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Hodder RK, O'Brien KM, Wyse RJ, Tzelepis F, Yoong S, Stacey FG, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2024; 9:CD008552. [PMID: 39312396 PMCID: PMC11418976 DOI: 10.1002/14651858.cd008552.pub8] [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] [Indexed: 09/25/2024]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions designed to increase children's consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment, is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the benefits and harms of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 March 2023. We searched Proquest Dissertations and Theses in December 2022. We reviewed reference lists of included trials and contacted authors of the included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-randomised controlled trials (C-RCTs) and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both amongst children aged five years and under compared to no-intervention control, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. We used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the certainty of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 53 trials with 120 trial arms and 12,350 participants. Sixteen trials examined the impact of child-feeding practice interventions only (e.g. repeated food exposure) in increasing child vegetable intake. Twenty trials examined the impact of multicomponent interventions primarily conducted in the childcare setting (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Seventeen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children only in increasing child fruit and vegetable intake and one each examined a child-focused mindfulness intervention or providing families with fruit and vegetable interventions. We judged nine of the 53 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is moderate-certainty evidence that child-feeding practice interventions versus no-intervention control probably have a small positive effect on child vegetable consumption, equivalent to an increase of 15.5 grams as-desired consumption of vegetables (SMD 0.44, 95% confidence interval (CI) 0.24 to 0.65; 15 trials, 1976 participants; mean post-intervention follow-up = 12.3 weeks). No trials in this comparison reported information about intervention costs. One trial reported no harms or serious unintended adverse consequences (low-certainty evidence). Multicomponent interventions versus no-intervention control probably have a small effect on child consumption of fruit and vegetables (SMD 0.27, 95% CI 0.11 to 0.43; 14 trials, 4318 participants; moderate-certainty evidence; mean post-intervention follow-up = 4.0 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. One trial, which tested a multicomponent garden-based intervention, reported the installation of the garden as part of the intervention to be USD 1500 per childcare centre (low-certainty evidence). No trials in this comparison reported information about unintended adverse consequences of interventions. Parent nutrition education interventions may have little to no short-term impact on child consumption of fruit and vegetables versus no-intervention control (SMD 0.10, 95% CI -0.02 to 0.22; 14 trials, 4122 participants; low-certainty evidence; mean post-intervention follow-up = 6.4 weeks). One trial reported the total estimated cost of delivering a parent nutrition education intervention for infant feeding, physical activity and sedentary behaviours delivered by a dietitian as approximately AUD 500 per family (low-certainty evidence). One trial reported no unintended adverse consequences on family food expenditure following implementation of an intervention delivered over the telephone to improve parental knowledge and skills about the home food environment (low-certainty evidence). Trials reported receiving governmental or charitable funds, except for one trial reporting industry funding. AUTHORS' CONCLUSIONS There was moderate-certainty evidence that child-feeding practice interventions and multicomponent interventions probably lead to only small increases in fruit and vegetable consumption in children aged five years and under. Parent nutrition education interventions may have little or no effect on increasing fruit and vegetable consumption in children aged five years and under. Future research should be prioritised on assessment and reporting of both intervention cost and adverse effects, and development and evaluation of interventions in research gaps, including in a broader range of settings and in low- and middle-income countries. This review continues to be maintained as a living systematic review with monthly searches for new evidence and incorporation of relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
| | - Serene Yoong
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
- Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Fiona G Stacey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, The University of Newcastle, Callaghan, Australia
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Argumedo G, López y Taylor JR, Ortiz Brunel J, Gaytán-González A, González-Casanova I, González Villalobos MF, Jáuregui A, Jáuregui Ulloa E, Medina C, Pacheco Miranda YS, Pérez Rodríguez M, Retano Pelayo RA, Rodríguez Martínez MDP, Galaviz KI. Results from the 2022 Mexican report card on physical activity for children and adolescents. Front Public Health 2024; 11:1304719. [PMID: 38249393 PMCID: PMC10796772 DOI: 10.3389/fpubh.2023.1304719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction The Mexican Report Card on Physical Activity for Children and Adolescents aims to assess the prevalence of movement behaviors and opportunities to perform them. Methods Data on 11 indicators were obtained from national health surveys, census data, government documents, websites, and published studies. Data were compared against established benchmarks, and a grade between 0 and 10 was assigned to each indicator. Results For Daily Behaviors, we found 34.5% of Mexican children and adolescents meet Physical Activity recommendations (Grade 3), 48.4% participate in Organized Sports (Grade 5), 35-75.8% engage in Active Play outdoors (Grade 4), 54.1% use Active Transportation (Grade 5), 43.6% spend <2 h in Sedentary Behavior per day (Grade 4), and 65-91% meet Sleep recommendations (Grade 7). Girls have lower physical activity levels and sports participation than boys of the same age. For Physical Fitness, we found 56.2-61.8% of children and adolescents have an adequate body mass index for their age (Grade 6). For Sources of Influence, we found 65-67% of parents engage in physical activity or sports in a week (Grade 7), 32.2-53.3% of basic education schools have a physical education teacher (Grade 6), and 37% of neighborhoods in Mexico have sidewalks with trees (Grade 4). Regarding Government, several policies and programs aimed at improving children physical activity were launched but their impact and allocated implementation budget are unknown (Grade 6). Discussion Mexican children and adolescents engage in low levels of movement behaviors and have limited opportunities to perform such behaviors. The grades and recommendations provided here should be considered to improve such opportunities.
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Affiliation(s)
- Gabriela Argumedo
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
- Colegio de Ciencias y Humanidades, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Juan Ricardo López y Taylor
- Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Julissa Ortiz Brunel
- Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Alejandro Gaytán-González
- Physical Activity Promotion and Chronic Disease Prevention Unit, School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | | | - Martín Francisco González Villalobos
- Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Alejandra Jáuregui
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Edtna Jáuregui Ulloa
- Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Catalina Medina
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | | | - Marcela Pérez Rodríguez
- Centro de Adiestramiento en Investigación Clínica, División de Desarrollo de la Investigación, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ricardo Alejandro Retano Pelayo
- Coordinación de Cultura y Educación para un Estilo de Vida Saludable, Sistema de Educación Media superior, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | - Karla I. Galaviz
- Indiana University School of Public Health Bloomington, Bloomington, IN, United States
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Bleiweiss-Sande R, Skelton K, Zaltz D, Bacardí-Gascón M, Jiménez-Cruz A, Benjamin-Neelon SE. Interventions to prevent obesity in Latinx children birth to 6 years globally: a systematic review. Public Health Nutr 2023; 26:2498-2513. [PMID: 37622420 PMCID: PMC10641617 DOI: 10.1017/s1368980023001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/03/2023] [Accepted: 06/20/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To conduct a systematic review of obesity prevention interventions in Latinx children ages birth to 6 years published in any language from 2010-2020. DESIGN We used PubMed, ERIC, PsycINFO, Scopus, Scientific Electronic Library Online (SciELO) and Google Scholar databases to conduct a search on May 1 2020, January 1 2021 and November 1 2022. We included randomised controlled trials, quasi-experimental studies and non-randomised interventions with a control or comparison group that reported measures of adiposity. SETTING Interventions taking place in the United States, Latin America or the Caribbean. PARTICIPANTS Latinx children ages birth to 6 years. RESULTS Of 8601 unique records identified, forty manuscripts about thirty-nine unique studies describing thirty distinct interventions in the United States and nine interventions in Latin America and the Caribbean met our inclusion criteria. Interventions were primarily based in early care and education centres (n 13) or combined home settings, for example home and community (n 7). Randomised interventions taking place in community or home settings were more likely to report significant reductions in adiposity or weight-related outcomes compared to other settings. Using the Cochrane risk of bias tools for randomised and non-randomised studies, we judged thirty-eight randomised trials and nine non-randomised interventions to have a high or unclear risk of bias. CONCLUSIONS The results highlight a need for more rigorous designs and more effective intervention strategies in Latinx children at risk for having overweight and obesity. Registered with the PROSPERO database for systematic reviews under registration number CRD42020161339.
