PAAPPAS community trial protocol: a randomized study of obesity prevention for adolescents combining school with household intervention.

BACKGROUND: The prevalence of childhood obesity is increasing at a high rate in Brazil, making prevention a health priority. Schools are the central focus of interventions aiming the prevention and treatment of childhood obesity, however, randomized trials and cohort studies have not yet provided clear evidence of strategies to reduce prevalence of obesity. The aim of this study is to present a protocol to evaluate the efficacy of combining school and household level interventions to reduce excessive weight gain among students. METHODS: The intervention target fifth and sixth graders from 18 public schools (9 interventions and 9 controls) in the municipality of Duque de Caxias, metropolitan area of Rio de Janeiro, Brazil. A sample size of 2500 students will be evaluated at school for their weight status and those from the intervention group who are overweight or obese will be followed monthly at home by community health agents. Demographic, socioeconomic, anthropometric, eating behavior and food consumption data will be collected at school using a standardized questionnaire programmed in personal digital assistant. At school, all students from the intervention group will be encouraged to change eating habits and food consumption and to increase physical activity and reducing sedentary behavior. DISCUSSION: This study will provide evidence whether integration of school with primary health care can prevent excessive weight gain among adolescents. Positive results will inform a sustainable strategy to be disseminated in the health care system in Brazil. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02711488 . Date of registration: March 11, 2016.

A cross-cultural comparison of eating behaviors and home food environmental factors in adolescents from São Paulo (Brazil) and Saint Paul-Minneapolis (US).

OBJECTIVE: Describe cross-cultural differences in nutrition-related factors among adolescents from São Paulo, Brazil and St Paul-Minneapolis, US. DESIGN: Two large-population-based studies with cross-cultural comparisons. SETTING: Twelve São Paulo and 10 St Paul-Minneapolis high schools in 2009-2010. PARTICIPANTS: A total of 1,148 adolescents from São Paulo and 1,632 adolescents from St Paul-Minneapolis. MAIN OUTCOME MEASURE(S): Meal consumption, family meals, fast-food consumption, and home food availability. ANALYSIS: Binomial regressions, weighted for age distributions and adjusted for gender, were used to compare identical measures from each sample. RESULTS: Generally, São Paulo adolescents reported healthier nutritional outcomes than St Paul-Minneapolis adolescents. São Paulo adolescents were 7 times less likely to report high fast-food consumption than St Paul-Minneapolis adolescents (P < .001). Whereas most measures of the home environment indicated healthier home environments in São Paulo, more São Paulo adolescents reported that sugar-sweetened beverages were usually available at home than did St Paul-Minneapolis adolescents (P < .001). CONCLUSIONS AND IMPLICATIONS: São Paulo youth tended to have healthier eating behaviors and home food environment factors than St Paul-Minneapolis youth. Brazilian eating patterns tend to be healthier and support a connection with food and culture. Interventions are needed to encourage youth and their families to maintain these patterns.