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Randomized Controlled Trial
. 2017 Dec 11;16(1):79.
doi: 10.1186/s12937-017-0299-5.

A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial

Angélica Ochoa-Avilés  1 , Roosmarijn Verstraeten  2   3 , Lieven Huybregts  4 , Susana Andrade  5 , John Van Camp  3 , Silvana Donoso  5 , Patricia Liliana Ramírez  5 , Carl Lachat  3 , Lea Maes  6 , Patrick Kolsteren  3
Affiliations
Randomized Controlled Trial

A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial

Angélica Ochoa-Avilés et al. Nutr J. .

Abstract

Background: In Ecuador, adolescents' food intake does not comply with guidelines for a healthy diet. Together with abdominal obesity adolescent's inadequate diets are risk factors for non-communicable diseases. We report the effectiveness of a school-based intervention on the dietary intake and waist circumference among Ecuadorian adolescents.

Methods: A pair-matched cluster randomized controlled trial including 1430 adolescents (12-14 years old) was conducted. The program aimed at improving the nutritional value of dietary intake, physical activity (primary outcomes), body mass index, waist circumference and blood pressure (secondary outcomes). This paper reports: (i) the effect on fruit and vegetable intake, added sugar intake, unhealthy snacking (consumption of unhealthy food items that are not in line with the dietary guidelines eaten during snack time; i.e. table sugar, sweets, salty snacks, fast food, soft drinks and packaged food), breakfast intake and waist circumference; and, (ii) dose and reach of the intervention. Dietary outcomes were estimated by means of two 24-h recall at baseline, after the first 17-months (stage one) and after the last 11-months (stage two) of implementation. Dose and reach were evaluated using field notes and attendance forms. Educational toolkits and healthy eating workshops with parents and food kiosks staff in the schools were implemented in two different stages. The overall effect was assessed using linear mixed models and regression spline mixed effect models were applied to evaluate the effect after each stage.

Results: Data from 1046 adolescents in 20 schools were analyzed. Participants from the intervention group consumed lower quantities of unhealthy snacks (-23.32 g; 95% CI: -45.25,-1.37) and less added sugar (-5.66 g; 95% CI: -9.63,-1.65) at the end of the trial. Daily fruit and vegetable intake decreased in both the intervention and control groups compared to baseline, albeit this decrease was 23.88 g (95% CI: 7.36, 40.40) lower in the intervention group. Waist circumference (-0.84 cm; 95% CI: -1.68, 0.28) was lower in the intervention group at the end of the program; the effect was mainly observed at stage one. Dose and reach were also higher at stage one.

Conclusions: The trial had positive effects on risk factors for non-communicable diseases, i.e. decreased consumption of unhealthy snacks. The program strategies must be implemented at the national level through collaboration between the academia and policy makers to assure impact at larger scale.

Trial registration: ClinicalTrial.gov-NCT01004367 .

Keywords: Andes; Cluster randomized controlled trial; Dietary intake; Health promotion.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the ethics committees of the University Central in Quito-Ecuador (CBM/cobi-001 - 2008/462) and the Ghent University Hospital Belgium (FWA00002482). The study was registered at ClinicalTrial.gov with identifier NCT01004367. The CONSORT guidelines were followed to report the results of the study [49]. Only adolescents with a signed written consent from their parents/guardians (response rate 90%) and an informed assent signed by themselves (response rate 85%) were included in the final sample. Students were excluded prior and during the intervention if they were pregnant or suffered from a chronic medical or physical disorder, which may have interfered with a normal diet or physical activity performance, e.g. Crohn’s Disease or severe physical disability.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of progress
Fig. 2
Fig. 2
Description of the intervention development process. IM: Intervention mapping, CPPE: Comprehensive and Participatory Planning and Evaluation
Fig. 3
Fig. 3
Timeline and measurements of the ACTIVITAL trial. ●Activities performed in both, intervention and control schools. ○ Activities performed in the intervention schools only
See this image and copyright information in PMC

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