = 8.34) participated in monthly physical activity and nutritional events during a 9-month academic year. The children's nutritional knowledge, number of different physical activities, fitness level, dietary habits, waist circumference, BMI percentile, and percentage body fat were measured pre- and postintervention. Changes on these measures were compared to students in a school employing the school system's standard health curriculum. Regression analyses with residualized change scores revealed that the intervention school showed statistically significant improvement in percentage body fat, physical activity, performance on fitness tests, and dietary habits compared to the control school. There was no evidence of differences in outcomes based on gender or ethnicity/race. With rates of obesity and overweight reaching 50% in southern rural communities, intervening early in development may offer the best outcome because of the difficulties with changing lifestyle behaviors later in adulthood. A population-based approach is recommended over a targeted approach to cultivate a culture of healthy lifestyle behaviors when children are developing their health-care habits. Evidence suggests that both boys and girls, and African-American and white children can benefit equally from such interventions.
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Affiliation(s)
- Leilani Greening
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA.
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Yildirim M, van Stralen MM, Chinapaw MJM, Brug J, van Mechelen W, Twisk JWR, Te Velde SJ. For whom and under what circumstances do school-based energy balance behavior interventions work? Systematic review on moderators. INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY : IJPO : AN OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION FOR THE STUDY OF OBESITY 2011; 6:e46-57. [PMID: 21651421 PMCID: PMC3190836 DOI: 10.3109/17477166.2011.566440] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 12/02/2010] [Indexed: 12/05/2022]
Abstract
The aim of this review was to systematically review the results and quality of studies investigating the moderators of school-based interventions aimed at energy balance-related behaviors. We systematically searched the electronic databases of Pubmed, EMBASE, Cochrane, PsycInfo, ERIC and Sportdiscus. In total 61 articles were included. Gender, ethnicity, age, baseline values of outcomes, initial weight status and socioeconomic status were the most frequently studied potential moderators. The moderator with the most convincing evidence was gender. School-based interventions appear to work better for girls than for boys. Due to the inconsistent results, many studies reporting non-significant moderating effects, and the moderate methodological quality of most studies, no further consistent results were found. Consequently, there is lack of insight into what interventions work for whom. Future studies should apply stronger methodology to test moderating effects of important potential target group segmentations.
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Affiliation(s)
- Mine Yildirim
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands.
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Gittelsohn J, Rowan M. Preventing diabetes and obesity in American Indian communities: the potential of environmental interventions. Am J Clin Nutr 2011; 93:1179S-83S. [PMID: 21411614 DOI: 10.3945/ajcn.110.003509] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Obesity, diabetes, and other diet-related chronic diseases persist in American Indians at rates that are significantly higher than those in other ethnic minority populations. Environmental interventions to improve diet and increase physical activity have the potential to improve these health outcomes, but relatively little work has taken place in American Indian communities. We reviewed the experiences and findings of the following 3 case studies of intervention trials in American Indian communities: the Pathways trial, which was a school-based trial that focused on children; the Apache Healthy Stores program, which was a food-store program that focused on food preparers and shoppers; and the Zhiwaapenewin Akino'maagewin trial, which was a multiinstitutional trial for First Nations adults that worked with food stores, elementary schools, and health and social services agencies. All 3 trials showed mixed success. Important lessons were learned, including the need to focus on supply and demand, institutional and multilevel approaches, and the identification of institutional bases to sustain programs.
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Affiliation(s)
- Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-2179, USA.
