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Miguel-Berges ML, Larruy-García A, De Miguel-Etayo P, Jimeno-Martinez A, Torres A, Moreno LA. Weight Status Determines the Impact of a School-Based Nutrition Education Intervention on Lifestyle Behaviors in Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1093. [PMID: 39334625 PMCID: PMC11430318 DOI: 10.3390/children11091093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND/OBJECTIVES This study investigated the impact of the FLUYE school-based intervention on children's lifestyle behaviors, Mediterranean diet adherence, and emotional well-being in Spain. The objective was to promote healthy habits through nutrition education, physical activity, and emotional support within the school environment, with a focus on addressing the needs of both normal-weight and overweight/obese children. METHODS A total of 552 children aged 3 to 12 years participated in the study, with data collected at baseline (T0) and follow-up (T1). The intervention was designed to integrate health education into the school curriculum, emphasizing the development of personal competencies in diet, physical activity, and emotional well-being. The analysis included changes in dietary habits, screen time, physical activity, and psychosocial outcomes, with comparisons made between the normal-weight and overweight/obese groups. RESULTS Significant improvements were observed in water consumption and reductions in sugar-sweetened beverage intake across both weight groups. However, an increase in screen time, particularly among normal-weight children, highlighted ongoing challenges in reducing sedentary behavior. Adherence to the Mediterranean diet improved more significantly in the overweight/obese group, suggesting the program's effectiveness in promoting healthier eating patterns among at-risk children. Emotional well-being and self-esteem also saw significant enhancements, with children reporting increased feelings of pride and positivity post-intervention. CONCLUSIONS The FLUYE program effectively improved various aspects of children's lifestyle behaviors, particularly in dietary habits and emotional well-being. These findings underscore the importance of comprehensive, school-based interventions that address both physical and psychosocial aspects of health, especially for children at higher risk for obesity.
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Affiliation(s)
- María L. Miguel-Berges
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; (A.L.-G.); (P.D.M.-E.); (A.J.-M.); (L.A.M.)
- Instituto Agroalimentario de Aragón (IA2), C/Miguel Servet 177, 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), (CB15/00043), Institute of Health Carlos III (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Alicia Larruy-García
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; (A.L.-G.); (P.D.M.-E.); (A.J.-M.); (L.A.M.)
- Instituto Agroalimentario de Aragón (IA2), C/Miguel Servet 177, 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; (A.L.-G.); (P.D.M.-E.); (A.J.-M.); (L.A.M.)
- Instituto Agroalimentario de Aragón (IA2), C/Miguel Servet 177, 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), (CB15/00043), Institute of Health Carlos III (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Andrea Jimeno-Martinez
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; (A.L.-G.); (P.D.M.-E.); (A.J.-M.); (L.A.M.)
- Instituto Agroalimentario de Aragón (IA2), C/Miguel Servet 177, 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Antonio Torres
- School of Health Sciences Blanquerna, University Ramon Llull, 08022 Barcelona, Spain;
| | - Luis A. Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain; (A.L.-G.); (P.D.M.-E.); (A.J.-M.); (L.A.M.)
- Instituto Agroalimentario de Aragón (IA2), C/Miguel Servet 177, 50013 Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Avda. San Juan Bosco 13, 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBEROBN), (CB15/00043), Institute of Health Carlos III (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
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Patterson E, Nyberg G, Norman Å, Schäfer Elinder L. Universal healthy school start intervention reduced the body mass index of young children with obesity. Acta Paediatr 2024; 113:2119-2125. [PMID: 38381539 DOI: 10.1111/apa.17164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
AIM To evaluate the effect of a universal, school-based family support programme on body mass index (BMI) of children aged 5-7 years, using pooled data from three trials. METHODS The programme has three to four components and is delivered during the first school year. It aims to promote healthy dietary and physical activity behaviours, and secondarily prevent unhealthy weight gain. Three cluster-randomised controlled trials were conducted between 2010 and 2018 in low and mixed socioeconomic status areas in Sweden. Weight and height were measured. Multiple mixed linear regression analysis was performed on the pooled data. RESULTS In total, 961 children were included (50% girls, mean age 6.3 years). The post-intervention effect on BMI z-score in all children was small, but in those with obesity at baseline, we observed a significant, clinically relevant, decrease in BMI z-score (-0.21). This was most pronounced in children with a non-Nordic born parent (-0.24). Five to six months after the intervention, decreases were no longer statistically significant. CONCLUSION The intervention resulted in changes in BMI comparable to obesity treatment programmes focusing on behaviour change. However, the effect attenuated with time suggesting the programme should be sustained and evaluated for a longer time.