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Affiliation(s)
- Rachel Bleiweiss-Sande
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD21205, USA
| | - Kara Skelton
- Department of Health Sciences, Towson University, Towson, MD, USA
| | - Daniel Zaltz
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD21205, USA
| | | | - Arturo Jiménez-Cruz
- Universidad Autónoma de Baja California, Department of Medicine and Psychology, Tijuana, Mexico
| | - Sara E Benjamin-Neelon
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 N Broadway, Baltimore, MD21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 292] [Impact Index Per Article: 292.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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Skinner AC, Staiano AE, Armstrong SC, Barkin SL, Hassink SG, Moore JE, Savage JS, Vilme H, Weedn AE, Liebhart J, Lindros J, Reilly EM. Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions. Pediatrics 2023; 151:190447. [PMID: 36622110 DOI: 10.1542/peds.2022-060642] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
Abstract
The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are clinically based, effective treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori key questions.
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Affiliation(s)
- Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Amanda E Staiano
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shari L Barkin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Sandra G Hassink
- Medical Director, American Academy of Pediatrics, Institute for Healthy Childhood Weight, Wilmington, Delaware
| | - Jennifer E Moore
- Institute for Medicaid Innovation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Pennsylvania State University, Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Helene Vilme
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Yang L, Liang C, Yu Y, Xiao Q, Xi M, Tang L. Family sports interventions for the treatment of obesity in childhood: a meta-analysis. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:40. [PMID: 36056414 PMCID: PMC9440531 DOI: 10.1186/s41043-022-00317-7] [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: 02/12/2021] [Accepted: 08/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Obesity in children has become one of the key concerns of the World Health Organization, and the incidence of related non-communicable diseases is also rising. This study evaluates the effect of family sports participation on the treatment and prevention of obesity in children aged 0–14 years by systematic analysis. Method A literature review from 2000 to 2020 was conducted. According to PRISMA-IPD (Preferred Reporting Items for MetaAnalyses of individual participant data) guidelines. The two researchers independently assessed the risk and bias of the articles, obtained a comprehensive, high-quality result, and extracted the data based on the Cochrane intervention system review manual. Randomized controlled trials (RCTs) were selected from the searches that used family sports interventions or family sports combined with dietary adjustments and behavioral habits change. Only studies targeting overweight or obese children aged 0–14 years were included. Results The search resulted in a total of 16 studies. Across all 16 studies, there were a total of 1680 participants in the experimental groups and 1701 participants in the control groups. The results are as follows: body mass index (BMI) (SMD-RE = − 4.10, 95% CI (− 0.84 to 0.02), Z = 1.88, p = 0.06); Body weight (SMD-RE = − 0.77, 95% CI (− 1.53 to − 0.01), Z = 2.00, p = 0.05); Waist circumference (SMD-RE = − 0.45, 95% CI (− 1.36 to 0.47), Z = 0.96, p = 0.34); and Body fat rate (SMD-FE = − 0.06, 95% CI (− 0.22 to 0.11), Z = 0.69, p = 0.49). Hence, through family sports intervention among obese children, juvenile and obese body composition—BMI, body weight, waist circumference, and body fat rate—are all reduced. But only body weight was statistically significant. Conclusions Compared with the samples without family sports, the weight of obese children participating in family sports decreased, but there were no significant differences in other relevant physical indicators. Follow-up research should examine large-scale clinical trials with family sports as a single factor intervention, which are needed to provide stronger evidence of the intervention effect. However, family activities can help obese children grow and develop by improving their exercise capacity, enhancing their lifestyles, and facilitating communication and relationships with their parents. In the future, long-term sports training plans for children with obesity should be implemented.
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Flores-Peña Y, He M, Sosa ET, Avila-Alpirez H, Trejo-Ortiz PM, Gutiérrez-Sánchez G. Impacts of an early childhood obesity prevention program in Mexico. HEALTH EDUCATION RESEARCH 2022; 37:242-253. [PMID: 35686999 DOI: 10.1093/her/cyac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/18/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
The Healthy Change Program aimed to improve the accuracy of maternal perceptions of children's weight (MPCW), maternal feeding style (MFS) and feeding practices. Using a randomized control trial design, the intervention group received 4-weekly group sessions focusing on MPCW, MFS and healthy behaviors. The control group received the same dose of attention-control sessions on food hygiene. Data were collected at the baseline and at the end of the program via self-administered questionnaires and anthropometric measurements. Participants included 294 mother-child dyads with 149 in the intervention group and 145 in the control group. The accuracy of MPCW significantly increased at the study end point in the intervention group (57.0-67.1%, P < 0.05) but not in the control group (67.6-69.7%, P > 0.05), with no between-group difference in pre- and post-change (P > 0.05). At the study end point, more mothers of overweight and obese children in the intervention group had accurate MPCW than their control counterparts (31.4% versus 11.1%, P < 0.01). The intervention group had a shift toward an authoritative style at the study end point (17.4% versus 26.2%, P < 0.001) and favorable changes in feeding practices. The Healthy Change Program contributed to improving the accuracy of MPCW and shifts toward favorable MFS and feeding practices.
