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Sultana M, Nichols M, Jacobs J, Karacabeyli D, Allender S, Novotny R, Brown V. The range of outcomes and outcome measurement instruments collected in multisectoral community-based obesity prevention interventions in children: A systematic review. Obes Rev 2024; 25:e13731. [PMID: 38432682 DOI: 10.1111/obr.13731] [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: 04/05/2023] [Revised: 01/14/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
Multicomponent and multisectoral community-based interventions (CBIs) have proven potential in preventing overweight and obesity in children. Synthesizing evidence on the outcomes collected and reported in such CBIs is critical for the evidence of effectiveness and cost-effectiveness. This systematic review aimed to identify the range of outcomes and outcome measurement instruments collected and reported in multisectoral and multicomponent CBIs for obesity prevention in children. A systematic search updated an existing review and extended the search to 11 academic databases (2017-2023) and gray literature. Outcomes were classified into outcome domains, and common measurement instruments were summarized. Seventeen outcome domains from 140 unique outcomes were identified from 45 included interventions reported in 120 studies. The most frequently collected outcome domains included anthropometry and body composition (91% of included interventions), physical activity (84%), dietary intake (71%), environmental (71%), and sedentary behavior (62%). The most frequently collected outcomes from each of these domains included body mass index (89%), physical activity (73%), fruit and vegetable intake (58%), school environment (42%), and screen time (58%). Outcome measurement instruments varied, particularly for behavioral outcomes. Standardization of reported outcomes and measurement instruments is recommended to facilitate data harmonization and support quantifying broader benefits of CBIs for obesity prevention.
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Affiliation(s)
- Marufa Sultana
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Jane Jacobs
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Derin Karacabeyli
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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Catalán-Lambán A, Ojeda-Rodríguez A, Marti Del Moral A, Azcona-Sanjulian C. Changes in objectively measured sleep after a multidisciplinary lifestyle intervention in children with abdominal obesity: A randomized trial. Sleep Med 2023; 109:252-260. [PMID: 37487278 DOI: 10.1016/j.sleep.2023.07.004] [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: 04/26/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND/OBJECTIVE childhood obesity and sleep disorders have a well-established cross-sectional association, but lifestyle interventions' effects on sleep quality remain under-researched. This study aimed to evaluate the sleep quality of 122 participants (7-16 years) with abdominal obesity after a 2-year necessary lifestyle intervention. PATIENTS/METHODS participants were assigned to either the intervention group (moderate hypocaloric Mediterranean Diet) or the usual care group (standard recommendations on a healthy diet). Sleep was objectively assessed using triaxial accelerometry, and sleep parameters analyzed included latency, efficiency, wake after sleep onset, total time in bed, total sleep time, number of awakenings, and awakening duration. RESULTS AND CONCLUSIONS the results showed that the intervention group significantly improved sleep latency at 12 and 24 months and improved sleep efficiency at 2 and 12 months, compared to the usual care group. Wake after sleep onset and the number of awakenings were significantly reduced at 24 months in the intervention group. Wake after sleep onset and leptin levels were positively associated in all participants. Total time in bed was inversely associated with triglycerides and metabolic score, and total sleep time was inversely associated with leptin, triglycerides, and metabolic score after the 2-month intervention. Triglyceride levels were inversely associated with total time in bed and total sleep time at one year, while the metabolic score was directly associated with wake after sleep onset and the number of awakenings and inversely associated with efficiency. In conclusion, the multidisciplinary intervention in children and adolescents with abdominal obesity reduced anthropometric parameters and improved sleep habits.
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Affiliation(s)
- Ana Catalán-Lambán
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ana Ojeda-Rodríguez
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, School of Pharmacy and Nutrition, University of Navarra, Spain; Lipids and Atherosclerosis Unit, Unidad de Gestión Clinica Medicina Interna, Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Av. Menendez Pidal, S/N. 14004, Córdoba, Spain
| | - Amelia Marti Del Moral
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, School of Pharmacy and Nutrition, University of Navarra, Spain; CIBER Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029, Madrid, Spain; Institute of Research of Navarra (IdisNa), Pamplona, Spain
| | - Cristina Azcona-Sanjulian
- Department of Pediatrics, Clínica Universidad de Navarra, Pamplona, Spain; Institute of Research of Navarra (IdisNa), Pamplona, Spain.
