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The Healthy Start Project: Primary Prevention of Overweight in Preschool Children Susceptible to Future Overweight

13. mai 2020 oppdatert av: Berit Lilienthal Heitmann, Bispebjerg Hospital

Prevention of Weight Gain Among Normal Weight, Obesity Susceptible, Pre-school Children - a Randomized Controlled Interventions Study.

Obesity prevention should remain a priority, although there is some evidence of a possible leveling off in some age groups across European countries and in USA, Japan and Australia. Besides adult health problems such as type-2 diabetes and cardiovascular diseases, obesity in childhood is associated with psychological and social problems, low self-esteem, stigmatization and being teased and bullied by friends. Danish research suggests that the causes behind the increase in obesity occurrence are present already in early childhood, and that prevention of obesity therefore has to start early. Research has suggested that at least three sub-groups can be considered susceptible to develop obesity: Children with obesity among their 1st degree relatives; children with a high birth weight or children coming from socially disadvantaged families (low socioeconomic status). Earlier intervention programs has showed little effect in preventing excessive weight gain and knowledge on how to develop effective intervention programs that reduce overweight and obesity remains limited. It has been suggested that future prevention programs may be more successful if specifically targeting groups that are at high risk, as mention above, of excessive weight gain.

Based on these suggestions, the "Sund Start" project was initiated. The purpose of the study was to determine whether aiming prevention towards 2-6 years old Danish children who were yet normal weight, but were considered susceptible to develop overweight or obese could prevent later on risk of becoming overweight or obese. Furthermore, to investigate if it was possible to improve diet habits, increase physical activity, reduce stress and improve sleeping habits among children at high risk for later on overweight and obesity.

The "Sund Start" project will contribute with knowledge about whether targeting normal weight, predisposed children is effective in preventing overweight and obesity, and if reduced stress and improved sleep, should be considered important new obesity prevention tools. Moreover, the project will contribute with knowledge about how to change lifestyle and its effects on development of overweight and obesity in high risk Danish preschool children.

Studieoversikt

Status

Fullført

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

In 2009, data on all births between 2004 and 2007 in 11 selected municipalities from the greater Copenhagen area was obtained from the Danish national birth register at the National Board of Health. This register contains information on all births, whether at hospital or home, on factors such as birth weight and length, height and pre-pregnant weight of the mother, parity, and Central Personal Registry number (CPR-number). Data on socioeconomic status was obtained from the administrative birth forms. This was done manually using the CPR-numbers obtained from the birth register.

After selection of the children eligible for participation, the children were allocated to three groups, (intervention group, control group, shadow group) using computer based randomization. All siblings were allocated to the same group. After the random allocation, children from the intervention group and the control group were sent a letter with an invitation to participate in the project. Children from the shadow group were also identified, and their general practitioners were contacted and asked for information on each child's height and weight.

Studietype

Intervensjonell

Registrering (Faktiske)

1202

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

  • Danmark
      • Frederiksberg, Danmark, 2000
        • Parker Institute, Research Unit for Dietary Studies

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

2 år til 6 år (Barn)

Tar imot friske frivillige

Ja

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

Inclusion Criteria:

  • Born between 2004-2007
  • Born in 11 selected municipalities in the greater Copenhagen area
  • Classified as susceptible to overweight and obesity (At least one of the following risk factors present: A high birth weight (> 4000 grams), maternal pre-pregnancy obesity (BMI > 28 kg/m^2), or maternal low education (<= 10 years)
  • Normal weight at baseline examination

Exclusion Criteria:

  • Moved to another municipality after birth,
  • Had requested protection from participation in statistical or scientific surveys based on data delivered from the Danish Central Person Registry
  • No permanent address
  • Lived in a children's home
  • Had died
  • Had emigrated
  • Registered in the Danish Central Person Registry as being disappeared or had unknown life status
  • Not speaking Danish
  • Overweight (including obesity) at baseline examination

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Forebygging
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Enkelt

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Eksperimentell: Improved lifestyle
Atferdsmessig: Lifestyle habits, including sleep and stress
The intervention group was offered up to 10 individual consultations focusing on improving diet, physical activity and sleep habits and reducing stress. Moreover, the intervention group was offered participation in monthly cooking classes and playing arrangements
Ingen inngripen: Control group
The control group was seen at baseline and follow-up, but not in between.
Ingen inngripen: Shadow group
The shadow group was followed in registers exclusively

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Anthropometric measurements
Tidsramme: 1.3 years

Changes between baseline and 1.3 years follow.up per intervention year in:

Height in cm Weight in kg BMI in kg/m^2 BMI z-score in SD Waist circumference in cm Hip circumference in cm Sum of four skinfolds (biceps, triceps, subscapular and suprailiac) in cm Body composition measured by bio-electrical impedance
1.3 years
Anthropometric measurements
Tidsramme: 5 years

Changes between baseline and 5 years follow.up per intervention year in:

Height in cm Weight in kg BMI in kg/m^2 BMI z-score in SD
5 years
Anthropometric measurements
Tidsramme: 10 years

Changes between baseline and 10 years follow.up per intervention year in:

