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Raut S, Kc D, Singh DR, Dhungana RR, Pradhan PMS, Sunuwar DR. Effect of nutrition education intervention on nutrition knowledge, attitude, and diet quality among school-going adolescents: a quasi-experimental study. BMC Nutr 2024; 10:35. [PMID: 38414069 PMCID: PMC10900745 DOI: 10.1186/s40795-024-00850-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Nutrition education is being used to encourage school adolescents to adopt healthy eating habits. To the best of our knowledge, very little study has been undertaken in Nepal to examine the effectiveness of nutrition education programs. This study aimed to assess the effect of nutrition education on nutritional knowledge, attitude, and diet quality among school-going adolescents in selected private schools in Nepal. METHODS A quasi-experimental study was conducted among 226 students aged 12 - 19 years of two selected private schools in Banepa municipality of Nepal. Students (n = 113) from the first school were assigned to intervention and the same number of students from the second school were enrolled in the study as the control. Over 12 weeks, students in the intervention group received one hour of nutrition education in the form of mini-lectures and interactive discussions, whilst students in the control group received no education. The student's two-sample t-test was used to compare two groups and to assess the effectiveness of the nutrition education program. RESULTS Between the intervention and control group, the magnitude of difference in knowledge score was 1.80 (95% CI: 1.11 - 2.49), emotional eating was 0.98 (95% CI: 0.42 - 1.54), uncontrolled eating was 3.60 (95% CI: 2.10 - 5.09), and cognitive restraint of eating was 2.26 (95% CI: 1.51 - 3.01). CONCLUSIONS A tailored health education intervention was found to be effective in increase nutritional knowledge and attitude among school-going adolescents. Adopting nutrition education interventions as part of public health school intervention builds positive knowledge, attitudes, and healthy eating habits in school-going adolescents.
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Affiliation(s)
- Sagar Raut
- Department of Nutrition and Dietetics, College of Applied Food and Dairy Technology, Purbanchal University, Lalitpur, Nepal
| | - Dirghayu Kc
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Raja Ram Dhungana
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal.
- Department of Nutritional Science, University of Michigan School of Public Health, Ann Arbor, USA.
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Cortés YI, Berry DC, Perreira KM, Stuebe A, Stoner L, Giscombé CW, Crandell J, Santíago L, Harris LK, Duran M. A multi-component, community-engaged intervention to reduce cardiovascular disease risk in perimenopausal Latinas: pilot study protocol. Pilot Feasibility Stud 2021; 7:10. [PMID: 33407947 PMCID: PMC7786946 DOI: 10.1186/s40814-020-00756-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) risk increases substantially during perimenopause. Latinas have a significantly worse CVD risk factor profile than non-Hispanic White women, potentially due to multiple sociocultural and environmental factors. To date, interdisciplinary interventions have not focused on improving nutrition, physical activity, stress management, and biologic CVD risk in perimenopausal Latinas. The purpose of this study is to examine the feasibility and initial efficacy of a multi-component intervention to reduce CVD risk in perimenopausal Latinas. METHODS This is a two-group, repeated measures experimental study. Eighty perimenopausal Latinas (age 40-55 years) from two community groups will be randomized: one group will complete the intervention; the other will be a wait-list control. The intervention consists of 12-weekly sessions (education, physical activity, stress management, coping skills training), followed by 3 months of continued support, and 6 months of skill maintenance on their own. The primary outcomes include arterial stiffness, blood pressure, lipids, and blood glucose. Secondary outcomes are health behaviors (nutrition, physical activity, sleep, coping strategies), self-efficacy, and other biological factors related to CVD risk (adiposity, C-reactive protein, hair cortisol, vasomotor symptoms). We will assess changes in outcomes from Time 1 (baseline) to Time 2 (6 months) and Time 3 (12 months) using general linear mixed models to test the hypotheses. We will also evaluate the feasibility of the intervention by assessing enrollment and retention rates, barriers, and facilitators to enrollment, intervention fidelity, the suitability of study procedures, and participant satisfaction with the intervention and study protocol. We hypothesize the intervention group will decrease biologic CVD risk and improve health behaviors and self-efficacy significantly more than the wait-list control. DISCUSSION Results from this study will contribute to knowledge on the feasibility of behavioral interventions, including stress management and coping skills training, which could reduce CVD burden among perimenopausal Latinas. Because Hispanic/Latinos are the largest ethnic minority in the United States (US), progress regarding CVD risk among perimenopausal Latinas may lead to significant improvement in the overall CVD burden in the US. TRIAL REGISTRATION Prospectively registered, NCT04313751 (03/19/2020), Protocol version 1.0.
