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2.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(9): 1428-1432, 2020 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-33076593

RESUMO

Most cardiovascular disease (CVD) related risk factors are prevalent in children and adolescents, especially obesity, elevated blood pressure (BP) and increased unhealthy lifestyle. To prevent CVD in adulthood, it is necessary to attach importance to the prevention and control of CVD risk factors in childhood. Of note, the prevention of childhood obesity is key measure, the control of childhood BP is the first goal, and the development of healthy lifestyle is important basis. The prevention and control of CVD risk factors in childhood can benefit the future prevention and treatment of CVD in adulthood, provide scientific base for the prevention and intervention of cardiovascular risk factors in childhood, and provide new perspective for the early prevention of cardiovascular diseases in adulthood.


Assuntos
Doenças Cardiovasculares , Adolescente , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Criança , Humanos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Estilo de Vida , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Fatores de Risco
3.
PLoS One ; 15(9): e0238977, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941530

RESUMO

BACKGROUND: Early childhood is a critical period for the development of obesity, with new approaches to prevent obesity in this age group needed. We designed and piloted the 3 Pillars Study (3PS), a healthy lifestyle programme informed by attachment theory for parents of preschool-aged children. METHODS: A 2-arm, randomised controlled pilot study was conducted to assess the effectiveness of 3PS, a 6-week programme involving a half-day workshop plus 6-week access to a study website. The programme was designed to promote routines around healthy lifestyle behaviours, including sleep, limited screen use, and family meals, within the context of positive, reciprocal parent-child interactions. Parents (n = 54) of children aged 2-4 years who regularly exceeded screen use recommendations (≥1 hour per day), were randomised to the 3PS programme (n = 27) or a wait-list control group (n = 27). Child screen time at 6 weeks was the primary endpoint. Frequency of family meals, parent feeding practices, diet quality, sleep, Child Routine Inventory (to assess predictability of commonly occurring routines), and household chaos were also assessed. Study data were collected online at baseline, 6 weeks, and 12 weeks via REDCap. RESULTS: No group differences were observed for changes from baseline in screen time (primary endpoint), feeding behaviour scores, Child Routine Inventory scores, or total night time sleep duration at 6 and 12 weeks, although all measures improved in the hypothesised direction in the 3PS group. Compared with controls, the intervention group demonstrated significant improvements from baseline in household chaos scores (i.e. a reduction in chaos) and a number of measures of sleep outcomes, indicating improved sleep continuity. The programme was highly acceptable to parents. CONCLUSIONS AND RECOMMENDATIONS: A relational approach appears promising as a novel way to promote healthy lifestyle behaviours associated with the prevention of childhood obesity in children aged 2-4 years. A larger study is warranted.


Assuntos
Família/psicologia , Estilo de Vida Saudável/fisiologia , Obesidade Pediátrica/prevenção & controle , Adulto , Índice de Massa Corporal , Criança , Pré-Escolar , Dieta/psicologia , Exercício Físico/psicologia , Comportamento Alimentar/psicologia , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Relações Pais-Filho/etnologia , Pais/educação , Projetos Piloto
5.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32883807

RESUMO

OBJECTIVES: To determine impact of a primary care-based child obesity prevention intervention beginning during pregnancy on early childhood weight outcomes in low-income Hispanic families. METHODS: A randomized controlled trial comparing mother-infant pairs receiving either standard care or the Starting Early Program providing prenatal and postpartum nutrition counseling and nutrition parenting support groups targeting key obesity-related feeding practices in low-income groups. Primary outcomes were reduction in weight-for-age z-scores (WFAzs) from clinical anthropometric measures, obesity prevalence (weight for age ≥95th percentile), and excess weight gain (WFAz trajectory) from birth to age 3 years. Secondary outcomes included dose effects. RESULTS: Pregnant women (n = 566) were enrolled in the third trimester; 533 randomized to intervention (n = 266) or control (n = 267). Also, 358 children had their weight measured at age 2 years; 285 children had weight measured at age 3 years. Intervention infants had lower mean WFAz at 18 months (0.49 vs 0.73, P = .04) and 2 years (0.56 vs 0.81, P = .03) but not at 3 years (0.63 vs 0.59, P = .76). No group differences in obesity prevalence were found. When generalized estimating equations were used, significant average treatment effects were detected between 10-26 months (B = -0.19, P = .047), although not through age 3 years. In within group dose analyses at 3 years, obesity rates (26.4%, 22.5%, 8.0%, P = .02) decreased as attendance increased with low, medium, and high attendance. CONCLUSIONS: Mean WFAz and growth trajectories were lower for the intervention group through age 2 years, but there were no group differences at age 3. Further study is needed to enhance sustainability of effects beyond age 2.