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Affiliation(s)
- Emma Patterson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Division for Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Gisela Nyberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden
| | - Åsa Norman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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3
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Olsen NJ, Larsen SC, Heitmann BL. Long-Term Effects of a Primary Weight Gain Prevention Intervention among Healthy Weight Obesity Susceptible Children: Results from the Healthy Start Study. Obes Facts 2024; 17:545-550. [PMID: 38934182 DOI: 10.1159/000540005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Primary prevention is a public health strategy that hitherto has not been widely applied in obesity prevention research. The objectives were to examine the long-term effects of the Healthy Start primary obesity prevention study, an intervention conducted among healthy weight children susceptible to develop obesity. METHODS At baseline, children (2-6 years) were allocated to the intervention group (n = 271), the control group (n = 272), or the shadow control group (n = 383). Children in the shadow control group had no contact with project staff during the intervention period (1.3 years on average). The intervention was designed to deliver individually tailored improvements in diet and physical activity habits, optimization of sleep quantity and quality and reduce family stress. After the intervention was completed, height and weight at school entry were obtained from the Danish National Child Health Register when children were around 7 years. The average follow-up time was 2.7 years after baseline. Linear regression analyses on annual changes in BMI (ΔBMI) and BMI z-scores (ΔBMIz) were conducted. RESULTS At mean 2.7 years after the baseline examination, no differences were observed between the intervention and control group in ΔBMI (β = 0.07 [-0.02; 0.15], p = 0.14) or ΔBMIz (β = 0.04 [-0.02; 0.10], p = 0.19). Likewise, no differences were observed between the intervention and shadow control group in ΔBMI (β = -0.03 [-0.12; 0.06], p = 0.50) or in ΔBMIz (β = -0.02 [-0.08; 0.05], p = 0.62). CONCLUSION We are still in urgent need of more primary overweight prevention interventions to begin to understand how to prevent that healthy weight children develop overweight.
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Affiliation(s)
- Nanna Julie Olsen
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Sofus Christian Larsen
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Public Health, Section for General Practice, University of Copenhagen, Copenhagen, Denmark
- The Boden Group, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
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4
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Olsen NJ, Østergaard JN, Bjerregaard LG, Høy TV, Kierkegaard L, Michaelsen KF, Sørensen TIA, Grønbaek MK, Bruun JM, Heitmann BL. A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: A report produced by a working group of the Danish Council on Health and Disease Prevention. Obes Rev 2024; 25:e13641. [PMID: 37871966 DOI: 10.1111/obr.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 08/18/2023] [Accepted: 09/09/2023] [Indexed: 10/25/2023]
Abstract
Primary prevention targets development of overweight in individuals with healthy weight and is a great challenge. This paper summarizes the main findings of a working group of the Danish Council on Health and Disease Prevention that reviewed the literature on primary prevention of overweight and obesity among children and adolescents. The results were presented in a Danish report, in which a 2019 Cochrane review on childhood obesity prevention was complemented by searches in PubMed to include all relevant subsequent studies published from January 2018 until March 2020. In this paper, the review was updated until June 2023. Numerous childhood overweight prevention interventions have been developed during the past decades, primarily targeting diet and/or physical activity. Several of these interventions showed positive effects on diet and physical activity level but did not show effects on risk of developing overweight. The evidence foundation is inconsistent as four out of five interventions did not show positive effects. Previously observed intervention effects may not reflect excessive weight gain prevention among children with healthy weight but rather bodyweight reduction among those with overweight or obesity. We do not have sufficient knowledge about how to prevent children with healthy weight from developing overweight, and creative solutions are urgently needed.
