Effectiveness of a school-based physical activity intervention on obesity in school children: a nonrandomized controlled trial

Associations of School-Level Factors and School Sport Facility Parameters with Overweight and Obesity among Children and Adolescents in Pakistan: An Empirical Cross-Sectional Study

Childhood overweight and obesity are increasingly prevalent in Pakistan, posing significant public health challenges. This study explores the associations of school-level factors and school sports facility parameters with overweight and obesity among children and adolescents in Pakistan. A cross-sectional study across seven random districts in Punjab province, Pakistan, was conducted using a representative multistage random cluster sample. Underweight (BMI < 5th percentile), overweight (85th ≤ BMI < 95th percentile), and obese (95th percentile ≤ BMI) were defined using the US Center for Disease Control (CDC) 2000 criteria. Statistical analyses including the Chi-square test, Pearson correlation coefficient, and linear regression were performed to investigate predictive characteristics. Logistic regression analysis assessed the simultaneous impact of several covariates on dichotomous outcomes, with 95% confidence intervals (CIs) computed and a significance level set at p < 0.05. The study included 4108 Pakistani school children aged 9 to 17 years (mean age = 13.92 years, 59.3% boys) from 62 schools. The prevalence of overweight and obesity was 19.4% and 10.7%, respectively. Findings revealed a concerning lack of physical education activities (60% reported 0 sessions per week), morning exercise (60%), and classroom exercises (66%) among school-aged children. Leadership attitudes toward physical education (β = 0.04, p = 0.006) and students' satisfaction with the playground (β = 0.05, p = 0.015) showed significant associations with body weight status. Conversely, provision of physical education facilities, effective fund utilization for physical education, meeting school sports facility requirements, and weekend opening of school sports grounds did not significantly impact weight status. Satisfaction with the playground was significantly associated with a lower risk of overweight (OR 0.81, 95% CI 0.69-0.95, p < 0.05), indicating reduced overweight likelihood among students satisfied with school playgrounds. The study underscores significant gaps in promoting physical activity within school environments and highlights the urgent need for interventions to enhance physical education resources and sports facilities, aiming to create healthier school environments and reduce overweight and obesity prevalence among students. Further research and interventions are crucial for promoting lifelong physical activity habits and improving student health and well-being.

Neck Circumference as a Valuable Tool to Identify the Risk of Metabolic Syndrome in Mexican Children

BACKGROUND/OBJECTIVES

Neck circumference (NC) has been proposed as a simple measurement to identify patients with overweight and obesity. It has been found that adipose tissue at the cervical level is associated with the presence of metabolic alterations. The aim of this study was to estimate the association between NC and indicators of Metabolic Syndrome (MS) to subsequently estimate its capacity to identify the risk of MS compared to waist circumference (WC) and Body Mass Index (BMI).

METHODS

A cross-sectional study was carried out with a sample of 286 children 6-9 years old who attended six public primary schools in Jalisco, Mexico. Pearson's correlation coefficients along with sensitivity and specificity tests were performed to analyze the relationship between NC and MS indicators. Odds ratio (OR) and concordance analyses were performed considering the Kappa index.

RESULTS

NC showed statistically significant correlations with all MS indicators except for LDL cholesterol and total cholesterol. The cut-off points of NC to identify MS according to sex was >27.4 cm for girls and >29.8 cm for boys. The association of NC with values above the cutoff point and the presence of MS was OR: 21.6 (CI: 7.11-65.74).

CONCLUSIONS

NC represents a simple and cost-effective alternative to identify children at risk of MS when compared to BMI and WC.

Association of nutrition behavior and food intake with overweight and obesity among school-aged children and adolescents in Pakistan: a cross-sectional study

Purpose

This study aimed to assess the association between nutrition behavior, food intake, being overweight, and obesity among school-aged children and adolescents aged 9 to 17 years. Additionally, it sought to examine how these factors influence being overweight and obese within this population.

Methods

A population-based cross-sectional study was conducted with a representative multistage cluster sample of 4200 Pakistani school-aged children and adolescents aged 9 to 17 years from 62 schools across seven random districts in Punjab province, Pakistan. Underweight (BMI < 5th percentile), overweight (85th ≤ BMI < 95th percentile), and obese (95th percentile ≤ BMI) were defined using the US Center for Disease Control (CDC) 2000 criteria, and a Chi-square test utilized for comparison. The Pearson correlation coefficient (r) assessed any correlations, while a linear regression analysis explored the predictive power of Nutrition Behavior/Food Intake factors (independent variables) on body-weight (dependent variable). A logistic regression analysis estimated the simultaneous influence of multiple factors on the dichotomous outcomes, and the 95% confidence intervals (CI) were calculated. The statistical significance level was set at p < 0.05.

Results

The study was comprised of 4108 Pakistani school children aged 9 to 17 years (mean age = 13.92 years, 59.3% boys) from 62 schools. Among them, the prevalence of being overweight and obese individuals was 19.4% and 10.7%, respectively. Factors such as skipping breakfast (OR 2.45, 95% CI 1.53-3.93, p < 0.001), consuming vegetables less than once a week (OR 4.12, 95% CI 3.06-5.55, p < 0.001), consuming soft drinks three or more times a week (OR 4.74, 95% CI 3.73-6.04, p < 0.001), and consuming fast food three or more times a week (OR 10.56, 95% CI 8.16-13.67, p < 0.001) were associated with a higher risk of obesity.

Conclusion

Being overweight and obese pose significant concerns among school-aged children and adolescents in Pakistan, showing a troubling upward trend. Poor nutrition behaviors, including frequenting fast-food restaurants and low consumption of fruits and vegetables, contribute to these issues. It is imperative to comprehend these risk factors to formulate impactful policies and dietary interventions that target childhood obesity in Pakistan. Identifying vulnerable populations and implementing tailored intervention strategies are essential for public health efforts. While further interventions may be needed to reduce the body mass index (BMI) and manage being overweight and obese, the findings of this study provide valuable insights into addressing these critical health challenges.

Effects of school nurse-led health education to reduce malnutrition among primary school children in Bangladesh: Cluster nonrandomized controlled trial

Background

Malnutrition is a major health concern among children especially in low and middle-income countries. However, there are limited studies on school health in Bangladesh. This study aimed to reduce malnutrition among primary school children in Bangladesh by increasing awareness and knowledge through school nurse-led health education.

Methods and Materials

A prospective, open-label, parallel-group (1:1), cluster nonrandomized controlled trial on primary school children conducted in rural Bangladesh. The study lasted 13 months between September 2021 and September 2022. Four schools were selected and assigned to the intervention and control groups (CGs). Next, school nurses provided evidence-based health education to the children in the intervention group (IG) for 9 months to improve awareness and knowledge of malnutrition. Data were collected at baseline, midline, and endline.

Results

Overall, 604 children were enrolled at the baseline; among them, 455 (CG, n = 220; IG, n = 235) completed the study. Changes in the malnutrition rate-the primary outcome-were not significant (P = 0.225). However, after adjusting the endline data with baseline and sociodemographic data, the children's body mass index improved significantly in the IG than in the CG (P < 0.05). Changes in eating behavior, and awareness and knowledge of malnutrition-the secondary outcomes-significantly differed between the groups (P < 0.001).

Conclusion

The school nurse-led health education program significantly improved primary school children's awareness and knowledge of malnutrition. This study revealed the effectiveness of school nurses in reducing malnutrition among children, which may decrease future morbidity and mortality rates in children.

Effects of school-based physical activity interventions on physical fitness and cardiometabolic health in children and adolescents with disabilities: a systematic review

Background: This study aimed to examine the influence of school-based physical exercise programs on physical fitness and cardiometabolic health in children and adolescents with disabilities. Methods: Web of Science, Scopus, and PubMed were thoroughly searched to identify relevant investigations. To be included in the systematic review, studies needed to fulfill the following inclusion criteria: 1) performed school-based physical exercise interventions; 2) parameters evaluated referred to health-related physical fitness (HRPF), skill-related physical fitness (SRPF), and cardiometabolic health; 3) a sample of participants consisted of children and adolescents with disabilities; 4) the mean age of respondents was less than 18 years; and 5) were written in the English language. Results: After searching the databases, a total of 474 studies have been identified, 18 of them met the eligibility criteria, and their outcomes were presented. Relating to the respondents' characteristics, the investigations involved 681 children and adolescents with disabilities, out of which 440 were male and 241 female. Regarding types of physical exercise interventions, the most commonly implemented were combined aerobic and resistance training, aerobic exercise, sports games, adapted high-intensity interval training, as well as sprint interval training. The obtained results unambiguously demonstrated that applied exercise interventions improved HRPF components such as cardiorespiratory fitness, muscular fitness, and flexibility. In terms of the SRPF, agility, balance, coordination, and power were considerably enhanced following the school-based exercise. On the other hand, the influence on indices of body composition and cardiometabolic health is quite controversial. The majority of the available studies did not find favorable effects. Additionally, no adverse events were reported in 7 of 8 research, and adherence to exercise was approximately 92%. Conclusion: School-based physical exercise programs were very efficient in improving HRPF and SRPF in children and adolescents with disabilities, while the evidence concerning the variables of body composition and cardiometabolic health is inconclusive and warrants further investigations.

Experiences, Perspectives, and Barriers to Physical Activity Parenting Practices for Chinese Early Adolescents

BACKGROUND

Parents play an important role in shaping youth's lifestyle behaviors. This study aimed to investigate physical activity parenting practices (PAPP) for Chinese early adolescents and compare reporting discrepancies between parents and adolescent boys and girls.