Assuntos
Hispano-Americanos , Obesidade Pediátrica/prevenção & controle , Cuidado Pós-Natal , Pobreza , Gestantes/educação , Cuidado Pré-Natal , Adulto , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Cidade de Nova Iorque , Obesidade Pediátrica/etnologia , Gravidez , Gestantes/etnologia , Ganho de Peso
6.
PLoS One ; 15(9): e0237969, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32870928

RESUMO

This systematic review aims to summarize the evidence regarding the effectiveness of interventions targeting energy balance-related behaviors in children from lower socioeconomic environments and the applied behavior change techniques. The literature search was conducted in Cochrane, Embase, Psycinfo and Pubmed. Articles had to be published between January 2000 and September 2019. Studies were included that i) targeted dietary behavior, physical activity and/or sedentary behavior; ii) had a controlled trial design; iii) included children aged 9-12 years old; iv) focused on lower socioeconomic environments; and v) took place in upper-middle or high income countries. Two independent researchers extracted data, identified behavior change techniques using the Behavior Change Technique Taxonomy v1, and performed a methodological quality assessment using the quality assessment tool of the Effective Public Health Practice Project. We included 24 studies, of which one received a high and three a moderate quality rating. Demonstration, practice and providing instructions on how to perform a behavior were the most commonly applied behavior change techniques. Seven studies reported significant beneficial intervention effects: five on physical activity, one on physical activity and sedentary behavior and one on dietary behavior. When comparing effective versus non-effective interventions, and comparing our review to previous reviews focusing on children from the general population, similar behavior change techniques were applied. More high quality research is needed to evaluate the effectiveness of interventions and their behavior change techniques targeting children of low socioeconomic environments. PROSPERO registration number: CRD42016052599.


Assuntos
Terapia Comportamental , Fenômenos Fisiológicos da Nutrição Infantil , Ingestão de Energia , Metabolismo Energético , Exercício Físico , Obesidade Pediátrica/prevenção & controle , Criança , Humanos , Obesidade Pediátrica/psicologia , Comportamento Sedentário , Fatores Socioeconômicos
7.
BMC Public Health ; 20(1): 1240, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795294

RESUMO

BACKGROUND: Lifestyles habits such as eating unhealthy foodscommence at home and are associated with the development of obesity and comorbidities such as insulin resistance, metabolic syndrome, and chronic degenerative diseases, which are the main causes of death in adults. The present study compared changes in dietary habits, behaviors and metabolic profiles of obese children whose mothers attended at the hospital to group sessions, with those who received the usual nutritional consultation. METHODS: Randomized clinical trial, 177 mother/obese child pairs participated, 90 in the intervention group and 87 in the control group. The intervention group attended six group education sessions to promote healthy eating, being this an alternative of change of habits in children with obesity. The control group received the usual nutritional consultation; both groups were followed up for 3 months. Frequency of food consumption, behaviors during feeding in the house and metabolic profile was evaluated. Mixed effect linear regression models were used to evaluate the effect of the intervention on the variables of interest, especially in HOMA-IR. RESULTS: The intervention group reduced the filling of their dishes (p = 0.009), forcing the children to finish meals (p = 0.003) and food substitution (p <  0.001), moreover increased the consumption of roasted foods (p = 0.046), fruits (p = 0.002) and vegetables (p <  0.001). The children in the control group slightly increased HOMA-IR levels (0.51; 95% CI - 0.48 to 1.50), while the children in the intervention group significantly decreased (- 1.22; 95% CI - 2.28 to - 1.16). The difference in HOMA-IR between the control and intervention group at the end of the follow-up was - 1.67; 95% CI: - 3.11 to - 0.24. CONCLUSIONS: The educational intervention improved some eating habits at home, as well as HOMA-IR levels; why we consider that it can be an extra resource in the management of childhood obesity. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04374292 (Date assigned: May 5, 2020). Retrospectively registered.