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Affiliation(s)
- Y Flores-Peña
- School of Nursing, Autonomous University of Nuevo León, Ave. Gonzalitos No. 1500 Nte, Col. Mitras Centro, Monterrey, Nuevo León ZP 64460, Mexico
| | - M He
- College for Health, Community & Policy, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - E T Sosa
- College for Health, Community & Policy, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
| | - H Avila-Alpirez
- Multidisciplinary Unit, Autonomous University of Tamaulipas, Ave. Maestro and Marte S/N. Col. City Alianza, H. Matamoros, Tamaulipas ZP 87410, Mexico
| | - P M Trejo-Ortiz
- Health Sciences Department, Autonomous University of Zacatecas, Carretera Zacatecas-Guadalajara Km. 6, Ejido La Escondida, Zacatecas ZP 98160, Mexico
| | - G Gutiérrez-Sánchez
- Multidisciplinary Unit, Autonomous University of Tamaulipas, Ave. Maestro and Marte S/N. Col. City Alianza, H. Matamoros, Tamaulipas ZP 87410, Mexico
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Poulsen MN, Hosterman JF, Wood GC, Cook A, Wright L, Jamieson ST, Naylor A, Lutcher S, Mowery J, Seiler CJ, Welk GJ, Bailey-Davis L. Family-Based Telehealth Initiative to Improve Nutrition and Physical Activity for Children With Obesity and Its Utility During COVID-19: A Mixed Methods Evaluation. Front Nutr 2022; 9:932514. [PMID: 35898708 PMCID: PMC9309788 DOI: 10.3389/fnut.2022.932514] [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: 04/29/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Guidelines recommend primary care providers refer children with obesity to behavioral interventions, but given limited program availability, access, and parental engagement, referrals remain rare. We developed telehealth coaching interventions for families whose children received care at a health system in Pennsylvania, United States in 2019-2020. Intervention referrals were facilitated by the pediatrician and/or project team for 6–12-year-old children with obesity following well-child visits. Participants chose one of three 26-week interventions focused on healthy eating, physical activity, or a hybrid clinical/nutrition intervention. Interventions engaged parents as change agents, enhancing self-efficacy to model and reinforce behavior and providing resources to help create a healthy home environment. We enrolled 77 of 183 eligible parent/child dyads. We used mixed methods to evaluate the interventions. Repeated measures models among participants showed significant reductions in obesogenic nutrition behaviors post-intervention and at 1-year follow-up, including a reduction in sugar-sweetened beverage intake of 2.14 servings/week (95% confidence interval: −3.45, −0.82). There were also improvements in obesoprotective nutrition behaviors (e.g., frequency of family meals, parental self-efficacy related to meal management). One year post-baseline, we observed no significant differences in changes in body mass index (BMI) z-scores comparing child participants with matched controls. Given potential impacts of COVID-19 community restrictions on study outcomes, we conducted qualitative interviews with 13 participants during restrictions, which exemplified how disrupted routines constrained children’s healthy behaviors but that intervention participation prepared parents by providing cooking and physical activities at home. Findings support the potential of a telehealth-delivered nutrition intervention to support adoption of healthy weight behaviors.
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Affiliation(s)
- Melissa N. Poulsen
- Department of Population Health Sciences, Geisinger, Danville, PA, United States
- *Correspondence: Melissa N. Poulsen,
| | | | - G. Craig Wood
- Obesity Institute, Geisinger, Danville, PA, United States
| | - Adam Cook
- Obesity Institute, Geisinger, Danville, PA, United States
| | - Lyndell Wright
- Obesity Institute, Geisinger, Danville, PA, United States
| | | | - Allison Naylor
- Obesity Institute, Geisinger, Danville, PA, United States
| | | | - Jacob Mowery
- Obesity Institute, Geisinger, Danville, PA, United States
| | | | - Gregory J. Welk
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Lisa Bailey-Davis
- Department of Population Health Sciences, Geisinger, Danville, PA, United States
- Obesity Institute, Geisinger, Danville, PA, United States
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Flynn AC, Suleiman F, Windsor‐Aubrey H, Wolfe I, O'Keeffe M, Poston L, Dalrymple KV. Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting. MATERNAL & CHILD NUTRITION 2022; 18:e13354. [PMID: 35333450 PMCID: PMC9218326 DOI: 10.1111/mcn.13354] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 01/01/2023]
Abstract
The prevalence of childhood obesity is increasing worldwide with long-term health consequences. Effective strategies to stem the rising childhood obesity rates are needed but systematic reviews of interventions have reported inconsistent effects. Evaluation of interventions could provide more practically relevant information when considered in the context of the setting in which the intervention was delivered. This systematic review has evaluated diet and physical activity interventions aimed at reducing obesity in children, from birth to 5 years old, by intervention setting. A systematic review of the literature, consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Three electronic databases were searched from 2010 up to December 2020 for randomised controlled trials aiming to prevent or treat childhood obesity in children up to 5 years old. The studies were stratified according to the setting in which the intervention was conducted. Twenty-eight studies were identified and included interventions in childcare/school (n = 11), home (n = 5), community (n = 5), hospital (n = 4), e-health (n = 2) and mixed (n = 1) settings. Thirteen (46%) interventions led to improvements in childhood obesity measures, including body mass index z-score and body fat percentage, 12 of which included both parental/family-based interventions in conjunction with modifying the child's diet and physical activity behaviours. Home-based interventions were identified as the most effective setting as four out of five studies reported significant changes in the child's weight outcomes. Interventions conducted in the home setting and those which included parents/families were effective in preventing childhood obesity. These findings should be considered when developing optimal strategies for the prevention of childhood obesity.
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Affiliation(s)
- Angela C. Flynn
- Department of Women and Children's HealthKing's College LondonLondonUK
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Fatma Suleiman
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Hazel Windsor‐Aubrey
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Ingrid Wolfe
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| | - Majella O'Keeffe
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Lucilla Poston
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| | - Kathryn V. Dalrymple
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
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Aceves-Martins M, López-Cruz L, García-Botello M, Gutierrez-Gómez YY, Moreno-García CF. Interventions to Prevent Obesity in Mexican Children and Adolescents: Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:563-586. [PMID: 34725762 PMCID: PMC9072495 DOI: 10.1007/s11121-021-01316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 10/26/2022]
Abstract
The prevalence of overweight and obesity has been rising among Mexican children and adolescents in the last decades. To systematically review obesity prevention interventions delivered to Mexican children and adolescents. Thirteen databases and one search engine were searched for evidence from 1995 to 2021. Searches were done in English and Spanish to capture relevant information. Studies with experimental designs, delivered in any setting (e.g., schools or clinics) or digital domains (e.g., social media campaigns) targeting Mexican children or adolescents (≤ 18 years) and reporting weight outcomes, were included in this review. In addition, the risk of bias was appraised with the Effective Public Health Practice Project Quality Assessment Tool. Twenty-nine studies with 19,136 participants (3-17 years old) were included. The prevalence of overweight and obesity at baseline ranged from 21 to 69%. Most of the studies (89.6%) were delivered in school settings. The duration ranged from 2 days to 3 school years, and the number of sessions also varied from 2 to 200 sessions at different intensities. Overall, anthropometric changes varied across studies. Thus, the efficacy of the included studies is heterogeneous and inconclusive among studies. Current evidence is heterogeneous and inconclusive about the efficacy of interventions to prevent obesity in Mexican children and adolescents. Interventions should not be limited to educational activities and should include different components, such as multi-settings delivery, family inclusion, and longer-term implementations. Mixed-method evaluations (including robust quantitative and qualitative approaches) could provide a deeper understanding of the effectiveness and best practices.