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McKenna ML. Policy options to support healthy eating in schools. Canadian Journal of Public Health 2011. [PMID: 21133196 DOI: 10.1007/bf03405619] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES School nutrition policies offer a promising avenue by which to promote healthy eating and reduce the risk of chronic disease. This article reviews policy components that could support healthy eating, examines their evidence base and suggests directions for future research. METHOD Information was drawn from research and other literature written in English between 1994 and 2008. Guided by recommendations from the World Health Organization, evidence pertaining to five potential components of policies was identified and reviewed: foods available, the food environment, health education, health services and counselling, and family and community outreach. RESULTS A limited number of evaluations have examined the impact of school nutrition standards and have shown a positive impact on food availability and student nutrient intake. Results have shown that behaviourally focused nutrition education, especially when combined with food services and other initiatives, may affect students' eating habits positively but may not decrease obesity levels. Evidence pertaining to other potential policy subcomponents, such as limiting food marketing in schools, coordinating all food services and providing nutrition-related health services, is limited or lacking. CONCLUSION Conceptually, comprehensive school nutrition policies comprising all five policy components offer an integrated and holistic approach to school nutrition. They could provide an umbrella to guide all school actions pertaining to nutrition and serve as a framework for accountability. Does conceptualization match reality? Further research is needed to determine how policy components affect implementation and outcomes.
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Affiliation(s)
- Mary L McKenna
- Department of Kinesiology, University of New Brunswick, PO Box 4400, Fredericton, NB E3B 5A3.
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Waling M, Lind T, Hernell O, Larsson C. A one-year intervention has modest effects on energy and macronutrient intakes of overweight and obese Swedish children. J Nutr 2010; 140:1793-8. [PMID: 20739446 DOI: 10.3945/jn.110.125435] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To decrease BMI in overweight and obese children, improved dietary intake and increased physical activity are key elements. Our objective was to evaluate the impact of a 1-y food and physical activity intervention on energy and macronutrient intake in overweight and obese children. A randomized open trial was conducted with 92 overweight or obese 10.4 ± 1.08-y-old children. The intervention included 14 group sessions with different themes regarding food and physical activity. Dietary intake was assessed with diet history interviews covering 14 d at baseline and 4-d food records after 1 y and was evaluated according to national dietary recommendations. The control group participated in the same measurements as the intervention group but did not take part in group sessions. After 1 y, both groups had decreased their energy intake (EI) relative to total energy expenditure, but the effect was more pronounced for the intervention group than for the control group. At 1 y follow-up, a larger proportion of children in the intervention group compared with the control group met the recommended intake of refined sugar (P = 0.019). However, the groups did not differ in the proportion children who met the recommended intake of dietary fiber. Further, SFA intake relative to total EI did not differ between the groups at 1 y follow-up. In conclusion, despite a rather comprehensive intervention, only modest effects were achieved with respect to reduced EI and improved macronutrient intake.
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Affiliation(s)
- Maria Waling
- Department of Food and Nutrition, Pediatrics, Umeå University, 901 87 Umeå, Sweden.
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Baxter SD, Guinn CH, Royer JA, Hardin JW, Mackelprang AJ, Smith AF. Accuracy of children's school-breakfast reports and school-lunch reports (in 24-h dietary recalls) differs by retention interval. Eur J Clin Nutr 2009; 63:1394-403. [PMID: 19756033 PMCID: PMC2788046 DOI: 10.1038/ejcn.2009.107] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 07/15/2009] [Accepted: 07/20/2009] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Validation-study data were analyzed to investigate the effect of retention interval (time between the to-be-reported meal and interview) on accuracy of children's school-breakfast reports and school-lunch reports in 24-h recalls, and to compare accuracy of children's school-breakfast reports for two breakfast locations (classroom; cafeteria). SUBJECTS/METHODS Each of 374 fourth-grade children was interviewed to obtain a 24-h recall using one of six conditions from crossing two target periods (prior 24 h; previous day) with three interview times (morning; afternoon; evening). Each condition had 62 or 64 children (half boys). A recall's target period included one school breakfast and one school lunch, for which the child had been observed. Food-item variables (observed number; reported number; omission rate; intrusion rate) and energy variables (observed; reported; report rate; correspondence rate; inflation ratio) were calculated for each child for school breakfast and school lunch separately. RESULTS Accuracy for school-breakfast reports and school-lunch reports was inversely related to retention interval. Specifically, as indicated by smaller omission rates, smaller intrusion rates, larger correspondence rates and smaller inflation ratios, accuracy for school-breakfast reports was best for prior-24-h recalls in the morning, and accuracy for school-lunch reports was best for prior-24-h recalls in the afternoon. For neither school meal was a significant sex effect found for any variable. For school-breakfast reports, there was no significant school-breakfast location effect for any variable. CONCLUSIONS By shortening the retention interval, accuracy can be improved for school-breakfast reports and school-lunch reports in children's 24-h recalls.