Assuntos
Dieta Saudável , Comportamento Alimentar/psicologia , Educação em Saúde , Síndrome Metabólica/prevenção & controle , Mães/educação , Obesidade Pediátrica/prevenção & controle , Adulto , Criança , Feminino , Seguimentos , Humanos , Masculino , Obesidade Pediátrica/epidemiologia , Avaliação de Programas e Projetos de Saúde
8.
J Natl Black Nurses Assoc ; 31(1): 60-63, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32853498

RESUMO

African-Americans with hypertension continue to demonstrate poor blood pressure (BP) control and have markedly lower rates of hypertension self-management compared to non-African-Americans. Innovative and practical solutions such as mHealth technology are promising and can be leveraged to promote self-management of hypertension. Substantial evidence has demonstrated the importance of community support in improving patients' management of chronic illnesses. Unfortunately, such programs do not offer technology-based interventions (TBI) as a delivery method. Thus, this paper describes the design and rationale of an ongoing pilot study that incorporates TBI using a community-based participatory approach.


Assuntos
Afro-Americanos/educação , Educação de Pacientes como Assunto , Obesidade Pediátrica/etnologia , Obesidade Pediátrica/prevenção & controle , Afro-Americanos/estatística & dados numéricos , Criança , Pesquisa sobre Serviços de Saúde , Humanos , Projetos Piloto , Atenção Primária à Saúde/métodos , Melhoria de Qualidade , População Rural/estatística & dados numéricos
9.
Transplantation ; 104(8): 1644-1653, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732843

RESUMO

BACKGROUND: Obesity is a significant public health concern; however, the incidence post solid-organ transplantation is not well reported. METHODS: This study determined the incidence and risk factors of obesity among pediatric solid-organ transplant recipients (heart, lung, liver, kidney, multiorgan) at The Hospital for Sick Children (2002-2011), excluding prevalent obesity. Follow-up occurred from transplantation until development of obesity, last follow-up, or end of study. Incidence of obesity was determined overall, by baseline body mass index, and organ group. Risk factors were assessed using Cox proportional-hazards regression. RESULTS: Among 410 (55% male) children, median transplant age was 8.9 (interquartile range [IQR]: 1.0-14.5) years. Median follow-up time was 3.6 (IQR: 1.5-6.4) years. Incidence of obesity was 65.2 (95% confidence interval [CI]: 52.7-80.4) per 1000 person-years. Overweight recipients had a higher incidence, 190.4 (95% CI: 114.8-315.8) per 1000 person-years, than nonoverweight recipients, 56.1 (95% CI: 44.3-71.1). Cumulative incidence of obesity 5-years posttransplant was 24.1%. Kidney relative to heart recipients had the highest risk (3.13 adjusted hazard ratio [aHR]; 95% CI: 1.53-6.40) for obesity. Lung and liver recipients had similar rates to heart recipients. Those with higher baseline body mass index (z-score; 1.72 aHR; 95% CI: 1.39-2.14), overweight status (2.63 HR; 95% CI: 1.71-4.04), and younger transplant age (y; 1.18 aHR; 95% CI: 1.12-1.25) were at highest risk of obesity. Higher cumulative steroid dosage (per 10 mg/kg) was associated with increased risk of obesity after adjustment. CONCLUSIONS: Among all transplanted children at The Hospital for Sick Children, 25% developed obesity within 5-years posttransplant. Kidney recipients, younger children, those overweight at transplant, and those with higher cumulative steroid use (per 10 mg/kg) were at greatest risk. Early screening and intervention for obesity are important preventative strategies.


