Early Obesity Prevention the Role of Life Style. Experience from Toybox and Other Intervention Trials

Transcription

1 Early Obesity Prevention the Role of Life Style. Experience from Toybox and Other Intervention Trials Zbigniew Kułaga Public Health Department The Children s Memorial Health Institute Warszawa The Power of Programming Developmental Origins of Adiposity and Long-Term Health Munich Oct Note: for non-commercial purposes only

2 Dr John Snow; London 1854, Broad Street cholera outbreak water pump intervention

3 Aims The aim of ToyBox-study was to prevent obesity in early childhood ( years old) Create a supportive social and physical environment at kindergartens and home to facilitate desired behaviour At a potentially effective, low-cost, scalable-approach Mulitfactorial evidence based approach using behavioural models in understanding and promoting fun, healthy food, play and policy for the prevention of obesity in early childhood: ToyBox

4 ToyBox-study Academic Research Institutes Harokopio University, HUA (GR) Ludwig-Maximilians University of Munich, LMU (DE) State Institute of Early Childhood Research, IFP (DE) Ghent University, Ugent (BE) NORWAY VU University Medical Centre, Vumc (NL) University of Zaragoza, UniZar (ES) Akershus University College, HIAK (NO) Durham University, UDUR (UK) UK HOLLAND Roehampton University, RoU (UK) Children s Memorial Health Institute, CMHI (PL) BELGIUM GERMANY POLAND Medical University of Varna, MUV (BG) LUXEMBURG University of Luxembourg (ULU) (LUX) International / Health Promotion Organisations SPAIN BULGARIA International Association for the Study of Obesity, IASO (UK) CBO B.V., (CBO) (NL) SME GREECE AOK- Verlag GmbH (DE) April

5 ToyBox-study Development of the ToyBox-intervention May-June 2012 Baseline Measurements Academic year Implementation of ToyBoxintervention May-June 2013 Follow-up Measurements

6 Sample Baseline: May/June 2012 Country Kindergartens Children/ Parents Belgium Bulgaria BELGIUM GERMANY POLAND Germany Greece SPAIN GREECE BULGARIA Poland Spain Total

7 Measurements Anthropometric Weight Height Waist Parental questionnaire incl. FFQ Pedometers Accelerometers (only Belgian sub-sample) Baseline (May-June 2012) Follow-up (May- June 2013)

8 Prevalence of overweight*/obesity* by country 25% 20% p < % 15% 10% 1.9% 2.1% 2.4% 4.2% 4.1% Obese Overweight 5% 8.0% 9.5% 10.4% 11.0% 11.9% 14.0% 0% Germany Belgium Poland Bulgaria Spain Greece *Cole TJ, Lobstein T. Pediatr Obes. 2012;7:284-94

9 Toybox study intervention Targeted behaviours Water consumption Snacking Physical activity Sedentary behaviour Aiming to: Changes kindergarten environment Implement the behaviours Conduct interactive activities Target/Involve parents via newsletters/tip-cards/posters

10 Training of teachers

11 1 st Behaviour: Water consumption Change of kindergarten environment water station Implementation of behaviour

12 2 nd Behaviour: Snacking Change of kindergarten environment: fruits and vegetable snacks Implementation of behaviour

13 3 rd Behaviour: Physical activity Change of kindergarten environment ensure enough space for PA Implementation of behaviour

14 4 th Behaviour: Sedentary behaviour Change of kindergarten environment enable more acitivities standing instead of sitting Implementation of behaviour

15 Complete data May/June 2012 & May/June 2013 Country Kindergartens Children/ Parents Belgium Bulgaria BELGIUM GERMANY POLAND Germany Greece SPAIN GREECE BULGARIA Poland Spain Total

16 Results: targeted lifestyles WATER CONSUMPTION AND EATING HABITS PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOUR