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Hesketh KD, Downing KL, Galland BC, Nicholson JM, Taylor R, Orellana L, Abdelrazek M, Koorts H, Brown V, Haines J, Campbell KJ, Barnett LM, Löf M, Moodie M, Carson V, Salmon J. Protocol for the Let's Grow randomised controlled trial: examining efficacy, cost-effectiveness and scalability of a m-Health intervention for movement behaviours in toddlers. BMJ Open 2022; 12:e057521. [PMID: 35351726 PMCID: PMC8961153 DOI: 10.1136/bmjopen-2021-057521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Despite being an important period for the development of movement behaviours (physical activity, sedentary behaviour and sleep), few interventions commencing prior to preschool have been trialled. The primary aim of this trial is to assess the 12-month efficacy of the Let's Grow mHealth intervention, designed to improve the composition of movement behaviours in children from 2 years of age. Let's Grow is novel in considering composition of movement behaviours as the primary outcome, using non-linear dynamical approaches for intervention delivery, and incorporating planning for real-world implementation and scale-up from its inception. METHODS AND ANALYSIS A randomised controlled trial will test the effects of the 12-month parental support mHealth intervention, Let's Grow, compared with a control group that will receive usual care plus electronic newsletters on unrelated topics for cohort retention. Let's Grow will be delivered via a purpose-designed mobile web application with linked SMS notifications. Intervention content includes general and movement-behaviour specific parenting advice and incorporates established behaviour change techniques. Intervention adherence will be monitored by app usage data. Data will be collected from participants using 24-hour monitoring of movement behaviours and parent report at baseline (T0), mid-intervention (T1; 6 months post baseline), at intervention conclusion (T2; 12 months post baseline) and 1-year post intervention (T3; 2 years post baseline). The trial aims to recruit 1100 families from across Australia during 2021. In addition to assessment of efficacy, an economic evaluation and prospective scalability evaluation will be conducted. ETHICS AND DISSEMINATION The study was approved by the Deakin University Human Ethics Committee (2020-077). Study findings will be disseminated through publication in peer-reviewed journals, presentation at scientific and professional conferences, and via social and traditional media. TRIAL REGISTRATION NUMBER ACTRN12620001280998; U1111-1252-0599.
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Affiliation(s)
- Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Katherine L Downing
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Liliana Orellana
- Faculty of Health Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Burwood, Victoria, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Victoria Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Lisa M Barnett
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
- School of Health & Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Marie Löf
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
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Effects of the healthy start randomized intervention on psychological stress and sleep habits among obesity-susceptible healthy weight children and their parents. PLoS One 2022; 17:e0264514. [PMID: 35271601 PMCID: PMC8912262 DOI: 10.1371/journal.pone.0264514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/10/2022] [Indexed: 11/19/2022] Open
Abstract
Poor sleep and psychological stress are obesity determinants that are rarely included in obesity prevention programs. The aim was to report the effects of the Healthy Start randomized intervention on the secondary outcomes psychological stress and sleep duration and onset latency. Data was obtained from the Healthy Start randomized intervention conducted in 2009–2012 among Danish healthy weight children aged 2–6 years, who had either a high birth weight (>4,000 g), high maternal pre-pregnancy body mass index (>28 kg/m2), or low maternal educational level (≤10 years of schooling) and their parents. The intervention was designed to deliver improvements in diet and physical activity habits, optimization of sleep habits, and reduction of psychological family stress. The average intervention period was 15 months. Children with information on a 7-day sleep record, sleep onset latency, Strengths and Difficulties Questionnaire (SDQ), and a modified version of Parenting Stress Index (PSI) were included. The effects of the intervention on sleep habits, PSI scores, SDQ Total Difficulties (SDQ-TD) and Pro-social Behavior scores, and 95% Confidence Intervals (95% CI) were analyzed using linear regression intention-to-treat (n = 543 (intervention group n = 271, control group n = 272)) analyses. No statistically significant effects on sleep duration, sleep onset latency, PSI score, or SDQ Pro-social Behavior score were observed. Values both before and after the intervention were within the normal range both for children in the intervention and children in the control group. Mean change in SDQ-TD was 0.09 points (95% CI -0.57;0.59) in the intervention group, and -0.69 points (95% CI -1.16; -0.23) in the control group (p = 0.06). In conclusion, there were no intervention effects in relation to sleep duration, sleep onset latency, PSI score, or SDQ Pro-social behavior. There was an indication that children in the intervention group had slightly more behavioral problems than the control group after the intervention, but values were within normal range both before and after the intervention, and the difference is not considered to be clinically meaningful.
