BackgroundObesity is one of the main determinants of avoidable disease burden.To implement a program by university students acting as “health promoting agents” (HPAs) and to evaluate the effects on obesity prevalence of the primary-school-based program that promotes healthy lifestyle, including dietary and physical activity recommendations over 28 months.MethodsTwo school clusters were randomly assigned to intervention (24 schools, 1,222 pupils) or control (14 schools, 717 pupils); 78% of pupils were Western European. Mean age (±SD) was 8.4 ± 0.6 years (49.9% females) at baseline. Generalized linear mixed models were used to analyze differences in primary outcome between both groups. Data collected included body mass index (BMI) every year. Dietary habits and lifestyle questionnaires were filled in by the parents at baseline and at the end of the study. The interventions focused on eight lifestyle topics covered in 12 activities (1 hour/activity/session) implemented by HPAs over 3 school academic years.ResultsAt 28 months, obesity prevalence in boys was decreased −2.36% in the intervention group (from 9.59% to 7.23%) and increased 2.03% (from 7.40% to 9.43%) in the control group; the difference was 4.39% (95% CI 3.48 to 5.30; P = 0.01). The boys in the intervention group had an effective reduction of −0.24 units in the change of BMI z-score (from 0.01 to −0.04), compared to control (from −0.10 to 0.09); 5.1% more intervention pupils undertook physical activity >5 hours/week than control pupils (P = 0.02).Fish consumption was a protector (odds ratio 0.39; 95% CI 0.23 to 0.67) while “fast-food” consumption was a risk factor for childhood obesity (odds ratio: 2.27; 95% CI 1.08 to 4.77).ConclusionsOur school-based program, conducted by HPA students, successfully reduced childhood obesity prevalence in boys.Trial registrationInternational Standard Randomized Controlled Trial Number: ISRCTN29247645.

A school-based, peer-led, SM intervention developed by adolescents attending high schools in low-income neighborhoods effectively improved the healthy choices of their school-aged peers, leading to increased fruit consumption and PA in adolescents of both genders. Furthermore, adolescent males were more sensitive to improvements in healthy choices, showing increased vegetable consumption and decreased sedentary behavior.

BackgroundMexico is a developing country with one of the highest youth obesity rates worldwide; >34% of children and adolescents between 5 and 19 years of age are overweight or obese.ObjectivesThe current review seeks to compile, describe, and analyze dietary conditions, physical activity, socioeconomic status, and cultural factors that create and exacerbate an obesogenic environment among Mexican youth.DesignA narrative review was performed using PubMed and the Cochrane Library databases, as well as grey literature data from the Mexican government, academics, and statistical reports from nongovernmental organizations, included in electronic formats.ResultsThe recent socioeconomic and nutritional transition has resulted in reduced healthy meal options at public schools, high rates of sedentary lifestyles among adolescents, lack of open spaces and playgrounds, socioeconomic deprivation, false or misunderstood sociocultural traditional beliefs, misconceptions about health, a high percentage of overweight or obese adults, and low rates of maternal breastfeeding. Some of the factors identified are exacerbating the obesity problem in this population. Current evidence also shows that more policies and health programs are needed for prevention of childhood and adolescent obesity. Mexico presents alarming obesity levels, which need to be curtailed and urgently reversed.ConclusionsThe present narrative review presents an overview of dietary, physical activity, societal and cultural preconceptions that are potentially modifiable obesity-promoting factors in Mexican youth. Measures to control these factors need to be implemented in all similar developing countries by governments, policy makers, stakeholders, and health care professionals to tackle obesity in children and young people.

Malnutrition in the elderly could be tackled by addressing socioeconomic factors. This study aimed to determine the magnitude of the relationship between socioeconomic factors and the malnutrition or malnutrition risk (MR) in the elderly. The PubMed and SCOPUS databases were searched for observational studies that included assessment of malnutrition or/and MR and socioeconomic variables (educational level, living alone, marital status, income and occupational level, feeling of loneliness, place of residence, and food expenditure) in ≥60-year-old subjects, published in English among 2000-2018 (PROSPERO: CRD42019137097). The systematic review included 40 observational studies (34 cross-sectional and 4 cohort studies) and 16 cross-sectional studies in the meta-analysis (34,703 individuals) of malnutrition and MR in relation to low educational level (Odds Ratio (OR): 1.48; 95% Confidence Interval (CI): 1.33-1.64; p < 0.001), living alone (OR: 1.92; 95% CI: 1.73-2.14; p < 0.001), being single, widowed, or divorced (OR: 1.73; 95% CI: 1.57-1.90; p < 0.001), and low income level (OR: 2.69; 95% CI: 2.35-3.08; p < 0.001), and considering these four socioeconomic factors, malnutrition and MR is associated with them (OR: 1.83; 95% CI: 1.73-1.93; p < 0.001). Malnutrition and MR could be reduced by increasing economic level, supporting people living alone or being single, widowed, and divorced, and improving lifelong learning.

