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.
Independent researcher, Ghent, Belgium.
Nutr J. 2017 Dec 11;16(1):79. doi: 10.1186/s12937-017-0299-5.
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.
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.
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.
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.
ClinicalTrial.gov-NCT01004367 .
在厄瓜多尔，青少年的饮食摄入不符合健康饮食指南。青少年饮食不当加上腹部肥胖是导致非传染性疾病的危险因素。我们报告了一项基于学校的干预措施对厄瓜多尔青少年饮食摄入和腰围的有效性。
一项配对的聚类随机对照试验纳入了 1430 名 12-14 岁的青少年。该方案旨在提高饮食摄入的营养价值、身体活动（主要结果）、体重指数、腰围和血压（次要结果）。本文报告：（i）水果和蔬菜摄入量、添加糖摄入量、不健康零食摄入量（在零食时间食用不符合饮食指南的不健康食物，即食糖、糖果、咸点心、快餐、软饮料和包装食品）、早餐摄入量和腰围的变化；（ii）干预的剂量和范围。饮食结果通过在基线、第一阶段的 17 个月后（第一阶段）和实施的最后 11 个月后（第二阶段）进行两次 24 小时回顾来估计。剂量和范围通过现场记录和出勤表进行评估。在学校中为家长和食品亭工作人员实施了教育工具包和健康饮食研讨会。在两个不同阶段实施了干预措施。使用线性混合模型评估总体效果，并应用回归样条混合效应模型评估每个阶段后的效果。
对 20 所学校的 1046 名青少年进行了数据分析。与对照组相比，干预组在试验结束时食用的不健康零食量较低（-23.32g；95%CI：-45.25，-1.37），添加糖摄入量较低（-5.66g；95%CI：-9.63，-1.65）。与基线相比，干预组和对照组的每日水果和蔬菜摄入量均有所下降，但干预组的下降幅度为 23.88g（95%CI：7.36，40.40）。试验结束时，干预组的腰围（-0.84cm；95%CI：-1.68，0.28）较低；该效果主要在第一阶段观察到。在第一阶段，剂量和范围也更高。
该试验对非传染性疾病的风险因素产生了积极影响，即减少了不健康零食的摄入。必须通过学术界和政策制定者之间的合作，在国家一级实施该方案战略，以确保在更大范围内产生影响。
ClinicalTrial.gov-NCT01004367。
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