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Affiliation(s)
- Yamnia I. Cortés
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Diane C. Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Krista M. Perreira
- Department of Social Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Campus Box 7240, Chapel Hill, NC 27599-7240 USA
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The University of North Carolina at Chapel Hill, 3010 Old Clinic Building, Campus Box 7516, Chapel Hill, NC 27599-7516 USA
| | - Lee Stoner
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 306 Woollen Gym, Campus Box 8605, Chapel Hill, NC 27599-8605 USA
| | - Cheryl Woods Giscombé
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Jamie Crandell
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Lymarí Santíago
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Latesha K. Harris
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Mayra Duran
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
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St George SM, Agosto Y, Rojas LM, Soares M, Bahamon M, Prado G, Smith JD. A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence. Obes Rev 2020; 21:e12939. [PMID: 31808277 PMCID: PMC6980892 DOI: 10.1111/obr.12939] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/03/2023]
Abstract
The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and to provide recommendations for future intervention research in light of a recently proposed developmental cascade (DC) model of paediatric obesity. We conducted an electronic search of randomized controlled trials with a minimum 6-month postintervention follow-up published between 1995 and 2019. We included 74 interventions: prenatal/infancy (n = 4), early childhood (n = 11), childhood (n = 38), early to mid-adolescence (n = 18), and late adolescence (n = 3). Infancy and early childhood trials targeted early feeding and positive parenting skills. Half of the childhood and adolescence trials were school based and used universal prevention strategies; those classified as selective or indicated prevention tended to involve the family for more intensive lifestyle modification. Less than 10% of studies followed participants over long periods of time (greater than or equal to 5 years), and only 16% and 31% of studies assessed intervention mediators and moderators, respectively. We recommend that future interventions focus on early prevention, assess long-term intervention effects, use a standardized taxonomy for defining intervention behavioural strategies, assess underlying mechanisms of action and intervention moderators, target parent and family management strategies across development, and increase scientific equity. We also provide specific recommendations regarding intervention targets for each developmental stage.
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Affiliation(s)
- Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Yaray Agosto
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Lourdes M Rojas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary Soares
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Monica Bahamon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Department of Preventive Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Berry DC, Gonzales C, Montano NP, Perreira KM, Ammerman AS, Crandell J, Evenson KR, Faith MS, Waters H, Linares C, Cόrtes YI, Perrin EM. Rationale, design, and methodology for the healthy mothers-healthy children study: a randomized controlled trial. BMC Nutr 2019; 5:58. [PMID: 32153971 PMCID: PMC7050912 DOI: 10.1186/s40795-019-0322-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/08/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Hispanic women and children who become overweight or obese are at risk for developing prediabetes, type 2 diabetes, and cardiovascular disease later in life. Interdisciplinary interventions which target Hispanic women and their 3-5-year old children to improve nutrition and physical activity behaviors, manage adiposity and weight in mothers, and prevent excessive adiposity and weight gain trajectory in their children offer promise to break the intergenerational cycle. METHODS Using a randomized two-group, repeated measures experimental design, the goal of the proposed study is to investigate the efficacy of a 12-week nutrition and physical activity program including education, coping skills training, and home-based intervention in Hispanic women and their 3-5-year old children. The program includes 6 months