José L Peñalvo1, Gloria Santos-Beneit2, Mercedes Sotos-Prieto3, Patricia Bodega2, Belén Oliva4, Xavier Orrit2, Carla Rodríguez2, Juan Miguel Fernández-Alvira4, Juliana Redondo4, Rajesh Vedanthan5, Sameer Bansilal5, Emilia Gómez2, Valentin Fuster6. 1. Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts. 2. Fundación SHE, Barcelona, Spain. 3. Fundación SHE, Barcelona, Spain; Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 4. Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain. 5. Icahn School of Medicine at Mount Sinai, New York, New York. 6. Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: valentin.fuster@mountsinai.org.
Abstract
BACKGROUND: The preschool years offer a unique window of opportunity to instill healthy life-style behaviors and promote cardiovascular health. OBJECTIVES: This study sought to evaluate the effect of a 3-year multidimensional school-based intervention to improve life-style-related behaviors. METHODS: We performed a cluster-randomized controlled intervention trial involving 24 public schools in Madrid, Spain, that were assigned to either the SI! Program intervention or the usual curriculum and followed for 3 years. The SI! Program aimed to instill and develop healthy behaviors in relation to diet, physical activity, and understanding how the human body and heart work. The primary outcome was change in the overall knowledge, attitudes, and habits (KAH) score (range 0 to 80). The intervention's effect on adiposity markers was also evaluated. RESULTS: A total of 2,062 children from 3 to 5 years of age were randomized. After 3 years of follow-up, the overall KAH score was 4.9% higher in children in the intervention group compared with the control group (21.7 vs. 16.4; p < 0.001). A peak effect was observed at the second year (improvement 7.1% higher than in the control group; p < 0.001). Physical activity was the main driver of the change in KAH at all evaluation times. Children in the intervention group for 2 years and 1 year showed greater improvement than control subjects (5.9%; p < 0.001 and 2.9%; p = 0.002, respectively). After 3 years, the intervention group showed a higher probability than the control group of reducing the triceps skinfold z-score by at least 0.1 (hazard ratio: 1.40, 95% confidence interval: 1.04 to 1.89; p = 0.027). CONCLUSIONS: The SI! Program is an effective strategy for instilling healthy habits among preschoolers, translating into a beneficial effect on adiposity, with maximal effect when started at the earliest age and maintained over 3 years. Wider adoption may have a meaningful effect on cardiovascular health promotion. (Evaluation of the Program SI! for Preschool Education: A School-Based Randomized Controlled Trial [Preschool_PSI!]; NCT01579708).
RCT Entities:
BACKGROUND: The preschool years offer a unique window of opportunity to instill healthy life-style behaviors and promote cardiovascular health. OBJECTIVES: This study sought to evaluate the effect of a 3-year multidimensional school-based intervention to improve life-style-related behaviors. METHODS: We performed a cluster-randomized controlled intervention trial involving 24 public schools in Madrid, Spain, that were assigned to either the SI! Program intervention or the usual curriculum and followed for 3 years. The SI! Program aimed to instill and develop healthy behaviors in relation to diet, physical activity, and understanding how the human body and heart work. The primary outcome was change in the overall knowledge, attitudes, and habits (KAH) score (range 0 to 80). The intervention's effect on adiposity markers was also evaluated. RESULTS: A total of 2,062 children from 3 to 5 years of age were randomized. After 3 years of follow-up, the overall KAH score was 4.9% higher in children in the intervention group compared with the control group (21.7 vs. 16.4; p < 0.001). A peak effect was observed at the second year (improvement 7.1% higher than in the control group; p < 0.001). Physical activity was the main driver of the change in KAH at all evaluation times. Children in the intervention group for 2 years and 1 year showed greater improvement than control subjects (5.9%; p < 0.001 and 2.9%; p = 0.002, respectively). After 3 years, the intervention group showed a higher probability than the control group of reducing the triceps skinfold z-score by at least 0.1 (hazard ratio: 1.40, 95% confidence interval: 1.04 to 1.89; p = 0.027). CONCLUSIONS: The SI! Program is an effective strategy for instilling healthy habits among preschoolers, translating into a beneficial effect on adiposity, with maximal effect when started at the earliest age and maintained over 3 years. Wider adoption may have a meaningful effect on cardiovascular health promotion. (Evaluation of the Program SI! for Preschool Education: A School-Based Randomized Controlled Trial [Preschool_PSI!]; NCT01579708).
Authors: Jennifer C Sanchez-Flack; Annie Herman; Joanna Buscemi; Angela Kong; Alexis Bains; Marian L Fitzgibbon Journal: Transl Behav Med Date: 2020-10-12 Impact factor: 3.046
Authors: Sameer Bansilal; Rajesh Vedanthan; Jason C Kovacic; Ana Victoria Soto; Jacqueline Latina; Johan L M Björkegren; Risa Jaslow; Maribel Santana; Samantha Sartori; Chiara Giannarelli; Venkatesh Mani; Roger Hajjar; Eric Schadt; Andrew Kasarskis; Zahi A Fayad; Valentin Fuster Journal: Am Heart J Date: 2017-02-22 Impact factor: 4.749
Authors: Franco Giulianini; Bastiaan Geelhoed; Kathryn L Lunetta; Jeffrey R Misialek; Maartje N Niemeijer; Michiel Rienstra; Lynda M Rose; Albert V Smith; Neal A Chatterjee; Dan E Arking; Patrick T Ellinor; Jan Heeringa; Honghuang Lin; Steven A Lubitz; Elsayed Z Soliman; Niek Verweij; Alvaro Alonso; Emelia J Benjamin; Vilmundur Gudnason; Bruno H C Stricker; Pim Van Der Harst; Daniel I Chasman; Christine M Albert Journal: Circulation Date: 2016-12-14 Impact factor: 29.690
Authors: Rebecca K Hodder; Kate M O'Brien; Fiona G Stacey; Flora Tzelepis; Rebecca J Wyse; Kate M Bartlem; Rachel Sutherland; Erica L James; Courtney Barnes; Luke Wolfenden Journal: Cochrane Database Syst Rev Date: 2019-11-07
Authors: Tamara Brown; Theresa Hm Moore; Lee Hooper; Yang Gao; Amir Zayegh; Sharea Ijaz; Martha Elwenspoek; Sophie C Foxen; Lucia Magee; Claire O'Malley; Elizabeth Waters; Carolyn D Summerbell Journal: Cochrane Database Syst Rev Date: 2019-07-23
Authors: Rebecca K Hodder; Fiona G Stacey; Kate M O'Brien; Rebecca J Wyse; Tara Clinton-McHarg; Flora Tzelepis; Erica L James; Kate M Bartlem; Nicole K Nathan; Rachel Sutherland; Emma Robson; Sze Lin Yoong; Luke Wolfenden Journal: Cochrane Database Syst Rev Date: 2018-01-25
Authors: Rebecca K Hodder; Kate M O'Brien; Fiona G Stacey; Rebecca J Wyse; Tara Clinton-McHarg; Flora Tzelepis; Erica L James; Kate M Bartlem; Nicole K Nathan; Rachel Sutherland; Emma Robson; Sze Lin Yoong; Luke Wolfenden Journal: Cochrane Database Syst Rev Date: 2018-05-17