Effects of a 20-month cluster randomised controlled school-based intervention trial on BMI of school-aged boys and girls: the HEIA study

Abstract

BackgroundSchool-based interventions that target prevention of overweight and obesity in children have been tested with mixed results. Thus, successful interventions are still called for. The aim of the present study was to investigate effects of a multicomponent school-based intervention programme targeting physical activity, sedentary and dietary behaviours on anthropometric outcomes.MethodsA 20-month intervention was evaluated in a cluster randomised, controlled study of 1324 11-year-olds. Outcome variables were body mass index (BMI), BMI-for-age z-score (BMIz), waist circumference (WC), waist-to-height ratio (WTHR) and weight status (International Obesity Task Force's cut-offs). Weight, height and WC were measured objectively; pubertal status was self-reported and parental education was self-reported by the parents. Intervention effects were determined by one-way analysis of covariance and logistic regression, after checking for clustering effects of school, and moderating effects of gender, pubertal status and parental education.ResultsBeneficial effects were found for BMI (p=0.02) and BMIz (p=0.003) in girls, but not in boys. While a beneficial effect was found for BMI (p=0.03) in participants of parents reporting a high level of education, a negative effect was found for WTHR in participants with parents reporting a low level of education (p=0.003). There were no intervention effects for WC and weight status.ConclusionsA multicomponent 20-month school-based intervention had a beneficial effect on BMI and BMIz in adolescent girls, but not in boys. Furthermore, children of higher educated parents seemed to benefit more from the intervention, and this needs attention in future interventions to avoid further increase in social inequalities in overweight and obesity.

Análisis de los niveles de adiposidad y condición física en jóvenes escolares colombianos

“…Estos resultados son diferentes a los reportados en otros estudios llevados a cabo con escolares de edades similares, en los cuales estas diferencias no fueron significativas, aunque las chicas presentaron un mayor índice de masa corporal (6,44,54,55).…”

“…Las estrategias para combatir los hábitos contrarios a una vida saludable incluyen la promoción de la participación en programas de ejercicio físico regular, en condiciones programadas y sujetas a evaluación, cuyo objetivo es mantener el peso dentro de los niveles deseables, prevenir y tratar el sobrepeso, y garantizar una mejor calidad de vida con base en hábitos saludables (5)(6)(7)(8). Las acciones encaminadas a disminuir los hábitos sedentarios incluyen tanto los aspectos prácticos como los teóricos.…”

Physical activity level has a great influence on the nutritional status of adolescents: a review article

“…These results suggest that habits regarding PA play an important role in the control and/or increase of body weight [4], while there are no parallel results indicating that calorie intake has a similar role [32]. -black girls were heavier in adolescence than white girls -In the black group, caloric intake increased with time, while in white girls it stayed on the same level -58% inactive subjects of black girls stayed inactive, compared with 11% of the white girls group -bMI increased with age, but with significant differences in inactive subjects compared with others PAL groups -In groups that maintained active lifestyle, the increase of bMI and SF was smaller than in the less active groups boone et al [33] -% of obese in both sexes doubled with age -Normal weight subjects from both groups were more active and had less TV time than obese ones -In both sexes, obese impairment was noted in younger adult age if there had been no increase in PAL in adolescence Grydeland et al [26] CSLS N: for gaining body weight and risk of obesity in adulthood -Obese children had the habits of consuming snacks and skipping breakfast -Underweight children skipped breakfast at least once per week and had lower PAL than the other groups, even the obese AFM -android fat mass, b -boys, bC -body composition, bMI -body mass index, CRP -C-reactive protein, CSLS -cross-sectional longitudinal study, CSS -cross-sectional study, CVF -cardiovascular fitness, DEI -daily energy intake, DEXA -dual-energy X-ray absorptiometry, DFI -daily fat intake, ECMR -elevated cardiometabolic risk, FFM -fat-free mass, FFMI -fat-free mass index, FM -fat mass, FMI -fat mass index, FSQ -financial status questionnaire, FTO rs9939609 -Single Nucleotide Polymorphism (SNP) in the fat mass and obesity associated FTO gene, also known as fat gene, G -girls, HAQ -habitual activity questionnaire, HbA1c -glycol haemoglobin, HDL -high density lipoprotein, LbM -lean body mass, LDL -low density lipoprotein, MET -metabolic equivalent of task, MVPA -moderately vigorous physical activity, N -number, NR -not reported, PA -physical activity, PAL -physical activity level, PAQ -physical activity questionnaire, PE -parents' education, QFS -questionnaire concerning financial status, ROC -receiver operating characteristic, SAAT -subcutaneous abdominal adipose tissue, SbP -sedentary behaviour patterns, SES -socioeconomic status, SF -skin folds, ST -sedentary time, VAT -visceral adipose tissue, VATm -visceral adipose tissue mass, VO 2 max -maximal oxygen consumption, VPA -vigorous physical activity, WC -waist circumference, WHO -World Health Organization, WHR -waist to hip ratio Increasing the activity by 1 hour per week resulted in a decline in bMI by 0.13 kg/m 2 [47]. MVPA presented through a regression coefficient indicates that each increase of 100 minutes of MVPA results in bMI reduction by 0.23 kg/m 2 in adolescents aged 10-18 years, independently of sex or ethnicity [43].…”

“…both sexes were equally distributed in most of the studies; in one, only females were engaged [32]. Ara et al [36] included only male population, while in two studies [26,40] gender was not used as a variable of interest.…”

“…Only in 3 articles, a partly experimental nature of the study design can be found [26][27][28]. Treatment in the form of education about healthy lifestyle was carried out in one of the aforementioned studies; it was characterized by involving breaks for physical exercise and eating healthy meals during ordinary school hours [26].…”