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Effect of the Children’s Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial

IMPORTANCE: Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention. OBJECTIVES: To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children’s Health...

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Autores principales: Novotny, Rachel, Davis, James, Butel, Jean, Boushey, Carol J., Fialkowski, Marie Kainoa, Nigg, Claudio R., Braun, Kathryn L., Leon Guerrero, Rachael T., Coleman, Patricia, Bersamin, Andrea, Areta, Aufai Apulu Ropeti, Barber, Leroy R., Belyeu-Camacho, Tayna, Greenberg, Joshua, Fleming, Travis, Dela Cruz-Talbert, Elise, Yamanaka, Ashley, Wilkens, Lynne R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324447/
https://www.ncbi.nlm.nih.gov/pubmed/30646266
http://dx.doi.org/10.1001/jamanetworkopen.2018.3896
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author Novotny, Rachel
Davis, James
Butel, Jean
Boushey, Carol J.
Fialkowski, Marie Kainoa
Nigg, Claudio R.
Braun, Kathryn L.
Leon Guerrero, Rachael T.
Coleman, Patricia
Bersamin, Andrea
Areta, Aufai Apulu Ropeti
Barber, Leroy R.
Belyeu-Camacho, Tayna
Greenberg, Joshua
Fleming, Travis
Dela Cruz-Talbert, Elise
Yamanaka, Ashley
Wilkens, Lynne R.
author_facet Novotny, Rachel
Davis, James
Butel, Jean
Boushey, Carol J.
Fialkowski, Marie Kainoa
Nigg, Claudio R.
Braun, Kathryn L.
Leon Guerrero, Rachael T.
Coleman, Patricia
Bersamin, Andrea
Areta, Aufai Apulu Ropeti
Barber, Leroy R.
Belyeu-Camacho, Tayna
Greenberg, Joshua
Fleming, Travis
Dela Cruz-Talbert, Elise
Yamanaka, Ashley
Wilkens, Lynne R.
author_sort Novotny, Rachel
collection PubMed
description IMPORTANCE: Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention. OBJECTIVES: To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children’s Healthy Living Program. DESIGN, SETTING, AND PARTICIPANTS: In this multijurisdictional, multilevel, multicomponent community randomized clinical trial, where all evaluable children were analyzed according to the random assignment of their community, hierarchical difference-in-difference models accounted for the community randomization, community clustering with jurisdictions, and these models were adjusted for the age and sex distribution of the community. The setting was 27 communities in 5 jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and Hawaii). Participants were 4329 children (time 1) and 4042 children (time 2) aged 2 to 8 years in 27 selected communities from October 7, 2012, to October 25, 2015. Data analysis was completed in June 2018. INTERVENTIONS: Nineteen activities addressed policy, environment, messaging, training, and 6 target behaviors (sleep time, screen time, physical activity, fruits and vegetables, water, and sugar-sweetened beverages). MAIN OUTCOMES AND MEASURES: Primary outcomes were body size measurements. Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire reponses. RESULTS: The study included 27 communities and 8371 evaluable children (mean [SD] age, 5.4 [1.8] years; 50.9% male [n = 4264]). Data analysis included 952 children in the intervention group and 930 children in the control group aged 2 to 5 years at time 1; 825 children in the intervention group and 735 children in the control group aged 2 to 5 years at time 2; 565 children in the intervention group and 561 children in the control group aged 6 to 8 years at time 1; and 517 children in the intervention group and 560 children in the control group aged 6 to 8 years at time 2. The intervention communities showed significant improvement compared with control communities in overweight and obesity prevalence (effect size [d] = −3.95%; 95% CI, −7.47% to −0.43%), waist circumference (d = −0.71 cm; 95% CI, −1.37 to −0.05 cm), and acanthosis nigricans prevalence (d = −2.28%; 95% CI, −2.77% to −1.57%). Age and sex subgroup analysis revealed greater difference among the intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (−3.99%) vs the group aged 6 to 8 years (−3.40%), and the interaction was significant (d = 0.59%, P < .001), as well as the smaller difference in the group aged 2 to 5 years (−0.10%) vs the group aged 6 to 8 years (−1.07%) in screen time (d = −0.97 hour per day, P = .01). CONCLUSIONS AND RELEVANCE: The intervention reduced the prevalence of young child overweight and obesity and acanthosis nigricans. Comprehensive, effective, and sustainable interventions are needed to improve child health in the US-Affiliated Pacific region. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01881373