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Associations between sleep duration and insulin resistance in European children and adolescents considering the mediating role of abdominal obesity. PLoS One 2020; 15:e0235049. [PMID: 32603369 PMCID: PMC7326225 DOI: 10.1371/journal.pone.0235049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background Short sleep duration has been suggested to lead to insulin resistance both directly by altering glucose metabolism and indirectly through obesity. This study aims to investigate associations between nocturnal sleep duration and insulin resistance considering abdominal obesity as a mediator. Methods We analysed data of 3 900 children aged 2–15 years participating in the second (2009/10) and third (2013/14) examination wave of the European IDEFICS/I.Family study (hereafter referred to as baseline and follow-up). Information on nocturnal sleep duration was collected by questionnaires and age-standardised (SLEEP z-score). The homeostasis model assessment (HOMA) was calculated from fasting insulin and fasting glucose obtained from blood samples; waist circumference (WAIST) was measured with an inelastic tape. HOMA and WAIST were used as indicators for insulin resistance and abdominal obesity, respectively, and transformed to age- and sex-specific z-scores. Cross-sectional and longitudinal associations between SLEEP z-score and HOMA z-score were investigated based on a path model considering WAIST z-score as a mediator adjusting for relevant confounders. Results Cross-sectionally, baseline SLEEP z-score was negatively associated with baseline WAIST z-score (unstandardised effect estimate -0.120, 95% confidence interval [-0.167; -0.073]). We observed no direct effect of baseline SLEEP z-score on baseline HOMA z-score but a negative indirect effect through baseline WAIST z-score (-0.042 [-0.058; -0.025]). Longitudinally, there was no direct effect of baseline SLEEP z-score on HOMA z-score at follow-up but a negative indirect effect through both baseline WAIST z-score and WAIST z-score at follow-up (-0.028 [-0.040; -0.016]). Conclusions Our results do not support the hypothesis of an association between short sleep duration and insulin resistance independent of abdominal obesity. However, longer sleep duration may exert short and long term beneficial effects on insulin resistance through its beneficial effects on abdominal obesity.
