Abstract
OBJECTIVES: Childhood obesity interventions should be family-centered and focused on lifestyle behaviours that achieve sustainable reductions in adiposity. The primary objective of this randomized controlled trial was to test a family-centered lifestyle intervention using Canada’s Food and Physical Activity (PA) Guidelines to reduce body mass index-for-age z-scores (BAZ) in overweight and obese (OW/OB) children.
METHODS: Children (n = 78; ages 6–8.5 years) were randomized to standard (StnTx) or modified (ModTx) interventions or control (Ctrl). Measurements at baseline and every three months for one year included: anthropometry, BAZ, waist circumference (WC), and dual-energy X-ray absorptiometry scans for percent body fat (%BF), fat mass (FM) and trunk fat mass. Fatty acids measured by gas chromatography were used to assess compliance to the milk and alternatives interventions during the first six months. Six intervention sessions were based on Canada’s Food and PA Guidelines and individualized to meet the needs of the family. ModTx were advised to consume four milk and alternatives/day versus the recommended two (StnTx) and to preferentially engage in daily weight-bearing PA. Ctrl were provided the guidelines.
RESULTS: Baseline anthropometry did not differ among groups. At 12 months (n = 73), all groups increased height (p < 0.001) and lean mass (p < 0.001). ModTx decreased BAZ (p < 0.001); %BF decreased in ModTx (p = 0.018), but not in StnTx (p = 0.997) or Ctrl (p = 0.998). FM, WC and trunk fat mass all significantly increased in Ctrl (p < 0.001). At baseline and three months, fatty acids did not differ among groups, however they did decrease in ModTx at six months [C14:0 (−0.07%, p = 0.053), C15:0 (−0.04%, p = 0.049), C17:0 (−0.09%, p = 0.036)].
CONCLUSION: Participating in a family centered-lifestyle intervention that focused on Canadian dietary and PA Guidelines and emphasized increasing milk and alternatives and weight-bearing PA had positive effects on reducing adiposity in OW/OB children. Guidelines are appropriate for the obese pediatric population but need to be individualized to meet the needs of the family. Additional studies are warranted to test the use of biochemical indices to assess compliance to milk and alternative intakes in OW/OB children participating in lifestyle interventions.
Key words: Childhood obesity, overweight, obese, interventions, dairy, body mass index
Résumé
OBJECTIFS: Les interventions contre l’obésité juvénile devraient être centrées sur la famille et sur les habitudes de vie qui produisent des baisses durables de l’adiposité. L’objectif premier de notre essai comparatif randomisé était de tester une intervention sur le mode de vie centrée sur la famille utilisant le Guide alimentaire canadien et les Directives canadiennes en matière d’activité physique (AP) pour réduire les écarts Z de l’indice de masse corporelle en fonction de l’âge (ZIA) chez les enfants en surpoids et obèses (SP/OB).
MÉTHODE: Des enfants (n = 78; 6–8,5 ans) ont été affectés de façon aléatoire aux groupes d’intervention standard (StnTx) ou modifiée (ModTx) ou à un groupe témoin. Nous avons pris les mesures suivantes au départ et tous les trois mois pendant un an: anthropométrie, ZIA, périmètre ombilical (PO), et des scanographies d’absorptiométrie biphotonique à rayons X pour obtenir le pourcentage de masse grasse (%MG), la masse adipeuse (MA) et la masse adipeuse du tronc. Les acides gras, mesurés par chromatographie gazeuse, ont servi à évaluer la conformité aux interventions avec lait et substituts au cours des six premiers mois. Six séances d’intervention ont été fondées sur le Guide alimentaire canadien et les Directives canadiennes en matière d’AP et ont été individualisées pour répondre aux besoins de la famille. Les sujets de l’intervention modifiée (ModTx) ont reçu l’instruction de consommer quatre portions de lait et substituts par jour au lieu des deux portions recommandées (StnTx) et de pratiquer de préférence une AP de port de poids quotidiennement. Les témoins ont reçu le Guide et les Directives sans autre instruction.
RÉSULTATS: L’anthropométrie de chaque groupe n’était pas différente au départ. Après 12 mois (n = 73), la taille (p < 0,001) et la masse maigre (p < 0,001) ont augmenté dans tous les groupes. Le ZIA a diminué dans le groupe ModTx (p < 0,001); le %MG a diminué dans le groupe ModTx (p = 0,018), mais pas dans le groupe StnTx (p = 0,997) ni dans le groupe témoin (p = 0,998). La MA, le PO et la masse adipeuse du tronc ont tous présenté une hausse significative dans le groupe témoin (p < 0,001). Au départ et après trois mois, les acides gras de chaque groupe n’étaient pas différents, mais ils ont diminué dans le groupe ModTx au bout de six mois [C14:0 (−0,07 %, p = 0,053), C15:0 (−0,04 %, p = 0,049), C17:0 (−0,09 %, p = 0,036)].
CONCLUSION: La participation à une intervention sur le mode de vie centrée sur la famille, utilisant le Guide alimentaire et les Directives d’AP du Canada et insistant sur l’augmentation de la consommation de lait et de substituts et de l’AP de port de poids a eu des effets positifs sur la réduction de l’adiposité chez des enfants SP/OB. Les directives conviennent à la population pédiatrique obèse, mais elles doivent être individualisées pour répondre aux besoins de la famille. Il faudrait mener d’autres études pour tester l’utilisation d’indices biochimiques pour évaluer la conformité aux apports en lait et en substituts chez les enfants SP/OB qui participent à des interventions sur le mode de vie.
Mots clés: obésité juvénile, surpoids, obèse, interventions, produits laitiers, indice de masse corporelle
Footnotes
Acknowledgements: This study was supported by an operating grant from the Dairy Research Cluster Initiative (Agriculture and Agri-Food Canada, Dairy Farmers of Canada, and the Canadian Dairy Commission). Cohen is supported by Frederick Banting and Charles Best Canada Graduate Doctoral Award (Canadian Institutes of Health Research). Weiler is supported by funding from the Canada Research Chairs Program and the Canada Foundation for Innovation
The authors acknowledge Sarah-Eve Loiselle and Popi Kasvis for their help with the interventions; Nicolas Kim for his assistance with DXA measures; Caitlin Ellery for sample processing and Sandra Dell’Elce for assisting with blood sampling. Dr. Hugues Plourde is acknowledged for his guidance with conceptualizing the behavioural components of the interventions in the study.
Conflict of Interest: None to declare
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