Nutritional Sciences Programme & Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia.
Department of Bioscience, Faculty of Applied Sciences, Tunku Abdul Rahman University College, Kuala Lumpur 53300, Malaysia.
Nutrients. 2020 Sep 29;12(10):2972. doi: 10.3390/nu12102972.
Diet composition is a key determinant of childhood obesity. While whole grains and micronutrients are known to decrease the risk of obesity, there are no interventions originating from Southeast Asia that emphasize whole grain as a strategy to improve overall quality of diet in combating childhood obesity. The GReat-Child Trial aimed to improve whole grain intake and quality of diet among overweight and obese children. It is a quasi-experimental intervention based on Social Cognitive Theory. It has a 12-week intervention and 6-month follow-up, consisting of three components that address environmental, personal, and behavioral factors. The intervention consists of: (1) six 30 min lessons on nutrition, using the Malaysian Food Pyramid to emphasize healthy eating, (2) daily deliveries of wholegrain foods to schools so that children can experience and accept wholegrain foods, and (3) diet counseling to parents to increase availability of wholegrain foods at home. Two primary schools with similar demographics in Kuala Lumpur were assigned as control (CG) and intervention (IG) groups. Inclusion criteria were: (1) children aged 9 to 11 years who were overweight/obese; (2) who did not consume whole grain foods; and (3) who had no serious co-morbidity problems. The entire trial was completed by 63 children (31 IG; 32 CG). Study outcomes were measured at baseline and at two time points post intervention (at the 3rd [T1] and 9th [T2] months). IG demonstrated significantly higher intakes of whole grain (mean difference = 9.94, 95%CI: 7.13, 12.75, < 0.001), fiber (mean difference = 3.07, 95% CI: 1.40, 4.73, = 0.001), calcium (mean difference = 130.27, 95%CI: 74.15, 186.39, < 0.001), thiamin (mean difference = 58.71, 95%CI: 26.15, 91.28, = 0.001), riboflavin (mean difference = 0.84, 95%CI: 0.37, 1.32, = 0.001), niacin (mean difference = 0.35, 95%CI: 1.91, 5.16, < 0.001), and vitamin C (mean difference = 58.71, 95%CI: 26.15, 91.28, = 0.001) compared to CG in T1, after adjusting for covariates. However, T1 results were not sustained in T2 when intervention had been discontinued. The findings indicate that intervention emphasizing whole grains improved overall short-term but not long-term dietary intake among schoolchildren. We hope the present trial will lead to adoption of policies to increase whole grain consumption among Malaysian schoolchildren.
饮食结构是儿童肥胖的一个关键决定因素。虽然全谷物和微量营养素已被证实可降低肥胖风险，但目前还没有源自东南亚的干预措施强调全谷物作为改善儿童肥胖整体饮食质量的策略。GReat-Child 试验旨在提高超重和肥胖儿童的全谷物摄入量和饮食质量。这是一项基于社会认知理论的准实验干预研究。它有 12 周的干预和 6 个月的随访，包括三个部分，分别针对环境、个人和行为因素。干预措施包括：（1）六节 30 分钟的营养课程，使用马来西亚食物金字塔来强调健康饮食；（2）每天向学校提供全谷物食品，以便孩子们能够体验和接受全谷物食品；（3）对家长进行饮食咨询，以增加家庭中全谷物食品的供应。吉隆坡两所具有相似人口统计学特征的小学被分配为对照组（CG）和干预组（IG）。纳入标准为：（1）9 至 11 岁的超重/肥胖儿童；（2）不食用全谷物食品；（3）无严重合并症问题。整个试验由 63 名儿童（IG 组 31 名，CG 组 32 名）完成。研究结果在基线和干预后两个时间点（第 3 个月[T1]和第 9 个月[T2]）进行测量。IG 组的全谷物摄入量显著增加（平均差异=9.94，95%置信区间：7.13，12.75， < 0.001）、纤维摄入量（平均差异=3.07，95%置信区间：1.40，4.73， = 0.001）、钙摄入量（平均差异=130.27，95%置信区间：74.15，186.39， < 0.001）、硫胺素摄入量（平均差异=58.71，95%置信区间：26.15，91.28， = 0.001）、核黄素摄入量（平均差异=0.84，95%置信区间：0.37，1.32， = 0.001）、烟酸摄入量（平均差异=0.35，95%置信区间：1.91，5.16， < 0.001）和维生素 C 摄入量（平均差异=58.71，95%置信区间：26.15，91.28， = 0.001），与 CG 组相比，在 T1 时调整了协变量。然而，当干预停止后，T1 的结果在 T2 时并没有持续。研究结果表明，强调全谷物的干预措施提高了儿童的短期整体饮食摄入量，但对长期饮食摄入量没有影响。我们希望本试验将导致马来西亚采用增加儿童全谷物消费的政策。