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Affiliation(s)
- S D Baxter
- Institute for Families in Society, University of South Carolina, Columbia, SC 29208, USA.
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Lo E, Coles R, Humbert ML, Polowski J, Henry CJ, Whiting SJ. Beverage intake improvement by high school students in Saskatchewan, Canada. Nutr Res 2009; 28:144-50. [PMID: 19083401 DOI: 10.1016/j.nutres.2008.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 12/28/2007] [Accepted: 01/16/2008] [Indexed: 12/24/2022]
Abstract
Certain beverages contribute energy, protein, vitamins, and minerals. North American adolescents have shifted their beverage intake from predominantly milk to predominantly sugary beverages. Intake of these sugary beverages, in sufficient quantity, may increase the risk of bone fractures, may contribute to obesity, and may lead to tooth decay. This study evaluated the effectiveness of a school-nutrition education program (Fluids Used Effectively for Living) on nutrition knowledge, attitude, and self-reported behavior of grade 9 students in Saskatchewan, Canada. Two classes of grade 9 students, 1 (n = 33) in a high school in Saskatoon (n = 33) and 1 (n = 24) in a large high school in Prince Albert, Saskatchewan, received the peer educator intervention. Two other classes in the 2 cities (n = 24 and n = 24, respectively) were controls. Six sessions of Fluids Used Effectively for Living nutrition education were delivered by using 2 peer educator models (multiple and single), and the intervention was delivered in a 45-minute weekly class session over a 6-week period. After the intervention, students in these 2 peer educator classes decreased their sugary beverage intake significantly, which was sustained for 3 months. Students in the control self-taught class increased their juice intake at the end of the year. The significant decrease of juice and sugary beverage intakes in the single model peer educator class disappeared after Bonferroni correction. Carbonated sugary beverage intake of students in the control self-taught classes declined, but it was not sustainable at the 3-month follow-up. A peer educator school-based nutrition education approach can lead to a decrease in sugary beverage intake in high school children.
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Affiliation(s)
- Elisabeth Lo
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada S7N 5C9
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Harrington KF, Kohler CL, McClure LA, Franklin FA. Fourth graders' reports of fruit and vegetable intake at school lunch: does treatment assignment affect accuracy? JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2009; 109:36-44. [PMID: 19103321 PMCID: PMC2620190 DOI: 10.1016/j.jada.2008.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 06/13/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Dietary interventions with children often use self-reported data to assess efficacy despite that objective methods rarely support self-report findings in validation studies. This study compared fourth graders' self-reported to observed lunch fruit and vegetable intake to determine if the accuracy of self-reported intake varied by treatment condition. DESIGN Matched randomized follow-up design examined three treatment groups (high and low intensity interventions and control) post-intervention. SUBJECTS/SETTING Three hundred seventy-nine middle-school children participating in a randomized controlled trial of a school-based fruit and vegetable intervention were observed during school lunch one day and asked to recall intake the following day. MAIN OUTCOME MEASURES Food items were coded as: "match," "omission," or "intrusion." Students were classified as accurate if all food items matched, otherwise inaccurate. Matched foods' portions were compared for accuracy. Servings were computed for total fruit and vegetable intake. ANALYSES Accuracy for fruits and vegetables were compared in separate analyses and tested for multiple potential associates: treatment condition, sex, race, body mass index, subsidized meal eligibility, school district, fruit/vegetable availability, age, and test scores. Fitted multivariable regression models included variables found to be significant in univariate or chi(2) analyses. RESULTS Variables found to be significant for fruit item accuracy were availability at lunch, body mass index, and subsidized lunch eligibility. For vegetable item accuracy, availability at lunch was significant. No differences were found for food portions or for efficacy of the intervention between the two methods of dietary data collection: observation and self-report. CONCLUSIONS Condition assignment did not bias recalled fruit and vegetable intakes among fourth graders.