of continued monthly contact to help overweight and obese Hispanic mothers and their children improve adiposity, weight (trajectory for children), health behaviors (nutrition and physical activity), and self-efficacy We will partner with two federally qualified health departments in Durham and Chatham counties, North Carolina to enroll participants. We will partner with community centers to deliver the intervention. A total of 294 Hispanic women with a BMI ≥ 25 kg/m2 and 294 Hispanic 3-5-year old children with a ≥ 25th BMI percentile will be enrolled over 4 years and randomized to the experimental or equal attention control group. Data will be collected at Time 1 (0 months [baseline]) to Time 2 (9 months [completion of the intervention]) and Time 1 to Time 3 (15 months [after 6 months with no contact from the study staff]). Data collected will include adiposity and weight in mothers and children (primary outcomes). Secondary outcomes will include health behaviors and self-efficacy in the mothers and in the children. We will also evaluate the cost of delivering the program for public health departments. We will use general linear mixed models to test the hypotheses. DISCUSSION Decreasing overweight and obesity in Hispanic women and slowing adiposity and weight gain trajectory in young Hispanic children is urgently needed to decrease morbidity, mortality, and future health care costs. TRIAL REGISTRATION NCT03866902. (March 7, 2019).
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Affiliation(s)
- Diane C. Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, North Carolina 27599-7460 USA
| | - Cecilia Gonzales
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, North Carolina 27599-7460 USA
| | - Nilda Peragallo Montano
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, North Carolina 27599-7460 USA
| | - Krista M. Perreira
- Department of Social Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Room #348 / CB #7240, Chapel Hill, NC 27599-7240 USA
| | - Alice S. Ammerman
- Gillings School of Global Public Health, Department of Nutrition, The University of North Carolina at Chapel Hill, CB#7426, Chapel Hill, NC 27599 USA
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, CB#7426, Chapel Hill, NC 27599 USA
| | - Jaime Crandell
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, North Carolina 27599-8050 USA
- Gillings School of Global Public Health, Department of Biostatistics, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, North Carolina 27599-8050 USA
| | - Kelly R. Evenson
- Gillings School of Global Public Health, Department of Epidemiology, The University of North Carolina at Chapel Hill, Campus Box 8050, Chapel Hill, North Carolina 27599-8050 USA
| | - Myles S. Faith
- School and Educational Psychology, University of Buffalo Graduate School of Education, 420 Baldy Hall, North Campus, Buffalo, New York 14260-1000 USA
| | - Hugh Waters
- Health Economics Research, Milken Institute, 1250 Fourth Street, Santa Monica, California 90401 USA
| | - Crystal Linares
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, North Carolina 27599-7460 USA
| | - Yamnia I. Cόrtes
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, North Carolina 27599-7460 USA
| | - Eliana M. Perrin
- Division of Primary Care, Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University School of Medicine, DUMC 102645, 146 Civitan Building, 2213 Elba Street, Durham, NC 27705 USA
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Berry DC, Currin EG, Neal MN. The Process of Integrating an Evidence-Based Intervention into a Public Health Department to Improve Nutrition and Physical Activity Behaviors in Parents and Children. J Community Health Nurs 2019; 36:147-154. [PMID: 31291769 DOI: 10.1080/07370016.2019.1630990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The purpose of this manuscript is to describe a mutually beneficial collaboration with a Public Health Department and a University to implement an evidence-based program to teach nutrition and physical activity to improve adult and child outcomes. We first assessed the needs of the Public Health Department to build sustainable capacity. Next, all collaborators were invited to work together to focus on success. We invested in the leadership structure and strategically planned together. Finally, all of the collaborators worked together to practice cultural awareness. The process of implementing evidence-based programs allows all collaborators to emerge from the interaction stronger as a result of respectful dialogue and team building.