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Stahlmann K, Hebestreit A, DeHenauw S, Hunsberger M, Kaprio J, Lissner L, Molnár D, Ayala-Marín AM, Reisch LA, Russo P, Tornaritis M, Veidebaum T, Pohlabeln H, Bogl LH. A cross-sectional study of obesogenic behaviours and family rules according to family structure in European children. Int J Behav Nutr Phys Act 2020; 17:32. [PMID: 32138743 PMCID: PMC7059256 DOI: 10.1186/s12966-020-00939-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/21/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There has been an increase in children growing up in non-traditional families, such as single-parent and blended families. Children from such families have a higher prevalence of obesity and poorer health outcomes, but research on the relationship with obesogenic behaviours is limited. OBJECTIVES Therefore, the aim of this study was to investigate whether there are associations between family structures and obesogenic behaviours and related family rules in European children and adolescents. METHODS The sample included 7664 children (mean age ± SD: 10.9 ± 2.9) from 4923 families who were participants of the multi-centre I.Family study (2013/2014) conducted in 8 European countries. Family structure was assessed by a detailed interview on kinship and household. Obesogenic behaviours (screen time, sleep duration, consumption of sugar-sweetened beverages (SSBs)) and family rules (rules for computer and television, bedtime routine, availability of SSBs during meals) were determined by standardized questionnaires. Multilevel mixed-effects linear and logistic regression models were used to model the associations of family structure with obesogenic behaviours and family rules. Sex, age, parental education level, number of children and adults in the household and BMI z-score were covariates in the models. Two-parent biological families were set as the reference category. RESULTS Children from single-parent families were less likely to have family rules regarding screen time (OR: 0.62, 95% CI: 0.40-0.94, p = 0.026) with higher reported hours of screen time per week (β = 2.70 h/week, 95% CI: 1.39-4.00, p < 0.001). The frequency of weekly SSB consumption differed by family structure in a sex-specific manner: girls from single-parent (β = 3.19 frequency/week, 95% CI: 0.91-5.47, p = 0.006) and boys from blended/adoptive families (β = 3.01 frequency/week, 95% CI: 0.99-5.03, p = 0.004) consumed more SSBs. Sleep duration, bedtime routines and availability of SSBs during meals did not differ between children from these family structures. Parental education did not modify any of these associations. CONCLUSIONS Parents in non-traditional family structures appear to experience more difficulties in restricting screen time and the intake of SSBs in their children than parents in traditional two-parent family structures. Our findings therefore suggest that additional support and effective strategies for parents in non-traditional families may help to reduce obesogenic behaviours in children from such family types.
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Affiliation(s)
- Katharina Stahlmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Monica Hunsberger
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jaakko Kaprio
- Institute of Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dénes Molnár
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Alelí M Ayala-Marín
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Lucia A Reisch
- Department of Management, Society and Communication, Copenhagen Business School, Frederiksberg, Denmark
| | - Paola Russo
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | | | - Toomas Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Leonie H Bogl
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
- Institute of Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland.
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.
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Simon SL, Goetz AR, Meier M, Brinton J, Zion C, Stark LJ. Sleep duration and bedtime in preschool-age children with obesity: Relation to BMI and diet following a weight management intervention. Pediatr Obes 2019; 14:e12555. [PMID: 31215768 PMCID: PMC6812590 DOI: 10.1111/ijpo.12555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/13/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sleep duration is associated with obesity in preschoolers. Weight-management interventions may be an opportunity to incorporate sleep health recommendations. OBJECTIVES To examine changes in sleep in preschool-age children with obesity following a family-based weight-management intervention (Learning about Activity and Understanding Nutrition for Child Health [LAUNCH]) compared with motivational interviewing and standard care conditions. Additionally, we examined associations between sleep with body mass index (BMI) z score (BMIz) and diet. METHODS One hundred fifty-one children (4.6 ± 0.93 y) completed baseline (pretreatment) and posttreatment (week 24) assessments, including anthropometrics, 24-hour dietary recalls, and a 7-day sleep diary. Analysis of variance (ANOVA) and chi-squared tests compared sleep variables between groups; linear regression models examined effects of sleep on BMIz and dietary intake at posttreatment, controlling for baseline values. RESULTS Bedtime and sleep duration were not significantly different between treatment groups from baseline to posttreatment. After adjusting for baseline sleep, earlier bedtime was associated with lower BMIz (95% CI, 0.00-0.04; .03), intake of added sugars (95% CI, 0.70-4.32; .007), and sweet/dessert food servings (95% CI, 0.00-0.19; .04) at posttreatment. Longer night-time sleep duration was associated with fewer added sugars at posttreatment, adjusting for baseline sleep (95% CI, -3.79 to -0.35; .02). CONCLUSIONS More comprehensive sleep intervention incorporated into weight-management intervention may be necessary to promote positive changes for preschoolers with obesity. A focus on earlier bedtime and longer sleep duration appears to be important given associations between sleep duration and bedtime with BMIz and dietary intake.