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Affiliation(s)
- Nanna J Olsen
- Research Unit for Dietary Studies, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Jane N Østergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Lise G Bjerregaard
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Teresa V Høy
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lene Kierkegaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Thorkild I A Sørensen
- Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten K Grønbaek
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jens M Bruun
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish National Center for Obesity, Aarhus, Denmark
| | - Berit L Heitmann
- Research Unit for Dietary Studies, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- The Boden Group, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
- Section of General Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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5
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Olsen NJ, Ängquist L, Frederiksen P, Lykke Mortensen E, Heitmann BL. Primary prevention of fat and weight gain among obesity susceptible healthy weight preschool children. Main results from the "Healthy Start" randomized controlled intervention. Pediatr Obes 2021; 16:e12736. [PMID: 33021348 DOI: 10.1111/ijpo.12736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 08/05/2020] [Accepted: 09/07/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND A vital public health challenge lies in understanding the primary drivers behind excessive weight gain among healthy weight individuals. OBJECTIVES To examine if excessive weight and fat gain can be prevented among healthy weight, obesity susceptible children aged 2 to 6 years. METHODS Eligible children were identified based on information on either a high birth weight, maternal pre-pregnancy obesity or maternal low educational level from national registries, and randomized into an intervention group, a control group and a shadow control group. All children with overweight at baseline were excluded from subsequent analysis (n = 196), while healthy weight children were included (n = 926). The intervention was designed to deliver improvements in diet and physical activity habits, optimization of sleep quantity and quality, and reduction of family stress. The average intervention period was 1.3 years. RESULTS Intention-to-treat analyses indicated a lower gain in percentage fat mass and a higher gain in fat-free mass in the intervention group compared with the control group. However, the results should be interpreted with caution, as they were clinically small and borderline significant, only. CONCLUSION This primary prevention intervention among young healthy weight children with susceptibility to future obesity had clinically small effects on growth and body composition. More interventions, conducting primary obesity prevention, are urgently needed.
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Affiliation(s)
- Nanna Julie Olsen
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Frederiksberg, Denmark
| | - Lars Ängquist
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Peder Frederiksen
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Frederiksberg, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Frederiksberg, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia.,Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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6
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Recasens MA, Xicola-Coromina E, Manresa JM, Ullmo PA, Jensen BB, Franco R, Suarez A, Nadal A, Vila M, Recasens I, Pérez MJ, Castell C, Llargués E. Impact of school-based nutrition and physical activity intervention on body mass index eight years after cessation of randomized controlled trial (AVall study). Clin Nutr 2019; 38:2592-2598. [DOI: 10.1016/j.clnu.2018.12.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/13/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
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7
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Chaparro MP, Anderson CE, Crespi CM, Whaley SE, Wang MC. The effect of the 2009 WIC food package change on childhood obesity varies by gender and initial weight status in Los Angeles County. Pediatr Obes 2019; 14:e12526. [PMID: 30942561 DOI: 10.1111/ijpo.12526] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess whether the effect of the 2009 women, infants, and children (WIC) food package change on obesity outcomes varies by initial weight status and gender. METHODS Using 2003 to 2016 data from Los Angeles County, we compared growth trajectories and obesity at age 4 years among children exposed to WIC after the food package change (n = 53 075) vs children exposed before (n = 53 075). Analyses were stratified by gender and initial weight status: low weight-for-height z-score (WHZ ≤ 25th percentile), average WHZ (25th < WHZ < 75th percentile), and high WHZ (WHZ ≥ 75th percentile). Within strata, children exposed to the new vs old packages were matched on sociodemographic characteristics and compared using growth models and Poisson regression. RESULTS Mean WHZ trajectories for children exposed to the new food package, compared with the old, tended to be lower during ages 1 to 5 years. For boys, the new food package was associated with 10% to 14% lower obesity risk at age 4 years in all initial weight status strata. For girls, the new package was associated with 16% lower obesity risk at age 4 years only for those with average WHZ at baseline. CONCLUSIONS The change in WIC food packages appears to be associated with obesity prevention benefits for boys regardless of initial weight status, with more limited benefits for girls.
