Effective nationwide school-based participatory extramural program on adolescent body mass index, health knowledge and behaviors

American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update

OBJECTIVE

The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers.

METHODS

The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development.

RESULTS

This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes.

CONCLUSIONS

This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.

The Effectiveness of Nutritional Education Interventions on Dietary Intake in Young Black Males: A Near-Empty Systematic Review

The incidence of several diet and lifestyle-related diseases, previously seen only in adults, is increasing in prevalence in young people. The Black population, and particularly Black males, are at high risk of developing lifestyle-related diseases. Adolescence and young adulthood are considered a transitional period with increasing independence and responsibility, along with the development of lifelong lifestyle habits. This systematic review aimed to establish which methods and approaches to nutritional education interventions are the most effective in improving the nutritional/dietary intake in healthy young Black males. Eligibility criteria were designed using PICOS and included controlled trials of nutrition education interventions designed to improve dietary intake in healthy young Black or mixed-race males aged 14–21 years old. Medline, Cinahl and Scopus were searched in April 2021, resulting in 20,375 records being screened, and subsequently 72 full-text articles were reviewed. Risk of bias was assessed using the ROBINS-I tool. One study met the eligibility criteria. Results are presented in a narrative format as meta-analysis was not possible. This systematic review revealed a lack of evidence on the effectiveness of nutritional education interventions in this high-risk population. Limitations are noted and recommendations have been made.

Theoretical and practical approaches for dietary behavior change in urban socioeconomically disadvantaged adolescents: a systematic review

CONTEXT

There is limited evidence on strategies used to promote dietary behavior changes in socioeconomically disadvantaged urban adolescents and on their effectiveness.

OBJECTIVE

A synthesis of nutrition interventions used in this group of adolescents is provided in this systematic review.

DATA SOURCES

Five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, and ERIC) were searched until November 2020 to identify relevant studies.

DATA EXTRACTION

Forty-six manuscripts (n = 38 intervention studies) met the inclusion criteria. Quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool. A qualitative synthesis summarizing data on study characteristics was conducted.

DATA ANALYSIS

Studies were classified by intervention type as those focusing on hedonic determinants of dietary intake (n = 1), environmental changes to promote a specific dietary intake (n = 3), cognitive determinants (n = 29), and multicomponent strategies (n = 13). The social cognitive theory was the most applied theoretical framework, either alone or combined with other frameworks. Most of the intervention studies targeted multiple dietary outcomes, and success was not always reported for each.

CONCLUSIONS

Despite the heterogeneity of the studies and lack of combination of dietary outcomes into dietary scores or patterns to evaluate changes on the individuals' whole diets, long-term, theory-driven interventions targeting a single dietary factor seem promising in obtaining sustainable dietary behavior changes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020188219.

Themes in Train-the-Trainer Nutrition Education Interventions Targeting Middle School Students: A Systematic Review

Context-appropriate nutrition education interventions targeting middle school students have the potential to promote healthy dietary patters that may help prevent unnecessary weight gain at a point in childhood development when youth experience increasing agency over their food choices. The aim of this review was to identify and synthesize themes in train-the-trainer approaches, intervention content and delivery, and youth receptivity across teacher, mentor, and peer-led nutrition education interventions that targeted middle school-age youth in urban, primarily low-income settings. A systematic, electronic literature search was conducted in seven electronic databases, PubMed/Medline, CINAHL, ERIC, PsycINFO, Scopus, SPORTDiscus, and Cochrane CENTRAL, using fixed inclusion and exclusion criteria. A total of 53 papers representing 39 unique interventions were selected for data extraction and quality assessment. A framework synthesis approach was used to organize the interventions into six categories and identify themes according to whether the intervention was classroom-based or out-of-school-based and whether adults, cross-age peers or same-age peers delivered the intervention. Ten of the interventions contained multiple components such that they were included in two of the categories. The review findings indicated that trainings should be interactive, include opportunities to role-play intervention scenarios and provide follow-up support throughout intervention delivery. Interventions targeting middle school youth should include positive messaging and empower youth to make healthy choices within their specific food environment context.

Gender differences in the longitudinal association between multilevel latent classes of chronic disease risk behaviours and body mass index in adolescents

INTRODUCTION

Few studies have assessed the relationship between chronic disease risk behaviours and body mass index (BMI) in a longitudinal, sex/gender-specific context. This study used gender-specific analyses to assess the extent to which chronic disease risk behaviour latent classes are associated with BMI and weight status at follow-up.

METHODS

Longitudinal data from 4510 students in Grades 9 to 12, tracked from 2013- 2015, who participated in the COMPASS study were used to assess gender differences in the lagged association between previously determined latent classes (of physical activity and substance use) with BMI using multilevel mixed-effects models. Our multilevel regression models assessed the association between two latent classes, active experimenters and inactive non-using youth, with BMI when stratified by gender.

RESULTS

Male inactive non-substance-using youth were associated with a 0.29 higher continuous BMI (95% CI: 0.057, 0.53) and odds of overweight/obesity increased by 72% (OR = 1.72, 95% CI: 1.2, 2.4) for binary BMI at follow-up relative to active youth who experiment with substance use. No significant associations were detected in females.

CONCLUSION

Over time, physical activity has a protective role on BMI in male youth. Both substance use and physical inactivity should be addressed in obesity prevention efforts. Gender stratification in analyses is also important since females and males have different contributing factors to increases in BMI.

Being obese versus trying to lose weight: Relationship with physical inactivity and soda drinking among high school students

BACKGROUND

Among adolescents, physical inactivity and unhealthy dietary habits are associated with being obese. We know little about how those are associated with trying to lose weight.

METHODS

We analyzed the 2013 Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Surveillance data (N = 13,583) to examine how obesity and trying to lose weight are associated with: (1) <5 physically active days per week with ≥60 minutes physical activity; (2) playing with video computer games ≥3 hours per day on average; (3) no participation in any sports team in the past year; and (4) drinking soda ≥2 times per day. We applied survey logistic regression adjusting for age and Hispanic ethnicity, stratified by sex.

RESULTS

Both being obese (13.7%) and trying to lose weight (47.7%) are significantly associated with physical inactivity. Soda drinking was associated with being obese (odds ratio [OR] = 1.34, p = .003 for boys and OR = 1.36, p = .014 for girls); it was inversely associated trying to lose weight among girls (OR = 0.72, p < .001) but not among boys (OR = 1.13, p = .174).

CONCLUSION

Obesity was associated with physical inactivity and drinking soda in both sexes. Only girls appeared to avoid drinking soda as a strategy for losing weight. Trying to lose weight was associated with a higher likelihood of physically inactive behaviors both sexes. High schools need to develop collaborative strategies for reducing adolescent obesity and supporting students who are trying to lose weight that address physical inactivity and soda intake.

School education and childhood obesity: A systemic review

Childhood obesity prevalence is shooting up at a phenomenal rate worldwide, leading to long-term devastating consequences. A great number of studies have investigated factors contributing to the increase in BMI of children and adolescents. School-based, home-based and clinic-based solutions have been suggested as possible viable strategies, among which school-based interventions is believed to produce a noticeable effect on a massive scale. However, the question of whether school interventions, especially school education exert significant impact on childhood obesity or not, is left with mixing results. This article aims to holistically review the relationship between school education and childhood obesity. Various factors are covered, including health education, nutrition education, school nutrition, physical education, teachers' awareness, teaching practice and school stress, In all, school education is not the answer to childhood obesity but just part of it. More attempts from other stakeholders (parents, community, policy makers, researchers, etc.) should be made in order to solve this complicated puzzle.