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Affiliation(s)
- Diane C Berry
- a School of Nursing , The University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , United States
| | - Emily G Currin
- a School of Nursing , The University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , United States
| | - Madeline N Neal
- a School of Nursing , The University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , United States
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Berry DC, McMurray RG, Schwartz TA, Adatorwovor R. Benefits for African American and white low-income 7-10-year-old children and their parents taught together in a community-based weight management program in the rural southeastern United States. BMC Public Health 2018; 18:1107. [PMID: 30200925 PMCID: PMC6131854 DOI: 10.1186/s12889-018-6006-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/31/2018] [Indexed: 01/29/2023] Open
Abstract
Background Low-income children and parents are at increased risk for developing overweight and obesity. Therefore, the purpose of this exploratory study was to compare whether African American and white children and parents benefitted equally from a community-based weight management intervention delivered in two rural counties in southeastern North Carolina (N.C.). Methods We compared the efficacy of the Family Partners for Health intervention for African American and white children and their parents by testing the three-way interaction of the intervention group according to visit and race. Results African American children in the intervention group weighed significantly (P = 0.027) less than those in the control group, while white children in the intervention group weighed less than those in the control group, but the difference did not reach statistical significance. African American and white parents in the intervention group weighed less than their respective control groups across all three data collections, but the difference was only significant in the group of white parents (P = 0.010) at the completion of the study. At the completion of the study, African American children in the intervention group received significantly (P = 0.003) more support for physical activity than African American children in the control group. At both time points, white children in the intervention group were not significantly different from those in the control group. African American parents in the intervention group scored slightly worse in the stress management assessment compared to those in the control group, while white parents in the intervention group showed a significantly (P = 0.041) better level of stress management than those in the control group. At the completion of the study, African American parents in the intervention group scored somewhat worse in emotional eating self-efficacy compared to the scores of the African American parents in the control group, while white parents in the intervention group scored significantly (P < 0.001) better than those in the control group. Conclusions We were successful in affecting some outcomes in both African American and white children and parents using the same intervention. Trial registration NCT01378806 Registered June 22, 2011.
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Affiliation(s)
- Diane C Berry
- The University of North Carolina at Chapel Hill, School of Nursing, Campus Box 7460, Chapel Hill, NC, 27599-7460, USA.
| | - Robert G McMurray
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Campus Box 8700, Chapel Hill, NC, 27599-8700, USA
| | - Todd A Schwartz
- Department of Biostatistics, Gillings School of Global Public Health and School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7420, Chapel Hill, NC, 27599-7420, USA
| | - Reuben Adatorwovor
- Department of Biostatistics, Gillings School of Global Public Health and School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7420, Chapel Hill, NC, 27599-7420, USA
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Martin A, Booth JN, Laird Y, Sproule J, Reilly JJ, Saunders DH. Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database Syst Rev 2018; 3:CD009728. [PMID: 29499084 PMCID: PMC5865125 DOI: 10.1002/14651858.cd009728.pub4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions. OBJECTIVES To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. SEARCH METHODS In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes. MAIN RESULTS We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence). AUTHORS' CONCLUSIONS Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.
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Affiliation(s)
- Anne Martin
- University of EdinburghCentre for Population Health SciencesMedical School, Teviot PlaceEdinburghUKEH8 9AG
- University of GlasgowMRC/CSO Social and Public Health Sciences Unit200 Renfield StreetGlasgowUKG2 3QB
| | - Josephine N Booth
- The University of EdinburghInstitute for Education, Community and SocietyMoray House School of EducationRoom 2.17, St John's LandEdinburghUKEH8 8AQ
| | - Yvonne Laird
- University of EdinburghScottish Collaboration for Public Health Research and Policy (SCPHRP)20 West Richmond StreetEdinburghUKEH8 9DX
| | - John Sproule
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationHolyrood RoadEdinburghEH8 8AQUK
| | - John J Reilly
- University of StrathclydePhysical Activity for Health Group, School of Psychological Sciences and Health50 George StreetGlasgowUKG1 1QE
| | - David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
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Martin A, Booth JN, Laird Y, Sproule J, Reilly JJ, Saunders DH. Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database Syst Rev 2018; 1:CD009728. [PMID: 29376563 PMCID: PMC6491168 DOI: 10.1002/14651858.cd009728.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions. OBJECTIVES To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group. SEARCH METHODS In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes. DATA COLLECTION AND ANALYSIS Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes. MAIN RESULTS We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence). AUTHORS' CONCLUSIONS Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.