METHODS

Fifty-five adolescent-parent dyads participated in 16 paired focus group interviews, and an additional 122 dyads completed questionnaire surveys with open-ended questions. Participants were recruited from 3 public middle schools in Suzhou, China. Qualitative data were analyzed inductively using an open-coding scheme. Frequencies of codes were compared by parent-child role and adolescent gender using chi-square tests.

RESULTS

Eighteen types of PAPP were identified and grouped into 6 categories: goals/control, structure, parental physical activity participation, communication, support, and discipline. These PAPP were viewed as promotive, preventive, or ineffective. Participants had mixed opinions on the effects of 11 PAPP and identified parental, adolescent, and environmental barriers for parents to promote youth physical activity. Compared with parents, adolescents were more likely to value the effects of setting expectation, scheduling, and coparticipation as well as dislike pressuring, restriction, and punishment. Girls were more likely to favor coparticipation and were more sensitive about negative communication than boys. Parents paid more attention to environmental barriers, whereas adolescents, especially girls, focused more on personal issues.

CONCLUSIONS

Future studies need to address both positive and negative PAPP as well as perception discrepancies by child-parent role and adolescent gender to generate more evidence to promote parents as favorable socialization agents of youth physical activity.

Longitudinal effects of school policies on children's eating behaviors and weight status: findings from the childhood obesity study in China megacities

OBJECTIVES

To examine longitudinal effects of school policies on children's weight status and eating behaviors, and study how these effects may vary by children's age, sex, and baseline weight status in China.

METHODS

Data were collected in 2015, 2016, and 2017 in an open cohort of 3298 children aged 6-17, their parents, and schools in five large cities across China (Beijing, Shanghai, Xi'an, Nanjing, and Chengdu). Children's weight, height, and waist circumference were measured, and their eating behaviors were self-reported. The 1691 children with such repeated measures in ≥ two waves were included in longitudinal data analysis with mixed effects models, testing the associations.

RESULTS

Having school vicinity food stall policy was associated with less frequent consumption of fast food (β = -0.14, p < 0.01) and snack (β = -0.84, p < 0.01). More significant associations were found between school policies and unhealthy eating behaviors for girls and children aged 6-11 than their counterparts. Among children without overweight or central obesity at baseline, having school cafeteria food policy was associated with lower risks for overweight and obesity (OR = 0.33, 95% CI: 0.17-0.63) and central obesity (OR = 0.47, 95% CI: 0.26-0.85). This existed for girls, but not for boys. School vicinity food stall policy was associated with lower BMI (β = -0.20, 95% CI: -0.37, -0.03) among all children and in girls (β = -0.28, 95% CI: -0.50, -0.05) without overweight at baseline.

CONCLUSIONS

School policies could reduce children's unhealthy eating behaviors and obesity risk in megacities in China. Children's age, sex, and baseline weight status modify the effects. School policies are important to fight the growing childhood obesity epidemic.

Determining Trends and Factors Associated with Self-Reported Physical Activity among Adolescents in Rural North Carolina

It is important to better understand factors associated with physical activity (PA) levels in adolescents in rural areas. Cross-sectional data were used to obtain self-reported PA levels among adolescents in a school-based intervention in fall 2018. Demographic data, environmental variables, and cardiovascular fitness (PACER score) were also measured. Analyses included a two-sample t-test, ANOVA, a Chi-square test, and a linear regression model. Participants included 3799 7th graders. Male (p < 0.0001), white (p < 0.0001), and healthy weight (p < 0.0001) participants reported more days of PA. The correlation between school physical education (PE) and PACER was modest (r = 0.27, p < 0.0001). Multiple linear regression model showed significant effects of school PE (p = 0.0011), gender (p < 0.0001), race (p < 0.0001), and weight category (p < 0.0001) on self-reported PA. The percentage of students reporting 60 min of PA for 5 (p < 0.0001) or 7 (p = 0.0307) days per week tended to be higher with increased days per week of school PE. Policy changes that increase PA and PE in middle schools may present opportunities to improve PA levels in adolescents, with emphasis on being inclusive and mindful of minority and female youth.

Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use

BACKGROUND

Several school-based interventions are effective in improving child diet and physical activity, and preventing excessive weight gain, and tobacco or harmful alcohol use. However, schools are frequently unsuccessful in implementing such evidence-based interventions.

OBJECTIVES

1. To evaluate the benefits and harms of strategies aiming to improve school implementation of interventions to address student diet, physical activity, tobacco or alcohol use, and obesity. 2. To evaluate the benefits and harms of strategies to improve intervention implementation on measures of student diet, physical activity, obesity, tobacco use or alcohol use; describe their cost or cost-effectiveness; and any harms of strategies on schools, school staff or students.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search was between 1 September 2016 and 30 April 2021 to identify any relevant trials published since the last published review.

SELECTION CRITERIA

We defined 'Implementation' as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised controlled trial (RCT) or non-randomised controlled trial (non-RCT)) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by students to 'no intervention', 'usual' practice or a different implementation strategy.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Given the large number of outcomes reported, we selected and included the effects of a single outcome measure for each trial for the primary (implementation) and secondary (student health behaviour and obesity) outcomes using a decision hierarchy. Where possible, we calculated standardised mean differences (SMDs) to account for variable outcome measures with 95% confidence intervals (CI). For RCTs, we conducted meta-analyses of primary and secondary outcomes using a random-effects model, or in instances where there were between two and five studies, a fixed-effect model. The synthesis of the effects for non-randomised studies followed the 'Synthesis without meta-analysis' (SWiM) guidelines.

MAIN RESULTS

We included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty-six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Pooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low-certainty evidence). For secondary outcomes we found, relative to control, the use of implementation strategies to support intervention implementation may result in a slight improvement on measures of student diet (SMD 0.08, 95% CI 0.02 to 0.15; 11 RCTs, 16,649 participants; low-certainty evidence) and physical activity (SMD 0.09, 95% CI -0.02 to 0.19; 9 RCTs, 16,389 participants; low-certainty evidence). The effects on obesity probably suggest little to no difference (SMD -0.02, 95% CI -0.05 to 0.02; 8 RCTs, 18,618 participants; moderate-certainty evidence). The effects on tobacco use are very uncertain (SMD -0.03, 95% CIs -0.23 to 0.18; 3 RCTs, 3635 participants; very low-certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants). Few trials reported the economic evaluations of implementation strategies, the methods of which were heterogeneous and evidence graded as very uncertain. A lack of consistent terminology describing implementation strategies was an important limitation of the review.

AUTHORS' CONCLUSIONS

The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural- and obesity-related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.

Effectiveness of structured interventional strategy for middle-aged adolescence (SISMA-PA) for preventing atherosclerotic risk factors—A study protocol

Background

Atherosclerotic risk starts at an early stage in adolescents and interventions on adolescents’ lifestyles are most important. The pandemic of obesity-related morbidities like atherosclerosis among young adults and atherosclerotic risk factors for middle-aged adolescents in India is known. Yet, there is a lack of cost-effective and integrated intervention programs to treat this important health problem.

Objective

The main objective of this study is to evaluate the effect of a 12-week structured interventional strategy program, containing integrated education and supervised physical activity interventions for middle-aged adolescents.

Methods/design

This will be a school-based pre-experimental one-group pre-post time-series research design. The sample size is estimated to include 154 adolescents of 10^th to 12^th grade; aged 15–17 years will be grouped as a single arm. Data will be collected from July 2021 to January 2022. The intervention duration will be 3 months. The following measures will be evaluated before, during, and after intervention: knowledge, body mass index, level of physical activity, dietary habits, and sedentary activity.

Discussion

We believe that the structured interventional strategy approach which includes education related to atherosclerosis, physical activity, dietary habits, and sedentary activity, and cost-effective physical activity training will be more effective in preventing atherosclerotic-related changes among middle-aged adolescents. Further, this kind of approach may be applied in similar study areas elsewhere in India.

Trial registration

Clinical Trials Registry—India (Registered Number: CTRI/2021/03/032271).

Associations of genetic variants of lysophosphatidylcholine metabolic enzymes with levels of serum lipids

OBJECTIVE

Metabolic disturbance of lysophosphatidylcholine (LPC) is related with dyslipidemia. Therefore, eight single-nucleotide polymorphisms (SNPs) were selected from LPC metabolic enzymes to study their associations with obesity and serum levels of lipids.

METHODS

A total of 3305 children were recruited from four independent studies. Eight SNPs of LPC metabolic enzymes were selected and genotyped with the matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS). The multivariable linear regression model was applied to detect the associations of eight SNPs with obesity-related phenotypes and levels of lipids in each study. Meta-analyses were used to combine the results of four studies.

RESULTS

Only SNP rs4420638 of APOC-1 gene was associated with serum lipids even after Bonferroni correction. The rs4420638 was positively associated with TC (β = 0.15, P = 8.59 × 10^-9) and low-density-lipoprotein-cholesterol (LDL-C, β = 0.16, P = 9.98 × 10^-14) individually.

CONCLUSION

The study firstly revealed the association between APOC-1/rs4420638 and levels of serum lipids in Chinese children, providing evidence for susceptible gene variants of dyslipidemia.

Perception of School Committee Members (SCMs) on Factors Contributing to Overweight and Obesity Among High School Students in Kiribati: A Qualitative Study

Background

Schools are vital settings for overweight and obesity prevention among children and adolescents. School Committee Members (SCMs) are crucial assets to engaging students with overweight and obesity prevention programs. This study aimed to determine factors contributing to overweight and obesity among high school students in Kiribati through the perception of SCMs.