Assuntos
Transplante de Órgãos/efeitos adversos , Obesidade Pediátrica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Transplantados/estatística & dados numéricos , Adolescente , Fatores Etários , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Seguimentos , Glucocorticoides/efeitos adversos , Humanos , Incidência , Lactente , Masculino , Programas de Rastreamento/organização & administração , Ontário/epidemiologia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/etiologia , Obesidade Pediátrica/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
10.
PLoS One ; 15(8): e0237564, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810194

RESUMO

BACKGROUND: Prevention of overweight during early childhood seems promising. OBJECTIVE: To evaluate the effectiveness of the parenting-based BBOFT+ overweight prevention program on child BMI, child health behavior and parenting behavior among 0-36 month old children. BBOFT+ is an acronym for the key healthy lifestyle behaviors that are targeted in the BBOFT+ intervention: breastfeeding (B), daily breakfast (B), daily going outdoors (O), limiting sweet beverages (in Dutch, F) and minimal TV or computer time (T), complemented with healthy sleep behavior and improvement of parenting skills (+). METHODS: A cluster randomized controlled trial in newborn children visiting well-baby clinics, comparing the BBOFT+ intervention (N = 901) with care as usual (CAU) (N = 1094). In both groups, parents received regular well-child visits (±11 visits in the first 3 years). In the intervention group, care was supplemented with the BBOFT+ program, which focuses on improving parenting skills from birth onwards to increase healthy behavior. Questionnaires were filled in at child's age 2-4 weeks, 6, 14 and 36 months. In multivariate analyses we corrected for child's birthweight, age, ethnic background, mother's educational level and BMI. RESULTS: No differences were found in weight status at 36 months between intervention and control group children. At 6 months, BBOFT+ parents reported their child drinking less sweet beverages than control parents (48% vs 54%;p = .027), and going outdoors daily with their child less often (57% vs 62%;p = .03). At 14 months, more BBOFT+ parents than control parents reported to have breastfed for six months or longer (32% vs 29%;p = .022). At 36 months, more BBOFT+ parents than control parents reported their child going outside daily (78% vs 72%;p = .011) and having less TV/computer time on week- (38% vs 46%;p = .001) and weekend days (48% vs 56%;p = .002). Also, BBOFT+ parents reported having more parental control than control parents (3.92 vs 3.89;p = .02). No significant differences were found for daily breakfast, sleep duration and parenting practices in adjusted analyses. CONCLUSION: The BBOFT+ overweight prevention program showed small improvements in parent-reported child health behaviors, compared to care as usual; no effect was observed on child BMI. The identified modifiable elements are potentially relevant for interventions that aim to prevent overweight.


Assuntos
Índice de Massa Corporal , Educação não Profissionalizante/métodos , Comportamentos Relacionados com a Saúde/fisiologia , Sobrepeso/prevenção & controle , Poder Familiar , Adulto , Desenvolvimento Infantil/fisiologia , Serviços de Saúde da Criança , Pré-Escolar , Análise por Conglomerados , Feminino , Humanos , Lactente , Recém-Nascido , Estilo de Vida , Masculino , Países Baixos , Visita a Consultório Médico , Relações Pais-Filho , Obesidade Pediátrica/prevenção & controle , Prevenção Primária/métodos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
11.
Lancet Diabetes Endocrinol ; 8(9): 793-800, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32822601

RESUMO

Gestational diabetes, the most common medical disorder in pregnancy, is defined as glucose intolerance resulting in hyperglycaemia that begins or is first diagnosed in pregnancy. Gestational diabetes is associated with increased pregnancy complications and long-term metabolic risks for the woman and the offspring. However, the current diagnostic and management strategies recommended by national and international guidelines are mainly focused on short-term risks during pregnancy and delivery, except the Carpenter-Coustan criteria, which were based on the risk of future incidence of type 2 diabetes post-gestational diabetes. In this Personal View, first, we summarise the evidence for long-term risk in women with gestational diabetes and their offspring. Second, we suggest that a shift is needed in the thinking about gestational diabetes; moving from the perception of a short-term condition that confers increased risks of large babies to a potentially modifiable long-term condition that contributes to the growing burden of childhood obesity and cardiometabolic disorders in women and the future generation. Third, we propose how the current clinical practice might be improved. Finally, we outline and justify priorities for future research.