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Affiliation(s)
- M Pia Chaparro
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Christopher E Anderson
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Catherine M Crespi
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California
| | - Shannon E Whaley
- Research and Evaluation, Public Health Foundation Enterprises (PHFE) WIC, Irwindale, California
| | - May C Wang
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California
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Abstract
Obesity in adolescence will probably have major implications not only for the affected adolescents but also for society. Those who have obesity during adolescence usually have obesity into adulthood, which causes many medical and psychological issues that can result in premature death. Furthermore, obesity in adolescents is associated with a range of social problems, including difficulties securing an apprenticeship or a job or finding a partner. Adolescents with obesity are also at increased risk of having children with obesity later in life. All these consequences lead to high costs for the health-care system. Although efficient treatment options are available that have been proven in randomized controlled trials, such as lifestyle interventions for adolescents with obesity and bariatric surgery for adolescents with severe obesity, these interventions frequently fail in clinical practice as treatment adherence is low in adolescents and most adolescents with obesity do not seek medical care. Therefore, improving treatment adherence and identifying treatment barriers are necessary.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. Friedrich Steiner Street 5, Datteln 45711, Germany
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Ahrens W, Siani A, Adan R, De Henauw S, Eiben G, Gwozdz W, Hebestreit A, Hunsberger M, Kaprio J, Krogh V, Lissner L, Molnár D, Moreno LA, Page A, Picó C, Reisch L, Smith RM, Tornaritis M, Veidebaum T, Williams G, Pohlabeln H, Pigeot I. Cohort Profile: The transition from childhood to adolescence in European children-how I.Family extends the IDEFICS cohort. Int J Epidemiol 2017; 46:1394-1395j. [PMID: 28040744 PMCID: PMC5837508 DOI: 10.1093/ije/dyw317] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Bremen University, Bremen, Germany
| | - A Siani
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - R Adan
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium
| | - G Eiben
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - W Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - M Hunsberger
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Kaprio
- Department of Public Health, University of Helsinki, Institute for Molecular Medicine (FIMM), Helsinki, Finland
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Lissner
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - A Page
- Centre for Exercise, Nutrition & Health Sciences, University of Bristol, Bristol, UK
| | - C Picó
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Nutrigenomics), University of the Balearic Islands (UIB) and CIBER Fisiopatología de la Obesidad y Nutrición, Palma de Mallorca, Spain
| | - L Reisch
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - R M Smith
- Minerva Communications UK, Andover, UK
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia and
| | - G Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Bremen University, Bremen, Germany
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Nyström CD, Sandin S, Henriksson P, Henriksson H, Trolle-Lagerros Y, Larsson C, Maddison R, Ortega FB, Pomeroy J, Ruiz JR, Silfvernagel K, Timpka T, Löf M. Mobile-based intervention intended to stop obesity in preschool-aged children: the MINISTOP randomized controlled trial. Am J Clin Nutr 2017; 105:1327-1335. [PMID: 28446496 DOI: 10.3945/ajcn.116.150995] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/23/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Traditional obesity prevention programs are time- and cost-intensive. Mobile phone technology has been successful in changing behaviors and managing weight; however, to our knowledge, its potential in young children has yet to be examined.Objective: We assessed the effectiveness of a mobile health (mHealth) obesity prevention program on body fat, dietary habits, and physical activity in healthy Swedish children aged 4.5 y.Design: From 2014 to 2015, 315 children were randomly assigned to an intervention or control group. Parents in the intervention group received a 6-mo mHealth program. The primary outcome was fat mass index (FMI), whereas the secondary outcomes were intakes of fruits, vegetables, candy, and sweetened beverages and time spent sedentary and in moderate-to-vigorous physical activity. Composite scores for the primary and secondary outcomes were computed.Results: No statistically significant intervention effect was observed for FMI between the intervention and control group (mean ± SD: -0.23 ± 0.56 compared with -0.20 ± 0.49 kg/m2). However, the intervention group increased their mean composite score from baseline to follow-up, whereas the control group did not (+0.36 ± 1.47 compared with -0.06 ± 1.33 units; P = 0.021). This improvement was more pronounced among the children with an FMI above the median (4.11 kg/m2) (P = 0.019). The odds of increasing the composite score for the 6 dietary and physical activity behaviors were 99% higher for the intervention group than the control group (P = 0.008).Conclusions: This mHealth obesity prevention study in preschool-aged children found no difference between the intervention and control group for FMI. However, the intervention group showed a considerably higher postintervention composite score (a secondary outcome) than the control group, especially in children with a higher FMI. Further studies targeting specific obesity classes within preschool-aged children are warranted. This trial was registered at clinicaltrials.gov as NCT02021786.