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Affiliation(s)
- Stacey L. Simon
- Division of Pulmonary & Sleep Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
| | - Amy R. Goetz
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Maxene Meier
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
| | - John Brinton
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado, Aurora, CO
| | - Cynthia Zion
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lori J. Stark
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
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Tuohino T, Morales-Muñoz I, Saarenpää-Heikkilä O, Kiviruusu O, Paunio T, Hovi P, Pietiläinen KH, Paavonen EJ. Short Sleep Duration and Later Overweight in Infants. J Pediatr 2019; 212:13-19. [PMID: 31208782 DOI: 10.1016/j.jpeds.2019.05.041] [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: 01/23/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To provide further knowledge about the longitudinal association between sleep duration and overweight in infants. STUDY DESIGN The data for this study are from the CHILD-SLEEP birth cohort (n = 1679). The sleep data are based on parent-reported total sleep duration collected at 3, 8, 18, and 24 months. For a subgroup of 8-month old participants (n = 350), an actigraph recording was also made. Growth data were derived from the child health clinic records. A logistic regression model was used to study the association between sleep duration and later weight development. RESULTS Shorter sleep duration in 3-month-old infants was cross-sectionally associated with lower weight-for-length/height (all P values ≤ .026) and body mass index (all P values ≤ .038). Moreover, short sleep duration at the age of 3 months was associated with greater weight-for-length/height z score at the age of 24 months (aOR 1.56; 95% CI 1.02-2.38) as well as with a predisposition to gain excess weight between 3 and 24 months of age (aOR 2.61; 95% CI 1.75-3.91). No significant associations were found between sleep duration at 8, 18, or 24 months and concurrent or later weight status. Actigraph-measured short night-time sleep duration at the age of 8 months was associated with greater weight-for-length at the age of 24 months (aOR 1.51; 95% CI 1.02-2.23). CONCLUSIONS Short total sleep duration at the age of 3 months and short night-time sleep duration at the age of 8 months are associated with the risk of gaining excess weight at 24 months of age.
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Affiliation(s)
- Tuuli Tuohino
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Isabel Morales-Muñoz
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland; Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Outi Saarenpää-Heikkilä
- Department of Pediatrics, Tampere University Hospital; Tampere University, Faculty of Medicine and Medical Technology (Center for Child Health Research), Tampere, Finland
| | - Olli Kiviruusu
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tiina Paunio
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland; Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petteri Hovi
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland; Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Endocrinology, Abdominal Center, Obesity Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E Juulia Paavonen
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
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Feasibility of Integrating Physical Activity Into Early Education Learning Standards on Preschooler's Physical Activity Levels. J Phys Act Health 2019; 16:101-107. [PMID: 30626270 DOI: 10.1123/jpah.2017-0628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND For a health behavior intervention to be sustainable within preschool centers, the intervention should be implemented by classroom teachers. Unfortunately, teachers are constrained by demands such as meeting early childhood education standards. Therefore, the purpose of this pilot study was to examine the feasibility and preliminary efficacy of integrating a health behavior intervention into early education learning standards on physical activity (PA), diet, and sleep (PADS) behavior of preschoolers. METHODS Two preschool centers were randomized to either the PADS (children, n = 60) or the control (CON; children, n = 54) group. The PADS intervention consisted of PADS lesson plans and activities embedded into Massachusetts early learning standards and were implemented for 4 days per week for 12 weeks. The CON preschool participated in their usual curriculum. PA was assessed using accelerometers for 7 consecutive days at baseline, 6 weeks, and 12 weeks. Other outcome variables were assessed with parental surveys at baseline and 12 weeks. RESULTS Significant group by time interactions were observed for moderate to vigorous PA (percentage of time) during the preschool day (PADS: baseline = 10.6% (4.2%), 12 wk = 13.2% (2.3%); CON: baseline = 12.4% (3.9%), 12 wk = 11.2% (3.6%); P = .02). CONCLUSION This pilot study provides preliminary evidence that integrating health behaviors into learning standards is feasible and potentially an effective way for increasing preschoolers' PA levels.
