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Santos-Beneit G, Bodega P, de Cos-Gandoy A, de Miguel M, Rodríguez C, Orrit X, Carral V, Haro D, Carvajal I, Peyra C, Martínez-Gómez J, Fernández-Alvira JM, Fernández-Jiménez R, Fuster V. Effect of Time-Varying Exposure to School-Based Health Promotion on Adiposity in Childhood. J Am Coll Cardiol 2024; 84:499-508. [PMID: 39084824 DOI: 10.1016/j.jacc.2024.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The results of most school-based health promotion initiatives are inconclusive. OBJECTIVES This trial assessed the effect of time-varying exposures to a multicomponent school-based health promotion intervention (SI! Program) on adiposity markers. METHODS A total of 48 schools in Madrid (Spain) were cluster randomized to receive the SI! Program through elementary education grades 1 to 6 (E1-6, 12 schools, 459 children), 1 to 3 (E1-3, 12 schools, 513 children), or 4 to 6 (E4-6, 12 schools, 419 children) or to receive the standard curriculum (control, 12 schools, 379 children). The primary endpoint was the between-group difference at 3- and 6-year follow-up in the change from baseline in adiposity markers and the overall knowledge-attitudes-habits (KAH) score. RESULTS At 3-year follow-up, children who had the intervention showed significantly lower increases than the control group in z-scores for body mass index (BMI), waist-to-height ratio (WHtR), and waist circumference (WC) (zBMI: -0.09; 95% CI: -0.16 to -0.03; P = 0.003; zWC and zWHtR: -0.19; 95% CI: -0.28 to -0.10; P < 0.001). At 6-year follow-up, the beneficial trend in zWC and zWHtR was maintained in the E1-6 and E1-3 groups: difference zWC control vs E1-6 (-0.19; 95% CI: -0.36 to -0.03; P = 0.020), control vs E1-3 (-0.22; 95% CI: -0.38 to -0.06; P = 0.009); difference zWHtR control vs E1-6 (-0.24; 95% CI: -0.41 to -0.06; P = 0.009), and control vs E1-3 (-0.29; 95% CI: -0.47 to -0.11; P = 0.001). No significant between-group differences were found in the change of overall KAH score. CONCLUSIONS Early elementary school interventions may be more effective than later interventions on abdominal adiposity. Further research should assess the sustainability effects of school-based health promotion programs.
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Affiliation(s)
- Gloria Santos-Beneit
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Patricia Bodega
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Amaya de Cos-Gandoy
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Mercedes de Miguel
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Carla Rodríguez
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Xavier Orrit
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Vanesa Carral
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Domingo Haro
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Isabel Carvajal
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain
| | - Carlos Peyra
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jesús Martínez-Gómez
- National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Juan Miguel Fernández-Alvira
- National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain
| | - Rodrigo Fernández-Jiménez
- National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain; Center for Biomedical Network Research: Cardiovascular Diseases (Centro de Investigación Biomédica En Red en enfermedades CardioVasculares [CIBERCV]), Madrid, Spain; Department of Cardiology, Hospital Clínico San Carlos, Health Research Institute of Hospital Clinico San Carlos (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [IdISSC]), Madrid, Spain.
| | - Valentin Fuster
- Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Timóteo AT, Cachulo MC, Dinis P, Negrão L, Barreiros-Mota I, Dores H, Gonçalves L. "O meu coração bate saudável" - Results from a pilot project for health education in Portuguese children. Rev Port Cardiol 2024; 43:301-310. [PMID: 37952926 DOI: 10.1016/j.repc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Childhood offers an excellent window of opportunity to start interventions to promote behavioral changes before unhealthy lifestyles become established, leading to cardiovascular diseases. The goal of this pilot educational project for children is the promotion of healthy lifestyles and cardiovascular health. METHODS This project was implemented in 4th grade children and included teacher-led classroom activities, a lesson given by a cardiologist and a practical lesson with dietitians. The teacher received a manual containing information on the topics to be discussed in class with the pupils and the children received a book that addresses cardiovascular risk factors and prevention. The components included were diet (D), physical activity (PA) and human body and heart awareness (BH). At the beginning and at the end of the schoolyear, a questionnaire was applied to the children to assess knowledge (K), attitudes (A) and habits (H) on these topics. RESULTS A total of 73 children from two schools from an urban district public school in Lisbon, in a low to medium income area, participated in the project. Following the intervention, there was a 9.5% increase in the overall KAH score, mainly driven by the PA component (14.5%) followed by the BH component (12.3%). No improvement was observed for component D. The benefits were also more significant in children from a lower income area, suggesting that socioeconomic status is a determinant in the response obtained. CONCLUSIONS An educational project for cardiovascular health can be implemented successfully in children aged 9 years, but longer and larger studies are necessary.
