Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu.
Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu.
JAMA Netw Open. 2018 Oct 5;1(6):e183896. doi: 10.1001/jamanetworkopen.2018.3896.
Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention.
To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children's Healthy Living Program.
DESIGN, SETTING, AND PARTICIPANTS: In this multijurisdictional, multilevel, multicomponent community randomized clinical trial, where all evaluable children were analyzed according to the random assignment of their community, hierarchical difference-in-difference models accounted for the community randomization, community clustering with jurisdictions, and these models were adjusted for the age and sex distribution of the community. The setting was 27 communities in 5 jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and Hawaii). Participants were 4329 children (time 1) and 4042 children (time 2) aged 2 to 8 years in 27 selected communities from October 7, 2012, to October 25, 2015. Data analysis was completed in June 2018.
Nineteen activities addressed policy, environment, messaging, training, and 6 target behaviors (sleep time, screen time, physical activity, fruits and vegetables, water, and sugar-sweetened beverages).
Primary outcomes were body size measurements. Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire reponses.
The study included 27 communities and 8371 evaluable children (mean [SD] age, 5.4 [1.8] years; 50.9% male [n = 4264]). Data analysis included 952 children in the intervention group and 930 children in the control group aged 2 to 5 years at time 1; 825 children in the intervention group and 735 children in the control group aged 2 to 5 years at time 2; 565 children in the intervention group and 561 children in the control group aged 6 to 8 years at time 1; and 517 children in the intervention group and 560 children in the control group aged 6 to 8 years at time 2. The intervention communities showed significant improvement compared with control communities in overweight and obesity prevalence (effect size [d] = -3.95%; 95% CI, -7.47% to -0.43%), waist circumference (d = -0.71 cm; 95% CI, -1.37 to -0.05 cm), and acanthosis nigricans prevalence (d = -2.28%; 95% CI, -2.77% to -1.57%). Age and sex subgroup analysis revealed greater difference among the intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (-3.99%) vs the group aged 6 to 8 years (-3.40%), and the interaction was significant (d = 0.59%, P < .001), as well as the smaller difference in the group aged 2 to 5 years (-0.10%) vs the group aged 6 to 8 years (-1.07%) in screen time (d = -0.97 hour per day, P = .01).
The intervention reduced the prevalence of young child overweight and obesity and acanthosis nigricans. Comprehensive, effective, and sustainable interventions are needed to improve child health in the US-Affiliated Pacific region.
ClinicalTrials.gov Identifier: NCT01881373.
太平洋岛民的肥胖和 2 型糖尿病发病率在全球最高。针对儿童进行干预对于初级预防至关重要。
通过儿童健康生活计划预防美国太平洋附属地区的幼儿超重和肥胖，并改善儿童健康。
设计、设置和参与者：这是一项多司法管辖区、多层次、多成分的社区随机临床试验，根据社区的随机分配，对所有可评估的儿童进行分析，分层差异-差异模型考虑了社区随机化、社区与司法管辖区的聚类，并且这些模型根据社区的年龄和性别分布进行了调整。该研究地点为 5 个司法管辖区（阿拉斯加、美属萨摩亚、北马里亚纳群岛联邦、关岛和夏威夷）的 27 个社区。参与者为来自 2012 年 10 月 7 日至 2015 年 10 月 25 日的 27 个选定社区的 4329 名年龄在 2 至 8 岁的儿童（时间 1）和 4042 名年龄在 2 至 8 岁的儿童（时间 2）。数据分析于 2018 年 6 月完成。
19 项活动针对政策、环境、信息、培训和 6 项目标行为（睡眠时间、屏幕时间、体育活动、水果和蔬菜、水和含糖饮料）。
主要结果是身体尺寸测量。次要结果是黑棘皮病、睡眠质量和持续时间、饮食摄入、身体活动和其他问卷调查回答。
该研究包括 27 个社区和 8371 名可评估儿童（平均[标准差]年龄，5.4[1.8]岁；50.9%为男性[n=4264]）。数据分析包括时间 1 时年龄为 2 至 5 岁的干预组 952 名儿童和对照组 930 名儿童；时间 2 时年龄为 2 至 5 岁的干预组 825 名儿童和对照组 735 名儿童；时间 1 时年龄为 6 至 8 岁的干预组 565 名儿童和对照组 561 名儿童；时间 2 时年龄为 6 至 8 岁的干预组 517 名儿童和对照组 560 名儿童。与对照组社区相比，干预社区的超重和肥胖患病率（效应大小[d]为-3.95%；95%置信区间为-7.47%至-0.43%）、腰围（d=-0.71 cm；95%置信区间为-1.37 至-0.05 cm）和黑棘皮病患病率（d=-2.28%；95%置信区间为-2.77%至-1.57%）均有显著改善。年龄和性别亚组分析显示，干预社区在年龄为 2 至 5 岁的儿童中黑棘皮病患病率的差异较大（-3.99%），而在年龄为 6 至 8 岁的儿童中差异较小（-3.40%），且交互作用显著（d=0.59%，P<0.001），在年龄为 2 至 5 岁的儿童中屏幕时间的差异较小（-0.10%），而在年龄为 6 至 8 岁的儿童中差异较大（-1.07%）（d=每天减少 0.97 小时，P=0.01）。
干预措施降低了幼儿超重和肥胖以及黑棘皮病的患病率。需要全面、有效和可持续的干预措施来改善美国太平洋附属地区的儿童健康。
ClinicalTrials.gov 标识符：NCT01881373。