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Affiliation(s)
| | - Sven Sandin
- Medical Epidemiology and Biostatistics, and.,Department of Psychiatry, and.,Seaver Autism Center for Research and Treatment, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Pontus Henriksson
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Hanna Henriksson
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Ylva Trolle-Lagerros
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Christel Larsson
- Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Victoria, Australia
| | - Francisco B Ortega
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Jeremy Pomeroy
- Marshfield Clinic Research Foundation, Marshfield, WI; and Departments of
| | - Jonatan R Ruiz
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | | | - Toomas Timpka
- Medical and Health Sciences, Faculty of the Health Sciences, Linköping University, Linköping, Sweden
| | - Marie Löf
- Departments of Biosciences and Nutrition
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Die IDEFICS-Primärprävention als gutes Praxisbeispiel. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1385-1393. [DOI: 10.1007/s00103-016-2445-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nicholls SG, Pohlabeln H, De Bourdeaudhuij I, Chadjigeorgiou C, Gwozdz W, Hebestreit A, Lauria F, Lissner L, Molnár D, Santaliestra-Pasías AM, Veidebaum T, Williams G. Parents' evaluation of the IDEFICS intervention: an analysis focussing on socio-economic factors, child's weight status and intervention exposure. Obes Rev 2015; 16 Suppl 2:103-18. [PMID: 26707020 DOI: 10.1111/obr.12332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION From April 2008 to August 2010 the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) intervention aimed to encourage healthier diets, higher physical activity levels and lower stress levels among European children and their families. While the intervention was intended to improve children's health, we also wished to assess whether there were unwelcome aspects or negative side-effects. Therefore all parents of children who participated in the IDEFICS intervention were asked for their views on different aspects of the intervention. METHODS A total of 10,016 parents of children who participated in the IDEFICS survey and who were involved in the intervention were invited to complete a questionnaire on positive and negative impacts of the intervention. Responses to each of the statements were coded on a four point Likert-type scale. Demographic data were collected as part of the baseline (T0 ) and first follow-up (T1 ) surveys; intervention exposure data was also collected in the T1 follow-up survey. Anthropometric data was collected in the same surveys, and child's weight status was assessed according to Cole and Lobstein. After initial review of the univariate statistics multilevel logistic regression was conducted to analyse the influence of socio-economic factors, child's weight status and intervention exposure on parental responses. RESULTS In total 4,997 responses were received. Approval rates were high, and few parents reported negative effects. Parents who reported higher levels of exposure to the intervention were more likely to approve of it and were also no more likely to notice negative aspects. Less-educated and lower income parents were more likely to report that the intervention would make a lasting positive difference, but also more likely to report that the intervention had had negative effects. Parents of overweight and obese children were more likely to report negative effects - above all, that 'the intervention had made their child feel as if he/she was "fat" or "overweight." ' CONCLUSION While the results represent a broad endorsement of the IDEFICS intervention, they also suggest the importance of vigilance concerning the psychological effects of obesity interventions on overweight and obese children.
