Improving Nutrition Habits and Reducing Sedentary Time Among Preschool-Aged Children in Cuenca, Ecuador: A Trial of a School-Based Intervention

Abstract

Introduction: In Ecuador, the prevalence of overweight and obesity among school-age children is more than triple that of preschool-age children; however, preschoolers have not been the target of interventions.

Methods: We developed an educational and behavioral intervention that included games, singing, and storytelling. Children were recruited from municipal preschools in Cuenca and were enrolled in the pilot intervention (PI) (N=155) for the 2015-2016 school year, which consisted of a 3-month in-school program. For the 2016-2017 school year, a separate group of children was enrolled in the enhanced intervention (EI) (N=152), which consisted of a 7-month program at both school and home.

Results: Parents in both groups reported a post-intervention reduction in their child's daily at-home consumption of sugar-sweetened beverages (PI: -23.2%, P < .001; EI: -16.8%, P < .001). Additional beneficial effects of the EI not observed with the PI were an increase in drinking water daily at home (+8.3%, P = .04) and eating fruits and vegetables daily for snacks at home (+21.8%, P < .001), a reduction in excessive weekend screen time (-7.6%, P = .03), and a reduction of 0.11 in mean BMI-for-age z score (P = .003). When comparing the PI and EI, the EI was associated with a greater difference in mean BMI-for-age z score (-0.25; P < .001) and fruit and vegetable consumption (+15.9%; P = .01).

Conclusion: Our preschool-based intervention appeared to be successful in promoting healthy lifestyle habits, especially when combined with a household component. Further research is needed to determine if the intervention had long-term effects, as well as to adapt it for different settings.

Figure

Study timeline of the pilot intervention and enhanced intervention, Preschool Nutrition and Activity Study, Cuenca, Ecuador, 2015 – 2017. The figure represents the study timeline of the pilot intervention (PI) and enhanced intervention (EI) which occurred sequentially in the 2015–2016 and 2016–2017 school years. For the PI, the lag time between the pre-intervention assessment and the start of the intervention resulted from personnel changes at the Ministry of Education, which necessitated their re-review of the proposed intervention.