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Affiliation(s)
- Kathleen Fleege Harrington
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 619 19th Street South, OHB 138, Birmingham, Alabama 35249-7337, Phone: 205-996-5889, FAX: 205-975-6118,
| | - Connie L. Kohler
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, RPHB 227, Birmingham, AL 35294-0022, Phone 205-975-8071, FAX: 205-934-9325,
| | - Leslie A. McClure
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, RPHB 327, Birmingham, AL 35294-0022, Phone: 205-934-5924,
| | - Frank A. Franklin
- Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, RPHB 320, Birmingham, AL 35294-0022, Phone: 205-934-7161,
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Stevens J, Taber DR, Murray DM, Ward DS. Advances and controversies in the design of obesity prevention trials. Obesity (Silver Spring) 2007; 15:2163-70. [PMID: 17890483 DOI: 10.1038/oby.2007.257] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Because randomized controlled trial designs are used more frequently to evaluate obesity prevention programs, nuances in the methodology used for this application become apparent. Areas of attention are the selection of outcome measures with high validity, attention to the description of the intervention, the use of analyses that match the sampling design, and dealing with loss to follow-up. We recommend increased use of preliminary or evidentiary research designed to develop and test intervention components and hypothesized mediators before fully powered, randomized, obesity prevention trials are attempted. Both randomized and observational designs can be used for the purpose. Attention to design issues will ultimately lead to more successful, cost-effective randomized trials, and more rapid movement toward efficacious and effective obesity prevention programs.
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Affiliation(s)
- June Stevens
- Department of Nutrition, CB 7461, University of North Carolina, Chapel Hill, NC 27599, USA.
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Abstract
The purpose of this article was to review population-based interventions for preventing childhood obesity carried out in school settings published between 1999 and 2004. A total of 11 such interventions were found from USA and UK. The grade of the interventions was from kindergarten, primary grades, middle school to high school. Most of these interventions targeted both physical activity and nutrition behaviours although there were some interventions that focused on only one dimension such as TV watching or restricting drinking of carbonated drinks or increasing physical education time in the school. Most of the interventions were based on some behavioural theory and the most popular theory was social cognitive theory. Most of the interventions focused on individual level behaviour change approaches. Most of the interventions focused on short-term changes right after the intervention. On the whole, interventions resulted in modest changes in behaviours and mixed results with indicators of obesity. TV watching seems to be most modifiable behaviour, followed by physical activity and nutrition behaviours. The outcome measures such as lowered BMI (body mass index), triceps skin-fold thickness and waist circumference have not been measured by all studies. Recommendations for enhancing the effectiveness of school-based childhood obesity interventions are presented.
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Affiliation(s)
- M Sharma
- Health Promotion and Education, University of Cincinnati, Cincinnati, OH 45221-0002, USA.