Height in cm Weight in kg BMI in kg/m^2 BMI z-score in SD
10 years

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Dietary intake
Tidsramme: 1.3 years
Four day dietary record completed Wednesday-Saturday
1.3 years
Priority of serving fruit and vegetables
Tidsramme: 1.3 years
How high do you prioritize that fruit and vegetables are served at the meals? (Scale from 1 to 4, 1 being low and 4 being high. Higher values considered better outcome)
1.3 years
Physical activity
Tidsramme: 1.3 years
Children's Physical Activity Questionnaire (C-PAQ. 7-day recording of sports, games and leisure time activities outside daycare. The response options were indicated by doing a particular activity ("yes" or "no") and by an indication of total time used on the activity during the week (minutes per week). All minutes per week were summed to obtain an indication of overall physical activity level. Higher values considered better outcome)
1.3 years
Sleep duration
Tidsramme: 1.3 years
7 day sleep record from completed questionnaire (average number of minutes sleep summed from 7 day record on sleep- and wake time points)
1.3 years
Child stress level
Tidsramme: 1.3 years
Measured concentration of cortisol in hair samples
1.3 years
Parental stress level
Tidsramme: 1.3 year
Measured concentration of cortisol in hair samples
1.3 year
Sleep quality
Tidsramme: 1.3 year
Child's sleep is considered (calm all night, a little disturbed, disturbed with occasional awakenings, very disturbed with several awakenings. Calm all night considered best outcome).
1.3 year
Child stress level
Tidsramme: 1.3 year
Strengths and Difficulties Questionnaire (SDQ). Scored 0-2 and summed to Total Difficulties score (0-40, lower score indicate better outcome), and Prosocial Behavior score (0-10, lower score indicate worst outcome)
1.3 year
Parental stress level
Tidsramme: 1.3 years
Modified version of the Swedish Parental Stress Index (PSI). Each question was scored between 0 and 2 (0 considered best score and 2 the worst), according to its estimated indication of an overall stress level. Analysis of intercorrelations among the 10 questions and a principal component analysis suggested that 9 of the 10 questions could be added together to get a score for the overall family stress level (0-18)
1.3 years
Daily physical activity: Enjoys being active
Tidsramme: 1.3 years
If the child enjoyed being physically active (Never, often, some times, usually, always. Always considered best outcome)
1.3 years
Meal habits: Eating breakfast together
Tidsramme: 1.3 years
How many times per week does the family eat breakfast together (None, 1 day, 2-3 days, 4-5 days, 6-7 days. 6-7 days considered best outcome).
1.3 years
Meal habits: Eating dinner together
Tidsramme: 1.3 years
How many times per week does the family eat dinner together (None, 1 day, 2-3 days, 4-5 days, 6-7 days. 6-7 days considered best outcome).
1.3 years
Meal habits: Mealtime situation
Tidsramme: 1.3 years
How would you describe the meals with the child (Very conflictive, little conflictive, very cozy, little cozy, don't know. Very cozy considered best outcome).
1.3 years
Meal habits: Pickiness
Tidsramme: 1.3 years
How would you describe your child's way of eating (Picky, open to new tastes, eats everything. Eats everything considered best outcome).
1.3 years
Meal habits: Appetite
Tidsramme: 1.3 years
How would you describe your child's appetite (Too big appetite, good appetite, normal appetite, too small appetite, don't know. Normal appetite considered best outcome).
1.3 years
Sleep quality: Difficulties falling asleep
Tidsramme: 1.3 years
Difficulties falling asleep (yes/no. No considered best outcome)
1.3 years
Sleep quality: Difficulties waking up
Tidsramme: 1.3 years
Difficulties waking up (yes/no. No considered best outcome)
1.3 years
Sleep quality: Sleep onset latency
Tidsramme: 1.3 years
Sleep onset latency (numerical. Lower values considered better outcome)
1.3 years
Sleep quality: Bedtime routines
Tidsramme: 1.3 years
Routine activities before bedtime (No, < 1/week, 1-2 times/week, 3-4 times/week, 5-6 times/week, every day. Every day considered best outcome)
1.3 years
Sleep quality: Joining parents' bed
Tidsramme: 1.3 years
Child joining parents' bed (yes/no. If yes, how often (< 1/month, 1-3 times/month,1-3 times/week, 4-6 times/week, every night)
1.3 years
Sleep quality: Falling asleep
Tidsramme: 1.3 years
Child afraid to fall asleep (Never, rarely, some times, often, very often. Never considered best outcome)
1.3 years
Sleep quality: Dreams
Tidsramme: 1.3 years
Child has frightening/upsetting dreams (Never, rarely, some times, often, very often. Never considered best outcome)
1.3 years
Daily physical activity: Means of transportation
Tidsramme: 1.3 years
Means of transportation to and from day-care, and frequency (Walk, strolling, bike on its own, biked by parent, and bus, train or car, number of times per week (1,2,3,4 or 5. Walking or biking on its own considered best outcome).
1.3 years
Daily physical activity: Activity compared to other children
Tidsramme: 1.3 years
How active is the child compared to other children at similar age? (as active, somewhat active, very active, don't know. Very active considered best outcome)
1.3 years
Daily physical activity: Activity with parents
Tidsramme: 1.3 years
Frequency of which one or both parents were physically active with the child (once per week, 2-4 times per week, 5-7 times per week, multiple times per day. Multiple times per day considered best outcome)
1.3 years

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Bispebjerg Hospital

Samarbeidspartnere

TrygFonden, Denmark
Sygekassernes Helsefond
The Danish Medical Research Council

Etterforskere

  • Studieleder: Berit L Heitmann, Professor, Parker Institute

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Generelle publikasjoner

Hjelpsomme linker

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart

1. mai 2009

Primær fullføring (Faktiske)

1. august 2012

Studiet fullført (Faktiske)

1. juni 2018

Datoer for studieregistrering

Først innsendt

31. mars 2012

Først innsendt som oppfylte QC-kriteriene

20. april 2012

Først lagt ut (Anslag)

24. april 2012

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

15. mai 2020

Siste oppdatering sendt inn som oppfylte QC-kriteriene

13. mai 2020

Sist bekreftet

1. mai 2020

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • Tryg-7984-07

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