Assuntos
Saúde da Criança/tendências , Diabetes Gestacional/terapia , Saúde Materna/tendências , Criança , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/epidemiologia , Hiperglicemia/terapia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Gravidez
13.
Int J Behav Nutr Phys Act ; 17(1): 95, 2020 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-32711523

RESUMO

BACKGROUND: The few health behavior interventions commencing in infancy have shown promising effects. Greater insight into their longer-term benefits is required. This study aimed to assess post-intervention effects of the Melbourne INFANT Program to child age 5y on diet, movement and adiposity. METHODS: Two and 3.5y post-intervention follow-up (2011-13; analyses completed 2019) of participants retained in the Melbourne INFANT Program at its conclusion (child age ~ 19 m; 2008-10) was conducted. The Melbourne INFANT Program is a 15-month, six session program delivered within first-time parent groups in Melbourne, Australia, between child age 4-19 m. It involves strategies to help parents promote healthy diet, physical activity and reduced sedentary behavior in their infants. No intervention was delivered during the follow-up period reported in this paper. At all time points height, weight and waist circumference were measured by researchers, children wore Actigraph and activPAL accelerometers for 8-days, mothers reported children's television viewing and use of health services. Children's dietary intake was reported by mothers in three unscheduled telephone-administered 24-h recalls. RESULTS: Of those retained at program conclusion (child age 18 m, n = 480; 89%), 361 families (75% retention) participated in the first follow-up (2y post-intervention; age 3.6y) and 337 (70% retention) in the second follow-up (3.5y post-intervention; age 5y). At 3.6y children in the intervention group had higher fruit (adjusted mean difference [MD] = 25.34 g; CI95:1.68,48.99), vegetable (MD = 19.41; CI95:3.15,35.67) and water intake (MD = 113.33; CI95:40.42,186.25), than controls. At 5y they consumed less non-core drinks (MD = -27.60; CI95:-54.58,-0.62). Sweet snack intake was lower for intervention children at both 3.6y (MD = -5.70; CI95:-9.75,-1.65) and 5y (MD = -6.84; CI95:-12.47,-1.21). Intervention group children viewed approximately 10 min/day less television than controls at both follow-ups, although the confidence intervals spanned zero (MD = -9.63; CI95:-30.79,11.53; MD = -11.34; CI95:-25.02,2.34, respectively). There was no evidence for effect on zBMI, waist circumference z-score or physical activity. CONCLUSIONS: The impact of this low-dose intervention delivered during infancy was still evident up to school commencement age for several targeted health behaviors but not adiposity. Some of these effects were only observed after the conclusion of the intervention, demonstrating the importance of long-term follow-up of interventions delivered during early childhood. TRIAL REGISTRATION: ISRCTN Register ISRCTN81847050 , registered 7th November 2007.


Assuntos
Dieta , Exercício Físico , Comportamentos Relacionados com a Saúde , Obesidade Pediátrica/prevenção & controle , Comportamento Sedentário , Austrália/epidemiologia , Peso Corporal , Saúde da Criança/economia , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino
14.
Am J Public Health ; 110(S2): S251-S257, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32663093