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Affiliation(s)
- Magaly Aceves-Martins
- The Rowett Institute of Nutrition and Health, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Lizet López-Cruz
- Universidad Europea del Atlántico, Parque Científico Y Tecnológico de Cantabria, C/Isabel Torres 21, 39011, Santander, Spain
| | - Marcela García-Botello
- Universidad de Monterrey, Zona Valle Poniente, Av. Ignacio Morones Prieto 4500, 66238, San Pedro Garza García, N.L, Mexico
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Varman SD, Cliff DP, Jones RA, Hammersley ML, Zhang Z, Charlton K, Kelly B. Experiential Learning Interventions and Healthy Eating Outcomes in Children: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10824. [PMID: 34682570 PMCID: PMC8535521 DOI: 10.3390/ijerph182010824] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 12/24/2022]
Abstract
Experiential learning is the process where learners create meaning from direct experience. This systematic review aimed to examine the effects of experiential learning activities on dietary outcomes (knowledge, attitudes, behaviors) in children. Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to 2020. Eligible studies included children 0-12 years, assessed effect of experiential learning on outcomes of interest compared to non-experiential learning and were open to any setting. The quality of studies was assessed using the revised Cochrane risk of bias tool by two independent reviewers and effect size was calculated on each outcome. Nineteen studies were conducted in primary school, six in pre-school and one in an outside-of-school setting and used nine types of experiential learning strategies. Cooking, taste-testing, games, role-playing, and gardening were effective in improving nutrition outcomes in primary school children. Sensory evaluation, games, creative arts, and storybooks were effective for preschool children. Multiple strategies involving parents, and short/intense strategies are useful for intervention success. Experiential learning is a useful strategy to improve children's knowledge, attitudes, and behaviors towards healthy eating. Fewer studies in pre-school and outside of school settings and high risk of bias may limit the generalizability and strength of the findings.
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Affiliation(s)
- Sumantla D. Varman
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Health & Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Dylan P. Cliff
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Education, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
| | - Rachel A. Jones
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Education, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
| | - Megan L. Hammersley
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Health & Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
| | - Zhiguang Zhang
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Education, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Karen Charlton
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
- Faculty of Science, School of Medicine, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Bridget Kelly
- Early Start, University of Wollongong, Wollongong, NSW 2522, Australia; (D.P.C.); (R.A.J.); (M.L.H.); (Z.Z.); (B.K.)
- School of Health & Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
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12
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Byrne R, Terranova CO, Trost SG. Measurement of screen time among young children aged 0-6 years: A systematic review. Obes Rev 2021; 22:e13260. [PMID: 33960616 PMCID: PMC8365769 DOI: 10.1111/obr.13260] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.
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Affiliation(s)
- Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Caroline O. Terranova
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
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Sanchez-Flack J, Buscemi J, O'Donnell A, Clark Withington MH, Fitzgibbon M. Black American and Latinx Parent/Caregiver Participation in Digital Health Obesity Interventions for Children: A Systematic Review. Front Digit Health 2021; 3:687648. [PMID: 34713158 PMCID: PMC8522024 DOI: 10.3389/fdgth.2021.687648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022] Open
Abstract
Parents/caregivers are consistently described as integral targets given their influential role in supporting and managing behaviors such as diet and physical activity. Identifying effective obesity prevention interventions to enhance and sustain parent participation is needed. Digital obesity prevention interventions are a promising strategy to improve parent/caregiver participation. Digital health interventions demonstrate acceptable participation and retention among parents/caregivers. However, our understanding of digital obesity prevention interventions targeting Black American and Latinx parents/caregivers is limited. This systematic review aims to identify Black American and Latinx parents'/caregivers' level of participation in digital obesity prevention and treatment interventions and determine the relationship between parent/caregiver participation and behavioral and weight status outcomes. This review adheres to PRISMA guidelines and is registered in PROSPERO. Eligibility criteria include: intervention delivered by digital technology, targeted Black American and Latinx parents/caregivers of young children (2-12 years), reported parent/caregiver participation outcomes, targeted diet or physical activity behaviors, and randomized controlled trial study design. Searches were conducted in September 2020 in ERIC, PsychInfo, PubMed, and Web of Science. Initial searches returned 499 results. Four reviewers screened records against eligibility criteria and 12 studies met inclusion criteria. Across all studies, parent/caregiver participation ranged from low to high. Only half of the included studies reported significant improvements in behavioral or weight status outcomes for parents/caregivers and/or children. Of these studies, three reported high parental/caregiver participation rates, and three reported high satisfaction rates. These findings suggest that participation and satisfaction may impact behavior change and weight status. The small number of studies indicates that additional research is needed to determine whether engagement or other factors predict responsiveness to the digital health intervention. Our results lay the groundwork for developing and testing future digital health interventions with the explicit goal of parental/caregiver participation and considers the need to expand our digital health intervention research methodologies to address obesity inequities among diverse families better.
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Affiliation(s)
- Jennifer Sanchez-Flack
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, United States
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, United States
| | | | | | - Marian Fitzgibbon
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, United States
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, United States
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
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Webb EJD, Stamp E, Collinson M, Farrin AJ, Stevens J, Burton W, Rutter H, Schofield H, Bryant M. Measuring commissioners' willingness-to-pay for community based childhood obesity prevention programmes using a discrete choice experiment. BMC Public Health 2020; 20:1535. [PMID: 33046078 PMCID: PMC7549208 DOI: 10.1186/s12889-020-09576-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the UK, rates of childhood obesity remain high. Community based programmes for child obesity prevention are available to be commissioned by local authorities. However, there is a lack of evidence regarding how programmes are commissioned and which attributes of programmes are valued most by commissioners. The aim of this study was to determine the factors that decision-makers prioritise when commissioning programmes that target childhood obesity prevention. METHODS An online discrete choice experiment (DCE) was used to survey commissioners and decision makers in the UK to assess their willingness-to-pay for childhood obesity programmes. RESULTS A total of 64 commissioners and other decision makers completed the DCE. The impact of programmes on behavioural outcomes was prioritised, with participants willing to pay an extra £16,600/year if average daily fruit and vegetable intake increased for each child by one additional portion. Participants also prioritised programmes that had greater number of parents fully completing them, and were willing to pay an extra £4810/year for every additional parent completing a programme. The number of parents enrolling in a programme (holding the number completing fixed) and hours of staff time required did not significantly influence choices. CONCLUSIONS Emphasis on high programme completion rates and success increasing children's fruit and vegetable intake has potential to increase commissioning of community based obesity prevention programmes.
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Affiliation(s)
- Edward J D Webb
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Elizabeth Stamp
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - June Stevens
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Wendy Burton
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Holly Schofield
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Maria Bryant
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, UK
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15
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Ribeiro EHC, Guerra PH, Oliveira ACD, Silva KSD, Santos P, Santos R, Okely A, Florindo AA. Latin American interventions in children and adolescents' sedentary behavior: a systematic review. Rev Saude Publica 2020; 54:59. [PMID: 32491109 PMCID: PMC7263802 DOI: 10.11606/s1518-8787.2020054001977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 11/11/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To identify and evaluate the effects of community-based interventions on the sedentary behavior (SB) of Latin American children and adolescents. METHODS A systematic review on community-based trials to reduce and/or control SB in Latin American countries (Prospero: CRD42017072157). Five databases (PubMed, Web of Science, Scopus, SciELO and Lilacs) and a reference lists were searched. RESULTS Ten intervention studies met the eligibility criteria and composed the descriptive synthesis. These studies were conducted in Brazil (n=5), Mexico (n=3), Ecuador (n=1) and Colombia (n=1). Most interventions were implemented in schools (n=8) by educational components, such as meetings, lessons, and seminars, on health-related subjects (n=6). Only two studies adopted specific strategies to reduce/control SB; others focused on increasing physical activity and/or improving diet. Only one study used an accelerometer to measure SB. Seven studies investigated recreational screen time. Eight studies showed statistically significant effects on SB reduction (80%). CONCLUSIONS Latin America community-based interventions reduced children and adolescents' SB. Further studies should: define SB as a primary outcome and implement strategies to reduce such behaviour; focus in different SBs and settings, other than recreational screen time or at-home sitting time; and use objective tools together with questionnaires to measure sedentary behaviour in.