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10
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Sakamoto N, Gozal D, Smith DL, Yang L, Morimoto N, Wada H, Maruyama K, Ikeda A, Suzuki Y, Nakayama M, Horiguchi I, Tanigawa T. Sleep Duration, Snoring Prevalence, Obesity, and Behavioral Problems in a Large Cohort of Primary School Students in Japan. Sleep 2017; 40:2980939. [PMID: 28364432 DOI: 10.1093/sleep/zsw082] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Objectives Poor or short sleep and the presence of snoring indicative of sleep-disordered breathing (SDB) have been associated with behavioral problems in school-aged children. We examined the relationship between SDB, sleep duration, obesity risk, and behavioral characteristics in Japanese elementary school students using a large-scale survey. Methods We conducted a cross-sectional study of children enrolled in all 46 public primary schools in Matsuyama city, Japan. The children's parents or guardians completed a questionnaire that covered sleep habits, presence of SDB risk, and behavioral characteristics. Results In total, 24 296 responses were received (90% response rate). After excluding incomplete responses, we analyzed complete datasets for 17 769 children. Mean sleep duration decreased with age, as did the prevalence of pediatric SDB. We found an increased risk for the presence of SDB and short sleep among overweight/obese children. With SDB or short sleep, we observed significantly increased odds of restless behaviors, fidgety behaviors, and poor concentration in school. Conclusions Shorter sleep duration was associated with increased risk of obesity, and in turn, obesity increased SDB risk. Both short sleep duration and SDB risk were significantly associated with behavioral problems in school.
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Affiliation(s)
- Naoko Sakamoto
- Department of Epidemiologic Research, Toho University, Tokyo, Japan
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago,Chicago, IL
| | - Dale L Smith
- Department of Health Sciences, University of Chicago, Chicago, IL
| | - Limin Yang
- Medical Support Center for Japan Environment and Children's Study, Tokyo, Japan
- National Center for Child Health and Development, Tokyo, Japan
| | - Noriko Morimoto
- National Center for Child Health and Development, Tokyo, Japan
| | - Hiroo Wada
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kotatsu Maruyama
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ai Ikeda
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yohei Suzuki
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Meiho Nakayama
- Department of Otolaryngology and Good Sleep Center, Nagoya City University, Nagoya, Japan
| | - Itsuko Horiguchi
- Center for Relations Strategy, Nagasaki University, Nagasaki, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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11
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Brazendale K, Beets MW, Weaver RG, Pate RR, Turner-McGrievy GM, Kaczynski AT, Chandler JL, Bohnert A, von Hippel PT. Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. Int J Behav Nutr Phys Act 2017; 14:100. [PMID: 28747186 PMCID: PMC5530518 DOI: 10.1186/s12966-017-0555-2] [Citation(s) in RCA: 340] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/19/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although the scientific community has acknowledged modest improvements can be made to weight status and obesogenic behaviors (i.e., physical activity, sedentary/screen time, diet, and sleep) during the school year, studies suggests improvements are erased as elementary-age children are released to summer vacation. Emerging evidence shows children return to school after summer vacation displaying accelerated weight gain compared to the weight gained occurring during the school year. Understanding how summer days differ from when children are in school is, therefore, essential. DISCUSSION There is limited evidence on the etiology of accelerated weight gain during summer, with few studies comparing obesogenic behaviors on the same children during school and summer. For many children, summer days may be analogous to weekend days throughout the school year. Weekend days are often limited in consistent and formal structure, and thus differ from school days where segmented, pre-planned, restrictive, and compulsory components exist that shape obesogenic behaviors. The authors hypothesize that obesogenic behaviors are beneficially regulated when children are exposed to a structured day (i.e., school weekday) compared to what commonly occurs during summer. This is referred to as the 'Structured Days Hypothesis' (SDH). To illustrate how the SDH operates, this study examines empirical data that compares weekend day (less-structured) versus weekday (structured) obesogenic behaviors in U.S. elementary school-aged children. From 190 studies, 155 (~80%) demonstrate elementary-aged children's obesogenic behaviors are more unfavorable during weekend days compared to weekdays. CONCLUSION In light of the SDH, consistent evidence demonstrates the structured environment of weekdays may help to protect children by regulating obesogenic behaviors, most likely through compulsory physical activity opportunities, restricting caloric intake, reducing screen time occasions, and regulating sleep schedules. Summer is emerging as the critical period where childhood obesity prevention efforts need to be focused. The SDH can help researchers understand the drivers of obesogenic behaviors during summer and lead to innovative intervention development.
