A Cluster Randomized Controlled Trial of the Archena Infancia Saludable Project on 24-h Movement Behaviors and Adherence to the Mediterranean Diet among Schoolchildren: A Pilot Study Protocol

Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention's "halo" effect on parents'/guardians' 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6-13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.

Adherence to the Mediterranean Diet and Health-Related Quality of Life during the COVID-19 Lockdown: A Cross-Sectional Study including Preschoolers, Children, and Adolescents from Brazil and Spain

Scientific literature has suggested positive associations between the Mediterranean diet (MD) and the health-related quality of life (HRQoL) in young populations. However, to our knowledge, this relationship is unexplored during a situation of social isolation (i.e., lockdown). The objective of the current study is to examine the relationship between the MD and HRQoL during the COVID-19 lockdown among preschoolers, children, and adolescents from Brazil and Spain. This cross-sectional study includes a sample of 1099 three- to seventeen-year-old participants (47.6% girls) who were recruited via social networks. The HRQoL was assessed with the EQ-5D-Y. The Quality Index for Children and Teenagers (KIDMED) questionnaire was applied to evaluate the relationship between the MD and HRQoL. The highest prevalence of reported problems was found for worried, sad, or unhappy participants (39.8%). Furthermore, the lowest proportion of HRQoL problems was observed for "mobility" (2.5%). The proportion of high adherence to the MD was 44.3%. Participants with greater MD adherence reported higher HRQoL mean scores when compared with those who did not adhere to the MD (83.7 ± 0.6 vs. 85.6 ± 0.7, respectively; p < 0.05). Adherence to the MD and especially daily fruit intake were related to higher HRQoL during the COVID-19 lockdown among Brazilian and Spanish young people aged three to seventeen years.

Food consumption patterns related to excess weight and obesity in Spanish preschoolers

PURPOSE

The aims of this study were (1) to identify the different food consumption patterns among Spanish preschoolers and (2) to examine the association between having a different food consumption pattern and the odds of having excess weight (i.e., overweight or obesity) or obesity among this population.

METHODS

This was a nationwide cross-sectional study with data from the Spanish National Health Survey-2017. All preschoolers (aged 3-5 years) with complete information on all the variables analyzed were selected. The frequency of consumption of the fourteen food groups was evaluated by a food frequency questionnaire. Excess weight/obesity were computed following the World Health Organization criteria. A hierarchical cluster analysis using Ward's method (i.e., based on squared Euclidean distances) and k-means were performed including all food group consumption. A total sample of 663 was included in the cluster analysis.

RESULTS

Three different clusters were established. Compared to the healthiest food consumption pattern (Cluster 1), higher odds of excess weight (OR = 1.51; CI: 95%, 1.02-2.25) and obesity (OR = 1.59; CI: 95%, 1.01-2.51) were found for participants with the unhealthiest food consumption pattern (Cluster 3).

CONCLUSION

Having a food consumption pattern considered unhealthy (i.e., low intake of vegetables/fruits, high consumption of confectionery products, sugar-sweetened beverages, fast-food, and snacks) was associated with presenting excess weight/obesity among Spanish preschoolers.

IMPACT

No studies have examined the specific food consumption patterns associated with excess weight or obesity among Spanish preschoolers. The unhealthiest food consumption pattern was characterized by a food consumption pattern that included a lower intake of vegetables and fruits and a higher consumption of confectionery products, sugar-sweetened beverages, fast-food, and snacks. Having a food consumption pattern considered unhealthy was associated with a higher prevalence of excess weight and obesity in comparison with other healthier food consumption patterns.

Influence of the confinement that occurred in Spain due to the SARS-CoV-2 virus outbreak on adherence to the Mediterranean diet

Introduction

The Mediterranean diet (MDiet), reduces morbidity and mortality. The lockdown that took place in Spain between the months of March and May 2020 may have led to behavioural changes. The aim of the present study was to assess adherence to the MDiet at the end of the lockdown period and to compare it with the situation prior to it.

Methods

Data were obtained by means of two online questionnaires, one at the beginning of lockdown and the other at the end, completed by adults from the Spanish population, who responded anonymously and voluntarily. The assessment of adherence to the MDiet was carried out using two questionnaires: Mediterranean Diet Adherence Screener (MEDAS) and modified PREDIMED, which contained 14 questions each. Other variables included were: age, gender, body mass index (BMI), Autonomous Community of origin, home living conditions, and level of studies achieved. At the end of the lockdown period, the comparison was made using the Student t statistic and the McNemar test.