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Affiliation(s)
| | - Paulo Henrique Guerra
- Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ana Carolina de Oliveira
- Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Kelly Samara da Silva
- Núcleo de Pesquisa em Atividade Física e Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Priscila Santos
- Núcleo de Pesquisa em Atividade Física e Saúde, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Rute Santos
- Centro de Investigação em Actividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | | | - Alex Antonio Florindo
- Grupo de Estudos e Pesquisas Epidemiológicas em Atividade Física e Saúde, Universidade de São Paulo, São Paulo, SP, Brasil
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Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
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17
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Landgren K, Quaye AA, Hallström E, Tiberg I. Family-based prevention of overweight and obesity in children aged 2–6 years: a systematic review and narrative analysis of randomized controlled trials. CHILD AND ADOLESCENT OBESITY 2020. [DOI: 10.1080/2574254x.2020.1752596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Kajsa Landgren
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Angela A. Quaye
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Elinor Hallström
- Research Institute of Sweden, Department of Agriculture and Food, Lund, Sweden
| | - Irén Tiberg
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
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18
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Argumedo G, Taylor JRL, Gaytán-González A, González-Casanova I, Villalobos MFG, Jáuregui A, Ulloa EJ, Medina C, Miranda YSP, Rodríguez MP, Resendiz E, Pelayo RAR, Martínez MDPR, Galaviz KI. Mexico's 2018 Report Card on Physical Activity for Children and Youth: Full report. Rev Panam Salud Publica 2020; 44:e26. [PMID: 32341689 PMCID: PMC7178555 DOI: 10.26633/rpsp.2020.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/15/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives. Mexico’s 2018 Report Card evaluates the opportunities available for Mexican children and youth to reach healthy levels of physical activity, sleep, and sedentary behavior. Methods. The Report Card is a surveillance system that gathers data from national surveys, censuses, government documents, websites, grey literature, and published studies to evaluate 16 indicators in four categories: Daily Behaviors; Physical Fitness; Settings and Sources of Influence; and Strategies and Investments. Data were compared to established benchmarks. Each indicator was assigned a grade from 1 – 10 (< 6 is a failing grade) or “incomplete” if data was insufficient/unavailable. Results. Daily Behavior grades were: Overall Physical Activity, 4; Organized Sport Participation, 5; Active Play, 3; Active Transportation, 5; Sleep, 7; and Sedentary Behavior, 3. Physical Fitness, received a 7. Settings and Sources of Influence grades were: Family and Peers, incomplete; School, 3; and Community and Environment, 4. Strategies and Investments were: Government Strategies, 6; and Non-Government Organizations, 2. Conclusion. Low grades in 11 of the 16 indicators indicate that schools, families, communities, and government need to work together to improve physical activity opportunities for children and youth in Mexico.
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Affiliation(s)
- Gabriela Argumedo
- Department for Health University of Bath BathSomerset United Kingdom Department for Health, University of Bath, Bath, Somerset, United Kingdom
| | - Juan Ricardo López Taylor
- Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Departamento de Ciencias del Movimiento Humano Centro Universitario de Ciencias de la Salud Universidad de Guadalajara GuadalajaraJalisco México Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Alejandro Gaytán-González
- Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Departamento de Ciencias del Movimiento Humano Centro Universitario de Ciencias de la Salud Universidad de Guadalajara GuadalajaraJalisco México Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Inés González-Casanova
- Hubert Department of Global Health Rollins School of Public Health Emory University AtlantaGeorgia United States of America Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Martín Francisco González Villalobos
- Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Departamento de Ciencias del Movimiento Humano Centro Universitario de Ciencias de la Salud Universidad de Guadalajara GuadalajaraJalisco México Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Alejandra Jáuregui
- Departamento de Actividad Física y Estilos de Vida Saludables Centro de Investigación en Nutrición y Salud Instituto Nacional de Salud Pública Cuernavaca México Departamento de Actividad Física y Estilos de Vida Saludables, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Edtna Jáuregui Ulloa
- Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Departamento de Ciencias del Movimiento Humano Centro Universitario de Ciencias de la Salud Universidad de Guadalajara GuadalajaraJalisco México Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Catalina Medina
- Departamento de Actividad Física y Estilos de Vida Saludables Centro de Investigación en Nutrición y Salud Instituto Nacional de Salud Pública Cuernavaca México Departamento de Actividad Física y Estilos de Vida Saludables, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Yoali Selene Pacheco Miranda
- Departamento de Alimentación, Cultura y Ambiente Instituto Nacional de Salud Pública Cuernavaca México Departamento de Alimentación, Cultura y Ambiente, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Marcela Pérez Rodríguez
- Centro de Adiestramiento en Investigación Clínica División de Desarrollo de la Investigación Instituto Mexicano del Seguro Social Ciudad de México México Centro de Adiestramiento en Investigación Clínica, División de Desarrollo de la Investigación Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Eugen Resendiz
- Departamento de Actividad Física y Estilos de Vida Saludables Centro de Investigación en Nutrición y Salud Instituto Nacional de Salud Pública Cuernavaca México Departamento de Actividad Física y Estilos de Vida Saludables, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Ricardo Alejandro Retano Pelayo
- Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Departamento de Ciencias del Movimiento Humano Centro Universitario de Ciencias de la Salud Universidad de Guadalajara GuadalajaraJalisco México Instituto de Ciencias Aplicadas a la Actividad Física y al Deporte, Departamento de Ciencias del Movimiento Humano, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - María Del Pilar Rodríguez Martínez
- Centro de Educación Física y Salud Integral Instituto Tecnológico y de Estudios Superiores de Occidente TlaquepaqueJalisco México Centro de Educación Física y Salud Integral, Instituto Tecnológico y de Estudios Superiores de Occidente, Tlaquepaque, Jalisco, México
| | - Karla I Galaviz
- Hubert Department of Global Health Rollins School of Public Health Emory University AtlantaGeorgia United States of America Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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19
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Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
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20
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Reilly JJ, Hughes AR, Gillespie J, Malden S, Martin A. Physical activity interventions in early life aimed at reducing later risk of obesity and related non-communicable diseases: A rapid review of systematic reviews. Obes Rev 2019; 20 Suppl 1:61-73. [PMID: 31419046 DOI: 10.1111/obr.12773] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 08/30/2018] [Accepted: 09/01/2018] [Indexed: 12/15/2022]
Abstract
To identify useful components of interventions aimed at prevention of childhood obesity and related non-communicable diseases (NCDs), which included physical activity and which targeted any or all of four life-course stages: peri-conception; pregnancy; infancy and toddlerhood (0 to 23 months); and early childhood (24 to 59 months). In May 2016, WHO Geneva searched the Cochrane Library and PubMed for systematic reviews of interventions including physical activity to prevent childhood obesity or risk factors for obesity-related NCDs. Using a narrative synthesis, the efficacy of randomized controlled trials (RCTs) to alter energy balance outcomes (measures of weight status or body fatness) was characterized by life-course stage, study characteristics, intervention functions (as defined in the behaviour change wheel), and level of the socio-ecological model (SEM) targeted. The quality of included systematic reviews was assessed. We retrieved 82 reviews from the World Health Organization (WHO) search, of which 23 were eligible for the present synthesis. The number of eligible studies by life-course stage was: 0 (peri-conception); 0 (pregnancy); 8 (infancy and toddlerhood, age 0 to 23 months; seven RCTs; age); and 37 (early childhood, age 24 to 59 months; 30 RCTs;). Thus, there was a lack of evidence for physical activity interventions during peri-conception and pregnancy. Almost all relevant studies in the 0- to 23- and 24- to 59-month life-course stages were multicomponent interventions (ie, targeted physical activity, dietary, and/or sedentary behaviours). Interventions with evidence of efficacy tended to target multiple levels of the SEM, with emphasis on parents, and extend over long periods. Effective intervention elements for early life obesity prevention included classes on parenting skills, alteration of the kindergarten playground, and financial incentives. Evidence from low- and middle-income countries was scarce, and evidence for intervention effect on obesity-related NCDs was missing. Future physical activity interventions in toddlerhood and early childhood aimed at prevention of obesity should adopt the characteristics typical of effective interventions identified by the present synthesis. There is an urgent need for more evidence on physical activity interventions set in low- and middle-income countries and which target the peri-conception and pregnancy periods.
