Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain; National Center for Cardiovascular Research (Centro Nacional de Investigaciones Cardiovasculares [CNIC]), Madrid, Spain.
Foundation for Science, Health and Education (Fundación SHE), Barcelona, Spain.
J Am Coll Cardiol. 2024 Aug 6;84(6):499-508. doi: 10.1016/j.jacc.2024.04.065.
The results of most school-based health promotion initiatives are inconclusive.
This trial assessed the effect of time-varying exposures to a multicomponent school-based health promotion intervention (SI! Program) on adiposity markers.
A total of 48 schools in Madrid (Spain) were cluster randomized to receive the SI! Program through elementary education grades 1 to 6 (E1-6, 12 schools, 459 children), 1 to 3 (E1-3, 12 schools, 513 children), or 4 to 6 (E4-6, 12 schools, 419 children) or to receive the standard curriculum (control, 12 schools, 379 children). The primary endpoint was the between-group difference at 3- and 6-year follow-up in the change from baseline in adiposity markers and the overall knowledge-attitudes-habits (KAH) score.
At 3-year follow-up, children who had the intervention showed significantly lower increases than the control group in z-scores for body mass index (BMI), waist-to-height ratio (WHtR), and waist circumference (WC) (zBMI: -0.09; 95% CI: -0.16 to -0.03; P = 0.003; zWC and zWHtR: -0.19; 95% CI: -0.28 to -0.10; P < 0.001). At 6-year follow-up, the beneficial trend in zWC and zWHtR was maintained in the E1-6 and E1-3 groups: difference zWC control vs E1-6 (-0.19; 95% CI: -0.36 to -0.03; P = 0.020), control vs E1-3 (-0.22; 95% CI: -0.38 to -0.06; P = 0.009); difference zWHtR control vs E1-6 (-0.24; 95% CI: -0.41 to -0.06; P = 0.009), and control vs E1-3 (-0.29; 95% CI: -0.47 to -0.11; P = 0.001). No significant between-group differences were found in the change of overall KAH score.
Early elementary school interventions may be more effective than later interventions on abdominal adiposity. Further research should assess the sustainability effects of school-based health promotion programs.
大多数基于学校的健康促进计划的结果尚无定论。
本试验旨在评估时间变化的多组分基于学校的健康促进干预措施（SI！计划）对肥胖指标的影响。
马德里（西班牙）共有 48 所学校进行了聚类随机分组，以通过小学 1 至 6 年级（E1-6，12 所学校，459 名儿童），1 至 3 年级（E1-3，12 所学校，513 名儿童）或 4 至 6 年级（E4-6，12 所学校，419 名儿童）接受 SI！计划，或接受标准课程（对照组，12 所学校，379 名儿童）。主要终点是在 3 年和 6 年随访时，基线时肥胖指标和总体知识态度习惯（KAH）评分的变化。
在 3 年随访时，与对照组相比，接受干预的儿童的体重指数（BMI）、腰围身高比（WHtR）和腰围（WC）的 z 评分增加幅度明显较低（zBMI：-0.09；95％CI：-0.16 至-0.03；P=0.003；zWC 和 zWHtR：-0.19；95％CI：-0.28 至-0.10；P<0.001）。在 6 年随访时，E1-6 和 E1-3 组的 zWC 和 zWHtR 仍保持有益趋势：与对照组相比，WC 差值 zWC （E1-6）（-0.19；95％CI：-0.36 至-0.03；P=0.020），WC 差值 zWC （E1-3）（-0.22；95％CI：-0.38 至-0.06；P=0.009）；与对照组相比，WHtR 差值 zWHtR （E1-6）（-0.24；95％CI：-0.41 至-0.06；P=0.009），WHtR 差值 zWHtR （E1-3）（-0.29；95％CI：-0.47 至-0.11；P=0.001）。总体 KAH 评分的变化无显著组间差异。
小学早期干预可能比后期干预对腹部肥胖更有效。应进一步研究评估基于学校的健康促进计划的可持续效果。
