A cluster randomised school-based lifestyle intervention programme for the prevention of childhood obesity and related early cardiovascular disease (JuvenTUM 3)

Monika Siegrist, Henner Hanssen, Christoph Lammel, Bernhard Haller, Martin Halle, Monika Siegrist, Henner Hanssen, Christoph Lammel, Bernhard Haller, Martin Halle

Abstract

Background: Childhood obesity is not only associated with adult obesity but also with increased risk of adult onset of type 2 diabetes and subsequent coronary heart disease. The potential effects of school-based health intervention programmes on cardiovascular risk and surrogate markers are unclear, as only few studies have attempted to investigate a complete risk profile including a detailed laboratory analysis or micro- and macrovascular function. In this study a comprehensive school-based randomized intervention programme will be investigated in 10-14-year old children addressing the influence of lifestyle intervention on inactivity, cardiometabolic risk factors and early signs of vascular disease.

Methods/design: 15 secondary schools in Southern Germany are randomly assigned to intervention or control schools. Children in the fifth grade (10-11 years) will be observed over four years. The study combines a school-based with a home-based approach, aiming at children, teachers and parents. The main components are weekly lifestyle-lessons for children, taught by regular classroom teachers to increase physical activity in- and outside of school, to improve eating patterns at school and at home, to reduce media consumption and to amplify well-being. In 4-6 annual meetings, teachers receive information about health-related topics with worksheets for children and supporting equipment, accounting for school-specific needs and strategies. Parents' trainings are provided on a regular basis.All examinations are performed at the beginning and at the end of every school year. Anthropometry includes measurements of BMI, waist and upper arm circumferences, skinfold thickness as well as peripheral blood pressure. Blood sampling includes lipid parameters, insulin, glucose, hsCRP, adiponectin, and IL-6 as well as testosteron and estrogen to determine maturation status. Vascular function is non-invasively assessed by measuring arterial stiffness in large arteries using a sphygmograph and by analysing arteriolar and venular diameters in the retinal microcirculation using a non-mydriatric vessel analyser. A questionnaire is filled out to determine daily physical activity, motivational factors, dietary habits, quality of life (KINDL-R) and socio-economic data. Physical fitness is assessed by a six-item test battery.

Discussion: Our study aims to provide a feasible long-term intervention strategy to re-establish childhood health and to prevent obesity-related cardiovascular dysfunction in children.

Trial registration: NCT00988754.

Figures

Figure 1
Figure 1
Flow of School Classes.
Figure 2
Figure 2
Content and Timetable of Intervention.