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Affiliation(s)
- Keith Brazendale
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 1st Floor Suite, Room 131, Columbia, SC 29208 USA
| | - Michael W. Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 1st Floor Suite, Room 131, Columbia, SC 29208 USA
| | - R. Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 1st Floor Suite, Room 131, Columbia, SC 29208 USA
| | - Russell R. Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 1st Floor Suite, Room 131, Columbia, SC 29208 USA
| | - Gabrielle M. Turner-McGrievy
- Department of Health Promotion, Education and Behavior, University of South Carolina, 915 Greene Street, Columbia, SC 29201 USA
| | - Andrew T. Kaczynski
- Department of Health Promotion, Education and Behavior, University of South Carolina, 915 Greene Street, Columbia, SC 29201 USA
| | - Jessica L. Chandler
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street, Charleston, SC 29425 USA
| | - Amy Bohnert
- Department of Psychology, Loyola University Chicago, 1032 West Sheridan Road, Chicago, IL 60626 USA
| | - Paul T. von Hippel
- The University of Texas at Austin, Lyndon B. Johnson School of Public Affairs, 2300 Red River Street, Austin, TX 78712 USA
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12
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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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13
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Verloigne M, Ahrens W, De Henauw S, Verbestel V, Mårild S, Pigeot I, De Bourdeaudhuij I. Process evaluation of the IDEFICS school intervention: putting the evaluation of the effect on children's objectively measured physical activity and sedentary time in context. Obes Rev 2015; 16 Suppl 2:89-102. [PMID: 26707019 DOI: 10.1111/obr.12353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/09/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The first aim was to describe the intervention implementation and reception with specific regard to physical activity (PA) within Belgian schools participating in the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) intervention. Second, we examined if a higher intervention process score in schools showed more favourable effects on children's objectively measured PA and sedentary time (ST). METHODS The IDEFICS intervention focused on improving children's health behaviour (including PA) at the community, school/kindergarten and family level. Five process evaluation questionnaires completed by school working groups, and (physical education) teachers were used for the process evaluation of four intervention modules (school working groups, healthy weeks, school environment, health-related physical education and PA). Items were summed to calculate a total intervention process score per school. Schools were subdivided into three groups (low, medium and high score). Multilevel models were used to examine if changes in PA or ST differed between schools with a low, medium or high score. In total, 333 children (54.1% girls, mean age 6.0 ± 1.5 years) from 34 intervention schools (18 pre-schools and 16 primary schools) in the town of Geraardsbergen, Belgium, provided valid accelerometer data for two weekdays and one weekend day. RESULTS Mean intervention process score (maximum value = 44) was 20.9 ± 5.8 for schools. The breakdown per module showed which components were implemented and received well and which components could have been improved. After the intervention, the decrease in light PA and increase in ST was much higher in children from primary schools with a low intervention process score, whereas the behaviours remained relatively stable in children from primary schools with a medium or high score. The change in moderate to vigorous PA did not differ significantly between schools with a low, medium or high score. CONCLUSION The IDEFICS intervention was relatively able to prevent unfavourable changes in ST and light PA in schools with a medium and high intervention process score. Further process evaluation research is needed to obtain a more profound picture of the IDEFICS intervention process.