RESUMO

Objectives. To examine effects of unmet social needs on adherence to pediatric weight management intervention (PWMI).Methods. We examined individual associations of positive screens for parental stress, parental depression, food insecurity, and housing insecurity with intervention adherence, and associations of 0, 1 or 2, and 3 or 4 unmet social needs with adherence, among children enrolled in a 2017-2019 comparative effectiveness trial for 2 high-intensity PWMIs in Massachusetts. Models were adjusted for child age, body mass index (BMI), parent BMI, and intervention arm.Results. Families with versus without housing insecurity received a mean of 5.3 (SD = 8.0) versus 8.3 (SD = 10.9) contact hours (P < .01). There were no statistically significant differences in adherence for families reporting other unmet social needs. Children with 3 to 4 unmet social needs versus without received a mean of 5.2 (SD = 8.1) versus 9.2 (SD = 11.8) contact hours (P < .01). In fully adjusted models, those with housing insecurity attended a mean difference of -3.14 (95% confidence interval [CI] = -5.41, -0.88) hours versus those without. Those with 3 or 4 unmet social needs attended -3.74 (95% CI = -6.64, -0.84) hours less than those with none.Conclusions. Adherence to PWMIs was lower among children with housing insecurity and in families with 3 or 4 unmet social needs. Addressing social needs should be a priority of PWMIs to improve intervention adherence and reduce disparities in childhood obesity.Trial Registration: ClinicalTrials.gov identifier: NCT03012126.


Assuntos
Habitação , Obesidade Pediátrica/prevenção & controle , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adulto , Índice de Massa Corporal , Criança , Depressão , Feminino , Abastecimento de Alimentos , Humanos , Masculino , Massachusetts , Pais/psicologia , Fatores Socioeconômicos , Estresse Psicológico
15.
Health Qual Life Outcomes ; 18(1): 213, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631401

RESUMO

BACKGROUND AND PURPOSE: Obesity has become a serious public health problem and family- and school-based interventions including physical exercise and diet control have been widely applied to attempt to combat this issue. The purpose of our study was to verify the effectiveness of an obesity-related comprehensive intervention model aimed at improving quality of life (QoL) among adolescents. METHODS: A cluster randomized controlled trial (RCT) was conducted involving 948 subjects who were divided into an intervention group (n = 518) and a control group (n = 430). The intervention group received 1 year of obesity-related health education, physical exercise, and diet control. Their baseline body mass index (BMI) was calculated, and their QoL and basic information were assessed both before and after the intervention period using a self-designed Adolescent Quality of Life Scale and a basic information questionnaire. RESULTS: After the intervention, significant differences in the psychological, social, and pubertal dimensions, and in total QoL (P < 0.05) were observed in the intervention group relative to the control group. Improved psychological QoL in the intervention group was our most robust study finding, with increases in psychological (B = 1.883, SE = 0.646, P = 0.004), pubertal (B = 0.853, SE = 0.296, P = 0.004) and total (B = 3.024, SE = 1.214, P = 0.013) QoL all being higher in this group. This intervention effect was found to be more substantial in boys than in girls. CONCLUSIONS: Family-individual-school-based interventions combining obesity-related health education, physical exercise, and diet control can improve psychological, pubertal, and total QoL in children, with these effects being most pronounced in boys. TRIAL REGISTRATION: retrospectively registered NCT02343588 .


Assuntos
Exercício Físico/psicologia , Obesidade Pediátrica/dietoterapia , Obesidade Pediátrica/prevenção & controle , Obesidade Pediátrica/psicologia , Qualidade de Vida/psicologia , Serviços de Saúde Escolar/organização & administração , Estudantes/psicologia , Adolescente , Índice de Massa Corporal , Criança , China/epidemiologia , Feminino , Humanos , Masculino , Obesidade Pediátrica/epidemiologia , Fatores Socioeconômicos
16.
PLoS One ; 15(7): e0236261, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687510

RESUMO

Dietary and physical activity behaviors formed early in life can increase risk for childhood obesity and have continued negative consequences for lifelong health. Previous research has highlighted the importance of both genetic and environmental (e.g., cultural environment or parental lifestyle) contributions to obesity risk, although these studies typically involve genetically-related individuals residing in the same household, where genetic similarity and rearing environment are inextricably linked. Here we utilize a sibling-adoption design to independently estimate genetic and environmental contributions to obesity risk in childhood and describe how these influences might vary as children age. As part of a prospective adoption study, the current investigation used data from biological siblings reared either apart or together, and nonbiological siblings reared together to estimate the contributions of genetics and environment to body mass indices (BMI) in a large cohort of children (N = 711). We used a variance partitioning model to allocate variation in BMI to that which is due to shared genetics, common environment, or unique environment in this cohort during middle childhood and adolescence. We found 63% of the total variance in BMI could be attributed to heritable factors in middle childhood sibling pairs (age 5-11.99; 95% CI [0.41,0.85]). Additionally, we observed that common environment explained 31% of variation in BMI in this group (95% CI [0.11,0.5]), with unique environment and error explaining the remaining variance. We failed to detect an influence of genetics or common environment in older sibling pairs (12-18) or pairs spanning childhood and adolescence (large sibling age difference), but home type (adoptive versus birth) was an important predictor of BMI in adolescence. The presence of strong common environment effects during childhood suggests that early interventions at the family level in middle childhood could be effective in mitigating obesity risk in later childhood and adolescence.