Results

A total of 207 people (137 women) participated, with a mean age 51.3 ± 12.4 years, age range: 20−83 years. After lockdown, BMI remained unchanged (initial 24.55 ± 3.7 kg/m² and final 24.57 ± 3.7 kg/m², P = .752), as well as fish consumption (initial 51.2%) and 60.9% at the end, P = .003) mainly due to the women and adherence to the Mdiet. The mean total score of MEDAS increased with 10.6 ± 2.0 at the beginning, and 10.57 ± 2.0 at the end; P = .001). This also occurred with the modified PREDIMED (9.47 ± 2.1 at the beginning and 9.93 ± 2.1 at the end, P < .001). Similarly, the proportion of participants that had a score classified as high at the beginning increased at the end of lockdown: from 80.7% initially in MEDAS to 87.9% at the end, P = .021, and from 68.6% initially in modified PREDIMED to 75.8% at the end, P = .037.

Conclusions

In the study sample, during lockdown there were no changes in BMI, but there were increases in fish consumption and adherence to the MDiet.

Influence of the confinement that occurred in Spain due to the SARS-CoV-2 virus outbreak on adherence to the Mediterranean diet

INTRODUCTION

The Mediterranean diet (MDiet) reduces morbidity and mortality. The lockdown that took place in Spain between the months of March and May 2020 may have led to behavioural changes. The aim of the present study was to assess adherence to the MDiet at the end of the lockdown period and to compare it with the situation prior to it.

METHODS

Data were obtained by means of 2online questionnaires, one at the beginning of lockdown and the other at the end, completed by adults from the Spanish population, who responded anonymously and voluntarily. The assessment of adherence to the MDiet was carried out using 2questionnaires: Mediterranean Diet Adherence Screener (MEDAS) and modified PREDIMED, which contained 14 questions each. Other variables included were: age, gender, body mass index (BMI), autonomous community of origin, home living conditions, and level of studies achieved. At the end of the lockdown period, the comparison was made using the Student t statistic and the McNemar test.

RESULTS

A total of 207 people (137 women) participated, with a mean age 51.3±12.4 years, age range: 20-83 years. After lockdown, BMI remained unchanged (initial 24.55±3.7kg/m2 and final 24.57±3.7kg/m2, P=.752), as well as fish consumption (initial 51.2%) and 60.9% at the end, P=.003), mainly due to the women, and adherence to the Mdiet. The mean total score of MEDAS increased with 10.16±2.0 at the beginning, and 10.57±2.0 at the end; P=.001). This also occurred with the modified PREDIMED (9.47±2.1 at the beginning and 9.93±2.1 at the end, P<.001). Similarly, the proportion of participants that had a score classified as high at the beginning increased at the end of lockdown: from 80.7% initially in MEDAS to 87.9% at the end (P=.021) and from 68.6% initially in modified PREDIMED to 75.8% at the end (P=.037).

CONCLUSIONS

In the study sample, during lockdown there were no changes in BMI, but there were increases in fish consumption and adherence to the MDiet.

Resultados de una intervención motivacional con niños obesos o con sobrepeso y sus familias: Estudio Piloto

Introducción: el objetivo fue analizar los resultados de una intervención motivacional con modificación de los hábitos alimentarios, los estilos de vida y los trastornos emocionales en niños obesos de 6 a 12 años y sus familias. Material y métodos: Estudio de intervención con evaluación pre- y posintervención del programa Familias en Movimiento. Se incluyeron 11 niños (10 niñas y 1 niño) de 6 a 12 años tratados con otros programas para la pérdida de peso sin éxito. Se evaluaron al inicio y al final los parámetros: Índice de Masa Corporal (IMC), los resultados de los cuestionarios: de Dieta Mediterránea y ansiedad en niños y el peso y la ansiedad de los adultos tras la intervención.Resultados: El IMC disminuyó de una mediana de 25,2 (Rango intercuartílico de 23,3–28,0) a 23,9 y (22,9–27,6) tras la intervención, cambio no estadísticamente significativo (p<0,086). La mediana de adherencia a la Dieta Mediterránea aumentó significativamente en 2,2 puntos (7,1 a 9,3), debido principalmente a que un mayor número de niños tomaban desayuno (44%) y hubo una disminución del consumo de golosinas y bollería industrial en el desayuno (22,2%). La intervención redujo significativamente en 8,7 puntos la ansiedad en los niños. De los adultos, 9 de ellos participaron en la evaluación inicial, la media de disminución de peso fue de 3,6kg y la disminución de la ansiedad pasó de 45,6 a 27,3 (p=0,02).Conclusiones: La aplicación del programa Familias en Movimiento disminuyó el IMC, aumentó la puntuación en la adherencia a Dieta Mediterránea y disminuyó la ansiedad en los niños, además se redujo el peso y la ansiedad en los adultos que acompañaron en el programa a los niños.

