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Effect of multidimensional lifestyle interventions on metabolic risk reduction in children: a cluster randomised
Xianwen Shang1, Yanping Li2, Haiquan Xu3
1National 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.
Insights
A comprehensive lifestyle intervention significantly reduced clustered metabolic risk scores in primary school children. This intervention, combining diet and physical activity, showed greater effectiveness than isolated approaches and was influenced by factors like birthweight and parental involvement.
Area of Science:
- Pediatric Health
- Metabolic Syndrome Research
- Public Health Interventions
Background:
- Childhood metabolic health is a growing concern, with limited research on effective lifestyle interventions.
- Clustered Metabolic Risk Score (CMRS) is a key indicator of metabolic health in children.
- Understanding moderators and mediators of interventions is crucial for optimizing public health strategies.
Purpose of the Study:
- To evaluate the impact of a comprehensive lifestyle intervention (diet and physical activity) on CMRS in children.
- To identify moderators (e.g., birthweight, parental factors) influencing intervention effectiveness.
- To investigate mediators, such as Body Mass Index (BMI), of the intervention's effect on CMRS.
Main Methods:
- A multicentre, clustered randomized controlled trial involving 7110 primary school children.
- Intervention groups included diet-only, physical activity-only, and a comprehensive approach; a control group received no intervention.
- CMRS was calculated using Z scores for % fat mass, blood pressure, glucose, cholesterol-to-HDL ratio, and triglycerides.
Main Results:
- The comprehensive intervention group showed a significant reduction in CMRS compared to controls (mean difference: -0.49).
- Diet-only or physical activity-only interventions did not yield significant CMRS reductions.
- BMI reduction accounted for 7.3% of the total intervention effect, and effectiveness varied by birthweight, parental BMI, and parental data completeness.
Conclusions:
- A multidimensional, comprehensive lifestyle intervention effectively reduces CMRS in primary school children.
- Intervention effectiveness is moderated by child's birthweight, parental BMI, and parental involvement.
- While BMI plays a role, other factors likely contribute to the observed metabolic risk reduction.
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.
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