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Dietary and metabolic effects of a 2-year lifestyle intervention in overweight and obese children
Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Childhood overweight and obesity have increased during the past decades and there is a need for effective intervention programs both for treatment and prevention to interrupt the increased trend. Overweight and obesity result from a combination of genetic predisposition and lifestyle where an imbalance in energy intake (EI) and total energy expenditure (TEE) is the key factor. The objective of this thesis is to evaluate the impact of a 2-year lifestyle intervention on food habits, anthropometry and metabolic markers on children with overweight and obesity.

Methods Overweight and obese children 8-12 years old were recruited to participate in a 2-year randomized controlled trial (RCT). One hundred and five children agreed to participate and were randomized into one intervention group and one control group. Both groups participated in the same measurements while the intervention group also participated in a lifestyle program aiming at improving food habits and increasing physical activity. The first year of the program consisted of 14 group sessions and the second year of the intervention was web-based. Food habits were assessed at baseline and at endpoint by a diet history interview (DHI) and by a 4-day food record at 1-year measurement. At baseline 22 randomly chosen children were included in a validation study to validate reported EI against TEE measured by doubly labeled water (DLW) method and SenseWear Armband Pro 2 and 3 (version 5.1) (SWA). Anthropometric and biochemical parameters were measured at baseline, 1-year and endpoint.

Results The DHI underestimated EI by 14% when validated against measured TEE by DLW and SWA. At the 1-year measurement the intervention group had a lower intake of fat (g and E%), monounsaturated fat (MUFA) (g) and polyunsaturated fat (PUFA) (g and E%) compared to the control group. At endpoint the intervention group had a lower intake of fat (g), MUFA (g) and cholesterol compared to the control group. Children in the intervention group consumed less sugar sweetened beverages at endpoint and had increased their intake of keyhole labeled foods compared to the control group. During the first year the growing children in both groups remained stable with respect to BMI and had decreased their BMI zscore.

Conclusion The 2-year lifestyle intervention resulted in some improvements regarding food habits, but overall the effects on anthropometrics and metabolic markers were limited. This strongly supports that efforts should primarily be aimed at primary prevention of childhood overweight and obesity.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, Institutionen för kostvetenskap , 2011. , 68 p.
National Category
Food Science
Research subject
Food and Nutrition
Identifiers
URN: urn:nbn:se:umu:diva-43679ISBN: 978-91-7459-141-5OAI: oai:DiVA.org:umu-43679DiVA: diva2:415084
Public defence
2011-06-10, Hörsal C, Samhällsvetarhuset, Umeå universitet, 90187 Umeå, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-05-09 Created: 2011-05-05 Last updated: 2011-05-09Bibliographically approved
List of papers
1. Energy intake of Swedish overweight and obese children is underestimated using a diet history interview
Open this publication in new window or tab >>Energy intake of Swedish overweight and obese children is underestimated using a diet history interview
2009 (English)In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 139, no 3, 522-527 p.Article in journal (Refereed) Published
Abstract [en]

Estimating energy intake (EI) of a child by using a diet history interview (DHI) method may be a challenge because of difficulties for the child to remember what has been eaten as well as to report portion sizes. The aim of this research was to validate reported EI from a DHI in children classified as overweight or obese by comparing the reported EI to total energy expenditure (TEE) measured by two objective measures. Eighty-five 10.5 ± 1.1 y old overweight and obese children, with help from one or two parents, reported their EI two weeks retrospectively in a DHI. Reported EI was compared with TEE, as measured by SenseWear Armaband (n=85) and the doubly-labelled water (DLW) method (n=21), during the same period as the DHI. Reported EI was under-estimated by 14 % when validated against both the armband and DLW method. Under-estimation did not differ between boys and girls. However, the EI of obese children was under-estimated by 22 %, which is twice the rate as for the overweight children (95% CI: 0.55, 3.08). Under-estimated EI was negatively correlated with body mass index (BMI) (r=-0.38, P= <0.01) as well as age (r=-0.21, P=0.05). EI is under-estimated to a higher extent among children with higher BMI and higher age when using a DHI method. The findings show the importance of validating dietary intake of children in general and in overweight and obese children in particular.