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Flynn MAT, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, Tough SC. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations. Obes Rev 2006; 7 Suppl 1:7-66. [PMID: 16371076 DOI: 10.1111/j.1467-789x.2006.00242.x] [Citation(s) in RCA: 508] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Childhood obesity is a global epidemic and rising trends in overweight and obesity are apparent in both developed and developing countries. Available estimates for the period between the 1980s and 1990s show the prevalence of overweight and obesity in children increased by a magnitude of two to five times in developed countries (e.g. from 11% to over 30% in boys in Canada), and up to almost four times in developing countries (e.g. from 4% to 14% in Brazil). The goal of this synthesis research study was to develop best practice recommendations based on a systematic approach to finding, selecting and critically appraising programmes addressing prevention and treatment of childhood obesity and related risk of chronic diseases. An international panel of experts in areas of relevance to obesity provided guidance for the study. This synthesis research encompassed a comprehensive search of medical/academic and grey literature and the Internet covering the years 1982-2003. The appraisal approach developed to identify best practice was unique, in that it considered not only methodological rigour, but also population health, immigrant health and programme development/evaluation perspectives in the assessment. Scores were generated based on pre-determined criteria with programmes scoring in the top tertile of the scoring range in any one of the four appraisal categories included for further examination. The synthesis process included identification of gaps and an analysis and summary of programme development and programme effectiveness to enable conclusions to be drawn and recommendations to be made. The results from the library database searches (13,158 hits), the Internet search and key informant surveys were reduced to a review of 982 reports of which 500 were selected for critical appraisal. In total 158 articles, representing 147 programmes, were included for further analysis. The majority of reports were included based on high appraisal scores in programme development and evaluation with limited numbers eligible based on scores in other categories of appraisal. While no single programme emerged as a model of best practice, synthesis of included programmes provided rich information on elements that represent innovative rather than best practice under particular circumstances that are dynamic (changing according to population subgroups, age, ethnicity, setting, leadership, etc.). Thus the findings of this synthesis review identifies areas for action, opportunities for programme development and research priorities to inform the development of best practice recommendations that will reduce obesity and chronic disease risk in children and youth. A lack of programming to address the particular needs of subgroups of children and youth emerged in this review. Although immigrants new to developed countries may be more vulnerable to the obesogenic environment, no programmes were identified that specifically targeted their potentially specialized needs (e.g. different food supply in a new country). Children 0-6 years of age and males represented other population subgroups where obesity prevention programmes and evidence of effectiveness were limited. These gaps are of concern because (i) the pre-school years may be a critical period for obesity prevention as indicated by the association of the adiposity rebound and obesity in later years; and (ii) although the growing prevalence of obesity affects males and females equally; males may be more vulnerable to associated health risks such as cardiovascular disease. Other gaps in knowledge identified during synthesis include a limited number of interventions in home and community settings and a lack of upstream population-based interventions. The shortage of programmes in community and home settings limits our understanding of the effectiveness of interventions in these environments, while the lack of upstream investment indicates an opportunity to develop more upstream and population-focused interventions to balance and extend the current emphasis on individual-based programmes. The evidence reviewed indicates that current programmes lead to short-term improvements in outcomes relating to obesity and chronic disease prevention with no adverse effects noted. This supports the continuation and further development of programmes currently directed at children and youth, as further evidence for best practice accumulates. In this synthesis, schools were found to be a critical setting for programming where health status indicators, such as body composition, chronic disease risk factors and fitness, can all be positively impacted. Engagement in physical activity emerged as a critical intervention in obesity prevention and reduction programmes. While many programmes in the review had the potential to integrate chronic disease prevention, few did; therefore efforts could be directed towards better integration of chronic disease prevention programmes to minimize duplication and optimize resources. Programmes require sustained long-term resources to facilitate comprehensive evaluation that will ascertain if long-term impact such as sustained normal weight is maintained. Furthermore, involving stakeholders in programme design, implementation and evaluation could be crucial to the success of interventions, helping to ensure that needs are met. A number of methodological issues related to the assessment of obesity intervention and prevention programmes were identified and offer insight into how research protocols can be enhanced to strengthen evidence for obesity interventions. Further research is required to understand the merits of the various forms in which interventions (singly and in combination) are delivered and in which circumstances they are effective. There is a critical need for the development of consistent indicators to ensure that comparisons of programme outcomes can be made to better inform best practice.