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Affiliation(s)
- M Verloigne
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.,Research Foundation - Flanders (FWO), Brussel, Belgium
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium.,Department of Health Sciences, Vesalius, University College Ghent, Ghent, Belgium
| | - V Verbestel
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - S Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
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14
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De Bourdeaudhuij I, Verbestel V, De Henauw S, Maes L, Mårild S, Moreno LA, Barba G, Siani A, Kovács E, Konstabel K, Tornaritis M, Pigeot I, Ahrens W. Implementation of the IDEFICS intervention across European countries: perceptions of parents and relationship with BMI. Obes Rev 2015; 16 Suppl 2:78-88. [PMID: 26707018 DOI: 10.1111/obr.12330] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 08/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The primary aim of the present study was to obtain insight into parents' perception of the IDEFICS intervention at the school or preschool/kindergarten and community levels and whether they received specific materials related to the intervention. The secondary aim was to analyse whether parents who reported higher levels of exposure to the IDEFICS intervention had children with more favourable changes in body mass index (BMI) z-scores between baseline and after 2 years of intervention. METHODS Process evaluation of the IDEFICS intervention investigated the implementation of the 2-year intervention in the intervention communities. Intervention group parents (n = 4,180) in seven countries (Belgium, Cyprus, Estonia, Germany, Italy, Spain and Sweden) answered questions about their exposure to the IDEFICS study. To analyse the relationship between exposure and BMI z-score, a composite score was calculated for exposure at the setting and at the community levels. RESULTS The frequency of parental exposure to the IDEFICS messages not only through the community but also through the (pre)school/kindergarten was lower than what was intended and planned. The dose received by the parents was considerably higher through the (pre)school/kindergarten settings than that through the community in all countries. Efforts by the settings or communities related to fruit and vegetable consumption (range 69% to 97%), physical activity promotion (range 67% to 91%) and drinking water (range 49% to 93%) were more visible and also realized more parental involvement than those related to TV viewing, sleep duration and spending time with the family (below 50%). Results showed no relation of parental exposure at the setting or the community level on more favourable changes in children's BMI z-scores for the total sample. Country-specific analyses for parental exposure at the setting level showed an expected positive effect in German girls and an unexpected negative effect in Italian boys. CONCLUSION Parental exposure and involvement in the IDEFICS intervention in all countries was much less than aimed for, which might be due to the diverse focus (six key messages) and high intensity and duration of the intervention. It may also be that the human resources invested in the implementation and maintenance of intervention activities by the study centres, the caretakers and the community stakeholders were not sufficient. Higher levels of parental exposure were not related to more favourable changes in BMI z-scores.
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Affiliation(s)
- I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - V Verbestel
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium
| | - L Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - S Mårild
- Department of Pediatrics, Göteborg University, Göteborg, Sweden
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Universidad de Zaragoza, Zaragoza, Spain
| | - G Barba
- Institute of Food Science, National Research Council, Avellino, Italy
| | - A Siani
- Institute of Food Science, National Research Council, Avellino, Italy
| | - E Kovács
- Department Paediatrics, University of Pécs, Pécs, Hungary
| | - K Konstabel
- National Institute for Health Development, Tallinn, Estonia
| | - M Tornaritis
- Research and Education Institute for Child Health, Strovolos, Cyprus
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
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15
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Baranowski T, Lytle L. Should the IDEFICS outcomes have been expected? Obes Rev 2015; 16 Suppl 2:162-72. [PMID: 26707025 DOI: 10.1111/obr.12359] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/27/2015] [Indexed: 01/16/2023]
Abstract
The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study evaluated with a large sample a comprehensive carefully planned obesity prevention intervention targeting multiple levels of influence that were culturally adapted to the situations in eight European countries. Despite the great effort and attention to detail, the IDEFICS study did not achieve its targeted adiposity or behaviour change objectives. Should we be surprised that the IDEFICS trial did not have its intended effects? We think not, and would have been surprised if it did. Recent research has revealed the lack of consistent meaningful relationships between several apparently obesogenic behaviours and adiposity, weak or no relationships among behavioural change procedures, mediating variables and targeted behaviours and inadequate attention to moderating effects. Future obesity prevention interventions would benefit from a more thorough understanding of the complex relationships that have been hypothesized and the interrelationships with biological factors. While systems modelling has been proposed as providing the solution, important less complex identification of new constructs, new relationships and community interventions are still needed, both to find innovative solutions and to provide input into the systems models. We should question results from cross-sectional studies and be satisfied only with longitudinal or experimental tests of relationships.
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Affiliation(s)
- T Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - L Lytle
- Department of Health Behavior, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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