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Affiliation(s)
- John J Reilly
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Adrienne R Hughes
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Jennifer Gillespie
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Stephen Malden
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK
| | - Anne Martin
- School of Psychological Sciences & Health, Physical Activity for Health Group, University of Strathclyde, Glasgow, UK.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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21
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Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 275] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
EDITORIAL NOTE This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024. BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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22
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Zacarías G, Shamah-Levy T, Elton-Puente E, Garbus P, García OP. Development of an intervention program to prevent childhood obesity targeted to Mexican mothers of school-aged children using intervention mapping and social cognitive theory. EVALUATION AND PROGRAM PLANNING 2019; 74:27-37. [PMID: 30807872 DOI: 10.1016/j.evalprogplan.2019.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 02/10/2019] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
In Mexico, data from the last National Health and Nutrition Survey (2016) described the increase in the prevalence of overweight and obesity in school-aged children (33.2%). Obesity prevention strategies have not been effective, and currently, Mexico has one of the highest prevalence of childhood obesity. Thus, there is an urgent need to develop strategies that can prevent childhood obesity and also to avoid these children to remain overweight/obese through adulthood. The objective of this study was to provide a step-by-step description of the design, implementation and evaluation of an intervention plan for Mexican mothers of school aged children to promote healthy eating and to prevent childhood obesity. The program Niño Sano Adulto Sano was developed using the Intervention Mapping Approach and the Social Cognitive Theory frameworks to provide Mexican mothers with knowledge and skills to positively modify their children's food behavior, thus preventing future weight gain. The program was developed, piloted and delivered to the target population with positive results on the mothers' nutrition knowledge and children's BMI. Intervention Mapping and Social Cognitive Theory are useful models to design and deliver an intervention that provides a holistic approach to promote healthy eating.
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Affiliation(s)
- Gilda Zacarías
- School of Natural Sciences, Universidad Autónoma de Querétaro, Avenida de las Ciencias s/n Juriquilla, 76230, Queretaro, Mexico.
| | - Teresa Shamah-Levy
- National Institute of Public Health, Av. Universidad #655, Col. Sta. Ma. Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
| | - Elizabeth Elton-Puente
- School of Natural Sciences, Universidad Autónoma de Querétaro, Avenida de las Ciencias s/n Juriquilla, 76230, Queretaro, Mexico.
| | - Pamela Garbus
- School of Psychology, Universidad Autónoma de Querétaro, Cerro de las Campanas s/n. Las Campanas, 76010, Querétaro, Mexico.
| | - Olga P García
- School of Natural Sciences, Universidad Autónoma de Querétaro, Avenida de las Ciencias s/n Juriquilla, 76230, Queretaro, Mexico.
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23
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Turnbull B, Gordon SF, Martínez-Andrade GO, González-Unzaga M. Childhood obesity in Mexico: A critical analysis of the environmental factors, behaviours and discourses contributing to the epidemic. Health Psychol Open 2019; 6:2055102919849406. [PMID: 31205736 PMCID: PMC6537260 DOI: 10.1177/2055102919849406] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mexico has the highest prevalence globally for children who are overweight. We
conducted a qualitative study to understand childhood obesity in Mexico and the
complex factors at play. Data were collected at three elementary schools in a
low socio-economic area in Mexico City. Semi-structured interviews were
conducted with 60 children, 24 parents and 28 teachers. The children interviewed
were between the ages of 8 and 12 years old. Interview texts were analysed using
NVivo 9 and 10 and thematic discourse analysis was used. Findings revealed how
children’s choices around nutrition and physical activity were constrained by
their environment and discursive constructions.
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Affiliation(s)
| | - Sarah Frances Gordon
- Universidad Iberoamericana, Mexico
- Sarah Frances Gordon, Universidad
Iberoamericana, 01219 México City, Mexico.
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24
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Browne JL, Rees CO, van Delden JJM, Agyepong I, Grobbee DE, Edwin A, Klipstein-Grobusch K, van der Graaf R. The willingness to participate in biomedical research involving human beings in low- and middle-income countries: a systematic review. Trop Med Int Health 2019; 24:264-279. [PMID: 30565381 PMCID: PMC6850431 DOI: 10.1111/tmi.13195] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives To systematically review reasons for the willingness to participate in biomedical human subjects research in low‐ and middle‐income countries (LMICs). Methods Five databases were systematically searched for articles published between 2000 and 2017 containing the domain of ‘human subjects research’ in ‘LMICs’ and determinant ‘reasons for (non)participation’. Reasons mentioned were extracted, ranked and results narratively described. Results Ninety‐four articles were included, 44 qualitative and 50 mixed‐methods studies. Altruism, personal health benefits, access to health care, monetary benefit, knowledge, social support and trust were the most important reasons for participation. Primary reasons for non‐participation were safety concerns, inconvenience, stigmatisation, lack of social support, confidentiality concerns, physical pain, efficacy concerns and distrust. Stigmatisation was a major concern in relation to HIV research. Reasons were similar across different regions, gender, non‐patient or patient participants and real or hypothetical study designs. Conclusions Addressing factors that affect (non‐)participation in the planning process and during the conduct of research may enhance voluntary consent to participation and reduce barriers for potential participants.
