Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised controlled trial

Xianwen Shang; Yanping Li; Haiquan Xu; Qian Zhang; Xiaoqi Hu; Ailing Liu; Songming Du; Tingyu Li; Hongwei Guo; Ying Li; Guifa Xu; Weijia Liu; Jun Ma; Guansheng Ma

doi:10.1016/j.ypmed.2020.106010

Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised controlled trial

Prev Med. 2020 Feb 3:133:106010. doi: 10.1016/j.ypmed.2020.106010. Online ahead of print.

Authors

Xianwen Shang¹, Yanping Li², Haiquan Xu³, Qian Zhang⁴, Xiaoqi Hu⁴, Ailing Liu⁴, Songming Du⁴, Tingyu Li⁵, Hongwei Guo⁶, Ying Li⁷, Guifa Xu⁸, Weijia Liu⁹, Jun Ma¹⁰, Guansheng Ma¹¹

Affiliations

¹ National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
² National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
³ National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China; Institute of food and nutrition development, Ministry of Agriculture and Rural Affairs, Beijing, China.
⁴ National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.
⁵ Chongqing Children's Hospital, Chongqing, China.
⁶ School of Public Health, Fudan University, Shanghai, China.
⁷ Harbin Medical University, Harbin, China.
⁸ Department of Public Health, Shandong University, Jinan, China.
⁹ Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
¹⁰ Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
¹¹ Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China. Electronic address: mags@bjmu.edu.cn.

PMID: 32027918
DOI: 10.1016/j.ypmed.2020.106010

Abstract

Few clinical trials have investigated lifestyle intervention effect on metabolic health in children. The study aimed to examine the effect of diet and physical activity intervention on the reduction of clustered metabolic risk score (CMRS) in children and moderators and mediators of the intervention effect. A multicentre, clustered randomised controlled trial was conducted with examination conducted at baseline and after intervention over one year. 7110 children (49.7% girls) with a mean of 9.06 (95% CI: 9.03, 9.09) years were included in the analysis. In Beijing, each three schools were randomly assigned to diet-only, physical activity-only intervention and control groups. In five other urban cities, each 15 schools were randomly assigned to comprehensive intervention and control groups. CMRS was computed by summing the Z scores of % fat mass, systolic blood pressure, fasting glucose, ratio of cholesterol to high-density lipoprotein, and triglyceride. Compared with controls (n = 2808), children in the comprehensive intervention group (n = 2848) had more reduction in CMRS (multivariate-adjusted mean difference (95% CI): -0.49 (-0.85, -0.14)). The body mass index (BMI) reduction explained 7.3% (95% CI 2.8%-18.1%) of the total intervention effect. The intervention was more effective in children with higher birthweight, lower parental BMI, or complete parental data. Diet-only or physical activity-only intervention had non-significant effects on CMRS reduction. Our multidimensional comprehensive intervention resulted in significant reduction in CMRS in primary school children and this effect was modified by birthweight, parental BMI, and parental involvement. A minority of metabolic risk reduction was mediated through BMI. Clinical Trial Registry number and website: ChiCTR-PRC-09000402, URL: http://www.chictr.org.cn.

Keywords: Clustered metabolic risk; Lifestyle intervention; Mediation; Moderation; Obesity.