Methods

This prospective qualitative study was conducted in four randomly selected senior high schools in South Tarawa, Kiribati, from August to November 2020. With a purposive selection of 20 SCMs employed at the four high schools, both male and female participants consented to participate in the study. A semi-structured open-ended questionnaire was used for data collection using focus group discussions (FGDs). Data were transcribed and analyzed using the thematic analysis method.

Results

Twenty participants were involved in FGDs with equal number of SCMs (n = 5) who attended FGDs for each school and 45% of them were female participants. Six themes were identified, namely, knowledge, behaviors, perceived status toward overweight and obesity, perceived action benefits, perceived barriers to practices, and proposed strategies to overweight and obesity prevention. These themes reveal that SCMs have a broad understanding and skill set for overweight and obesity causes and effects. However, the aptitude alone is not enough to prevent the occurrence, and thus, proposed feasible plans were voiced for responsible stakeholders to include in policy developments for overweight and obesity prevention.

Conclusion

This study recognized that the knowledge-behavior gap is the main reason behind the failure in preventative strategic approaches among adolescents. As role models to students, SCMs and their schools should team up in implementing the public health policies and building mutual awareness and understanding with students and other specialist stakeholders for a more momentous and viable impact.

Prevalence of Obesity and Associated Risk Factors among Children and Adolescents in the Eastern Cape Province

Obesity is a global public health concern that begins in childhood and is on the rise among people aged 18 and up, with substantial health consequences that offer socioeconomic challenges at all levels, from households to governments. Obesity and associated risk factors were investigated in children and adolescents in the Eastern Cape Province of South Africa. A cross-sectional study was conducted at Mt Frere among 209 conveniently selected participants using anthropometric measurements and a structured questionnaire. Chi-squared statistics or Fisher's exact test were used to evaluate the risk factors predicting different outcomes such as hypertension or diabetes mellitus. A 5% level of significance was used for statistical significance (p-value 0.05). The prevalence of overweight or obesity among females when using waist circumference (2.7%), triceps skinfold (6.9%), and body mass index cut-offs (16.4%) were respectively higher when compared to those of males. About 89% engaged in physical activities. After school, 53% watched television. About 24.9% of participants did not eat breakfast. Most of overweight or obese participants (92.9%) brought pocket money to school. Use of single anthropometric measurements for assessing nutritional status indicated inconclusive results. Strengthening parental care, motivation for consumption of breakfast and limiting pocket money for children going to school are important steps to improve child health.

Perceptions and knowledge of school management teams about non-communicable diseases and strategies to prevent them

Background

In 2016, non-communicable diseases (NCDs) were reported to be responsible for 41 million of the world’s 57 million deaths. These deaths were reported to be associated with modifiable lifestyle behaviours, such as tobacco smoking, poor physical activity and diets of poor nutritional value. There could be a knowledge gap on NCD risk factors amongst non-health professionals. Knowledge of NCDs is, therefore, important for the implementation of preventive measures to onset of NCDs.

Aim

This study aimed at describing perceptions and knowledge of school management teams about NCDs and strategies to prevent them.

Setting

This study was conducted in Mt Frere, South Africa.

Methods

This explorative qualitative study using a phenomenological data collection approach was conducted amongst purposively selected school authorities in 2016–2017 to understand their perceptions and knowledge about NCDs and what can be performed to prevent them. Two focus group discussions (FGDs) were conducted using open-ended and unstructured questions guided by interview schedule. Tesch’s eight phases of thematic analysis approach was used to analyse narrative data resulting in two main themes and nine subthemes.

Results

Two themes (understanding and prevention of NCDs, and control measures for NCDs) and nine sub-themes emerged from the data analysis. Inconsistent description of NCDs, its causes and controls were identified amongst school management teams in the FGD. Diet, poverty, societal factors, gaps between decision makers and communities, and poor policy implementation were identified by participants as major issues in the development of NCDs.

Conclusion

There was no adequate knowledge on NCDs amongst the school management team participants. Improved visibility of health promotion personnel is needed to ensure community empowerment on NCDs prevention.

Contribution

The findings in this study will help in closing the gaps in the implementation of preventive health services for NCDs within school health.

Effectiveness of After-School Physical Activity Intervention on Body Mass Index and Waist Circumference/Height Ratio among Overweight Adolescents in Selected Schools at Puducherry, India: A Randomized Controlled Trial

Background:

Globally, the prevalence of overweight and obesity has dramatically increased in the recent years. In India, more than 10% of schoolchildren are overweight or obese. Schools play a major role in the modification of behavior. The aim of this study was to assess the effectiveness of after-school physical activity intervention on body mass index (BMI) and waist circumference/height ratio as primary outcomes.

Materials and Methods:

A randomized controlled trial was adopted where the schools were randomized. Each group, i.e., study and control groups, had 140 overweight adolescents. BMI and waist circumference/height ratio were measured. After-school physical activity intervention was carried out for a period of 9 months by the study group. The posttests were carried out at an interval of 3 months up till 9 months.

Results:

There was a statistically significant difference in BMI between the study and control groups during the 6^th and 9^th months (t = 1.256, P < 0.001 and t = 0.920, P < 0.001), respectively. The repeated measures analysis of variance did not show a significant reduction in BMI and waist circumference/height ratio over a period of time.

Conclusion:

School-based physical activity interventions are effective in prevention of childhood overweight/obesity and are a very cost-effective measure that can be easily implemented in schools.

Effects of a physical activity intervention on schoolchildren fitness

The global prevalence of childhood obesity is high. Obesity main causes are linked to sedentary lifestyles. Increasing physical activity (PA) and reducing sedentary activities are recommended to prevent and treat obesity. This study aimed to evaluate the effectiveness of a 6-month school PA intervention on obesity prevention and healthy behaviors in school-aged children. Participating students (10-11 years of age) were randomly divided into an intervention group and a control group. Children in the intervention group (n = 80) participated in a multicomponent PA that included improvement in extracurricular physical activities (with an additional 40 min per day for 5/6 days per week). Children (n = 80) in the control group participated in usual practice. Participants had mean body mass index of 19.7 ± 2.9 kg/m2 , and 33.7% of them were overweight or with obesity at T0. The change in body mass index in intervention group (-2.4 ± 0.6 kg/m2 ) was significantly different from that in control group (3.01 ± 1.8 kg/m2 ). The effects on waist circumference, waist-to-height ratio, and physic fitness were also significant in intervention group compared with control group (all p < 0.05). Furthermore, there is a significant decrease in overweight or children with obesity in the experimental group (to 17.5%, p < 0.05). These findings suggest that a school-based intervention program represents an effective strategy for decreasing the number of overweight and children with obesity.

Harmonizing Ratings From Different School Environment Assessment Methods: A Simplified Approach

BACKGROUND

This study describes a method for harmonizing data collected with different tools to compute a rating of compliance with national recommendations for school physical activity (PA) and nutrition environments.

METHODS

We reviewed questionnaire items from 84 elementary schools that participated in the Childhood Obesity Research Demonstration (CORD) project, which was 3 distinct childhood obesity prevention projects in 7 communities in California, Massachusetts, and Texas. Each project used tools specific to its programs, schools, and communities. While this approach increased the feasibility of data collection, it created a challenge with the need to combine data across projects. We evaluated all questionnaire items and retained only those items that assessed one or more recommendations and constructed several items to indicate compliance or noncompliance with the respective associated recommendations.

RESULTS

Ten constructed items covered 11 of the 20 recommendations. Analysis indicated that the scores detected variability in compliance both among communities and among school within communities.

CONCLUSIONS

The scores captured differences in compliance with the national recommendations at multiple levels. Our method, designed for creating common scores, may be useful in integrated data analysis, systematic reviews, or future studies requiring harmonizing of data collected via different tools.

Effectiveness of a school-based intervention on physical activity and screen time among adolescents

OBJECTIVES

To evaluate the effectiveness of a multi-component school-based intervention on physical activity (PA) and screen time (ST) among urban adolescents in Bangladesh.

DESIGN

Cluster-randomised controlled trial.

METHODS

Eight high schools were randomly assigned to either intervention group (IG) or control group (CG). Participants (n = 160 per group, 40 school) were in grades 8-9. A 12-week multi-component intervention was developed based on the WHO's Health-Promoting Schools framework. The IG received weekly supervised circuit exercise (30 min/week), health education session (10 min/week) with health educational materials, and lunchtime sports activities (20 min/week). The main outcome measures included self-reported PA, ST, knowledge on PA and SB, which were assessed at baseline, 8 and 12 weeks. Repeated measures ANCOVA was used to evaluate the intervention effects.

RESULTS

Total PA (MET-min/week) was increased from baseline to 8 and 12 weeks in the IG (3%-5%) but decreased in the CG (5%-3%) and significantly improved in the IG compared to the CG (p < 0.001) over time. Average ST (min/day) reduced from baseline to 8 and 12 weeks in the IG (28%-35%), while remained unchanged in the CG (6%-5%). The IG had a significantly lower average ST than the CG at 12 weeks. The average knowledge scores on PA and SB were significantly higher in the IG than the CG at 12 weeks (p < 0.001).

CONCLUSIONS

Our intervention has demonstrated some promising effects on increasing PA, reducing ST, and improving PA and SB knowledge. This study underscores the need for a scaled-up evaluation in other locations including rural settings.

Physiotherapy and related management for childhood obesity: A systematic scoping review

INTRODUCTION

Despite targeted efforts globally to address childhood overweight/obesity, it remains poorly understood and challenging to manage. Physiotherapists have the potential to manage children with obesity as they are experts in movement and physical activity. However, their role remains unclear due to a lack of physiotherapy-specific guidelines. This scoping review aims to explore existing literature, critically appraising and synthesising findings to guide physiotherapists in the evidence-based management of childhood overweight/obesity.

