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A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents : a cluster randomized controlled trial

Angélica Ochoa-Avilés, Roosmarijn Verstraeten UGent, Lieven Huybregts, Susana Andrade, John Van Camp UGent, Silvana Donoso, Patricia Liliana Ramírez, Carl Lachat UGent, Lea Maes UGent and Patrick Kolsteren UGent (2017) NUTRITION JOURNAL. 16.
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.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
Health promotion, Dietary intake, Andes, Cluster randomized controlled trial, ECUADORIAN ADOLESCENTS, BEHAVIORAL INTERVENTIONS, OBESITY PREVENTION, CHILDHOOD OBESITY, PHYSICAL-ACTIVITY, RISK-FACTORS, DISEASE, FITNESS, HEALTH, VEGETABLES
journal title
NUTRITION JOURNAL
Nutr. J.
volume
16
article number
79
pages
12 pages
Web of Science type
Article
Web of Science id
000417872800001
ISSN
1475-2891
DOI
10.1186/s12937-017-0299-5
language
English
UGent publication?
yes
classification
A1
copyright statement
Creative Commons Attribution 4.0 International Public License (CC-BY 4.0)
id
8542169
handle
http://hdl.handle.net/1854/LU-8542169
date created
2017-12-16 17:34:41
date last changed
2018-01-08 15:22:33
@article{8542169,
  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.},
  articleno    = {79},
  author       = {Ochoa-Avil{\'e}s, Ang{\'e}lica and Verstraeten, Roosmarijn and Huybregts, Lieven and Andrade, Susana and Van Camp, John and Donoso, Silvana and Ram{\'i}rez, Patricia Liliana and Lachat, Carl and Maes, Lea and Kolsteren, Patrick},
  issn         = {1475-2891},
  journal      = {NUTRITION JOURNAL},
  keyword      = {Health promotion,Dietary intake,Andes,Cluster randomized controlled trial,ECUADORIAN ADOLESCENTS,BEHAVIORAL INTERVENTIONS,OBESITY PREVENTION,CHILDHOOD OBESITY,PHYSICAL-ACTIVITY,RISK-FACTORS,DISEASE,FITNESS,HEALTH,VEGETABLES},
  language     = {eng},
  pages        = {12},
  title        = {A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents : a cluster randomized controlled trial},
  url          = {http://dx.doi.org/10.1186/s12937-017-0299-5},
  volume       = {16},
  year         = {2017},
}

Chicago
Ochoa-Avilés, Angélica, Roosmarijn Verstraeten, Lieven Huybregts, Susana Andrade, John Van Camp, Silvana Donoso, Patricia Liliana Ramírez, Carl Lachat, Lea Maes, and Patrick Kolsteren. 2017. “A School-based Intervention Improved Dietary Intake Outcomes and Reduced Waist Circumference in Adolescents : a Cluster Randomized Controlled Trial.” Nutrition Journal 16.
APA
Ochoa-Avilés, A., Verstraeten, R., Huybregts, L., Andrade, S., Van Camp, J., Donoso, S., Ramírez, P. L., et al. (2017). A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents : a cluster randomized controlled trial. NUTRITION JOURNAL, 16.
Vancouver
1.
Ochoa-Avilés A, Verstraeten R, Huybregts L, Andrade S, Van Camp J, Donoso S, et al. A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents : a cluster randomized controlled trial. NUTRITION JOURNAL. 2017;16.
MLA
Ochoa-Avilés, Angélica, Roosmarijn Verstraeten, Lieven Huybregts, et al. “A School-based Intervention Improved Dietary Intake Outcomes and Reduced Waist Circumference in Adolescents : a Cluster Randomized Controlled Trial.” NUTRITION JOURNAL 16 (2017): n. pag. Print.