Yin Zenong, Liang Yuanyuan, Howard Jeffrey T, Errisuriz Vanessa, Estrada Vanessa Marie, Martinez Cristina, Li Shiyu, Ullevig Sarah Lynn, Sosa Erica, Olmstead Todd, Small Sharon, Ward Dianne Stanton, Parra-Medina Deborah
The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, TX, USA.
The University of Maryland, School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD, USA.
Public Health Nutr. 2023 Feb;26(2):476-487. doi: 10.1017/S1368980022002439. Epub 2022 Nov 11.
To test a culturally tailored obesity prevention intervention in low-income, minority preschool age children.
A three-group clustered randomised controlled trial.
Twelve Head Start centres were randomly assigned to a centre-based intervention, a combined centre- and home-based intervention, or control using a 1:1:1 ratio. The centre-based intervention modified centre physical activity and nutrition policies, staff practices, and child behaviours, while the home-based intervention supported parents for obesity prevention at home.
The primary end point was change in children's BMI (kg/m) at post-test immediately following completion of the 8-month intervention. Secondary end points included standardised scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl).
Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent ( 325), 87 % Latino, 57 % female with mean age (sd) of 3·58 years (0·29).
Change in BMI at post-test was 1·28 (0·97), 1·28 (0·87) and 1·41 (0·71) in the centre + home-based intervention, centre-based intervention and control, respectively. There was no significant difference in BMI change between centre + home-based intervention and control or centre-based intervention and control at post-test. BMIz (adjusted difference -0·12 (95 % CI, -0·24, 0·01), = 0·06) and WAZ (adjusted difference, -0·09 (-0·17, -0·002), = 0·04) were reduced for children in centre + home-based intervention compared with control group.
There was no reduction in BMI at post-test in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention.
在低收入少数族裔学龄前儿童中测试一种针对文化定制的肥胖预防干预措施。
三组整群随机对照试验。
12个启智中心被随机分配为以中心为基础的干预组、中心与家庭相结合的干预组或对照组，比例为1:1:1。以中心为基础的干预措施修改了中心的体育活动和营养政策、工作人员的做法以及儿童行为，而家庭干预措施则支持家长在家中预防肥胖。
主要终点是在8个月干预结束后立即进行的测试中儿童BMI（kg/m）的变化。次要终点包括BMI标准化分数（BMIz）、体重标准化分数（WAZ）和BMI百分位数（BMI pctl）。
在德克萨斯州圣安东尼奥市参加启智计划的三岁儿童，获得家长书面同意（325名），87%为拉丁裔，57%为女性，平均年龄（标准差）为3.58岁（0.29）。
在中心与家庭相结合的干预组、以中心为基础的干预组和对照组中，测试后BMI的变化分别为1.28（0.97）、1.28（0.87）和1.41（0.71）。在测试后，中心与家庭相结合的干预组与对照组之间或中心为基础的干预组与对照组之间的BMI变化没有显著差异。与对照组相比，中心与家庭相结合的干预组儿童的BMIz（调整差异-0.12（95%CI，-0.24，0.01），P=0.06）和WAZ（调整差异，-0.09（-0.17，-0.002），P=0.04）有所降低。
接受干预的儿童在测试后BMI没有降低。研究结果揭示了儿童肥胖研究中的方法学挑战，并为探索以健康公平为导向的肥胖预防提供了未来方向。