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Affiliation(s)
- S G Nicholls
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - C Chadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - W Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, Denmark
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - F Lauria
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - L Lissner
- Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, University of Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, University of Pécs, Hungary
| | - A M Santaliestra-Pasías
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Spain; Red de Salud Materno Infantil y del Desarrollo (RED SAMID), Instituto Carlos III, Madrid, Spain
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia
| | - G Williams
- Department of Politics, Philosophy and Religion, Lancaster University, UK
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Arvidsson L, Bogl LH, Eiben G, Hebestreit A, Nagy P, Tornaritis M, Moreno LA, Siani A, Veidebaum T, De Henauw S, Lissner L. Fat, sugar and water intakes among families from the IDEFICS intervention and control groups: first observations from I.Family. Obes Rev 2015; 16 Suppl 2:127-37. [PMID: 26707022 DOI: 10.1111/obr.12325] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/30/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND The objective of this paper is to investigate differences in diets of families in intervention versus control communities 5 years after the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants intervention ended. METHODS Altogether, 4,691 families from the I.Family study with at least one participating parent and one child are included in this analysis. Diet quality indicators, defined as propensities to consume fat, sugar, water and fruit and vegetables, are calculated from a 59-item food frequency questionnaire. Multilevel linear models with random intercepts for study centre are used to determine whether mean diet indicators, calculated at the family level, differed as a function of previous exposure to the intervention. RESULTS Families in the intervention communities reported a significantly lower sugar propensity (19.8% vs. 20.7% of total food items, p < 0.01) and a higher water propensity (47.3% vs. 46.0% of total beverages, p < 0.05) compared with families in the control communities, while fat and fruit and vegetables propensities were similar. No significant diet differences between intervention and control children were present at the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants baseline. DISCUSSION This result indicates better diet quality in intervention families, which was not present in children when their diets were assessed before the intervention, and gives some cause for optimism regarding the sustainability of some aspects of the diet intervention.
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Affiliation(s)
- L Arvidsson
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L-H Bogl
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - G Eiben
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - P Nagy
- Department of Pediatrics, University of Pécs, Pécs, Hungary
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition, and Development) research group, University of Zaragoza, Zaragoza, Spain
| | - A Siani
- Epidemiology & Population Genetics, Institute of Food Sciences, CNR, Avellino, Italy
| | - T Veidebaum
- Research Centre, National Institute for Health Development, Tallinn, Estonia
| | - S De Henauw
- Department of Public Health, University of Ghent, Ghent, Belgium
| | - L Lissner
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Williams G. The IDEFICS intervention: what can we learn for public policy? Obes Rev 2015; 16 Suppl 2:151-61. [PMID: 26707024 DOI: 10.1111/obr.12355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 10/09/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As considered in the rest of this volume, the effects of the IDEFICS intervention on obesity rates were not encouraging. This paper considers how far findings from the IDEFICS study and similar intervention studies are relevant to the policy process and political decision-making. METHODS The paper offers theoretical and policy-level arguments concerning the evaluation of evidence and its implications for policymaking. The paper is divided into three parts. The first considers problems in the nature and applicability of evidence gained from school- and community-level obesity interventions. The second part considers whether such interventions present a model that policymakers could implement. The third part considers how we should think about policy measures given the limited evidence we can obtain and the many different goals that public policy must take account of. RESULTS The paper argues that (1) there are clear reasons why we are not obtaining good evidence for effective school- and community-level interventions; (2) public policy is not in a good position to mandate larger-scale, long-term versions of these interventions; and (3) there are serious problems in obtaining 'evidence' for most public policy options, but this should not deter us from pursuing options that tackle systemic problems and have a good likelihood of delivering benefits on several dimensions. CONCLUSIONS Research on school- and community-level obesity interventions has not produced much evidence that is directly relevant to policymaking. Instead, it shows how difficult it is to affect obesity rates without changing wider social and economic factors. Public policy should focus on these.
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Affiliation(s)
- G Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
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