Elsevier

Preventive Medicine

Volume 54, Issue 5, 1 May 2012, Pages 335-340
Preventive Medicine

Effect of a lifestyle intervention on adiposity and fitness in socially disadvantaged subgroups of preschoolers: A cluster-randomized trial (Ballabeina)

https://doi.org/10.1016/j.ypmed.2012.02.007Get rights and content

Abstract

Objective

A multidimensional lifestyle intervention performed in 652 preschoolers (72% of migrant, 38% of low educational level (EL) parents) reduced body fat, but not BMI and improved fitness. The objective of this study is to examine whether the intervention was equally effective in children of migrant and/or low EL parents.

Methods

Cluster-randomized controlled single blinded trial, conducted in 2008/09 in 40 randomly selected preschools in Switzerland. The culturally tailored intervention consisted of a physical activity program and lessons on nutrition, media use and sleep. Primary outcomes included BMI and aerobic fitness. Secondary outcomes included %body fat, waist circumference and motor agility.

Results

Children of migrant parents benefitted similarly from the intervention compared to their counterparts (p for interaction  0.09). However, children of low EL parents benefitted less, although these differences did not reach statistical significance (p for interaction  0.06). Average intervention effect sizes for BMI were − 0.10, − 0.05, − 0.11 and 0.04 kg/m2 and for aerobic fitness were 0.55, 0.20, 0.37 and − 0.05 stages for children of non-migrant, migrant, middle/high EL and low EL parents, respectively.

Conclusions

This intervention was similarly effective among preschoolers of migrant parents compared to their counterparts, while children of low EL parents benefitted less.

Highlights

► The intervention was beneficial for body fat and fitness, but not for BMI. ► Children of migrant parents benefitted similarly from the intervention, but low EL children benefitted less. ► Culturally tailored programs represent a promising option to reach these children.

Introduction

The high prevalence of childhood overweight and obesity represents a great public health concern (Ogden et al., 2008). Children of migrant parents and children of parents with a low educational level (EL, a proxy of socioeconomic status (Pappa et al., 2009)) are considered high risk groups for the development of obesity and of low fitness (Lasserre et al., 2007, Muckelbauer et al., 2010, Okely et al., 2010), both important cardiovascular risk factors. Unfortunately, interventions in these populations seem to be less effective (Danielzik et al., 2005, Muckelbauer et al., 2010, Muller et al., 2005, Nemet et al., 2011, van Sluijs et al., 2007). Therefore, innovative interventions are needed to prevent adiposity and low fitness.

To develop effective approaches in these high risk populations, it is recommended to integrate health promotion programs in the context of the broader social and cultural values (Caprio et al., 2008, Naylor et al., 2010, Wilson, 2009). However, the few existing prevention studies targeting or including high risk children showed both beneficial (Fitzgibbon et al., 2005, Greening et al., 2011) or no (Fitzgibbon et al., 2006, Muckelbauer et al., 2010, Nemet et al., 2011) effects on adiposity in this population. In addition, previous research has mainly been conducted in Black or Hispanic US minority groups (Fitzgibbon et al., 2005, Fitzgibbon et al., 2006, Greening et al., 2011), but there is a lack of evidence for interventions among multicultural migrant populations which are typically found in Europe.

Recently, we demonstrated that our lifestyle intervention study could reduce body fat and waist circumference, but not BMI, and enhance aerobic fitness and agility in preschool children both in the French and German speaking regions in Switzerland (Puder et al., 2011). The study included a high proportion of children of migrant parents of multicultural origins and/or of low EL parents. Therefore, we examined in this current analysis whether our intervention was equally effective in the two predefined subgroups of high risk children (migrant and/or low EL parents) regarding its effects on adiposity and fitness (Niederer et al., 2009).

Section snippets

Study design, setting and participants

The Ballabeina study was a cluster-randomized controlled trial conducted in 40 randomly selected public preschool classes in areas with a high migrant population from two different socio-cultural and linguistic regions in Switzerland (clinicaltrials.gov NCT00674544). Randomization of classes (1:1) was performed separately for the German (city of St. Gallen; 70,000 inhabitants) and French (urban surroundings of Lausanne; 50,000 inhabitants) speaking regions. Eligibility criteria for the

Study population

Overall, 652 preschool children were included in the analysis (mean age 5.2 ± 0.6 years, 72% migrant children, 38% children of low EL). The detailed participants' trial profile has been described elsewhere (Puder et al., 2011). There were no differences in age and sex according to parental migrant status or EL, but a higher population of low EL children was overweight. The proportion of children of migrant and low EL parents was higher in the French compared to the German part of Switzerland (

Main results

In a previous paper, we had demonstrated that a multidimensional lifestyle intervention reduced body fat and improved aerobic fitness and agility, while no effects on BMI were found (Puder et al., 2011). We now show that this intervention was similarly beneficial among preschoolers of migrant compared to non-migrant parents. In general, the intervention effect was similar irrespective of the migrant region. However, children of low EL parents had a smaller benefit (i.e. had smaller intervention

Conclusion

This culturally tailored intervention was similarly effective in preschoolers of migrant parents compared to their counterpart, while children of low EL parents had a smaller benefit. It needs adaptations to better reach the latter population, but might represent a promising approach to reduce adiposity and increase fitness in these children.

Conflict of interest statement

The authors declare no conflict of interest.

The study was principally supported by the Swiss National Science Foundation (Grant # 3200B0-116837) and Health Promotion Switzerland (Project # 2104). Additional funding was obtained from a research award for Interdisciplinary Research from the University of Lausanne, a Takeda research award, the Wyeth Foundation for the Health of children and adolescents, the Freie Akademische Gesellschaft and an unrestricted educational grant from Nestlé.

Acknowledgements

The authors would like to thank all children, their parents, the school teachers and the respective school health services for their participation and help in the study.

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