References

    1. Bonow RO. World Heart Day 2002: the international burden of cardiovascular disease: responding to the emerging global epidemic. Circulation. 2002;106(13):1602–1605. doi: 10.1161/01.CIR.0000035036.22612.2B.
    1. Berrington dGA. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–2219. doi: 10.1056/NEJMoa1000367.
    1. Ekelund U. Prevalence and correlates of the metabolic syndrome in a population-based sample of European youth. Am J Clin N. 2009;89:90–96.
    1. Morrison JA. Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later. J Pediatr. 2008;152(2):201–206. doi: 10.1016/j.jpeds.2007.09.010.
    1. Srinivasan SR. Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: the Bogalusa Heart Study. Metabolism. 1996;45(2):235–240. doi: 10.1016/S0026-0495(96)90060-8.
    1. Sun SS. Childhood obesity predicts adult metabolic syndrome: the Fels Longitudinal Study. J Pediatr. 2008;152(2):191–200. doi: 10.1016/j.jpeds.2007.07.055.
    1. Dietz WH. Childhood weight affects adult morbidity and mortality. J Nutr. 1998;128(2 Suppl):411:S–414S.
    1. Freedman DS. Relation of body mass index and skinfold thicknesses to cardiovascular disease risk factors in children: the Bogalusa Heart Study. Am J Clin Nutr. 2009;90(1):210–216. doi: 10.3945/ajcn.2009.27525.
    1. Franks PW. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med. 2010;362(6):485–493. doi: 10.1056/NEJMoa0904130.
    1. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond) 2010. in press .
    1. Baker JL, Olsen LW, Sorensen TI. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007;357(23):2329–2337. doi: 10.1056/NEJMoa072515.
    1. Bibbins-Domingo K. Adolescent overweight and future adult coronary heart disease. N Engl J Med. 2007;357(23):2371–2379. doi: 10.1056/NEJMsa073166.
    1. Fraser LK. The geography of Fast Food outlets: a review. Int J Environ Res Public Health. 2010;7(5):2290–2308. doi: 10.3390/ijerph7052290.
    1. Naska A. Eating out, weight and weight gain. A cross-sectional and prospective analysis in the context of the EPIC-PANACEA study. Int J Obes (Lond) 2011;35(3):416–26. doi: 10.1038/ijo.2010.142.
    1. Schulze MB. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004;292(8):927–934. doi: 10.1001/jama.292.8.927.
    1. WHO. Global Recommendations on Physical Activity for Health. WHO Library. 2010. ISBN 978 92 4 159 997 9.
    1. Goldstein LB. Guidelines for the Primary Prevention of Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2010;42(2):517–584.
    1. Colberg SR. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147–e167. doi: 10.2337/dc10-9990.
    1. Lampert T. Körperlich-sportliche Aktivität von Kindern und Jugendlichen in Deutschland. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KIGGS) Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007;50(5/6):634–642.
    1. DiGuiseppi C, Li L, Roberts I. Influence of travel patterns on mortality from injury among teenagers in England and Wales, 1985-95: trend analysis. BMJ. 1998;316(7135):904–905.
    1. Cecchini M. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet. 2010;376(9754):1775–1784. doi: 10.1016/S0140-6736(10)61514-0.
    1. Ridker PM. High-sensitivity C-reactive protein and cardiovascular risk: rationale for screening and primary prevention. Am J Cardiol. 2003;92(4B):17K–22K.
    1. Pasceri V, Willerson JT, Yeh ET. Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation. 2000;102(18):2165–2168.
    1. Ford ES. C-reactive protein and body mass index in children: findings from the Third National Health and Nutrition Examination Survey, 1988-1994. J Pediatr. 2001;138(4):486–492. doi: 10.1067/mpd.2001.112898.
    1. Mattsson N. Childhood predictors of the metabolic syndrome in adulthood. The Cardiovascular Risk in Young Finns Study. Ann Med. 2008;40(7):542–552. doi: 10.1080/07853890802307709.
    1. Meyer AA. Improvement of early vascular changes and cardiovascular risk factors in obese children after a six-month exercise program. J Am Coll Cardiol. 2006;48(9):1865–1870. doi: 10.1016/j.jacc.2006.07.035.
    1. Rosenbaum M. School-based intervention acutely improves insulin sensitivity and decreases inflammatory markers and body fatness in junior high school students. J Clin Endocrinol Metab. 2007;92(2):504–508.
    1. Van Snick J. Interleukin-6: an overview. Annu Rev Immunol. 1990;8:253–278. doi: 10.1146/annurev.iy.08.040190.001345.
    1. Lindmark E. Relationship between interleukin 6 and mortality in patients with unstable coronary artery disease: effects of an early invasive or noninvasive strategy. JAMA. 2001;286(17):2107–2113. doi: 10.1001/jama.286.17.2107.
    1. Fried SK, Bunkin DA, Greenberg AS. Omental and subcutaneous adipose tissues of obese subjects release interleukin-6: depot difference and regulation by glucocorticoid. J Clin Endocrinol Metab. 1998;83(3):847–850. doi: 10.1210/jc.83.3.847.
    1. Nemet D. Adipocytokines, body composition, and fitness in children. Pediatr Res. 2003;53(1):148–152.
    1. Platat C. Relationships of physical activity with metabolic syndrome features and low-grade inflammation in adolescents. Diabetologia. 2006;49(9):2078–2085. doi: 10.1007/s00125-006-0320-6.
    1. Hopkins TA. Adiponectin actions in the cardiovascular system. Cardiovasc Res. 2007;74(1):11–18. doi: 10.1016/j.cardiores.2006.10.009.
    1. Kadowaki T. Adiponectin and adiponectin receptors in obesity-linked insulin resistance. Novartis Found Symp. 2007;286:164–176.
    1. Lindsay RS. Adiponectin and development of type 2 diabetes in the Pima Indian population. Lancet. 2002;360(9326):57–58. doi: 10.1016/S0140-6736(02)09335-2.
    1. Thomas NE, Williams DR. Inflammatory factors, physical activity, and physical fitness in young people. Scand J Med Sci Sports. 2008;18(5):543–556. doi: 10.1111/j.1600-0838.2008.00824.x.
