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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...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2018
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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 |
format | Online Article Text |
id | pubmed-6324447 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
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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