Assuntos
Adoção , Índice de Massa Corporal , Interação Gene-Ambiente , Obesidade Pediátrica/epidemiologia , Irmãos , Adolescente , Criança , Desenvolvimento Infantil/fisiologia , Educação Infantil , Pré-Escolar , Feminino , Humanos , Masculino , Obesidade Pediátrica/genética , Obesidade Pediátrica/fisiopatologia , Obesidade Pediátrica/prevenção & controle , Estudos Prospectivos
17.
Artigo em Inglês | MEDLINE | ID: mdl-32727086

RESUMO

Background: The purpose of this study was to evaluate the implementation and effectiveness of an ecological, multi-component adolescent obesity prevention intervention called School Wellness Integration Targeting Child Health-Middle School (SWITCH-MS). Methods: Following the effectiveness-implementation hybrid type 3 quasi-experimental design, seven middle schools (377 students) in Iowa, United States, were stratified into "experienced" (n = 3; 110 students) or "inexperienced" (n = 4; 267 students) groups to receive the 12-week SWITCH-MS intervention. To evaluate implementation, school informants (n = 10) responded to a survey and students completed behavioral tracking in the classroom on a website. For effectiveness evaluation, students in 6th, 7th, and 8th grades completed a validated questionnaire before and after intervention, to measure behaviors of physical activity (PA; "Do"), screen-based activity ("View"), and fruits and vegetable consumption ("Chew"). Results: The two groups of schools showed similar levels of implementation for best practices, awareness, and engagement. Behavioral tracking rate favored the experienced schools early on (47.5% vs. 11.7%), but differences leveled off in weeks 3-12 (sustained at 30.1-44.3%). Linear mixed models demonstrated significant time effects for "Do" (at school and out of school; p < 0.01) and "View" behaviors (p = 0.02), after controlling for student- and school-level covariates. Conclusions: This study demonstrates that prior experience with SWITCH-MS may not be a prominent factor for implementation and effectiveness, although greater experience is associated with favorable behavioral tracking when the intervention is first launched.


Assuntos
Promoção da Saúde , Obesidade Pediátrica , Serviços de Saúde Escolar , Adolescente , Criança , Exercício Físico , Feminino , Humanos , Iowa , Masculino , Obesidade Pediátrica/prevenção & controle , Instituições Acadêmicas
18.
High Blood Press Cardiovasc Prev ; 27(5): 417-419, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32648163

RESUMO

Too many children in Europe are overweight. The unregulated marketing of unhealthy products target to children, and the installation of vending machines stocked with unhealthy snacks in public venues, are contributing factors. While innovative legislation on the regulation of the nutritional quality of food and beverages sold in vending machines in schools has become law in some European countries, it is not on the political agenda in others. However, an easy alternative solution could be to introduce a clause in all new tenders for vending machines, which states that the successful supplier must commit to ensuring that at least 50% of the products sold have a medium-to-small portion size, are low in saturated fat, salt, calories, and have no added sugar. This strategy, called "A vending machine for a friend", was developed at CNR of Rome, and with the support of the SIPREC, the LHA and the EHN, and with the alliance with teachers and students, is being rolled out in some Italian and Lithuanian high schools. Creating a healthy nutritional environment with the aim of encouraging healthier choices, is a real possibility.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dieta Saudável , Comportamento Alimentar , Distribuidores Automáticos de Alimentos , Serviços de Alimentação , Obesidade Pediátrica/prevenção & controle , Serviços Preventivos de Saúde , Comportamento de Redução do Risco , Serviços de Saúde Escolar , Adolescente , Fatores Etários , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Valor Nutritivo , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Tamanho da Porção , Fatores de Proteção , Medição de Risco , Fatores de Risco
19.
BMC Public Health ; 20(1): 941, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539822