    1. Grundy SM. Primary prevention of coronary heart disease: integrating risk assessment with intervention. Circulation. 1999;100(9):988–998.
    1. McGill HC, McMahan CA, Gidding SS. Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study. Circulation. 2008;117(9):1216–1227. doi: 10.1161/CIRCULATIONAHA.107.717033.
    1. Tounian P. Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet. 2001;358(9291):1400–1404. doi: 10.1016/S0140-6736(01)06525-4.
    1. Sakuragi S. Influence of adiposity and physical activity on arterial stiffness in healthy children: the lifestyle of our kids study. Hypertension. 2009;53(4):611–616. doi: 10.1161/HYPERTENSIONAHA.108.123364.
    1. Wang JJ. Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations. Eur Heart J. 2007;28(16):1984–1992. doi: 10.1093/eurheartj/ehm221.
    1. Wong TY. Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study. JAMA. 2002;287(9):1153–1159. doi: 10.1001/jama.287.9.1153.
    1. Cheung N. BMI and retinal vascular caliber in children. Obesity (Silver Spring) 2007;15(1):209–215. doi: 10.1038/oby.2007.576.
    1. Mitchell P. Blood pressure and retinal arteriolar narrowing in children. Hypertension. 2007;49(5):1156–1162. doi: 10.1161/HYPERTENSIONAHA.106.085910.
    1. AAP. American Academy of Pediatrics: Children, adolescents, and television. Pediatrics. 2001;107(2):423–426.
    1. Aktas A. The effects of television food advertisement on children's food purchasing requests. Pediatrics International. 2006;48:138–145. doi: 10.1111/j.1442-200X.2006.02180.x.
    1. Ludwig DS, Gortmaker SL. Programming obesity in childhood. Lancet. 2004;364(9430):226–227. doi: 10.1016/S0140-6736(04)16688-9.
    1. Epstein LH. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. 2008;162(3):239–245. doi: 10.1001/archpediatrics.2007.45.
    1. Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282(16):1561–1567. doi: 10.1001/jama.282.16.1561.
    1. Hancox RJ, Milne BJ, Poulton R. Association of television viewing during childhood with poor educational achievement. Arch Pediatr Adolesc Med. 2005;159(7):614–618. doi: 10.1001/archpedi.159.7.614.
    1. Winnail SD. Relationship between physical activity level and cigarette, smokeless tobacco, and marijuana use among public high school adolescents. J Sch Health. 1995;65(10):438–442. doi: 10.1111/j.1746-1561.1995.tb08209.x.
    1. Ells LJ. Prevention of childhood obesity. Best Pract Res Clin Endocrinol Metab. 2005;19(3):441–454. doi: 10.1016/j.beem.2005.04.008.
    1. Harris KC. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ. 2009;180(7):719–726.
    1. Kropski JA, Keckley PH, Jensen GL. School-based obesity prevention programs: an evidence-based review. Obesity (Silver Spring) 2008;16(5):1009–1018. doi: 10.1038/oby.2008.29.
    1. Zenzen W, Kridli S. Integrative review of school-based childhood obesity prevention programs. J Pediatr Health Care. 2009;23(4):242–258. doi: 10.1016/j.pedhc.2008.04.008.
    1. Kriemler S. Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. BMJ. 2010;340:c785. doi: 10.1136/bmj.c785.
    1. Donner A, Klar N. Design and Analysis of Cluster Randomization Trials in Health Research. 2000. Arnold.
    1. Liang KY, Zeger S. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22. doi: 10.1093/biomet/73.1.13.
    1. Sharples K, Breslow N. Regression Analysis of Correlated Binary Data: Some Small Sample Results for the Estimating Equation Approach. Journal of Statistical Computation and Simulation. 1992;42:1–20.
    1. Donner A, Klar N. Statistical Considerations in the Design and Analysis of Community Intervention Trials. Journal of Clinical Epidemiology. 1996;49:435–439. doi: 10.1016/0895-4356(95)00511-0.
    1. Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–164. doi: 10.1177/1090198104263660.
    1. Cole TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr. 1990;44(1):45–60.
    1. Kromeyer-Hauschild K. Perzentile für den Body Mass Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschrift Kinderheilkunde. 2001;149:807–818. doi: 10.1007/s001120170107.
    1. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555–576.
    1. Chen CH. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function. Circulation. 1997;95(7):1827–1836.
    1. Hubbard LD. Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the Atherosclerosis Risk in Communities Study. Ophthalmology. 1999;106(12):2269–2280. doi: 10.1016/S0161-6420(99)90525-0.
    1. Rusch H, Irrgang W. Münchner Fitnesstest. Haltung und Bewegung. 1994;14(1):4–11.
    1. Prochaska JJ, Sallis JF, Long B. A physical activity screening measure for use with adolescents in primary care. Arch Pediatr Adolesc Med. 2001;155(5):554–559.
    1. Bös K, Worth A, Opper E, Oberger J, Woll A, Motorik-Modul. Motorische Leistungsfähigkeit und körperlich-sportliche Aktivität von Kindern und Jugendlichen in Deutschland. The motoric-module: motor performance ability and physical activity of children and adolescents in Germany. 1. Nomos-Verlag, Baden-Baden; 2009. pp. 354–361.
    1. Mensink G, Kleiser C, Richter A. Lebensmittelverzehr bei Kindern und Jugendlichen in Deutschland - Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS) Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2007;50(5/6):609–623.
    1. Ravens-Sieberer U, Bullinger M. Assessing health-related quality of life in chronically ill children with the German KINDL: first psychometric and content analytical results. Qual Life Res. 1998;7(5):399–407.
    1. Brambilla P, Pozzobon G, Pietrobelli A. Physical activity as the main therapeutic tool for metabolic syndrome in childhood. Int J Obes (Lond) 2010. in press .
    1. Tudor-Locke C. Omission of active commuting to school and the prevalence of children's health-related physical activity levels: the Russian Longitudinal Monitoring Study. Child Care Health Dev. 2002;28(6):507–512. doi: 10.1046/j.1365-2214.2002.00295.x.

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