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Affiliation(s)
| | - Josephine N Booth
- The University of EdinburghInstitute for Education, Community and SocietyMoray House School of EducationRoom 2.17, St John's LandEdinburghUKEH8 8AQ
| | - Yvonne Laird
- University of EdinburghScottish Collaboration for Public Health Research and Policy (SCPHRP)20 West Richmond StreetEdinburghUKEH8 9DX
| | - John Sproule
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationHolyrood RoadEdinburghUK
| | - John J Reilly
- University of StrathclydePhysical Activity for Health Group, School of Psychological Sciences and Health50 George StreetGlasgowUKG1 1QE
| | - David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEDINBURGHUKEH8 8AQ
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9
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Berry DC, McMurray RG, Schwartz TA, Hall EG, Neal MN, Adatorwover R. A cluster randomized controlled trial for child and parent weight management: children and parents randomized to the intervention group have correlated changes in adiposity. BMC OBESITY 2017; 4:39. [PMID: 29225899 PMCID: PMC5715629 DOI: 10.1186/s40608-017-0175-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/20/2017] [Indexed: 11/26/2022]
Abstract
Background Studies have suggested that obesity is linked within families and that successful interventions involve both the parent and child with obesity. However little information exists regarding similarities in adiposity and weight loss between the parent and child, especially in low socio-economic ethnically diverse households. Methods The purpose of this study was to examine the relationships between the changes from baseline over time in adiposity, weight, health behaviors, and self-efficacy in children (n = 184) and parents (n = 184) participating in an 18-month weight loss program. Within the intervention group only and for each post-baseline time point, Pearson correlation coefficients were computed for children's changes (from baseline) in adiposity, weight, health behaviors, and self-efficacy, with their parents' corresponding changes from baseline, to determine how strongly the dyads were correlated. Results At the completion of 18 months, the intervention group parents demonstrated strong positive correlations between parent and child change in waist circumference (r = 0.409, p < 0.001), triceps (r = 0.332, p < 0.001), and subscapular (r = 0.292, p = 0.002) skinfolds. There were no significant correlations between weight, health behaviors, eating, and exercise self-efficacy. Conclusions The results suggest that in the Southern United States low-income parents and their children with obesity are strongly correlated. Trial registration NCT01378806 Retrospectively Registered on June 22, 2011.
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Affiliation(s)
- Diane C. Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Robert G. McMurray
- Department of Exercise and Sport Science, Department of Nutrition, The University of North Carolina at Chapel Hill, Campus Box 8700, Chapel Hill, NC 27599-8700 USA
| | - Todd A. Schwartz
- Department of Biostatistics, Gillings School of Global Public Health and School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7420, Chapel Hill, NC 27599-7420 USA
| | - Emily G. Hall
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Madeline N. Neal
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Reuben Adatorwover
- Department of Biostatistics, Gillings School of Global Public Health and School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7420, Chapel Hill, NC 27599-7420 USA
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10
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Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al‐Khudairy L, Baur L, Metzendorf M, Demaio A, Ells LJ. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev 2017; 6:CD012651. [PMID: 28639319 PMCID: PMC6481885 DOI: 10.1002/14651858.cd012651] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
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Affiliation(s)
- Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Tamara Brown
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Victoria Whittaker
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Dan Jones
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Giulia M Mainardi
- School of Medicine, University of São PauloDepartment of Preventive MedicineSão PauloBrazilCEP 01246 903
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | | | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
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11
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McMurray RG, Berry DC, Schwartz TA, Hall EG, Neal MN, Li S, Lam D. Relationships of physical activity and sedentary time in obese parent-child dyads: a cross-sectional study. BMC Public Health 2016; 16:124. [PMID: 26851940 PMCID: PMC4744403 DOI: 10.1186/s12889-016-2795-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/28/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Research suggests physical activity is linked to obesity. Further, the physical activity of healthy parents and their children is associated with each other. However, this relationship has not been examined in obese parents and their obese children. METHODS The purpose of this study was to compare the physical activity and sedentary time of obese, low-income, ethnic minority parents and their children on weekdays and weekend days using accelerometry. Data were obtained from eight rural sites in the middle and eastern part of North Carolina (N.C.), United States (U.S.) from 2007-2010 using a rolling enrollment. One hundred and ninety-nine obese parents (94 % female) and their obese children (54 % female) wore accelerometers simultaneously for three weekdays and one weekend day. Total physical activity, moderate-to-vigorous physical activity (MVPA) and sedentary time and proportions were determined. RESULTS Parents' and children's total physical activity and MVPA levels were lower on weekend days than weekdays. Total counts per minute for children on weekdays and weekend days were greater than for parents (p < 0.001). Total counts per minute were more highly correlated on weekend days than weekdays (r = 0.352, p < 0.0002 versus r = 0.165, p < 0.025). Parents' performed MVPA for 14 (SD = ±25) and 9 (SD = ±16) minutes/day on weekdays and weekend days, respectively; children performed MVPA for 37 (SD = ±25) and 31(SD = ±38) minutes/day for weekdays and weekend days, respectively. Correlations between parents and children for MVPA were higher on weekend days versus weekdays (r = 0.253 and 0.177, respectively; p < 0.015). Associations for sedentary time followed a similar trend, with r = 0.33 (p < 0.0002) for weekend days and r = 0.016 (p < 0.026) for weekdays. Associations between obese parent-child dyads on sedentary time were stronger for girls, while associations between dyads on MVPA were stronger for boys. However, formal interaction analyses were not significant (p > 0.13). DISCUSSION Since physical activity levels of obese parents and their obese child are somewhat related, especially on weekend days, combined parent-child obesity programs focused on reducing sedentary time could be beneficial, particularly for the child. CONCLUSION In conclusion, this study of the physical activity levels of obese parents and their obese children found some relationships between the parents' and children's physical activity and sedentary behavior patterns, especially on weekend days. TRIAL REGISTRATION NCT01378806 .
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Affiliation(s)
- Robert G McMurray
- Department of Exercise & Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Diane C Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, North Carolina, USA.
| | - Todd A Schwartz
- Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Emily G Hall
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, North Carolina, USA.
| | - Madeline N Neal
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, North Carolina, USA.
| | - Siying Li
- Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Diana Lam
- Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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12
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Cui Z, Seburg EM, Sherwood NE, Faith MS, Ward DS. Recruitment and retention in obesity prevention and treatment trials targeting minority or low-income children: a review of the clinical trials registration database. Trials 2015; 16:564. [PMID: 26651822 PMCID: PMC4674912 DOI: 10.1186/s13063-015-1089-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 11/27/2015] [Indexed: 12/27/2022] Open
Abstract
Background Efforts to recruit and retain participants in clinical trials are challenging, especially in studies that include minority or low-income children. To date, no studies have systematically examined recruitment and retention strategies and their effectiveness in working successfully with this population. We examined strategies employed to recruit or retain minority or low-income children in trials that included an obesity-related behavior modification component. Methods First, completed home-, community-, and school-based trials involving minority or low-income children aged 2–17 years were identified in a search of the ClinicalTrials.gov registry. Second, a PubMed search of identified trials was conducted to locate publications pertinent to identified trials. Recruitment and retention rates were calculated for studies that included relevant information. Results Our final analytic sample included 43 studies. Of these, 25 studies reported recruitment or retention strategies, with the amount of information varying from a single comment to several pages; 4 published no specific information on recruitment or retention; and 14 had no publications listed in PubMed. The vast majority (92 %) of the 25 studies reported retention rates of, on average, 86 %. Retention rates were lower in studies that: targeted solely Hispanics or African Americans (vs. mixed races of African Americans, whites, and others); involved children and parents (vs. children only); focused on overweight or obese children (vs. general children), lasted ≥1 year (vs. <1 year), were home or community-based (vs. school-based), included nutrition and physical activity intervention (vs. either intervention alone), had body mass index or other anthropometrics as primary outcome measures (vs. obesity-related behavior, insulin sensitivity, etc.). Retention rates did not vary based on child age, number of intervention sessions, or sample size. Conclusions Variable amounts of information were provided on recruitment and retention strategies in obesity-related trials involving minority or low-income children. Although reported retention rates were fairly high, a lack of reporting limited the available information. More and consistent reporting and systematic cataloging of recruitment and retention methods are needed. In addition, qualitative and quantitative studies to inform evidence-based decisions in the selection of effective recruitment and retention strategies for trials including minority or low-income children are warranted.