METHOD

A scoping review was conducted, including literature up to May 2020. A review protocol exists on Open Science Framework at https://osf.io/fap8g/. Four databases were accessed including PubMed, Embase, CINAHL, Medline via OVID, with grey literature searched through google via "file:pdf". A descriptive synthesis was undertaken to explore the impact of existing interventions and their efficacy.

RESULTS

From the initial capture of 1871 articles, 263 intervention-based articles were included. Interventions included qualitative focused physical activity, quantitative focused physical activity and multicomponent interventions. Various outcome measures were utilised including health-, performance- and behaviour-related outcomes. The general trend for physiotherapy involvement with children who are obese appears to favour: 1) multicomponent interventions, implementing more than one component with environmental modification and parental involvement and 2) quantitative physical activity interventions, focusing on the quantity of bodily movement. These approaches most consistently demonstrated desirable changes across behavioural and health-related outcome measures for multicomponent and quantitative physical activity interventions respectively.

CONCLUSION

When managing children with obesity, physiotherapists should consider multicomponent approaches and increasing the quantity of physical activity, given consistent improvements in various obesity-related outcomes. Such approaches are well suited to the scope of physiotherapists and their expertise in physical activity prescription for the management of childhood obesity. Future research should examine the effect of motor skill interventions and consider the role of environmental modification/parental involvement as factors contributing to intervention success.

Percentile Reference Values for the Neck Circumference of Mexican Children

Neck circumference was studied for the first time in a pediatric population in 2010. Since then, various countries have proposed cutoff values to identify overweight, obesity, and metabolic syndrome. However, no reference values have been established for the Mexican child population. The aim of this study is to provide percentile reference values for the neck circumference of Mexican schoolchildren. Only normal-weight schoolchildren aged 6–11 years were included. Percentiles and growth charts were constructed based on the “Generalized Additive Model for Location, Scale and Shape” (GAMLSS). A total of 1059 schoolchildren (52.9% female) was evaluated. Weight, height, and BMI values were higher for males; however, this difference was not statistically significant. The 50th percentile for females was 24.6 cm at six years old and 28.25 cm at 11 years old, and for males, it was 25.75 cm and 28.76 cm, respectively. Both males and females displayed a pronounced increase in neck circumference between 10 and 11 years of age. The greatest variability was found in the 11-year-old group, with an increase of 5.5 cm for males and 5.4 cm for females. This study presents the first reference values for neck circumference for a Mexican child population.

Iranian children with overweight and obesity: an internet-based interventional study

Background

Obesity or overweight in children is an excessive accumulation of adipose tissue that can potentially regress health indicators and increase the likelihood of various diseases.

Objectives

This model was implemented to improve the nutritional status and lifestyle behavior of children aged 6–12 years with overweight/obesity.

Methods

A quasi-experimental design with 90 participants in each control and intervention group with a multistage cluster random sampling method after reviewing the literature, and their screening by experts were adopted.

Results

After 6 months there were significant differences in Body Mass Index and weight for age percentile values of children allocated in control and intervention groups after controlling for beginning values (p = 0.024, Partial eta2 = 0.028, 0.044, Partial eta2 = 0.023), respectively. Although there was an increased rate in BMI and weight for age percentile in both groups this increase in the control group after the 6th month significantly was more than that in the intervention group after the 6th months. A considerable difference in BMI of girls after the intervention was observed in the experimental group (p = 0.006, Partial eta2 = 0.092). However, our results showed that there was no significant difference in BMI of boys in the intervention and control groups before and 6 months after the intervention (p = 0.507).

Conclusions

We conclude that though the weight increase rate was lower in the experimental group, the implemented model alone was not enough.

Trial registration

Iranian Registry of Clinical Trials (IRCT): IRCT20200717048124N1 at 05/08/2020, retrospectively registered.

A Systematic Review of Multi-Component Comprehensive School Physical Activity Program (CSPAP) Interventions

OBJECTIVE

To identify, review, and describe multicomponent physical activity (PA) interventions in terms of: (a) number and combination of Comprehensive School Physical Activity Program (CSPAP) components, (b) study characteristics, and (c) primary outcomes.

DATA SOURCE

Five electronic databases (i.e., PubMed, PsychInfo, Physical Education Index, Sport Discus, and ERIC).

STUDY INCLUSION AND EXCLUSION CRITERIA

Included articles were peer-reviewed, written in English language, published since 1987, and included multicomponent school-based interventions.

DATA EXTRACTION

Data items extracted were: school level, setting, CSPAP component description, health outcomes, academic outcomes, main conclusion, and reference.

DATA SYNTHESIS

Included articles were synthesized by: (1) CSPAP components utilized, and (2) research outcome measured (i.e., health or academic).

RESULTS

Across 32 studies, 11 included physical education plus 1 additional CSPAP component (PE + 1); 10 included PE + 2 additional CSPAP components; 8 included PE + 3 additional CSPAP components; and 1 included all 5 CSPAP components. Two other studies included 2 or 3 CSPAP components without PE. Most interventions targeted health outcomes (94%) rather than academic outcomes (6%).

CONCLUSIONS

Multicomponent approaches aligned with CSPAPs are effective in promoting PA and other positive outcomes for youth in schools. Future research should seek to understand effects of CSPAP components on a variety of outcomes and settings.

The effectiveness of physical activity interventions in Asian children and adolescents: a systematic review

OBJECTIVE

The objective of this review is to investigate the effectiveness of interventions to promote physical activity (PA) among children and adolescents in Asian countries.

STUDY DESIGN

Systematic review.

METHODS

A systematic search of eight electronic databases was performed to retrieve articles published between January 1990 and August 2019, in English language, including any interventions to promote PA outcomes among children (aged 3-12 years) and adolescents (aged 13-18 years) in Asian countries.

RESULTS

Thirty studies met the eligibility criteria and were included. Most studies were school-based (70%, n = 21), and half were cluster randomized controlled trials (53%, n = 16). Twelve of 30 included studies were among children, 15 among adolescents, and three among both children and adolescents. Only four studies (13%) used device-based measures of PA. The duration of intervention ranged from one day to 60 months (median 4.5 months). Twenty-one studies were of moderate-to-high quality, of which 15 demonstrated significant increases in PA behavior or physical fitness. Evidence was found that school-based, short-term (up to six months) interventions with a single or multicomponent approach including PA sessions, physical education, health education, and/or educational materials may increase overall PA in Asian children and adolescents.

CONCLUSIONS

The present review provides some evidence supporting the effectiveness of interventions in promoting PA-related outcomes. However, the findings are inconsistent due to the low number of studies, low-methodological quality, and/or small sample size. Well-designed interventions are needed to inform strategies to enhance PA engagements among children and adolescents in Asia.

Effect of nutrition education and traditional game-based physical activity interventions, on lipid profile improvement in overweight and obese children in West Java Indonesia

BACKGROUND/OBJECTIVES

One ongoing effort to curtail dyslipidemia in school children is through lifestyle intervention. This study analyzes outcomes of the intervention of nutrition education and Javanese traditional game-based physical activity, on lipid profiles of overweight and obese children.

SUBJECTS/METHODS

The experimental study consisted of three steps: data collection (October to December 2016), intervention processes (January to March 2017), and final report preparation (April to May 2017). This was a split-plot block study, enrolling a total of 72 subjects. Traditional game intervention (12 meetings) and nutrition education (9 meetings) was carried out within 3 months with material related to obesity.

RESULTS

Our results showed no decrease in the levels of total cholesterol in the group receiving nutrition education (rise by 1.56 mg/dL), but when compared to subjects without intervention, total cholesterol levels experienced was increased. The group which did not receive physical activity showed increase in the total cholesterol, whereas the traditional game intervention group showed a decrease of 0.05 mg/dL total cholesterol at the end of the intervention. Nutrition education and physical activity interventions did not influence any reduction in the low-density lipoprotein cholesterol (LDL-C) levels, but rather showed a tendency to increase at the end of the intervention. However, the increase in LDL-c levels in the traditional game group was lower than in other intervention groups. Duncan's test indicated that the effect of nutrition education and physical activity interventions did not differ from the cut-off values of LDL-C and high-density lipoprotein cholesterol.

CONCLUSIONS

Total cholesterol and triglyceride levels in the traditional game group tended to decrease at the end of the intervention, but the results did not differ much from other intervention groups. We deduce that nutrition education and traditional game-based physical activity interventions are not capable of improving blood lipid profiles in overweight and obese children within 3 months. It is necessary to increase the time of physical activity intervention to maintain the lipid profile in another study.

Effect of interventions based on regular physical activity on weight management in adolescents: a systematic review and a meta-analysis

BACKGROUND

Physical inactivity is one of the major risk factors for non-communicable diseases. This systematic review and meta-analysis aimed to assess the effects of educational interventions on promoting regular physical activity in adolescent weight management programs.

METHODS

The relevant studies indexed in Embase, Web of Science, Scopus, and ProQuest databases were searched using keywords namely "Physical Activity, Adolescent, Weight Management, Body Mass Index (BMI), Randomized Controlled Trials, and Clinical Trial." Up to the end of March 2020, two authors independently screened the papers, extracted data, and assessed the methodological quality of the studies using Effective Public Health Practice Project (EPHPP) tool.

RESULTS

Out of 12,944 initial studies, 14 met the inclusion criteria after screening the titles, abstracts, and full texts of the papers. The participants in these studies were aged between 6 and 18 years, and 13 studies included participants from both sexes. Moreover, eight of them were performed as a controlled clinical trial. The overall estimate of the difference showed that the interventions improved weight loss which is a statistically significant finding. The participants in the intervention group had a weight loss of 1.02 kg compared to the control group at a 95% confidence interval (- 4.794-0.222).