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spelling pubmed-63244472019-01-22 Effect of the Children’s Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial Novotny, Rachel Davis, James Butel, Jean Boushey, Carol J. Fialkowski, Marie Kainoa Nigg, Claudio R. Braun, Kathryn L. Leon Guerrero, Rachael T. Coleman, Patricia Bersamin, Andrea Areta, Aufai Apulu Ropeti Barber, Leroy R. Belyeu-Camacho, Tayna Greenberg, Joshua Fleming, Travis Dela Cruz-Talbert, Elise Yamanaka, Ashley Wilkens, Lynne R. JAMA Netw Open Original Investigation IMPORTANCE: Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention. OBJECTIVES: To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children’s Healthy Living Program. DESIGN, SETTING, AND PARTICIPANTS: In this multijurisdictional, multilevel, multicomponent community randomized clinical trial, where all evaluable children were analyzed according to the random assignment of their community, hierarchical difference-in-difference models accounted for the community randomization, community clustering with jurisdictions, and these models were adjusted for the age and sex distribution of the community. The setting was 27 communities in 5 jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and Hawaii). Participants were 4329 children (time 1) and 4042 children (time 2) aged 2 to 8 years in 27 selected communities from October 7, 2012, to October 25, 2015. Data analysis was completed in June 2018. INTERVENTIONS: Nineteen activities addressed policy, environment, messaging, training, and 6 target behaviors (sleep time, screen time, physical activity, fruits and vegetables, water, and sugar-sweetened beverages). MAIN OUTCOMES AND MEASURES: Primary outcomes were body size measurements. Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire reponses. RESULTS: The study included 27 communities and 8371 evaluable children (mean [SD] age, 5.4 [1.8] years; 50.9% male [n = 4264]). Data analysis included 952 children in the intervention group and 930 children in the control group aged 2 to 5 years at time 1; 825 children in the intervention group and 735 children in the control group aged 2 to 5 years at time 2; 565 children in the intervention group and 561 children in the control group aged 6 to 8 years at time 1; and 517 children in the intervention group and 560 children in the control group aged 6 to 8 years at time 2. The intervention communities showed significant improvement compared with control communities in overweight and obesity prevalence (effect size [d] = −3.95%; 95% CI, −7.47% to −0.43%), waist circumference (d = −0.71 cm; 95% CI, −1.37 to −0.05 cm), and acanthosis nigricans prevalence (d = −2.28%; 95% CI, −2.77% to −1.57%). Age and sex subgroup analysis revealed greater difference among the intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (−3.99%) vs the group aged 6 to 8 years (−3.40%), and the interaction was significant (d = 0.59%, P < .001), as well as the smaller difference in the group aged 2 to 5 years (−0.10%) vs the group aged 6 to 8 years (−1.07%) in screen time (d = −0.97 hour per day, P = .01). CONCLUSIONS AND RELEVANCE: The intervention reduced the prevalence of young child overweight and obesity and acanthosis nigricans. Comprehensive, effective, and sustainable interventions are needed to improve child health in the US-Affiliated Pacific region. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01881373 American Medical Association 2018-10-26 /pmc/articles/PMC6324447/ /pubmed/30646266 http://dx.doi.org/10.1001/jamanetworkopen.2018.3896 Text en Copyright 2018 Novotny R et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Novotny, Rachel
Davis, James
Butel, Jean
Boushey, Carol J.
Fialkowski, Marie Kainoa
Nigg, Claudio R.
Braun, Kathryn L.
Leon Guerrero, Rachael T.
Coleman, Patricia
Bersamin, Andrea
Areta, Aufai Apulu Ropeti
Barber, Leroy R.
Belyeu-Camacho, Tayna
Greenberg, Joshua
Fleming, Travis
Dela Cruz-Talbert, Elise
Yamanaka, Ashley
Wilkens, Lynne R.
Effect of the Children’s Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial
title Effect of the Children’s Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial
title_full Effect of the Children’s Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial
title_fullStr Effect of the Children’s Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial
title_full_unstemmed Effect of the Children’s Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial
title_short Effect of the Children’s Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial
title_sort effect of the children’s healthy living program on young child overweight, obesity, and acanthosis nigricans in the us-affiliated pacific region: a randomized clinical trial
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324447/
https://www.ncbi.nlm.nih.gov/pubmed/30646266
http://dx.doi.org/10.1001/jamanetworkopen.2018.3896
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