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A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial.
Nutr J 2017; 16(1):79NJ

Abstract

BACKGROUND

In Ecuador, adolescents' food intake does not comply with guidelines for a healthy diet. Together with abdominal obesity adolescent's inadequate diets are risk factors for non-communicable diseases. We report the effectiveness of a school-based intervention on the dietary intake and waist circumference among Ecuadorian adolescents.

METHODS

A pair-matched cluster randomized controlled trial including 1430 adolescents (12-14 years old) was conducted. The program aimed at improving the nutritional value of dietary intake, physical activity (primary outcomes), body mass index, waist circumference and blood pressure (secondary outcomes). This paper reports: (i) the effect on fruit and vegetable intake, added sugar intake, unhealthy snacking (consumption of unhealthy food items that are not in line with the dietary guidelines eaten during snack time; i.e. table sugar, sweets, salty snacks, fast food, soft drinks and packaged food), breakfast intake and waist circumference; and, (ii) dose and reach of the intervention. Dietary outcomes were estimated by means of two 24-h recall at baseline, after the first 17-months (stage one) and after the last 11-months (stage two) of implementation. Dose and reach were evaluated using field notes and attendance forms. Educational toolkits and healthy eating workshops with parents and food kiosks staff in the schools were implemented in two different stages. The overall effect was assessed using linear mixed models and regression spline mixed effect models were applied to evaluate the effect after each stage.

RESULTS

Data from 1046 adolescents in 20 schools were analyzed. Participants from the intervention group consumed lower quantities of unhealthy snacks (-23.32 g; 95% CI: -45.25,-1.37) and less added sugar (-5.66 g; 95% CI: -9.63,-1.65) at the end of the trial. Daily fruit and vegetable intake decreased in both the intervention and control groups compared to baseline, albeit this decrease was 23.88 g (95% CI: 7.36, 40.40) lower in the intervention group. Waist circumference (-0.84 cm; 95% CI: -1.68, 0.28) was lower in the intervention group at the end of the program; the effect was mainly observed at stage one. Dose and reach were also higher at stage one.

CONCLUSIONS

The trial had positive effects on risk factors for non-communicable diseases, i.e. decreased consumption of unhealthy snacks. The program strategies must be implemented at the national level through collaboration between the academia and policy makers to assure impact at larger scale.

TRIAL REGISTRATION

ClinicalTrial.gov-NCT01004367 .

Authors+Show Affiliations

Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador. angelica.ochoa@ucuenca.edu.ec.Independent researcher, Ghent, Belgium. Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium.Poverty, Health and Nutrition Division, International Food Policy Research Institute, 2033 K St, NW, Washington, DC, USA.Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador.Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium.Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador.Departmento de Biociencias, Grupo Nutrición Alimentación y Salud, Facultad de Ciencias Químicas, Universidad de Cuenca, Avenida 12 de Abril y Avenida Loja, 0101168, Cuenca, Ecuador.Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium.Department of Public Health, Ghent University, Ghent, Belgium.Department of Food Safety and Food Quality, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, B-9000, Ghent, Belgium.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29228946

Citation

Ochoa-Avilés, Angélica, et al. "A School-based Intervention Improved Dietary Intake Outcomes and Reduced Waist Circumference in Adolescents: a Cluster Randomized Controlled Trial." Nutrition Journal, vol. 16, no. 1, 2017, p. 79.
Ochoa-Avilés A, Verstraeten R, Huybregts L, et al. A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial. Nutr J. 2017;16(1):79.
Ochoa-Avilés, A., Verstraeten, R., Huybregts, L., Andrade, S., Van Camp, J., Donoso, S., ... Kolsteren, P. (2017). A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial. Nutrition Journal, 16(1), p. 79. doi:10.1186/s12937-017-0299-5.
Ochoa-Avilés A, et al. A School-based Intervention Improved Dietary Intake Outcomes and Reduced Waist Circumference in Adolescents: a Cluster Randomized Controlled Trial. Nutr J. 2017 Dec 11;16(1):79. PubMed PMID: 29228946.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial. AU - Ochoa-Avilés,Angélica, AU - Verstraeten,Roosmarijn, AU - Huybregts,Lieven, AU - Andrade,Susana, AU - Van Camp,John, AU - Donoso,Silvana, AU - Ramírez,Patricia Liliana, AU - Lachat,Carl, AU - Maes,Lea, AU - Kolsteren,Patrick, Y1 - 2017/12/11/ PY - 2017/02/15/received PY - 2017/11/23/accepted PY - 2017/12/13/entrez PY - 2017/12/13/pubmed PY - 2018/7/31/medline KW - Andes KW - Cluster randomized controlled trial KW - Dietary intake KW - Health promotion SP - 79 EP - 79 JF - Nutrition journal JO - Nutr J VL - 16 IS - 1 N2 - BACKGROUND: In Ecuador, adolescents' food intake does not comply with guidelines for a healthy diet. Together with abdominal obesity adolescent's inadequate diets are risk factors for non-communicable diseases. We report the effectiveness of a school-based intervention on the dietary intake and waist circumference among Ecuadorian adolescents. METHODS: A pair-matched cluster randomized controlled trial including 1430 adolescents (12-14 years old) was conducted. The program aimed at improving the nutritional value of dietary intake, physical activity (primary outcomes), body mass index, waist circumference and blood pressure (secondary outcomes). This paper reports: (i) the effect on fruit and vegetable intake, added sugar intake, unhealthy snacking (consumption of unhealthy food items that are not in line with the dietary guidelines eaten during snack time; i.e. table sugar, sweets, salty snacks, fast food, soft drinks and packaged food), breakfast intake and waist circumference; and, (ii) dose and reach of the intervention. Dietary outcomes were estimated by means of two 24-h recall at baseline, after the first 17-months (stage one) and after the last 11-months (stage two) of implementation. Dose and reach were evaluated using field notes and attendance forms. Educational toolkits and healthy eating workshops with parents and food kiosks staff in the schools were implemented in two different stages. The overall effect was assessed using linear mixed models and regression spline mixed effect models were applied to evaluate the effect after each stage. RESULTS: Data from 1046 adolescents in 20 schools were analyzed. Participants from the intervention group consumed lower quantities of unhealthy snacks (-23.32 g; 95% CI: -45.25,-1.37) and less added sugar (-5.66 g; 95% CI: -9.63,-1.65) at the end of the trial. Daily fruit and vegetable intake decreased in both the intervention and control groups compared to baseline, albeit this decrease was 23.88 g (95% CI: 7.36, 40.40) lower in the intervention group. Waist circumference (-0.84 cm; 95% CI: -1.68, 0.28) was lower in the intervention group at the end of the program; the effect was mainly observed at stage one. Dose and reach were also higher at stage one. CONCLUSIONS: The trial had positive effects on risk factors for non-communicable diseases, i.e. decreased consumption of unhealthy snacks. The program strategies must be implemented at the national level through collaboration between the academia and policy makers to assure impact at larger scale. TRIAL REGISTRATION: ClinicalTrial.gov-NCT01004367 . SN - 1475-2891 UR - https://www.unboundmedicine.com/medline/citation/29228946/A_school_based_intervention_improved_dietary_intake_outcomes_and_reduced_waist_circumference_in_adolescents:_a_cluster_randomized_controlled_trial_ L2 - https://nutritionj.biomedcentral.com/articles/10.1186/s12937-017-0299-5 DB - PRIME DP - Unbound Medicine ER -