Effect on the lipid parameters of an intervention to reduce weight in overweight and obese patients

OBJECTIVE

To assess the effect on lipid parameters most associated with excess weight (triglycerides [TG], cholesterol, and high density lipoprotein [HDL-C]) of an intervention to reduce weight in overweight and obese patients.

METHODS

A randomised, controlled, double blind clinical trial, with three groups, and a follow-up of 12 months. Patients included in the study were randomised into three intervention groups: Obesity motivational intervention group with previously trained nurse (G1), lower intensity consultation, non-motivational group, with digital platform support (G2), and a third group that received a recommendation to lose weight and usual follow-up (G3). The anthropometric variables measured were height, weight, and abdominal/waist circumference, and laboratory results, total cholesterol, TG and HDL cholesterol).

RESULTS

The study include 176 patients, of whom 60 were randomised to G1, 61 to G2, and 59 to G3. All groups significantly decreased body weight at the end of the study, with a decrease in G1 (-5.6kg), followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean loss of -3.9kg. There was a also significant decrease (P<.05) in total cholesterol and TG, and an increased HDL-C. These changes were more marked in the G1 group (the group that lost more weight). The clinical relevance indicators that were significant were: in the case of TG: G1/G3: relative risk: 1.42 (95% CI: 1.11-1.80); relative risk reduction: 41.7% (11.4-80.2); absolute risk reduction: 25% (9.2-40.8) and NNT: 5 (3-11). In the case of G1/G2 HDL-C: relative risk: 1.32 (1.07-1.63); relative risk reduction: 32.2% (7.4-62.6); absolute risk reduction: 21.1% (6.4-35.8) and NNT: 5 (3-16).

CONCLUSIONS

Weight reduction is accompanied by favorable changes in the lipid parameters related to overweight and obesity, being more intense the greater the weight loss.

[Active interventions in hypercholesteroloemia patients with high cardiovascular risk in primary care; estudio ESPROCOL]

INTRODUCTION

Hypercholesterolemia is a major modifiable risk factors for cardiovascular disease (CVD). Its reduction reduces morbidity and mortality from ischemic heart disease and CVD in general, primary prevention and secondary prevention especially.

OBJECTIVE

To determine whether a notarized and intensive clinical practice can overcome inertia and achieve the therapeutic goal (OT) LDL-C <100 mg/dL in high-risk patients attended in Primary Care (PC) in our country.

METHODOLOGY

Epidemiological, prospective, multicenter study conducted in centers of different ACs By AP consecutive sampling 310 patients at high cardiovascular risk (diabetic or established CVD) previously treated with statins, which did not reach the OT included c-LDL.

RESULTS

The study subjects had a mean age of 65.2 years, of which 60.32% were male. The 41.64% had a previous EVC, acute myocardial infarction (20.33%), angina (16.07%), stroke/TIA (9.19%), arthropathy (5.25%), diabetes (70.87%), hypertension (71.01%), and abdominal obesity (69.62%). The 43.57% (95% CI: 37,21; 50,08) of patients who performed the 2nd visit (241) got the OT. 62.50% (95% CI: 55.68, 68.98) of those who took the 3rd (216) got the OT. Finally, 77.56% (95% CI: 72.13, 83.08) patients who performed the last visit (205) got the OT. Throughout the study there was a reduction in LDL-C levels from 135.6 mg/dL at baseline, 107.4 mg dL in the 2nd visit, 97.3 mg/dL in the 3rd visit, up to 90.7 mg/dL at the final visit (p < 0.0001). The increase in HDL-C from baseline (50.9 mg/dL) and final (53.6 mg/dL) was also significant (p = 0.013).

