Sauder K A, Dabelea D, Bailey-Callahan R, Kanott Lambert S, Powell J, James R, Percy C, Jenks B F, Testaverde L, Thomas J M, Barber R, Smiley J, Hockett C W, Zhong V W, Letourneau L, Moore K, Delamater A M, Mayer-Davis E
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
Pediatr Obes. 2018 May;13(5):321-329. doi: 10.1111/ijpo.12223. Epub 2017 Jun 21.
American Indian (AI) youth are at high risk for type 2 diabetes.
To partner with Eastern Band of Cherokee Indians and Navajo Nation to develop a culturally sensitive behavioural intervention for youth (Tribal Turning Point; TTP) and assess feasibility in an 8-month randomized pilot study.
We enrolled 62 overweight/obese AI children (7-10 years) who participated with ≥1 parent/primary caregiver. Intervention participants (n = 29) attended 12 group classes and five individual sessions. Control participants (n = 33) attended three health and safety group sessions. We analysed group differences for changes in anthropometrics (BMI, BMI z-score, waist circumference), cardiometabolic (insulin, glucose, blood pressure) and behavioural (physical activity and dietary self-efficacy) outcomes.
Study retention was 97%, and intervention group attendance averaged 84%. We observed significant treatment effects (p = 0.02) for BMI and BMI z-score: BMI increased in control (+1.0 kg m , p < 0.001) but not intervention participants (+0.3 kg m , p = 0.13); BMI z-score decreased in intervention (-0.17, p = 0.004) but not control participants (0.01, p = 0.82). There were no treatment effects for cardiometabolic or behavioural outcomes.
We demonstrated that a behavioural intervention is feasible to deliver and improved obesity measures in AI youth. Future work should evaluate TTP for effectiveness, sustainability and long-term impact in expanded tribal settings.
美国印第安（AI）青年患2型糖尿病的风险很高。
与切罗基印第安人东部部落和纳瓦霍族合作，为青年开发一种具有文化敏感性的行为干预措施（部落转折点；TTP），并在一项为期8个月的随机试点研究中评估其可行性。
我们招募了62名超重/肥胖的AI儿童（7 - 10岁），他们至少有1名家长/主要照顾者参与。干预组参与者（n = 29）参加了12次小组课程和5次个人辅导。对照组参与者（n = 33）参加了3次健康与安全小组课程。我们分析了两组在人体测量指标（BMI、BMI z评分、腰围）、心脏代谢指标（胰岛素、血糖、血压）和行为指标（身体活动和饮食自我效能）变化方面的差异。
研究保留率为97%，干预组的平均出勤率为84%。我们观察到BMI和BMI z评分有显著的治疗效果（p = 0.02）：对照组的BMI增加（+1.0 kg/m²，p < 0.001），而干预组参与者没有增加（+0.3 kg/m²，p = 0.13）；干预组的BMI z评分下降（-0.17，p = 0.004），而对照组参与者没有下降（0.01，p = 0.82）。心脏代谢或行为指标没有治疗效果。
我们证明了一种行为干预措施在AI青年中实施是可行的，并且改善了肥胖指标。未来的工作应该评估TTP在扩大的部落环境中的有效性、可持续性和长期影响。