CONCLUSION

Published longitudinal data indicated that physical activity declines over the transition from adolescence to adulthood. Using the results of the study, policy-makers can design educational interventions using educational models and patterns.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020173869.

Genetic variants in the FAM3C gene are associated with lipid traits in Chinese children

BACKGROUND

Previous studies have related FAM3C gene with childhood bone health, and the regulation of lipid metabolism in hepatocytes. The present case-control study aimed to analyze the association of FAM3C genetic variants with overweight/obesity and lipid traits among Chinese children.

METHODS

Two genetic variants (rs7776725 and rs7793554) within the FAM3C gene were genotyped in 3305 Chinese children aged 6-18 years.

RESULTS

In the whole study population, the T-allele of rs7776725 and A-allele of rs7793554 within the FAM3C gene were associated with 40.2% (95% CI: 11.6-76.1%; P = 0.004) and 29.1% (6.9-56.0%; P = 0.008) increased risk of dyslipidemia, higher triglyceride (P = 0.014 and P = 0.001) and lower HDL-C (P = 0.015 and P = 0.003). In addition, we found that rs7776725 interacted with sex on dyslipidemia (P_{for interaction} = 0.004), and sex-stratified analyses showed that it was significantly associated with dyslipidemia only in girls (P = 8.78 × 10^-5). The variant also showed nominally significant interactions with sex on total cholesterol and LDL-C (P_{for interaction} = 0.012 and 0.008).

CONCLUSION

We found that FAM3C genetic variants were associated with dyslipidemia and lipid traits among Chinese children. In addition, we found significant gene-by-sex interactions. Our findings provided evidence supporting the role of FAM3C gene in regulating lipid metabolism in humans.

IMPACT

FAM3C genetic variants were associated with dyslipidemia and lipid traits among Chinese children. In addition, we found significant gene-by-sex interactions. FAM3C/rs7776725 was associated with dyslipidemia and lipid traits only in girls. Our findings provided evidence supporting the role of FAM3C gene in regulating lipid metabolism in humans.

A 2 year physical activity and dietary intervention attenuates the increase in insulin resistance in a general population of children: the PANIC study

AIMS/HYPOTHESIS

We studied for the first time the long-term effects of a combined physical activity and dietary intervention on insulin resistance and fasting plasma glucose in a general population of predominantly normal-weight children.

METHODS

We carried out a 2 year non-randomised controlled trial in a population sample of 504 children aged 6-9 years at baseline. The children were allocated to a combined physical activity and dietary intervention group (306 children at baseline, 261 children at 2-year follow-up) or a control group (198 children, 177 children) without blinding. We measured fasting insulin and fasting glucose, calculated HOMA-IR, assessed physical activity and sedentary time by combined heart rate and body movement monitoring, assessed dietary factors by a 4 day food record, used the Finnish Children Healthy Eating Index (FCHEI) as a measure of overall diet quality, and measured body fat percentage (BF%) and lean body mass by dual-energy x-ray absorptiometry. The intervention effects on insulin, glucose and HOMA-IR were analysed using the intention-to-treat principle and linear mixed-effects models after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The measures of physical activity, sedentary time, diet and body composition at baseline and 2 year follow-up were entered one-by-one as covariates into the models to study whether changes in these variables might partly explain the observed intervention effects.

RESULTS

Compared with the control group, fasting insulin increased 4.65 pmol/l less (absolute change +8.96 vs +13.61 pmol/l) and HOMA-IR increased 0.18 units less (+0.31 vs +0.49 units) over 2 years in the combined physical activity and dietary intervention group. The intervention effects on fasting insulin (regression coefficient β for intervention effect -0.33 [95% CI -0.62, -0.04], p = 0.026) and HOMA-IR (β for intervention effect -0.084 [95% CI -0.156, -0.012], p = 0.023) were statistically significant after adjustment for sex, age at baseline, and pubertal status at baseline and 2 year follow-up. The intervention had no effect on fasting glucose, BF% or lean body mass. Changes in total physical activity energy expenditure, light physical activity, moderate-to-vigorous physical activity, total sedentary time, the reported consumption of high-fat (≥60%) vegetable oil-based spreads, and FCHEI, but not a change in BF% or lean body mass, partly explained the intervention effects on fasting insulin and HOMA-IR.

CONCLUSIONS/INTERPRETATION

The combined physical activity and dietary intervention attenuated the increase in insulin resistance over 2 years in a general population of predominantly normal-weight children. This beneficial effect was partly mediated by changes in physical activity, sedentary time and diet but not changes in body composition.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01803776 Graphical abstract.

Comprehensive School Physical Activity Programming and Health Behavior Knowledge

No study to date has examined the effect of a multicomponent school-based physical activity program on health behavior knowledge in a large sample of low-income children from the US. The purpose of this study was to explore the change in physical activity and nutrition knowledge during a Comprehensive School Physical Activity Program (CSPAP) in children. Participants were a convenience sample of 789 children recruited from the 4th to 6th grades from five low-income Title I schools located within the Mountain West Region of the US. Students completed two questionnaires consisting of a physical activity and a nutrition knowledge assessment. Questionnaires were administered at baseline before the commencement of CSPAP and at a 36-week follow-up. Data were analyzed using a 3 × 2 × 2 doubly MANOVA test. Physical activity knowledge scores significantly improved from pretest to posttest during the intervention (p = 0.045, Cohen's d = 0.18). Grade level modified the time effects, with older children in grades 5 and 6 displaying greater improvements in physical activity knowledge than younger children in grade 4 (p = 0.044, Cohen's d = 0.33). There were no significant improvements in nutrition knowledge scores during the CSPAP (p = 0.150). These findings demonstrate that improvements in physical activity knowledge can occur during a multicomponent school-based intervention. Improvements in physical activity knowledge may translate to improvements in habitual physical activity behaviors and positively influence children's health outcomes, especially in older children.

A School-Based Comprehensive Intervention for Childhood Obesity in China: A Cluster Randomized Controlled Trial

BACKGROUND

A comprehensive approach involving both environmental and individual strategies offers opportunities to strengthen school-based interventions for childhood obesity.

OBJECTIVES

To evaluate a theory-based comprehensive intervention implemented within primary schools for childhood obesity in China.

METHODS

A 1-year, cluster randomized controlled trial was conducted in twelve primary schools (7-11 years old) in Beijing, China. Environmental and individual factors were improved in the intervention group (6 schools, 930 children) to promote knowledge and behaviors related to energy balance. The control group (6 schools, 959 children) did not receive any intervention. The primary outcome was body mass index (BMI) and its Z-score at 12 months. Generalized linear mixed models were used controlling for the cluster effect of school.

RESULTS

No significant differences were found between groups on BMI (0.07 kg/m² [95% confidence interval (CI) -0.16 to 0.31, p = 0.54]) and its Z-score (0.02 [95% CI: -0.08 to 0.11, p = 0.73]) at 12 months. Self-reported knowledge, daily consumption of sugar-sweetened beverage, and frequency of moderate to vigorous physical activity improved at 12 months.

CONCLUSIONS

The intervention did not mitigate excess weight gain, but did improve children's knowledge and several behaviors related to energy balance.

School-Based Intervention Programs for Preventing Obesity and Promoting Physical Activity and Fitness: A Systematic Review

With the significant decrease in physical activity rates, the importance of intervention programs in the schools, where children spend a significant part of the day, has become indisputable. The purpose of this review is to systematically examine the possibility of school-based interventions on promoting physical activity and physical fitness as well as preventing obesity. A systematic approach adopting PRISMA statement was implemented in this study. Three different databases (2010-2019) were screened and primary and secondary school-based intervention programs measuring at least one variable of obesity, physical activity, or physical fitness were included. The risk of bias was assessed using the validated quality assessment tool for quantitative studies. Among 395 potentially related studies, 19 studies were found to meet the eligibility criteria. A general look at the studies examined reveals that among the outcomes, of which most (18/19) were examined, a significant improvement was provided in at least one of them. When the program details are examined, it can be said that the success rate of the physical activity-oriented programs is higher in all variables. School-based interventions can have important potential for obesity prevention and promotion of physical activity and fitness if they focus more on the content, quality, duration and priority of the physical activity.

Physical activity attenuates the association between the IRS1 genotype and childhood obesity in Chinese children

BACKGROUND AND AIMS

The insulin receptor substrate 1 (IRS1) rs2943650 was found to be associated with obesity in adults, but the association has not been evaluated in children. The present study aimed to examine whether IRS1 rs2943650 was associated with obesity in Chinese children and investigate the interaction between rs2943650 and physical activity.

METHODS AND RESULTS

IRS1 rs2943650 was genotyped in 3303 Chinese children aged 6-18 years recruited from four independent studies. Logistic regression and linear regression were performed to examine associations. Meta-analyses were conducted to pool the results of the four independent studies. The C-allele carriers of rs2943650 showed a 29% higher risk of obesity than noncarriers (OR (95% CI) = 1.29 (1.05, 1.58), P = 0.02) and a 0.41 kg/m² increase in BMI (β (95% CI) = 0.41 (0.05, 0.78) kg/m², P = 0.02). We also observed significant interactions between rs2943650 and physical activity/sedentary behaviors on obesity (P_{forinteraction}<0.05). Compared with the physically active children (physical activity ≥1 h/d and sedentary behaviors <2 h/d), the risk allele (C) of rs2943650 was significantly associated with a 241% increased risk of obesity among inactive children who participated in physical activity <1 h/d and sedentary behaviors ≥2 h/d (OR (95% CI) = 3.41 (1.45, 8.01), P = 0.005).