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Affiliation(s)
- Ana Teresa Timóteo
- Serviço de Cardiologia, Hospital Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal.
| | - Maria Carmo Cachulo
- Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Fundação Portuguesa de Cardiologia, Portugal
| | - Paulo Dinis
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coinbra, Portugal; Centro de Saúde Militar de Coimbra, Coimbra, Portugal
| | - Luís Negrão
- Fundação Portuguesa de Cardiologia, Portugal
| | - Inês Barreiros-Mota
- CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Nutrition & Metabolism Department, NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Hélder Dores
- NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Hospital da Luz, Lisboa, Portugal
| | - Lino Gonçalves
- Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coinbra, Portugal; ICBR, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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Krijger A, ter Borg S, Elstgeest L, van Rossum C, Verkaik-Kloosterman J, Steenbergen E, Raat H, Joosten K. Lifestyle Screening Tools for Children in the Community Setting: A Systematic Review. Nutrients 2022; 14:nu14142899. [PMID: 35889854 PMCID: PMC9325265 DOI: 10.3390/nu14142899] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Screening of children’s lifestyle, including nutrition, may contribute to the prevention of lifestyle-related conditions in childhood and later in life. Screening tools can evaluate a wide variety of lifestyle factors, resulting in different (risk) scores and prospects of action. This systematic review aimed to summarise the design, psychometric properties and implementation of lifestyle screening tools for children in community settings. We searched the electronic databases of Embase, Medline (PubMed) and CINAHL to identify articles published between 2004 and July 2020 addressing lifestyle screening tools for children aged 0–18 years in the community setting. Independent screening and selection by two reviewers was followed by data extraction and the qualitative analysis of findings. We identified 41 unique lifestyle screening tools, with the majority addressing dietary and/or lifestyle behaviours and habits related to overweight and obesity. The domains mostly covered were nutrition, physical activity and sedentary behaviour/screen time. Tool validation was limited, and deliberate implementation features, such as the availability of clear prospects of actions following tool outcomes, were lacking. Despite the multitude of existing lifestyle screening tools for children in the community setting, there is a need for a validated easy-to-administer tool that enables risk classification and offers specific prospects of action to prevent children from adverse health outcomes.
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Affiliation(s)
- Anne Krijger
- Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, 3000 CB Rotterdam, The Netherlands;
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.E.); (H.R.)
- Correspondence: ; Tel.: +31(0)6-2461-2722
| | - Sovianne ter Borg
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Liset Elstgeest
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.E.); (H.R.)
- Reinier Academy, Reinier de Graaf Hospital, 2600 GA Delft, The Netherlands
| | - Caroline van Rossum
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Janneke Verkaik-Kloosterman
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Elly Steenbergen
- National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands; (S.t.B.); (C.v.R.); (J.V.-K.); (E.S.)
| | - Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands; (L.E.); (H.R.)
| | - Koen Joosten
- Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, University Medical Center Rotterdam, 3000 CB Rotterdam, The Netherlands;
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Lessons Learned From 10 Years of Preschool Intervention for Health Promotion. J Am Coll Cardiol 2022; 79:283-298. [DOI: 10.1016/j.jacc.2021.10.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022]
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Rationale and design of the SI! Program for health promotion in elementary students aged 6 to 11 years: A cluster randomized trial. Am Heart J 2019; 210:9-17. [PMID: 30716509 DOI: 10.1016/j.ahj.2018.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/15/2018] [Indexed: 01/17/2023]
Abstract
Unhealthy habits in children are increasing at an alarming rate. The school provides a promising setting for effective preventive strategies to improve children's lifestyle behaviors. The SI! Program is a multilevel multicomponent school-based educational intervention aimed at all stages of compulsory education in Spain. Here, we present the design of the SI! Program for Elementary School cluster-randomized controlled trial, targeting children aged 6 to 11 years. This trial aims to study the impact of different timings and intensities of exposure to SI! Program activities on elementary school children and their immediate environment (parents/caregivers, teachers, and school). The trial includes 1770 children from 48 public elementary schools in Madrid (Spain), together with their parents and teachers. Schools and their children were randomly assigned to the intervention group (the SI! curriculum-based educational program over 3 or 6 academic years) or to the control group (standard curriculum). The primary outcomes are the change from baseline at 3-year and 6-year follow-up in children's scores for knowledge, attitudes, and habits (KAH) and health factors (blood pressure, height, weight, waist circumference, and skinfold thickness). Secondary outcomes include 3-year and 6-year changes from baseline in lifestyle questionnaire scores for parents/caregivers and teachers, and in the school environment questionnaire. The overarching goal of the SI! Program is to provide an effective and sustainable health promotion program for the adoption of healthy behaviors in children. The present trial will address the impact and the optimal timing and duration of this educational intervention in the elementary school setting.
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Aperman-Itzhak T, Yom-Tov A, Vered Z, Waysberg R, Livne I, Eilat-Adar S. School-Based Intervention to Promote a Healthy Lifestyle and Obesity Prevention Among Fifth- and Sixth-Grade Children. AMERICAN JOURNAL OF HEALTH EDUCATION 2018. [DOI: 10.1080/19325037.2018.1486755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Zvi Vered
- Tel Aviv University
- Assaf Harofeh Medical Center
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