BackgroundAn important challenge of school-based childhood obesity (OB) intervention programs is understanding the maintenance of the effects after cessation of the intervention to overcome the limitations of follow-up studies. The aim of this study is to verify the sustainability of the benefits achieved at a 4-year follow-up of the post-Educació en Alimentació (EDAl) program intervention cessation by assessing the OB-related outcomes and lifestyles of 13- to 15-year-old adolescents.MethodsThis paper describes a 4-year follow-up study after the cessation of a school-based randomized controlled intervention in adolescents (n = 349, intervention; n = 154, control) with baseline and 4-year follow-up data from high schools in Reus (intervention group), Salou, Cambrils and Vila-seca (control group). The outcomes are body mass index (BMI), BMI z-score, and OB prevalence according to the World Health Organization and International Obesity Task Force criteria and lifestyle data (obtained from questionnaires).ResultsCompared with the control girls, the intervention girls showed reduced BMI z-scores (−0.33 units, p < 0.01) from baseline (2007) to the 4-year follow-up post-intervention (2014). Compared with the control boys, the intervention boys showed reduced OB prevalence (−7.7%; p = 0.02). Compared with the control boys, more boys in the intervention group (19% increase; p = 0.059) showed ≥4 h/week after-school physical activity (PA). A decrease in the consumption of dairy products, fruits and fish was observed in both groups.ConclusionsAt the 4-year post-intervention follow-up of the EdAl program, compared with the control groups, girls had lower BMI z-scores and boys had lower OB prevalence from the intervention. The encouragement in after-school PA was long-lasting and maintained after the cessation of the intervention, whereas healthy food habits must be further reinforced in adolescents.Trial registrationISRCTN29247645.Electronic supplementary materialThe online version of this article (10.1186/s12889-017-5006-0) contains supplementary material, which is available to authorized users.

Context: The use of social marketing to modify lifestyle choices could be helpful in reducing youth obesity. Some or all of the 8 domains of the National Social Marketing Centre’s social marketing benchmark criteria (SMBC) are often used but not always defined in intervention studies. Objective: The aim of this review is to assess the effectiveness of European school-based interventions to prevent obesity relative to the inclusion of SMBC domains in the intervention. Data Sources: The PubMed, Cochrane, and ERIC databases were used. Study Selection: Nonrandomized and randomized controlled trials conducted from 1990 to April 2014 in participants aged 5 to 17 years were included. Data Extraction: After the study selection, the 8 domains of the SMBC were assessed in each included study. Results: Thirty-eight publications were included in the systematic review. For the meta-analysis, randomized controlled trials (RCTs) reporting body mass index or prevalence of overweight and obesity were considered. Eighteen RCTs with a total of 8681 participants included at least 5 SMBC. The meta-analysis showed a small standardized mean difference in body mass index of −0.25 (95%CI, −0.45 to −0.04) and a prevalence of overweight and obesity odds ratio of 0.72 (95%CI, 0.5–0.97). Conclusion: Current evidence indicates that the inclusion of at least 5 SMBC domains in school-based interventions could benefit efforts to prevent obesity in young people.PROSPERO registration number: CRD42014007297.

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To determine the effectiveness of workplace interventions and the most effective methodological design for the improvement of employee productivity, work ability, and absenteeism. A meta-analysis of randomized controlled trials (RCTs) of workplace interventions was conducted (PROSPERO, CRD42018094083). The PubMed, Scopus, PsycINFO, and Cochrane databases were searched. RCTs from 2000 to 2017 and with employees (18-65 years) were selected. Then, intervention characteristics and work-related outcomes data were extracted. A total of 47 RCTs were included in the systematic review, and 19 RCTs (11 absenteeism, 7 productivity, and 5 work ability) were included in the meta-analysis. The meta-analysis showed that the effectiveness of workplace interventions for absenteeism was −1.56 (95% CI, −2.67 to −0.44) and −2.65 (95% CI, −4.49 to −0.81) considering only moderate quality RCTs. In contrast, only a few studies of workplace interventions for productivity and work ability were included, which was insufficient for determining the effectiveness and best design for improving these work outcomes. The workplace is an interesting environment to reduce absenteeism, and individualized and counseling interventions with <10 sessions/total were the most effective workplace intervention methodological design for reducing the absenteeism of employees. Future high-quality RCTs that also consider health risks should be implemented to strengthen the results. 2 of 26 specific task) and their effectiveness (the objectives achieved and problems solved) [5]. In some studies, productivity represents the maximum individual potential performance at employees' workplace [5]. Absenteeism is defined as the time that an employee is away from work due to illness or disability [2]. In contrast, presenteeism is defined as performing work at a lower level than usual during work time, with presenteeism problems not necessarily leading to absenteeism [2]. Consequently, both absenteeism and presenteeism could decrease the productivity of employees [2]. Additionally, another analyzed work-related aspect is work ability. Work ability has two definitions, namely, one definition for specific jobs that require special training, and one definition for jobs that most people can manage given a short period of practice [6].The workplace is an excellent context for improving health outcomes because employees spend a substantial part of their days there [1]. Additionally, employers not only are responsible for providing a safe and hazard-free workplace but also have opportunities to promote and foster a healthy work environment [7]. As an extra benefit, the maintenance of a healthy lifestyle among employees reduces the direct and indirect costs [7]. Another interesting focus concerns the effects of workplace interventions on employee health lifestyle outcomes, such as physical activity, nutrition, weight reduction, or stress management [8,9], whereas it has not been defined how these lifestyle health aspects can contribute to improved work-related outcomes [10]. A ...