CONCLUSIONS

We found that IRS1 rs2943650 was significantly associated with BMI and risk of childhood obesity. Additionally, we also found significant interaction between IRS1 rs2943650 polymorphism and physical activity/sedentary behaviors on childhood obesity. Our study would provide novel insights into the function of the IRS1 gene and the implementation of effective intervention strategies of childhood obesity.

Effects of the FIT Game on Physical Activity in Sixth Graders: A Pilot Reversal Design Intervention Study

Background

The FIT Game is a low-cost intervention that increases fruit and vegetable consumption in elementary school children. For this study, the FIT Game was adapted into an intervention designed to increase children’s physical activity at school.

Objective

We aimed to evaluate if the FIT Game could increase children’s physical activity relative to their baseline levels.

Methods

A total of 29 participants were recruited from a sixth-grade classroom. An ABAB reversal design was used. Participants wore an accelerometer while at school during pre/postintervention baseline (A) and intervention (B) phases. During the FIT Game intervention, daily physical activity goals encouraged the class to increase their median daily step count above the 60th percentile of the previous 10 days. When daily goals were met, game-based accomplishments were realized.

Results

Children met their activity goals 80% of the time during the intervention phases. Physical activity at school increased from a median of 3331 steps per day during the baseline to 4102 steps during the FIT Game phases (P<.001, Friedman test).

Conclusions

Preliminary evidence showed that playing the FIT Game could positively influence children’s physical activity at school.

Association of high birth weight with overweight and obesity in Chinese students aged 6-18 years: a national, cross-sectional study in China

BACKGROUND

The prevalence of childhood overweight and obesity in China has drastically increased 57 times over the past 30 years, and to control birth weight is an effective way to reduce the risk of overweight and obesity across the life course.

OBJECTIVE

This paper aimed to evaluate the association of high birth weight (HBW) with overweight and obesity in Chinese students aged 6-18 years.

METHODS

All students with HBW (n=4981) aged 6-18 years were selected from a cross-sectional survey from seven provinces of China, and 4981 other students with normal birth weight (NBW) were randomly sampled with matched gender, age and province. Anthropometric parameters were measured and characteristics were collected by questionnaires. Multiple logistic regression was used to estimate the OR of overweight and obesity with HBW, unadjusted and adjusted for confounding factors.

RESULTS

Participants with HBW revealed higher body mass index in childhood. The prevalence of overweight and obesity was significantly higher in the HBW group than in the NBW group (overweight 15.3% vs 13.1%, p<0.05; obesity 16.9% vs 10.6%, p<0.05), and the results were similar for overweight in all age groups except age 6-7, age 14-15 and age 16-18. Additionally, HBW was positively associated with overweight (OR=1.230; 95% CI 1.056 to 1.432) and obesity (OR=1.611; 95% CI 1.368 to 1.897) after adjustment for covariates.

CONCLUSIONS

HBW leads to an increased risk of overweight and obesity in childhood; thus, measures to control birth weight, such as controlling gestational weight gain, should be taken from the earliest beginning of life.

TRIAL REGISTRATION NUMBER

NCT02343588; Post-results.

Investing in non-communicable disease risk factor control among adolescents worldwide: a modelling study

INTRODUCTION

Exposure to non-communicable disease (NCD) risk factors is increasing among adolescents in most countries due to demographic, economic and epidemiological forces. We sought to analyse the potential health impact and costs of implementing NCD risk reduction interventions among adolescents worldwide.

METHODS

We identified six interventions targeted at adolescent tobacco smoking, heavy episodic drinking and obesity and supported by effectiveness and cost-effectiveness evidence. Based on a population-level cohort of adolescents in 70 representative countries, we assessed the global mortality consequences of fully implementing these interventions over 2020-2070 using the potential impact fraction approach. We calculated the economic benefits of reduced mortality and estimated the required financial costs, discounting both at 3% annually. We also conducted best-case and worst-case scenario analyses.

RESULTS

Full implementation of these interventions worldwide could avert nearly 10% of premature deaths among this cohort, translating to about US$400 billion in cumulative economic benefits. Cumulatively, the required costs would be about US$85 billion, suggesting that every US$1 of public money invested would generate US$5 in increased human capital. Tobacco taxes generally conferred the highest economic returns; however, an in-depth analysis of three countries illustrated the potential for different priorities, such as alcohol control, to emerge.

CONCLUSION

From a life course perspective, implementation of a package of interventions to reduce NCD risk among adolescents worldwide would substantially reduce premature mortality at reasonable costs. Our analysis illustrates the importance of integrating NCD prevention policies into the emerging global agenda for adolescent health and well-being.

Geographical variation and urban-rural disparity of overweight and obesity in Chinese school-aged children between 2010 and 2014: two successive national cross-sectional surveys

PURPOSE

The urban-rural disparity for childhood overweight and obesity shows different patterns in most countries. This study aimed to examine the recent trend of urban-rural disparity for childhood overweight and obesity at national and subnational levels in Chinese children from 2010 to 2014.

DESIGN

Two successive national cross-sectional studies. Overweight and obesity were classified using Chinese national age-specific and sex-specific body mass index reference. The prevalence of overweight and obesity was compared between urban and rural areas at national and subnational levels.

SETTING

Thirty-one provinces in China.

PARTICIPANTS

Data were obtained from the Chinese National Survey on Students' Constitution and Health in 2010 and 2014 with 215 214 (107 741 in 2010 and 107 473 in 2014) children aged 7-12 years.

RESULTS

The overweight and obesity prevalence increased from 17.1% in 2010 to 22.5% in 2014. The overweight and obesity prevalence in both urban and rural areas was higher in the eastern provinces but lower in the western provinces. The urban-rural disparity in overweight and obesity decreased steadily from 2010 to 2014 (1.79 to 1.42 for prevalence OR). There was greater urban-rural disparity in western China than eastern China. A reversal occurred in 2014 in several eastern provinces where the overweight and obesity prevalence in rural children surpassed that of their urban peers.

CONCLUSIONS

A narrowing urban-rural disparity and the reversal signal between urban and rural areas in overweight and obesity would contribute to a growing proportion of obese children in rural areas. Therefore, urgent region-specific policies and interventions with a forward-looking approach should be considered for Chinese children, especially in rural areas.

Subnational variation of stunting, wasting and malnutrition in Chinese primary-school children between 2010 and 2014: urban-rural disparity

OBJECTIVE

To examine urban-rural disparity in childhood stunting, wasting and malnutrition at national and subnational levels in Chinese primary-school children in 2010 and 2014.

DESIGN

Data were obtained from two nationwide cross-sectional surveys conducted in 2010 and 2014. Malnutrition was classified using the Chinese national 'Screening Standard for Malnutrition of Children'.

SETTING

All twenty-seven mainland provinces and four municipalities of mainland China.ParticipantsChildren aged 7-12 years (n 215 214; 107 741 in 2010 and 107 473 in 2014) from thirty-one provinces.

RESULTS

Stunting, wasting and malnutrition prevalence were 1·9, 12·3 and 13·7 % in 2010, but decreased to 1·0, 9·4 and 10·2 % in 2014, respectively. The prevalence of stunting, wasting and malnutrition in both urban and rural children was higher in western provinces, while lower in eastern provinces. Although the prevalence of wasting and malnutrition was higher in rural children than their urban counterparts, the urban-rural disparity in both wasting and malnutrition decreased from 2010 to 2014 (prevalence OR: wasting, 1·35 to 1·16; malnutrition, 1·50 to 1·27). A reversal occurred in 2014 in several eastern provinces where the prevalence of wasting and malnutrition in urban children surpassed their rural peers. The urban-rural disparity was larger in western provinces than eastern provinces.

CONCLUSIONS

The shrinking urban-rural disparity and the reversal in wasting and malnutrition suggest that the malnutrition situation has improved during the post-crisis period, especially in the western provinces. Region-specific policies and interventions can be useful to sustainably mitigate malnutrition in Chinese children, especially in rural areas and the western provinces.

The iCook 4-H Study: Report on Physical Activity and Sedentary Time in Youth Participating in a Multicomponent Program Promoting Family Cooking, Eating, and Playing Together

OBJECTIVE

To report physical activity and sedentary time outcomes of youth in iCook 4-H.

STUDY DESIGN AND SETTING

iCook 4-H was a 5-state, randomized, control-treatment, family-based childhood obesity prevention intervention promoting cooking, eating, and playing together.

PARTICIPANTS AND INTERVENTION

Youth aged 9-10 years and the main preparer of their meals participated in the 12-week program followed by monthly newsletters and biyearly booster sessions until 24 months.

MAIN OUTCOME MEASURE(S)

A total of 155 youth were fitted with an Actigraph GT3X+ accelerometer, which they wore for 7 days at baseline and 4, 12, and 24 months to measure mean daily minutes per hour of waking wear time for sedentary time (ST), light physical activity (PA) (LPA), moderate PA, vigorous PA, and moderate to vigorous PA. Self-reported PA was assessed using the Block Kids Physical Activity Screener and additional questions querying for the program goal of the frequency of family actively playing together. Linear mixed models were used to determine differences from baseline to 24 months. Significance was set at P ≤ .05.

RESULTS

There was a significant (P < .05) group × time interaction for LPA (adjusted interaction B estimate, 95% confidence interval; 0.18 [0.05, 0.30]) and ST (-0.15 [-0.26, -0.04]); ST increased and LPA decreased in the treatment group. There were no differences in other accelerometer-derived PA measures, self-report Block Kids Physical Activity Screener measures, or frequency of family actively playing together at any time point.