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Affiliation(s)
- M A T Flynn
- Nutrition and Active Living, Healthy Living, Calgary Health Region, Calgary, Canada
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Pyle SA, Sharkey J, Yetter G, Felix E, Furlong MJ, Poston WC. Fighting an epidemic: The role of schools in reducing childhood obesity. PSYCHOLOGY IN THE SCHOOLS 2006. [DOI: 10.1002/pits.20146] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Paradis G, Lévesque L, Macaulay AC, Cargo M, McComber A, Kirby R, Receveur O, Kishchuk N, Potvin L. Impact of a diabetes prevention program on body size, physical activity, and diet among Kanien'keha:ka (Mohawk) children 6 to 11 years old: 8-year results from the Kahnawake Schools Diabetes Prevention Project. Pediatrics 2005; 115:333-9. [PMID: 15687441 DOI: 10.1542/peds.2004-0745] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Report the 8-year impact on body size, physical activity, and diet of a community-based diabetes prevention program for elementary-school children in a Kanien'keha:ka (Mohawk) community in Canada. METHODS Follow-up (1994-1996) of subjects in the intervention and comparison community and repeat cross-sectional measurements in the intervention community alone from 1994 to 2002. Measures included triceps and subscapular skinfold thicknesses, body mass index (BMI), weekly number of 15-minute episodes of physical activity, run/walk test times, television watching, and consumption of sugared foods, fatty foods, and fruits and vegetables. RESULTS The longitudinal data of 1994-1996 showed some early positive effects of the program on skinfold thickness but not on BMI, physical activity, fitness, or diet. Repeat cross-sectional measures from 1994 to 2002 showed increases in skinfold thickness and BMI. Physical activity, fitness, and television watching showed favorable trends from 1994 to 1999 that were not sustained in 2002. Key high-fat and high-sugar foods consumption decreased, as did consumption of fruits and vegetables. CONCLUSIONS Although early results showed some successes in reducing risk factors for type 2 diabetes, these benefits were not maintained over 8 years.
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Affiliation(s)
- Gilles Paradis
- Direction de Santé Publique de Montréal and Division of Preventive Medicine, McGill University Health Center, Montreal, Quebec, Canada.
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Stone EJ, Norman JE, Davis SM, Stewart D, Clay TE, Caballero B, Lohman TG, Murray DM. Design, implementation, and quality control in the Pathways American-Indian multicenter trial. Prev Med 2003; 37:S13-23. [PMID: 14636805 PMCID: PMC4876702 DOI: 10.1016/j.ypmed.2003.08.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pathways was the first multicenter American-Indian school-based study to test the effectiveness of an obesity prevention program promoting healthy eating and physical activity. METHODS Pathways employed a nested cohort design in which 41 schools were randomized to intervention or control conditions and students within these schools were followed as a cohort (1,704 third graders at baseline). The study's primary endpoint was percent body fat. Secondary endpoints were levels of fat in school lunches; time spent in physical activity; and knowledge, attitudes, and behaviors regarding diet and exercise. Quality control (QC) included design of data management systems which provided standardization and quality assurance of data collection and processing. Data QC procedures at study centers included manuals of operation, training and certification, and monitoring of performance. Process evaluation was conducted to monitor dose and fidelity of the interventions. Registration and tracking systems were used for students and schools. RESULTS No difference in mean percent body fat at fifth grade was found between the intervention and control schools. Percent of calories from fat and saturated fat in school lunches was significantly reduced in the intervention schools as was total energy intake from 24-hour recalls. Significant increases in self-reported physical activity levels and knowledge of healthy behaviors were found for the intervention school students. CONCLUSIONS The Pathways study results provide evidence demonstrating the role schools can play in public health promotion. Its study design and QC systems and procedures provide useful models for other similar school based multi- or single-site studies.
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Affiliation(s)
- Elaine J Stone
- University of New Mexico, Department of Physical Performance and Development, Johnson Center Room 1150, Albuquerque, NM 87131, USA.
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