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Affiliation(s)
- Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Connie O Rees
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene Agyepong
- Ghana Health Service, Research and Development Division, Accra, Ghana.,Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ama Edwin
- Department of Psychological Medicine and Mental Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rieke van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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25
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Rodriguez-Ventura A, Parra-Solano A, Illescas-Zárate D, Hernández-Flores M, Paredes C, Flores-Cisneros C, Sánchez B, Tolentino M, Sámano R, Chinchilla D. "Sacbe", a Comprehensive Intervention to Decrease Body Mass Index in Children with Adiposity: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2010. [PMID: 30223517 PMCID: PMC6163998 DOI: 10.3390/ijerph15092010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/12/2022]
Abstract
Interventions in children with adiposity decrease less than 0.2 the body mass index (BMI) z-score less than 0.2 and only in 21⁻23% of cases. Experts recommend focusing on the habits of a healthy lifestyle (HLS) but considering the sociocultural context of children and their parents. Our objective was to achieve a higher percentage of success in lowering the BMI z-score in children with adiposity and their parents through a pilot program "Sacbe" based on HLS, sensitive to the sociocultural context previously explored and with the active participation of parents. This is a pilot study in children aged 8 to 18 years with adiposity according to the BMI z-score. The program consisted of two workshops on HLS and nutrition given by the pediatric endocrinologist in group sessions with 3⁻5 families and reinforcements in each visit by registered dietitians. We recorded lifestyle habits and anthropometric characteristics of children and their parents at the baseline visit and every month for 3⁻4 months. Forty-nine families, 55 children and 64 parents participated, 60% of the children were female, the average age was 13.95 ± 3.3 years, 72.7% and 86.7% lowered the z score of the BMI due to intention to treat and protocol analysis (p < 0.001), respectively; BMI z-score decreased by 0.22 ± 0.21, from 2.13 ± 0.57 to 1.91 ± 0.58 (p < 0.001). In total, 83% of the parents involved were mothers, the average age was 45.8 ± 9.4 years, 77% lost weight and body fat (p < 0.001), the frequency of unhealthy habits decreased. The results of "Sacbe" exceeded expectations by combining the active participation of parents, sessions in groups, and the education on various components of an HLS inside sociocultural context. The main challenge will be to standardize and reproduce this type of complex interventions, as well as to assure long-term success.
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Affiliation(s)
- Ana Rodriguez-Ventura
- Instituto Nacional de Perinatología, Department of Nutrition and Bioprogramming, 11000 Mexico City, Mexico.
| | - Arturo Parra-Solano
- Instituto Nacional de Perinatología, Department of Nutrition and Bioprogramming, 11000 Mexico City, Mexico.
| | - Daniel Illescas-Zárate
- Instituto Nacional de Perinatología, Department of Nutrition and Bioprogramming, 11000 Mexico City, Mexico.
| | - Minerva Hernández-Flores
- Instituto Nacional de Perinatología, Department of Nutrition and Bioprogramming, 11000 Mexico City, Mexico.
| | - Carolina Paredes
- Instituto Nacional de Perinatología, Department of Nutrition and Bioprogramming, 11000 Mexico City, Mexico.
| | - Carmen Flores-Cisneros
- Instituto Nacional de Perinatología, Department of Nutrition and Bioprogramming, 11000 Mexico City, Mexico.
| | - Bernarda Sánchez
- Instituto Nacional de Perinatología, Department of Nutrition and Bioprogramming, 11000 Mexico City, Mexico.
| | - Maricruz Tolentino
- Instituto Nacional de Perinatología, Department of Nutrition and Bioprogramming, 11000 Mexico City, Mexico.
| | - Reyna Sámano
- Instituto Nacional de Perinatología, Department of Nutrition and Bioprogramming, 11000 Mexico City, Mexico.
| | - Daniela Chinchilla
- Instituto Nacional de Perinatología, Department of Nutrition and Bioprogramming, 11000 Mexico City, Mexico.
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Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 5:CD008552. [PMID: 29770960 PMCID: PMC6373580 DOI: 10.1002/14651858.cd008552.pub5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2018. We searched Proquest Dissertations and Theses in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 63 trials with 178 trial arms and 11,698 participants. Thirty-nine trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fourteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Nine studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 63 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.There is very low quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 3.50 g as-desired consumption of vegetables (SMD 0.33, 95% CI 0.13 to 0.54; participants = 1741; studies = 13). Multicomponent interventions versus no intervention may have a very small effect on child consumption of fruit and vegetables (SMD 0.35, 95% CI 0.04 to 0.66; participants = 2009; studies = 5; low-quality evidence), equivalent to an increase of 0.37 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; participants = 3078; studies = 11; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for four studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 63 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low- and low-quality evidence respectively that child-feeding practice and multicomponent interventions may lead to very small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up is required and future research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority
Research Centre in Health Behaviour, and Priority Research Centre in
Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2-5 years. Appetite 2018; 127:138-154. [PMID: 29702128 DOI: 10.1016/j.appet.2018.04.019] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Most children do not meet daily recommendations for fruit and vegetable intake, and consumption of vegetables remains especially low. Eating habits track from childhood to adulthood hence establishing liking and intake of vegetables is important. OBJECTIVE To identify the most successful strategies to enhance vegetable intake in preschool children aged 2-5 years. DESIGN The research was a systematic review and a meta-analysis of published studies. A comprehensive search strategy was performed using key databases such as Medline, Embase, PsychINFO, EBSCO and CENTRAL. Articles published between 2005-January 2016, specifically with measured vegetable consumption were included. RESULTS 30 articles and 44 intervention arms were identified for inclusion (n = 4017). Nine dominant intervention strategies emerged to promote vegetable intake in preschool children. These included; choice, pairing (stealth), education, food service, modelling, reward, taste exposure, variety and visual presentation. The meta-analysis revealed that interventions implementing repeated taste exposure had better pooled effects than those which did not. Intake increased with number of taste exposures and intake was greater when vegetables offered were in their plain form rather than paired with a flavor, dip or added energy (e.g. oil). Moreover, intake of vegetables which were unfamiliar/disliked increased more than those which were familiar/liked. CONCLUSIONS Repeated taste exposure is a simple technique that could be implemented in childcare settings and at home by parents. Health policy could specifically target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8-10 exposures. The systematic review protocol was registered on the PROSPERO (number: CRD42016033984).