17 Table 2. Intervention effects for total water and all beverages in the total sample (adjusted for age, sex, SES and country). Pinket AS, Van Lippevelde W, De Bourdeaudhuij I, Deforche B, Cardon G, et al. (2016) Effect and Process Evaluation of a Cluster Randomized Control Trial on Water Intake and Beverage Consumption in Preschoolers from Six European Countries: The ToyBox-Study. PLoS ONE 11(4): e doi: /journal.pone

18 portion / day 2,2 2,15 2,1 2,05 2 1,95 Children s sweets consumption (portions/day) 2,16 p< ,12 p= ,94 2,05 1,9 1,85 1,8 baseline intervention control follow-up

19 % Children >10.000steps/day (pedometers) 70,0% 60,0% 50,0% 40,0% 30,0% 20,0% 62,3% 62,4% 49,8% 50,5% p<0.004 p< ,0% 42,1% 38,4% 35,0% Intervention Control 10,0% 0,0% Baseline Follow up Baseline Follow up Weekdays Weekend

20 Sedentary behaviour accelerometer data % of day SB weekdays (% / day) intervention control SB weekends (% / day) De Craemer M et al; ToyBox-study group. The effect of a cluster randomised control trial on objectively measured sedentary time and parental reports of time spent in sedentary activities in Belgian preschoolers: the ToyBox-study.Int J Behav Nutr Phys Act ;13:1.

21 Toybox children BMI kg/m 2 (BMI z-score*) boys intervention 15.9 (0.16) 16.0 (0.25) boys control 15.9 (0.16) 15.9 (0.25) girls intervention 15.9 (0.30) 16.0 (0.36) girls control 15.8 (0.25) 15.8 (0.28) p=0.04 *Cole TJ, Lobstein T. Pediatr Obes. 2012;7:284-94

22 Overweight incl. obesity among Toybox study children Overweight prevalence (%) ,4 13,4 15,5 14,3 2 0 baseline follow-up Intervention Control

23 Prevalence (%) Overweight incl. obesity among Toybox ,7 11,9 baseline boys intervention study children 13,7 control 13,8 follow-up 16,2 baseline girls 17,3 15,2 15,0 intervention follow-up control

24 Toybox overweight incl. obesity after the intervention (follow-up) according to the body mass category before intervention (baseline) Body mass category pre intervention (baseline 2012) Intervention (% of overweight 2013) Control (% of overweight 2013) non-overweight boys+girls non-overweight boys non-overweight girls overweight boys+girls overweight boys overweight girls

25 Wen LM et al. Effectiveness of home based early intervention on children s BMI at age 2: randomised controlled trial. BMJ. 2012;26;344:e3732 Intervention Randomized 1:1 (I:C); 667 mothers Home visits in the antenatal period, and at 1, 3, 5, 9, 12, 18 and 24 months after birth; trained community nurses Key intervention messages: Breast is best No solids for me until 6 months I eat a variety of fruit and vegetables every day Only water in my cup I am part of an active family Results Intervention vs Control Improved: vegetable servings (mother and child), TV viewing during meal TV>60 min/day; mother total activity time>150 min/week No difference: fruit servings, water, salty snacks, soft drinks intake BMI at the age 2 years: vs (p=0.01)

26 The TigerKids behavioral intervention program. Bayer O et al. Short- and mid-term effects of a setting based prevention program to reduce obesity risk factors in children: A cluster-randomized trial. Clinical Nutrition 2009;28: Intervention Kindergarten setting, children aged 6 y; Key targets to be reached by children: at least 30 min/day vigorous physical activity games at the Kindergarten, regular consumption of fresh fruit and vegetables as a snack, aiming at replacing high energy density snack, regular consumption of water and other non-sugared drinks aiming at replacing sugared beverages and reaching a habitual consumption of not more than one glass/day of sugared drinks and juices Simple messages on health related behavior for parents Randomization (kindergartens) 2:1 (I:C) Assesment after 6 and 18 months Intervention effects OR, controls as reference Outcome OR (CI) Overweight 0.73 ( ) Obesity 0.58 ( ) High fruit consumption 1.64 ( ) High vegetable consumption Low consumption of high caloric drinks 1.26 ( ) 1.66 ( )