RESUMO

BACKGROUND: The aims of the present study were to assess changes in weight status between the first and last year of primary education among children with overweight/obesity in response to locally implemented school-based prevention programs, and to assess the influence of process indicators, expressed as child-staff ratios (CSRs), on these changes. METHODS: To meet the study objectives, a quasi-experimental design was used. Four municipalities that systematically monitored the weight status of schoolchildren and participated in the "Vivons en Forme" program agreed to provide the data available in their school medical service records. The local implementers involved in training sessions were mainly municipal staff in charge of serving midday school meals, which is compulsory in France, and those in charge of designing and facilitating creative, interactive activities at school between and after classes. CSRs were determined by occupation (school catering service/facilitator of extracurricular activities) and training session (healthy eating/physical activity) in each municipality program, and classified as low (1-5 children per adult) or moderate. RESULTS: During the 4 years of primary education, weight status improved in half of the children with overweight/obesity, and worsened in 6.6% of children with overweight/normal weight. In children who remained overweight, the BMI z-score diminished over time. Estimates of the positive 4-year weight changes were related to low CSRs in locally implemented variations of the program. Estimates increased with age and were significantly higher in low-to-moderate CSR multicomponent interventions than moderate CSR single-component intervention (reference). The moderate CSR multicomponent intervention had a similar effect as the reference. The estimated negative weight change decreased with age. CONCLUSIONS: Our findings suggest that training ancillary school staff in experiential-focused interventions for healthy eating and physical activity in locally implemented school-based programs contributed positively to reducing childhood obesity during the four years of primary education without interfering with educational activities. The results also provide preliminary evidence that low CSRs could be pivotal for optimal outcomes, especially in deprived areas.


Assuntos
Trajetória do Peso do Corpo , Dieta Saudável/psicologia , Exercício Físico/psicologia , Promoção da Saúde/métodos , Obesidade Pediátrica/prevenção & controle , Serviços de Saúde Escolar/organização & administração , Adolescente , Criança , Feminino , França , Humanos , Masculino
20.
BMC Public Health ; 20(1): 917, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532242

RESUMO

BACKGROUND: There is a pressing need for policy makers to demonstrate progress made on investments in prevention, but few examples of monitoring systems capable of tracking population-level prevention policies and programs and their implementation. In New South Wales, Australia, the scale up of childhood obesity prevention programs to over 6000 childcare centres and primary schools is monitored via an electronic monitoring system, "PHIMS". METHODS: Via a focussed ethnography with all 14 health promotion implementation teams in the state, we set out to explore what aspects of program implementation are captured via PHIMS, what aspects are not, and the implications for future IT implementation monitoring systems as a result. RESULTS: Practitioners perform a range of activities in the context of delivering obesity prevention programs, but only specific activities are captured via PHIMS. PHIMS thereby defines and standardises certain activities, while non-captured activities can be considered as "extra" work by practitioners. The achievement of implementation targets is influenced by multi-level contextual factors, with only some of the factors accounted for in PHIMS. This evidences incongruencies between work done, recorded and, therefore, recognised. CONCLUSIONS: While monitoring systems cannot and should not capture every aspect of implementation, better accounting for aspects of context and "extra" work involved in program implementation could help illuminate why implementation succeeds or fails. Failure to do so may result in policy makers drawing false conclusions about what is required to achieve implementation targets. Practitioners, as experts of context, are well placed to assist policy makers to develop accurate and meaningful implementation targets and approaches to monitoring.


Assuntos
Eletrônica Médica , Implementação de Plano de Saúde , Promoção da Saúde , Obesidade Pediátrica/prevenção & controle , Antropologia Cultural , Criança , Humanos , New South Wales , Formulação de Políticas , Instituições Acadêmicas
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