CONCLUSIONS AND IMPLICATIONS

iCook 4-H was a multicomponent program observing youth aged 9-10 years for 24 months that focused on enhancing cooking skills, mealtime behavior and conversation, and PA through daily family activities. Greater emphasis on developing PA skills, changing environmental factors, and increasing PA both in and after school may be needed.

The National After-School Athletics Program Participation as a Tool to Reduce the Risk of Obesity in Adolescents after One Year of Intervention: A Nationwide Study

Regular exercise during school hours is encouraged; however many children and adolescents fail to meet the recommendations during this time. Extracurricular activities may be a more appealing way for youth to achieve guidelines, and it is recommended that they attend two sessions each week. The aim of the study was to assess the influence of participation in a national physical activity program accompanied by nutritional education for trainers on the risk of obesity and body composition in a nationwide sample of boys and girls, after one year of intervention. The #goathletics Study was conducted in a group of 1014 adolescents aged 12⁻13: 507 individuals for the Athletics for All program (210 boys, 297 girls) and 507 pair-matched individuals not participating in any physical activity program (matching including: gender, age, city of residence). The body mass (kg), Body Mass Index (BMI) (kg/m²), waist circumference (WC) (cm), waist-to-height ratio (WHtR) (-) and body composition (%) (measured using bioelectrical impedance method) were compared in a gender-related sub-groups using t-Student test (for parametric distributions) or Mann-Whitney U test (for nonparametric distributions) and chi² test (for the share of sub-groups). After one year of intervention, lower body mass percentile, BMI percentile, WC, WHtR and fat mass share, higher muscle mass share, as well as lower frequency of overweight/obesity and abdominal fat distribution were observed both for boys and girls participating in the physical activity intervention compared to the pair-matched controls. The after-school physical activity program accompanied by nutritional education for trainers may be a highly effective method for reducing the risk of obesity both for boys and girls, as regular participation is ensured.

A multivalued agent-based model for the study of noncommunicable diseases

This paper aims to test and illustrate the utility and extensibility of an existing model, SimNCD (Simulation of NonCommunicable Diseases). It also proposes a way to include questionnaires - widely used in epidemiology - in the individual's reasoning mechanism in order to identify his/her attitude and personal choices. SimNCD is a formal agent-based model. It helps researchers and health practitioners study and simulate the complex dynamics of noncommunicable diseases. It models individuals that evolve within a social network, and behave while engaging in activities offered by their physical environment. The literature strongly supports the influence of the individual's behavioral choices on their health, particularly, the acquirement and maintainability of noncommunicable diseases. Therefore, we propose to extend SimNCD in order to acquire the agents with a reasoning process that allows them to choose the activities to practice. Thus, we model their attitude via preferences that are modeled based on the available literature and expressed with the linguistic 2-tuple method. Our solution also employs a multi-attribute decision-making method. We specify the proposed solution in the study of childhood obesity and use it to predict children's corpulence variations in different scenarios.

Effect of a Multidimensional Physical Activity Intervention on Body Mass Index, Skinfolds and Fitness in South African Children: Results from a Cluster-Randomised Controlled Trial

Obesity-related conditions impose a considerable and growing burden on low- and middle-income countries, including South Africa. We aimed to assess the effect of twice a 10-week multidimensional, school-based physical activity intervention on children’s health in Port Elizabeth, South Africa. A cluster-randomised controlled trial was implemented from February 2015 to May 2016 in grade 4 classes in eight disadvantaged primary schools. Interventions consisted of physical education lessons, moving-to-music classes, in-class activity breaks and school infrastructure enhancement to promote physical activity. Primary outcomes included cardiorespiratory fitness, body mass index (BMI) and skinfold thickness. Explanatory variables were socioeconomic status, self-reported physical activity, stunting, anaemia and parasite infections. Complete data were available from 746 children. A significantly lower increase in the mean BMI Z-score (estimate of difference in mean change: −0.17; 95% confidence interval (CI): −0.24 to −0.09; p < 0.001) and reduced increase in the mean skinfold thickness (difference in mean change: −1.06; 95% CI: −1.83 to −0.29; p = 0.007) was observed in intervention schools. No significant group difference occurred in the mean change of cardiorespiratory fitness (p > 0.05). These findings show that a multidimensional, school-based physical activity intervention can reduce the increase in specific cardiovascular risk factors. However, a longer and more intensive intervention might be necessary to improve cardiorespiratory fitness.

Dietary Patterns in Primary School are of Prospective Relevance for the Development of Body Composition in Two German Pediatric Populations

This study performed comparative analyses in two pediatric cohorts to identify dietary patterns during primary school years and examined their relevance to body composition development. Nutritional and anthropometric data at the beginning of primary school and two or four years later were available from 298 and 372 participants of IDEFICS-Germany (Identification and prevention of Dietary-induced and lifestyle-induced health Effects In Children and infants Study) and the KOPS (Kiel Obesity Prevention Study) cohort, respectively. Principal component analyses (PCA) and reduced rank regression (RRR) were used to identify dietary patterns at baseline and patterns of change in food group intake during primary school years. RRR extracted patterns explaining variations in changes in body mass index (BMI), fat mass index (FMI), and waist-to-height-ratio (WtHR). Associations between pattern adherence and excess gain in BMI, FMI, or WtHR (>75th percentile) during primary school years were examined using logistic regression. Among PCA patterns, only a change towards a more Mediterranean food choice during primary school years were associated with a favorable body composition development in IDEFICS-Germany (p < 0.05). In KOPS, RRR patterns characterized by a frequent consumption of fast foods or starchy carbohydrate foods were consistently associated with an excess gain in BMI and WtHR (all p < 0.005). In IDEFICS-Germany, excess gain in BMI, FMI, and WtHR were predicted by a frequent consumption of nuts, meat, and pizza at baseline and a decrease in the consumption frequency of protein sources and snack carbohydrates during primary school years (all p < 0.01). The study confirms an adverse impact of fast food consumption on body composition during primary school years. Combinations of protein and carbohydrate sources deserve further investigation.

Effectiveness of school-based physical activity and nutrition interventions with direct parental involvement on children's BMI and energy balance-related behaviors - A systematic review

BACKGROUND

The aims of this systematic review were to study the effectiveness of primary school-based physical activity, sedentary behavior and nutrition interventions with direct parental involvement on children's BMI or BMI z-score, physical activity, sedentary behavior and nutrition behavior and categorize intervention components into targeted socio-cognitive determinants and environmental types using the Environmental Research framework for weight Gain prevention.

METHODS

In March 2018, a systematic search was conducted in four electronic literature databases. Articles written in English about effectiveness studies on school-based interventions with direct parental involvement targeting 4-12 year olds were included. Interventions with indirect parental involvement, interventions not targeting the school environment, and pilot studies were excluded. Study and intervention characteristics were extracted. Study quality and study effectiveness were assessed and effect sizes (Cohen's d) were calculated for the outcome measures. Types of socio-cognitive factors and environmental types targeted were distinguished.

RESULTS

In total, 25 studies were included. Most studies on BMI or BMI z-score, physical activity and sedentary behavior found favorable results: 61.1%, 81.1% and 75%, respectively. Results regarding nutrition behavior were inconclusive. Methodological study quality varied. All interventions targeted multiple environmental types in the school and family environment. Five targeted socio-cognitive determinants (knowledge, awareness, attitude, self-efficacy and intrinsic motivation) of the children were identified. No consistent pattern was found between either type of environment targeted, number of type of environment targeted, or the child's targeted socio-cognitive determinants and intervention effectiveness.

DISCUSSION

School-based interventions with direct parental involvement have the potential to improve children's weight status, physical activity and sedentary behavior. Based on the results, it is recommended that school-based interventions with direct parental involvement target more than one EBRB, last at least one year, and focus particularly on the physical and social environment within both the school and the family environment.

The Associations between Sleep Duration and Sleep Quality with Body-Mass Index in a Large Sample of Young Adults

Background: The main aims of this study were to explore the associations between time spent in bed (as a proxy of sleep duration) and sleep quality with overweight/obesity status in a large sample of young adults. Methods: In this cross-sectional study, participants were 2100 university students (49.6% of women). We used Pittsburgh Sleep Quality Index (PSQI) questionnaire to assess time spent in bed and sleep quality. Body-mass index (BMI) was self-reported and dichotomized as normal (<25 kg/m²) vs. overweight/obesity (≥25 kg/m²) status. Results: In model 1, both short (<6 h/day, OR = 2.72; 95% CI 1.27 to 5.84) and long (>10 h/day, OR = 3.38; 95% CI 2.12 to 5.40) time spent in bed were associated with a greater likelihood of being overweight/obese. In model 2, poor sleep quality (>5 points, OR = 1.45; 95% CI 1.14 to 1.83) was associated with a greater likelihood of being overweight/obese. After entering time spent in bed and sleep quality simultaneously into the model 3, both short (OR = 2.64; 95% CI 1.23 to 5.66) and long (OR = 3.27; 95% CI 2.04 to 5.23) time spent in bed and poor sleep quality (OR = 1.40; 95% CI 1.10 to 1.78) were associated with overweight/obesity status. Conclusions: Our results show that both short and long time spent in bed and poor sleep quality are associated with overweight/obesity status in young adults. Special interventions and policies that use both sleep duration and sleep quality as protective factors against overweight/obesity are warranted.

Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease

BACKGROUND

A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions.

OBJECTIVES

The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children.

SEARCH METHODS

All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We consulted with experts in the field to identify other relevant research.

SELECTION CRITERIA

'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy.

DATA COLLECTION AND ANALYSIS

Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated).