27 Lifestyle Education Schroeder N et al. J Obes. 2015;2015: four clinics (232 infants) were randomized to control or intervention intervention delivered by health care provider at each of 7 9 wellbaby visits over 2 years advice on infant feeding practices, physical activity, and developmental milestones related to eating patterns no difference in body size (BMI) but significant change of feeding practices Intervention Soda Cow s milk Control Sweetened tea Punch 27

28 LIMIT study Other interventions studies Dietary, exercise and behavioural strategies adressed to pregnant woman to limit GWG Limited impact of lifestyle intervention on primary outcome: infant large for gestational age Dodd J, Plenary Session II, Munich Systematic review: Redsell SA, Maternal Child Nutr 2016; 12: randomised controlled trials of interventions that aim to reduce the risk of overweight and obesity in infancy and early childhood 12 trials with lifestyle intervetion and weight outcome: no difference in weight outcome: 7 studies intervention heavier: 2 studies BMI lower in comparison to controls: 3 studies

29 Acknowledgements The ToyBox-study was funded by the Seventh Framework Programme (CORDIS FP7) of the European Commission The ToyBox-study group consists of: Co-ordinator: Yannis Manios; Steering Committee: Yannis Manios, Berthold Koletzko, Ilse De Bourdeaudhuij, Mai Chin A Paw, Luis Moreno, Carolyn Summerbell, Tim Lobstein, Lieven Annemans, Goof Buijs; External Advisors: John Reilly, Boyd Swinburn, Dianne Ward; Harokopio University (Greece): Yannis Manios, Odysseas Androutsos, Eva Grammatikaki, Christina Katsarou, Eftychia Apostolidou, Eirini Efstathopoulou, Paraskevi-Eirini Siatitska, Angeliki Giannopoulou, Effie Argyri, Konstantina Maragkopoulou, Athanasios Douligeris; Ludwig Maximilians Universitaet Muenchen (Germany): Berthold Koletzko, Kristin Duvinage, Sabine Ibrügger, Angelika Strauß, Birgit Herbert, Julia Birnbaum, Annette Payr, Christine Geyer; Ghent University (Belgium): Department of Movement and Sports Sciences: Ilse De Bourdeaudhuij, Greet Cardon, Marieke De Craemer, Ellen De Decker and Department of Public Health: Lieven Annemans, Stefaan De Henauw, Lea Maes, Carine Vereecken, Jo Van Assche, Lore Pil; VU University Medical Center EMGO Institute for Health and Care Research (the Netherlands): EMGO Institute for Health and Care Research: Mai Chin A Paw, Saskia te Velde; University of Zaragoza (Spain): Luis Moreno, Theodora Mouratidou, Juan Fernandez, Maribel Mesana, Pilar De Miguel-Etayo, Esther González, Luis Gracia-Marco, Beatriz Oves; Oslo and Akershus University College of Applied Sciences (Norway): Agneta Yngve, Susanna Kugelberg, Christel Lynch, Annhild Mosdøl; University of Durham (UK): Carolyn Summerbell, Helen Moore, Wayne Douthwaite, Catherine Nixon; State Institute of Early Childhood Research (Germany): Susanne Kreichauf, Andreas Wildgruber; Children s Memorial Health Institute (Poland): Piotr Socha, Kamila Zych, Magdalena Góźdź, Beata Gurzkowska, Katarzyna Szott; Medical University of Varna (Bulgaria): Violeta Iotova, Mina Lateva, Natalya Usheva, Sonya Galcheva, Vanya Marinova, Zhaneta Radkova, Nevyana Feschieva; International Association for the Study of Obesity (UK): Tim Lobstein, Andrea Aikenhead; National Institute for Health Promotion and Disease Prevention (the Netherlands): Goof Buijs, Annemiek Dorgelo, Aviva Nethe, Jan Jansen; AOK- Verlag (Germany): Otto Gmeiner, Jutta Retterath, Julia Wildeis, Axel Günthersberger; Roehampton University (UK): Leigh Gibson; University of Luxembourg (Luxembourg): Claus Voegele.