Efthymiou Vasiliki, Charmandari Evangelia, Vlachakis Dimitrios, Tsitsika Artemis, Pałasz Artur, Chrousos George, Bacopoulou Flora
University Research Institute of Maternal and Child Health and Precision Medicine, and UNESCO Chair in Adolescent Health Care, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece.
Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece.
Nutrients. 2021 Dec 27;14(1):97. doi: 10.3390/nu14010097.
Self-efficacy is perhaps the most important parameter associated with behavioral changes. The main aim of this study was to provide insight into the diet and exercise self-efficacy of Greek adolescents and how they could be modified via a multilevel multicomponent school-based lifestyle intervention. Secondary aims were to study the associations of students' dietary and exercise self-efficacy indices with their anthropometric and sociodemographic parameters. A representative sample of the adolescent population in Attica, consisting of 1610 adolescents aged 12-17 years, recruited from 23 public high schools in three municipalities of the Attica area in Greece, received a three-component lifestyle educational intervention for health promotion and underwent screening for characteristics of metabolic syndrome with the use of portable telemedicine. All assessments and anthropometric measurements were performed at baseline and after the 6-month intervention. Anthropometric measurements included body mass index, waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR). Assessment tools included the Self-efficacy for Diet and the Self-efficacy for Exercise questionnaires, as well as the Mediterranean Diet Quality Index in Children and Adolescents (KIDMED). Analysis included 1020 adolescent students (421 males and 599 females), who completed the self-efficacy questionnaires pre- and post-intervention. Overall, the dietary ( < 0.001) and exercise ( < 0.001) self-efficacy increased significantly post-intervention. Post-intervention, all adolescents decreased their abdominal obesity indices (WC, WHtR, WHR), and this improvement was even more pronounced and significant ( = 0.019, = 0.019, = 0.023 respectively) in the adolescents with overweight/obesity. Post-intervention, the proportion of adolescents with normal weight increased from 73.9% to 78.6%, whereas the proportion of adolescents with overweight and obesity decreased from 20.4% to 15.9% and from 5.7% to 5.5%, respectively. Abdominal obesity also decreased from 10.4% to 9.0%. Female adolescents achieved significantly ( = 0.010) higher changes in diet self-efficacy than males. Other sociodemographic characteristics such as family structure, parental age, parental educational level and family income showed non-significant differences. Adolescents with higher KIDMED scores manifested significantly higher dietary and exercise self-efficacy than those with lower KIDMED scores. Both adolescents with normal weight and overweight/obesity manifested a reciprocal relation between diet and exercise self-efficacy. Multicomponent lifestyle interventions in the school environment may provide a first step in students' behavior changes and provide grounds for future prevention programs in youth.
自我效能感可能是与行为改变相关的最重要参数。本研究的主要目的是深入了解希腊青少年的饮食和运动自我效能感，以及如何通过基于学校的多层次多成分生活方式干预来改变它们。次要目的是研究学生的饮食和运动自我效能感指数与他们的人体测量和社会人口学参数之间的关联。从希腊阿提卡地区三个城市的23所公立高中招募了1610名12至17岁的青少年，作为阿提卡青少年人群的代表性样本，他们接受了一项三成分的生活方式教育干预以促进健康，并使用便携式远程医疗对代谢综合征特征进行了筛查。所有评估和人体测量均在基线和6个月干预后进行。人体测量包括体重指数、腰围（WC）、腰高比（WHtR）和腰臀比（WHR）。评估工具包括饮食自我效能感问卷和运动自我效能感问卷，以及儿童和青少年地中海饮食质量指数（KIDMED）。分析纳入了1020名青少年学生（421名男性和599名女性），他们在干预前后完成了自我效能感问卷。总体而言，干预后饮食（<0.001）和运动（<0.001）自我效能感显著提高。干预后，所有青少年的腹部肥胖指数（WC、WHtR、WHR）均下降，超重/肥胖青少年的这种改善更为明显且具有统计学意义（分别为=0.019、=0.019、=0.023）。干预后，体重正常的青少年比例从73.9%增加到78.6%，而超重和肥胖青少年的比例分别从20.4%下降到15.9%，从5.7%下降到5.5%。腹部肥胖也从10.4%下降到9.0%。女性青少年在饮食自我效能感方面的变化显著高于男性（=0.010）。其他社会人口学特征，如家庭结构、父母年龄、父母教育水平和家庭收入，差异无统计学意义。KIDMED得分较高的青少年在饮食和运动自我效能感方面明显高于得分较低的青少年。体重正常和超重/肥胖的青少年在饮食和运动自我效能感方面均呈现出相互关系。学校环境中的多成分生活方式干预可能是学生行为改变的第一步，并为未来的青少年预防计划提供依据。
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