MAIN RESULTS

We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of trials for detection and performance bias.Among 13 trials reporting dichotomous implementation outcomes-the proportion of schools or school staff (e.g. classes) implementing a targeted policy or practice-the median unadjusted (improvement) effect sizes ranged from 8.5% to 66.6%. Of seven trials reporting the percentage of a practice, program or policy that had been implemented, the median unadjusted effect (improvement), relative to the control ranged from -8% to 43%. The effect, relative to control, reported in two trials assessing the impact of implementation strategies on the time per week teachers spent delivering targeted policies or practices ranged from 26.6 to 54.9 minutes per week. Among trials reporting other continuous implementation outcomes, findings were mixed. Four trials were conducted of strategies that sought to achieve implementation 'at scale', that is, across samples of at least 50 schools, of which improvements in implementation were reported in three trials.The impact of interventions on student health behaviour or weight status were mixed. Three of the eight trials with physical activity outcomes reported no significant improvements. Two trials reported reductions in tobacco use among intervention relative to control. Seven of nine trials reported no between-group differences on student overweight, obesity or adiposity. Positive improvements in child dietary intake were generally reported among trials reporting these outcomes. Three trials assessed the impact of implementation strategies on the attitudes of school staff and found mixed effects. Two trials specified in the study methods an assessment of potential unintended adverse effects, of which, they reported none. One trial reported implementation support did not significantly increase school revenue or expenses and another, conducted a formal economic evaluation, reporting the intervention to be cost-effective. Trial heterogeneity, and the lack of consistent terminology describing implementation strategies, were important limitations of the review.

AUTHORS' CONCLUSIONS

Given the very low quality of the available evidence, it is uncertain whether the strategies tested improve implementation of the targeted school-based policies or practices, student health behaviours, or the knowledge or attitudes of school staff. It is also uncertain if strategies to improve implementation are cost-effective or if they result in unintended adverse consequences. Further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.

Systematic review and meta-analysis of school-based obesity interventions in mainland China

Background

Numerous school-based interventions for childhood obesity have been emerging in mainland China in recent decades, but little is known about the effectiveness of such interventions. This study aims to assess the effectiveness of school-based interventions for childhood obesity conducted in mainland China.

Methods

A systematic search was undertaken in eight databases to identify both randomized and non-randomized controlled trials from January 1990 to December 2015 examining the effectiveness of school-based obesity interventions. A random effects meta-analysis was conducted assessing the impact of included interventions on (body mass index) BMI. The quality of each included studies were assessed using Effective Public Health Practice Project Quality Assessment Tool. A P value <0.05 (two-sided) was considered statistically significant.

Result

Of the seventy-six included studies, we found physical activity and health education were the two most common components of interventions. More treatment studies were effective compared with prevention studies (85.0% vs. 58.3%). Comprehensive interventions involving physical activity and health education appeared more effective than the physical activity only interventions in both obesity treatment and prevention studies. The meta-analyses showed comprehensive interventions involving physical activity and health education had larger effect on the change of BMI than physical activity only interventions (treatment studies: -1.80 kg/m² (95% CI: -2.15,-1.44) vs. -0.91 kg/m² (95% CI: -1.15,-0.67); prevention studies: -0.19 kg/m² (95% CI: -0.27, -0.11) vs. +0.05 kg/m² (95% CI: -0.04, +0.15)).

Conclusions

Comprehensive school-based interventions may assist in tackling the rising prevalence of childhood obesity in mainland China.

Prevalence of high blood pressure subtypes and its associations with BMI in Chinese children: a national cross-sectional survey

Background

Data on prevalence and characteristics of different high blood pressure subtypes are lacking among Chinese children. Regarding the mechanistic differences between isolated systolic high blood pressure and isolated diastolic high blood pressure and their different impact on end organ diseases, it is necessary to examine the prevalence of different high blood pressure subtypes in Chinese children and explore their associations with adiposity.

Methods

Data were derived from the baseline data of a multi-centered cluster randomized controlled trial involving participants from China. High blood pressure was defined according to age-, gender- and height-specific 95th percentile developed by the National High Blood Pressure Education Program Working Group. Body mass index was used to classify underweight, normal weight, overweight and obesity.

Results

The prevalence of HBP was 10.2% and 8.9% for boys and girls, respectively. Isolated systolic high blood pressure is the dominant high blood pressure subtype among Chinese boys aged 6–17 years and girls aged 12–17 years, while isolated diastolic high blood pressure was the most common high blood pressure subtype in girls aged 6–11 years. In boys, the status of overweight doubled the risk of isolated systolic high blood pressure (95% CI, 1.73, 2.31; P < 0.001) compared with the normal weight group, and the risk for obese children was 4.32 (95% CI, 3.81, 4.90; P < 0.001). The corresponding odds ratios in girls were 2.04 (95% CI, 1.68, 2.48, P < 0.001) for overweight, and 4.0 (95% CI, 3.36, 4.76, P < 0.001) for obesity. Similar patterns were also observed in the association between combined systolic and diastolic high blood pressure and adiposity.

Conclusion

The distribution of high blood pressure subtypes in boys differed from those in girls, and boys with adiposity showed a higher risk of high blood pressure than their female counterpart. Difference in strength of association between isolated diastolic high blood pressure and isolated systolic high blood pressure with body mass index was also found. These results may aid current strategies for preventing and controlling pediatric hypertension.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4522-2) contains supplementary material, which is available to authorized users.

Physical Activity and Sedentary Behaviors Modify the Association between Melanocortin 4 Receptor Gene Variant and Obesity in Chinese Children and Adolescents

Effects of MC4R variants in previous Chinese population studies were inconsistent. Gene-environment interactions might influence the effect of MC4R variants on obesity, which was still unclear. We performed the study to clarify the association of variants near MC4R gene with obesity-related phenotypes and gene-environment interactions in Chinese children and adolescents. Two common variants (rs12970134 and rs17782313) near MC4R were genotyped in 2179 children and adolescents aged 7-18 years in Beijing of China. Associations between the variants and obesity-related phenotypes together with gene-environment interactions were analyzed. The A-alleles of rs12970134 were nominally associated with risk of overweight/obesity (Odds Ratios (OR) = 1.21, 95%CI: 1.03-1.44, P = 0.025) and BMI (β = 0.33 kg/m2, 95%CI: 0.02-0.63, P = 0.025), respectively. The rs12970134 was also associated with HDL-C (β = -0.03mmol/L per A-allele, 95%CI: -0.05, -0.01, P = 0.013) independent of BMI. In the further analysis, we found the significant interaction of rs12970134 and physical activity/sedentary behaviors on BMI (Pinteraction = 0.043). The rs12970134 was found to be associated with BMI only in children with physical activity<1h/d and sedentary behaviors ≥2h/d (BMI: β = 1.27 kg/m2, 95%CI: 0.10-2.45, P = 0.034). The association was not detected in their counterparts with physical activity≥1h/d or sedentary behaviors <2h/d. We identified the effect of MC4R rs12970134 on overweight/obesity and BMI, and we also found physical activity and sedentary behaviors modified the association between the rs12970134 and BMI in Chinese children and adolescents.

Preventing childhood obesity in Asia: an overview of intervention programmes

The rapid economic growth in Asia in the past few decades has contributed to the global increase in childhood obesity prevalence. Yet, little is known about obesity prevention efforts in this region. This systematic review provides an overview of child obesity prevention programmes in Asia. Searches were performed in six electronic databases. Out of 4,234 studies, 17 were included, among them 11 controlled trials (of which five were randomized). Only one study was published before 2007. Identified studies were predominantly conducted in China and Thailand and targeted primary school children in a school setting. Most studies implemented different programmes, frequently targeting behavioural modification through nutrition/health education lectures and/or physical activity sessions. Programme effects related to obesity outcome measures were mixed. Most substantial effects were found for outcomes such as improved health knowledge and/or favourable lifestyle practices. The relatively small number of relevant publications in Asia highlights the need for scientific evaluations of existing and future programmes. This will help ensure the implementation and dissemination of evidence-based approaches that have been proven to be effective in the Asian context. Targeting preschool settings and applying a comprehensive multisectoral approach may increase the effectiveness and sustainability of childhood obesity prevention programmes.

Exercise intervention and cardiovascular risk factors in obese children. Comparison between obese youngsters taking part in a physical activity school-based programme with and without individualised diet counselling: the ACORDA project

AIM

To determine the effects of a school-based exercise intervention programme on cardiovascular risk factors, including body fat (BF), metabolic profile and physical activity (PA) in children with and without individualised dietary counselling approach (IDC and WIDC).

SUBJECTS AND METHODS

Forty-six overweight children from 6-16 years old (25 girls, 54.3%; age = 10.3 ± 2.8) of six schools took part in an 8-month interdisciplinary, school-based intervention programme. All children were engaged in PA classes, but only one group was exposed to individualised counselling. Blood pressure (BP), lipids and lipoproteins, accelerometer-based PA, percentage of body fat (%BF) and trunk fat (%TF) measures were taken before and after intervention. General Linear Model (Repeated Measures ANOVA) adjusted for age, maturation and height change was used to analyse the longitudinal effect of individualised counselling between two evaluations in each group.

RESULTS

Favourable changes were observed for %BF, %TF, systolic BP and total cholesterol in the IDC group. Subjects WIDC only increased light and moderate-vigorous PA. In IDC, significant effects for time * group interactions were found for systolic BP, total cholesterol and LDL-cholesterol, indicating that counselling might add favourable changes in these markers, beyond those explained by PA and growth.

CONCLUSION

School-based interventions can contribute to counteracting obesity in youth, particularly when individualised dietary counselling is provided. Therefore, the link between schools and professional counselling should be strengthened to ensure consolidated changes towards healthy behaviours.