The GReat-Child TrialTM: A Quasi-Experimental Dietary Intervention among Overweight and Obese Children

Abstract

Diet composition is a key determinant of childhood obesity. While whole grains and micronutrients are known to decrease the risk of obesity, there are no interventions originating from Southeast Asia that emphasize whole grain as a strategy to improve overall quality of diet in combating childhood obesity. The GReat-Child Trial aimed to improve whole grain intake and quality of diet among overweight and obese children. It is a quasi-experimental intervention based on Social Cognitive Theory. It has a 12-week intervention and 6-month follow-up, consisting of three components that address environmental, personal, and behavioral factors. The intervention consists of: (1) six 30 min lessons on nutrition, using the Malaysian Food Pyramid to emphasize healthy eating, (2) daily deliveries of wholegrain foods to schools so that children can experience and accept wholegrain foods, and (3) diet counseling to parents to increase availability of wholegrain foods at home. Two primary schools with similar demographics in Kuala Lumpur were assigned as control (CG) and intervention (IG) groups. Inclusion criteria were: (1) children aged 9 to 11 years who were overweight/obese; (2) who did not consume whole grain foods; and (3) who had no serious co-morbidity problems. The entire trial was completed by 63 children (31 IG; 32 CG). Study outcomes were measured at baseline and at two time points post intervention (at the 3rd [T1] and 9th [T2] months). IG demonstrated significantly higher intakes of whole grain (mean difference = 9.94, 95%CI: 7.13, 12.75, p < 0.001), fiber (mean difference = 3.07, 95% CI: 1.40, 4.73, p = 0.001), calcium (mean difference = 130.27, 95%CI: 74.15, 186.39, p < 0.001), thiamin (mean difference = 58.71, 95%CI: 26.15, 91.28, p = 0.001), riboflavin (mean difference = 0.84, 95%CI: 0.37, 1.32, p = 0.001), niacin (mean difference = 0.35, 95%CI: 1.91, 5.16, p < 0.001), and vitamin C (mean difference = 58.71, 95%CI: 26.15, 91.28, p = 0.001) compared to CG in T1, after adjusting for covariates. However, T1 results were not sustained in T2 when intervention had been discontinued. The findings indicate that intervention emphasizing whole grains improved overall short-term but not long-term dietary intake among schoolchildren. We hope the present trial will lead to adoption of policies to increase whole grain consumption among Malaysian schoolchildren.

Facilitators to improve whole-grain consumption among Malaysian adults: a qualitative study

“…The facilitator of repeated exposure to similar tastes may be included in the nutrition intervention, in which Malaysians are offered the same whole-grain food repeatedly and consistently over a long time. This facilitator is effective in increasing the whole-grain intake in a total of 31 Malaysian schoolchildren, carried out through an intervention named GReat-Child Trial™ (Koo et al, 2020). Perhaps, Improve whole-grain consumption the Malaysian government or non-government organisations may adopt the GReat-Child Trial™ intervention and implement it nationwide.…”

Perceived barriers towards whole grain consumption among the Malaysian adult population: findings from a theory-based qualitative study

“…Young and middle-aged adults indicated that they did not grow up with a specific diet and that whole grains were not very popular at the time, also adding that whole grains were not readily available and accepted in the Malaysian population due to their different sensory characteristics when compared to traditional Malaysian cuisines. Increased exposure to an uncommon food has been found in several studies to develop and cultivate a child's liking for that food, and such exposure may even decrease resistance to foods that were previously hated (Koo et al, 2020). Despite a majority of the respondents mentioning that they had previously tried whole grain foods, only a handful of them consumed whole grain foods on a regular basis that indicated habitual intake.…”