Place, publisher, year, edition, pages
Bethesda: American Society for nutrition, 2009
Keyword
validity, energy intake, overweight, obese, dietary assessment methods, diet history interview, children
National Category
Food Science
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-19082 (URN)10.3945/jn.108.101311 (DOI)
Projects
SELFH-projektet
Available from: 2009-03-11 Created: 2009-03-04 Last updated: 2011-05-09Bibliographically approved
2. A one-year intervention has modest effects on energy and macronutrient intakes of overweight and obese Swedish children.
Open this publication in new window or tab >>A one-year intervention has modest effects on energy and macronutrient intakes of overweight and obese Swedish children.
2010 (English)In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 140, no 10, 1793-1798 p.Article in journal (Refereed) Published
Abstract [en]

To decrease BMI in overweight and obese children, improved dietary intake and increased physical activity are key elements. Our objective was to evaluate the impact of a 1-y food and physical activity intervention on energy and macronutrient intake in overweight and obese children. A randomized open trial was conducted with 92 overweight or obese 10.4 ± 1.08-y-old children. The intervention included 14 group sessions with different themes regarding food and physical activity. Dietary intake was assessed with diet history interviews covering 14 d at baseline and 4-d food records after 1 y and was evaluated according to national dietary recommendations. The control group participated in the same measurements as the intervention group but did not take part in group sessions. After 1 y, both groups had decreased their energy intake (EI) relative to total energy expenditure, but the effect was more pronounced for the intervention group than for the control group. At 1 y follow-up, a larger proportion of children in the intervention group compared with the control group met the recommended intake of refined sugar (P = 0.019). However, the groups did not differ in the proportion children who met the recommended intake of dietary fiber. Further, SFA intake relative to total EI did not differ between the groups at 1 y follow-up. In conclusion, despite a rather comprehensive intervention, only modest effects were achieved with respect to reduced EI and improved macronutrient intake.

Place, publisher, year, edition, pages
American Society for Nutrition, 2010
Keyword
food habits, dietary intake, overweight, obesity, intervention
National Category
Nutrition and Dietetics
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-36280 (URN)10.3945/jn.110.125435 (DOI)000286086300014 ()20739446 (PubMedID)
Projects
SELFH
Available from: 2010-09-24 Created: 2010-09-24 Last updated: 2011-05-09Bibliographically approved
3. Effect on metabolic health after a 1 year lifestyle intervention in overweight and obese children: a randomized controlled trial
Open this publication in new window or tab >>Effect on metabolic health after a 1 year lifestyle intervention in overweight and obese children: a randomized controlled trial
2012 (English)In: Journal of Nutrition and Metabolism, ISSN 2090-0724, 913965- p.Article in journal (Other academic) Published
National Category
Other Social Sciences not elsewhere specified
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-37509 (URN)10.1155/2012/913965 (DOI)
Available from: 2010-11-05 Created: 2010-11-05 Last updated: 2012-04-02Bibliographically approved
4. Improved dietary intake among overweight and obese children followed from 8 to 12 years of age in a randomised controlled trial
Open this publication in new window or tab >>Improved dietary intake among overweight and obese children followed from 8 to 12 years of age in a randomised controlled trial
2012 (English)In: Journal of Nutritional Science, ISSN 2048-6790, E-ISSN 2048-6790, Vol. 1, 1-11 p., e16Article in journal (Refereed) Published
Abstract [en]

More knowledge about improving dietary intake in secondary preventive actions against childhood overweight and obesity is needed. The objective was to evaluate the impact of a 2-year intervention on energy, macronutrient and food intake of overweight and obese children participating in a randomised controlled trial. Children (8-12 years old) living in Sweden were recruited to participate for 2 years between 2006 and 2009. The children were randomised into either an intervention group (n 58), participating in an intervention concerning food habits, physical activity and behavioural change, or a control group (n 47). Dietary intake at baseline and the 2-year measurement were assessed with a diet history interview covering 14 d. Energy intake (EI) of the intervention and control groups was underestimated by 28 and 21 %, respectively, after 2 years, but with no difference between the groups (P = 0·51). After 2 years of intervention, the intervention group, compared with the control group, had a lower intake of sugar-sweetened beverages (P = 0·015) as well as a higher intake of foods high in fibre, low in saturated fat, sugar and salt (P = 0·031). Further, a lower EI in relation to BMR, lower total fat, MUFA and cholesterol was seen in the intervention group compared with the control group. In conclusion, the food and nutrient intake of overweight and obese children was improved after participating in a 2-year intervention programme. Dietary counselling should be included in secondary preventive actions against childhood overweight and obesity to promote healthy food habits.

Keyword
DHI, diet history interview, Dietary intake, E%, energy percentage of total intake, EI, energy intake, Obesity, Overweight, Randomised controlled trials, TEE, total energy expenditure
National Category
Nutrition and Dietetics
Research subject
Food and Nutrition
Identifiers
urn:nbn:se:umu:diva-43678 (URN)10.1017/jns.2012.17 (DOI)25191545 (PubMedID)
Available from: 2011-05-05 Created: 2011-05-05 Last updated: 2016-04-14Bibliographically approved

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