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Hodder RK, Stacey FG, O'Brien KM, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 1:CD008552. [PMID: 29365346 PMCID: PMC6491117 DOI: 10.1002/14651858.cd008552.pub4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase to identify eligible trials on 25 September 2017. We searched Proquest Dissertations and Theses and two clinical trial registers in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 55 trials with 154 trial arms and 11,108 participants. Thirty-three trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Thirteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 55 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% confidence interval (CI) 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 g of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for three studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 55 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains sparse. There was very low-quality evidence that child-feeding practice interventions are effective in increasing vegetable consumption in children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption in children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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Hodder RK, Stacey FG, Wyse RJ, O'Brien KM, Clinton‐McHarg T, Tzelepis F, Nathan NK, James EL, Bartlem KM, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2017; 9:CD008552. [PMID: 28945919 PMCID: PMC6483688 DOI: 10.1002/14651858.cd008552.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase Classic and Embase to identify eligible trials on 30 September 2016. We searched CINAHL and PsycINFO in July 2016, Proquest Dissertations and Theses in November 2016 and three clinical trial registers in November 2016 and June 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures.We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 50 trials with 137 trial arms and 10,267 participants. Thirty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Eleven trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.Thirteen of the 50 included trials were judged as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias of remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% CI 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 grams of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions.Studies reported receiving governmental or charitable funds, except for two studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 50 eligible trials of various intervention approaches, the evidence for how to increase fruit and vegetable consumption of children remains sparse. There was very low-quality evidence child-feeding practice interventions are effective in increasing vegetable consumption of children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption of children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | | | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter Population HealthLocked Bag 10WallsendAustralia
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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Azevedo LB, Ling J, Soos I, Robalino S, Ells L. The effectiveness of sedentary behaviour interventions for reducing body mass index in children and adolescents: systematic review and meta-analysis. Obes Rev 2016; 17:623-35. [PMID: 27098454 DOI: 10.1111/obr.12414] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/25/2016] [Accepted: 03/12/2016] [Indexed: 12/24/2022]
Abstract
Intervention studies have been undertaken to reduce sedentary behaviour (SB) and thereby potentially ameliorate unhealthy weight gain in children and adolescents. We synthesised evidence and quantified the effects of SB interventions (single or multiple components) on body mass index (BMI) or BMI z-score in this population. Publications up to March 2015 were located through electronic searches. Inclusion criteria were interventions targeting SB in children that had a control group and objective measures of weight and height. Mean change in BMI or BMI z-score from baseline to post-intervention were quantified for intervention and control groups and meta-analyzed using a random effects model. The pooled mean reduction in BMI and BMI z-score was significant but very small (standardized mean difference = -0.060, 95% confidence interval: -0.098 to -0.022). However, the pooled estimate was substantially greater for an overweight or obese population (standardized mean difference = -0.255, 95% confidence interval: -0.400 to -0.109). Multicomponent interventions (SB and other behaviours) delivered to children from 5 to 12 years old in a non-educational setting appear to favour BMI reduction. In summary, SB interventions are associated with very small improvement in BMI in mixed-weight populations. However, SB interventions should be part of multicomponent interventions for treating obese children. © 2016 World Obesity.
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Affiliation(s)
- Liane B Azevedo
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Jonathan Ling
- Department of Pharmacy Health and Well-being, University of Sunderland, Sunderland, UK
| | - Istvan Soos
- Department of Sports and Exercise Sciences, University of Sunderland, Sunderland, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Louisa Ells
- Health and Social Care Institute, Teesside University, Middlesbrough, UK
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Lenders CM, Manders AJ, Perdomo JE, Ireland KA, Barlow SE. Addressing Pediatric Obesity in Ambulatory Care: Where Are We and Where Are We Going? Curr Obes Rep 2016; 5:214-40. [PMID: 27048522 PMCID: PMC5497516 DOI: 10.1007/s13679-016-0210-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Since the "2007 summary report of child and adolescent overweight and obesity treatment" published by Barlow, many obesity intervention studies have been conducted in pediatric ambulatory care. Although several meta-analyses have been published in the interim, many studies were excluded because of the focus and criteria of these meta-analyses. Therefore, the primary goal of this article was to identify randomized case-control trials conducted in the primary care setting and to report on treatment approaches, challenges, and successes. We have developed four themes for our discussion and provide a brief summary of our findings. Finally, we identified major gaps and potential solutions and describe several urgent key action items.
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Affiliation(s)
- Carine M Lenders
- Nutrition and Fitness for Life Program, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Vose Hall-3, 88, East Newton Street, Boston, MA, 02118, USA.
| | - Aaron J Manders
- Nutrition and Fitness for Life Program, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Vose Hall-3, 88, East Newton Street, Boston, MA, 02118, USA
| | - Joanna E Perdomo
- Boston Combined Residency Program, Boston University School of Medicine and Harvard Medical School, Dowling 3-870 Harrison Avenue, Boston, MA, 02118, USA
| | - Kathy A Ireland
- Nutrition and Fitness for Life Program, Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Vose Hall-3, 88, East Newton Street, Boston, MA, 02118, USA
| | - Sarah E Barlow
- Division of Pediatric Gastroenterology, Nutrition, and Hepatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St. Suite 1010, Houston, TX, 77030, USA
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Hendrie GA, Lease HJ, Bowen J, Baird DL, Cox DN. Strategies to increase children's vegetable intake in home and community settings: a systematic review of literature. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 26924706 DOI: 10.1111/mcn.12276] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022]
Abstract
A systematic review was undertaken to identify intervention characteristics associated with increasing consumption of vegetables in children (2-12 years). PubMed, PsychINFO and CABabstracts were used to identify studies published between 2004-2014 that had measures of vegetable consumption, a minimum of 3-month follow-up and were conducted in home and community settings (outside of schools). Twenty-two studies were included in the review. Details of the study design, population, setting, intervention characteristics, target behaviour, behaviour change techniques used and vegetable intake were extracted. Study quality and intensity were scored. Overall, 12/22 studies were effective short-term, and 6/10 were effective long-term (6 + months); mean short-term change in vegetable intake was 29%, equating to an increase of a quarter to a half of a serving of vegetables. Intervention effectiveness was associated with number of settings targeted and frequency of contact but not length of intervention. Planning for social support, vegetable exposure and provision of staff training were commonly used behaviour change techniques in effective interventions. This review has identified strategies that may optimise effectiveness of future home-based and community-based interventions aiming to increase vegetable intake in young children.
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Affiliation(s)
- Gilly A Hendrie
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - Haidee J Lease
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - Jane Bowen
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - Danielle L Baird
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
| | - David N Cox
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Food and Nutrition, Adelaide, South Australia, Australia
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Interventions to prevent and manage overweight or obesity in preschool children: A systematic review. Int J Nurs Stud 2016; 53:270-89. [DOI: 10.1016/j.ijnurstu.2015.10.017] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 02/04/2023]
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Hayes JF, Altman M, Coppock JH, Wilfley DE, Goldschmidt AB. Recent Updates on the Efficacy of Group Based Treatments for Pediatric Obesity. CURRENT CARDIOVASCULAR RISK REPORTS 2015; 9:16. [PMID: 25866596 DOI: 10.1007/s12170-015-0443-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is limited research on optimal treatment formats for childhood obesity. Group-based interventions are popular, but it is unclear whether outcomes can be obtained without an additional individual component. AIM To examine statistically and clinically significant outcomes of recent group-based and mixed-format (group + Individual) pediatric obesity interventions. METHODS Effect sizes and magnitudes of weight change were calculated for studies published between January 2013 and September 2014. RESULTS Approximately half of the group-based studies reviewed produced significant results compared to control, and effect sizes were small. Mixed-format studies were less likely to include a control group, but those that did evidenced medium to large effects. Magnitudes of weight change post-intervention were generally greater in mixed-format studies than group-only studies. CONCLUSIONS Recent studies in pediatric obesity interventions suggest including an individual component in a group-based intervention produces optimal outcomes. Future research should directly compare group-only and mixed formats to confirm this observation.
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Affiliation(s)
- Jacqueline F Hayes
- Washington University in St. Louis 660 S. Euclid Street Campus Box 8134 St. Louis, MO 63110
| | - Myra Altman
- Washington University in St. Louis 660 S. Euclid Street Campus Box 8134 St. Louis, MO 63110
| | - Jackson H Coppock
- Washington University in St. Louis 660 S. Euclid Street Campus Box 8134 St. Louis, MO 63110
| | - Denise E Wilfley
- Washington University in St. Louis 660 S. Euclid Street Campus Box 8134 St. Louis, MO 63110
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