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Affiliation(s)
- Zhaohui Cui
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2202 McGavran-Greenberg Hall, Campus Box 7461, Chapel Hill, NC, 27599, USA.
| | - Elisabeth M Seburg
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
| | - Nancy E Sherwood
- HealthPartners Institute for Education and Research, Minneapolis, MN, USA.
| | - Myles S Faith
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2202 McGavran-Greenberg Hall, Campus Box 7461, Chapel Hill, NC, 27599, USA.
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2202 McGavran-Greenberg Hall, Campus Box 7461, Chapel Hill, NC, 27599, USA.
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13
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Berry DC, Schwartz TA, McMurray RG, Skelly AH, Neal M, Hall EG, Aimyong N, Amatuli DJ, Melkus G. The family partners for health study: a cluster randomized controlled trial for child and parent weight management. Nutr Diabetes 2014; 4:e101. [PMID: 24418827 PMCID: PMC3904082 DOI: 10.1038/nutd.2013.42] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The purpose of this study was to test a two-phased nutrition and exercise education, coping skills training, and exercise intervention program for overweight or obese low-income ethnic minority 2nd to 4th grade children and their parents in rural North Carolina, USA. METHODS A cluster randomized controlled trial was carried out with 358 children (7-10 years) and a parent for each child (n=358). General linear mixed models were used to determine the effects of the intervention on weight, adiposity, health behaviors, and eating and exercise self-efficacy by examining changes in children and parents from baseline to completion of the study (18 months). RESULTS At 18 months, children in the experimental group did not have a significantly decreased body mass index (BMI) percentile (P=0.470); however, they showed a reduction in the growth rate of their triceps (P=0.001) and subscapular skinfolds (P<0.001) and an improvement in dietary knowledge (P=0.018) and drank less than one glass of soda per day (P=0.052) compared with the control group. Parents in the experimental group had decreased BMI (P=0.001), triceps (P<0.001) and subscapular skinfolds (P<0.001) and increased nutrition (P=0.003) and exercise (P<0.001) knowledge and more often drank water or unsweetened drinks (P=0.029). At 18 months, children in the experimental group did not show significant improvement in eating (P=0.956) or exercise self-efficacy (P=0.976). Experimental parents demonstrated improved socially acceptable eating self-efficacy (P=0.013); however, they did not show significant improvement in self-efficacy pertaining to emotional eating (P=0.155) and exercise (P=0.680). CONCLUSION The results suggest that inclusion of children and parents in the same intervention program is an effective way to decrease adiposity and improve nutrition behaviors in both children and parents and improve weight and eating self-efficacy in parents.
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Affiliation(s)
- D C Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T A Schwartz
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - R G McMurray
- School of Exercise and Sport Science and Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A H Skelly
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Neal
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E G Hall
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N Aimyong
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D J Amatuli
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - G Melkus
- School of Nursing, Muriel and Virginia Pless Center for Nursing Research, New York University, New York, NY, USA
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