Department of Internal Medicine, Division of General Medicine, School of Medicine, Patient Support Services Building, 4150 V Street, Suite 2400, UC Davis Medical Center, Sacramento, CA, 95817, USA.
Department of Nutrition, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA.
BMC Public Health. 2019 May 16;19(1):582. doi: 10.1186/s12889-019-6897-8.
Obesity and overweight have increased dramatically in the United States over the last decades. The complexity of interrelated causal factors that result in obesity needs to be addressed within the cultural dynamic of sub-populations. In this study, we sought to estimate the effects of a multifaceted, community-based intervention on body mass index (BMI) among Mexican-heritage children.
Niños Sanos, Familia Sana (Healthy Children, Healthy Family) was a quasi-experimental intervention study designed to reduce the rate of BMI growth among Mexican-heritage children in California's Central Valley. Two rural communities were matched based on demographic and environmental characteristics and were assigned as the intervention or comparison community. The three-year intervention included parent workshops on nutrition and physical activity; school-based nutrition lessons and enhanced physical education program for children; and a monthly voucher for fruits and vegetables. Eligible children were between 3 and 8 years old at baseline. Intent-to-treat analyses were estimated using linear mixed-effect models with random intercepts. We ran a series of models for each gender where predictors were fixed except interactions between age groups and obesity status at baseline with intervention to determine the magnitude of impact on BMI.
At baseline, mean (SD) BMI z-score (zBMI) was 0.97 (0.98) in the intervention group (n = 387) and 0.98 (1.02) in the comparison group (n = 313) (NS). The intervention was significantly associated with log-transformed BMI (β = 0.04 (0.02), P = 0.03) and zBMI (β = 0.25 (0.12), P = 0.04) among boys and log-transformed BMI among obese girls (β = - 0.04 (0.02), P = 0.04). The intervention was significantly and inversely associated with BMI in obese boys and girls across all age groups and normal weight boys in the oldest group (over 6 years) relative to their counterparts in the comparison community.
A community-based, multifaceted intervention was effective at slowing the rate of BMI growth among Mexican-heritage children. Our findings suggest that practitioners should consider strategies that address gender disparities and work with a variety of stakeholders to target childhood obesity.
clinicaltrials.gov Identifier: NCT01900613 . Registered 16th July 2013.
在过去几十年中，美国的肥胖和超重人口急剧增加。需要在亚人群的文化动态中解决导致肥胖的复杂相互关联的因果因素。在这项研究中，我们试图评估一种多方面的基于社区的干预措施对墨西哥裔儿童体重指数（BMI）的影响。
Niños Sanos，Familia Sana（健康儿童，健康家庭）是一项准实验性干预研究，旨在降低加利福尼亚州中央山谷中墨西哥裔儿童的 BMI 增长率。根据人口统计学和环境特征对两个农村社区进行匹配，并将其分配为干预社区或对照社区。为期三年的干预措施包括针对父母的营养和体育活动研讨会；针对儿童的学校营养课程和强化体育教育计划；以及每月提供水果和蔬菜的代金券。合格的儿童在基线时年龄在 3 至 8 岁之间。使用具有随机截距的线性混合效应模型进行意向性治疗分析。我们为每个性别运行了一系列模型，其中预测因子是固定的，除了年龄组之间的交互作用和基线时的肥胖状态与干预之间的交互作用，以确定对 BMI 的影响程度。
在基线时，干预组（n=387）的平均（SD）体重指数 z 分数（zBMI）为 0.97（0.98），对照组（n=313）为 0.98（1.02）（NS）。该干预措施与男孩的对数转换 BMI（β=0.04（0.02），P=0.03）和 zBMI（β=0.25（0.12），P=0.04）以及肥胖女孩的对数转换 BMI（β=-0.04（0.02），P=0.04）呈显著正相关。该干预措施与所有年龄组中肥胖男孩和女孩的 BMI 以及年龄较大组（6 岁以上）正常体重男孩的 BMI 呈显著负相关，与对照组相比，这些儿童的 BMI 增长速度较慢。
基于社区的多方面干预措施可有效减缓墨西哥裔儿童的 BMI 增长率。我们的研究结果表明，从业者应考虑采取解决性别差异的策略，并与各种利益相关者合作，以解决儿童肥胖问题。
clinicaltrials.gov 标识符：NCT01900613。于 2013 年 7 月 16 日注册。