CONCLUSIONS

The reassessment and intensification of treatment in patients at high cardiovascular risk treated in primary care, applying the indications of the guides, achieves the OT in more than three quarters of the previously uncontrolled within half a year. These results should encourage us to overcome the therapeutic inertia in the control of CVD by early and energetic performance against hypercholesterolemia.

[Active interventions in hypercholesteroloemia patients with high cardivascular risk in primary care]

INTRODUCTION

Hypercholesterolemia is a major modifiable risk factors for cardiovascular disease (CVD). Its reduction reduces morbidity and mortality from ischemic heart disease and CVD in general, primary prevention and secondary prevention especially.

OBJECTIVE

To determine whether a notarized and intensive clinical practice can overcome inertia and achieve the therapeutic goal (OT) LDL-C <100 mg / dL in high-risk patients attended in Primary Care (PC) in our country.

METHODOLOGY

epidemiological, prospective, multicenter study conducted in centers of different ACs By AP consecutive sampling 310 patients at high cardiovascular risk (diabetic or established CVD) previously treated with statins, which did not reach the OT included c-LDL.

RESULTS

The study subjects had a mean age of 65.2 years, of which 60.32% were male. The 41.64% had a previous EVC, acute myocardial infarction (20.33%), angina (16.07%), stroke / TIA (9.19%), arthropathy (5.25%), diabetes (70 , 87%), hypertension (71.01%), and abdominal obesity (69.62%). The 43.57% (95% CI: 37,21; 50,08) of patients who performed the 2nd visit (241) got the OT. 62.50% (95% CI: 55.68, 68.98) of those who took the 3rd (216) got the OT. Finally, 77.56% (95% CI: 72.13, 83.08) patients who performed the last visit (205) got the OT. Throughout the study there was a reduction in LDL-C levels from 135.6 mg / dL at baseline, 107.4 mg / dL in the 2nd visit, 97.3 mg / dL in the 3rd visit, up to 90.7 mg / dL at the final visit (p <0.0001) The increase in HDL-C from baseline (50.9 mg / dL) and final (53.6 mg / dL) was also significant (p = 0.013).

CONCLUSIONS

The reassessment and intensification of treatment in patients at high cardiovascular risk treated in primary care, applying the indications of the guides, achieves the OT in more than three quarters of the previously uncontrolled within half a year. These results should encourage us to overcome the therapeutic inertia in the control of CVD by early and energetic performance against hypercholesterolemia.

[Efficacy of motivational interventions in the treatment of overweight and obesity]

INTRODUCTION AND OBJECTIVES

Changing unhealthy behaviors: Diet and physical activity are key to treating obesity. The objective of this study is to determine whether an intervention group motivational intervention group by nurses trained by expert psychologist, complementary to the usual intervention is more effective than the latter in the treatment of overweight and obesity in relation to weight reduction percentage and the persistence over time of the reduction achieved.

METHODS

A multicenter randomized clinical trial of intervention in overweight and obese patients. Randomization of the intervention by health areas (ZBS). Two groups located in different centers separated, one of which will receive motivational intervention group (study group) and the other routine monitoring (control group) were established.

VARIABLES

Sociodemographic, results: percentage of patients reduced by 5% of its weight and maintenance over time, anthropometric assessment, assessment of cardiovascular risk factors and laboratory data.

RESULTS

696 patients were studied; 377 control and 319 study group. In both groups the weight down in each of the visits. The mean percentage weight reduction stood at 1% for the control group and 2.5% in the intervention group (p -value = 0.009). 55.8% of patients reduced the weight in the control group and 65.5% of the study group (p -value = 0.0391). 18.1% of the control patient lost more than 5% by weight, in the intervention group, this percentage increased to 26.9%; statistically significant ( p -value = 0.0304). For the 10% target no significant differences at 2 years were detected (5% vs. 8%). It was found that after two years the BMI in the control group an average 0.9 kg/m2 and 2.4 kg/m2 was reduced in the study group ( p -value = 0.0237).

CONCLUSION

based motivational group intervention program can improve anthropometric and lifestyle parameters in obese patients treated in a primary care center.

[The nutritional epidemic: How do we eat? How do we shop? What do we purchase?]

The aim of this article is to provide some simple, clear norms which can help us to adopt and to "help to adopt" some healthy feeding habits, habits which we should transmit to our future generations.