Effect of an online lifestyle intervention on the BMI z-score of Mexican school children: a protocol for an outcome assessor-blinded pilot randomized controlled trial during the COVID-19 pandemic.

Authors

  • Diana L. Ramírez-Rivera Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.
  • Teresita Martínez-Contreras Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.
  • Alma L. Ruelas Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.
  • Gricelda Henry-Mejia Departamento de Ciencias del Deporte y de la Actividad Física. Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 8300
  • Trinidad Quizán-Plata Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.
  • Julián Esparza-Romero Centro de Investigación en Alimentación y Desarrollo A.C. Carretera Gustavo Enrique Astiazarán Rosas, NO.46. Col. La Victoria, C.P.83304, Hermosillo, Sonora.
  • Michelle M. Haby Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.
  • Rolando G. Díaz-Zavala Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.

DOI:

https://doi.org/10.14306/renhyd.25.S2.1320

Keywords:

Pediatric Obesity, Primary Prevention, Internet-Based Intervention, Nutritional Status, Exercise, COVID-19

Abstract

ABSTRACT

Introduction: School closures due to the COVID-19 pandemic represent a risk factor for the development of childhood obesity, due to the increase in unhealthy behaviors. Online lifestyle interventions in schoolchildren could help to mitigate this problem. However, to our knowledge, no randomized controlled trials have been conducted to prevent obesity in schoolchildren during COVID-19. The aim of this study is to evaluate the effect of a 4-month online lifestyle intervention on the BMI Z-score of Mexican schoolchildren during the COVID-19 pandemic in an intervention group compared to a control group.

Material and Methods: This is a protocol for an outcome assessor-blinded pilot randomized controlled trial. Schoolchildren from a public elementary school in Hermosillo, Sonora, Mexico will be invited to participate. Participants will be randomized to an intervention group (online lifestyle intervention) or a control group. The intervention will include online sessions of nutrition education and physical activity (60 minutes per session, 30 minutes for nutrition education and 30 minutes for physical activity) and nutrition information for parents. The control group will receive a digital brochure with nutrition recommendations at the beginning of the study and access to the program materials at the end of the study. The measurements will be performed at baseline and at 4 months. The primary outcome will be the BMI Z- score. Secondary outcomes will be waist circumference, body fat percentage, nutrition knowledge, lifestyle parameters, participation, retention and acceptance of the intervention. The changes on the outcomes will be analyzed using an intention to treat analysis. The protocol was approved by the Research Ethics Committee of the University of Sonora Nursing Department and registered in Clinical Trials.

Conclusion: To our knowledge, the study will provide the first evidence of the evaluation of online interventions for the prevention of obesity in schoolchildren derived from a randomized controlled trial, which could be useful in the fight against childhood obesity.

Author Biographies

Diana L. Ramírez-Rivera, Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.

Estudiante del Posgrado en Ciencias de la Salud. Universidad de Sonora.

Teresita Martínez-Contreras, Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.

Profesor. Técnico del Centro de Promoción de Salud Nutricional del Departamento de Ciencias Químico Biológicas. Universidad de Sonora.

Alma L. Ruelas, Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.

Estudiante del Programa de Doctorado en Ciencias de la Salud. Universidad de Sonora.

Gricelda Henry-Mejia, Departamento de Ciencias del Deporte y de la Actividad Física. Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 8300

Profesor. Investigador. Departamento de Ciencias del Deporte y la Actividad Física. Universidad de Sonora.

 

Trinidad Quizán-Plata, Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.

Profesor. Investigador. Departamento de Ciencias Químico Biológicas. Universidad de Sonora.

Julián Esparza-Romero, Centro de Investigación en Alimentación y Desarrollo A.C. Carretera Gustavo Enrique Astiazarán Rosas, NO.46. Col. La Victoria, C.P.83304, Hermosillo, Sonora.

Investigador Titular "C"

Michelle M. Haby, Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.

Profesor. Investigador. Departamento de Ciencias Químico Biológicas. Universidad de Sonora.

Rolando G. Díaz-Zavala, Departamento de Ciencias Químicas y Biológicas Universidad de Sonora, Blvd. Luis Encinas y Rosales S / N, Hermosillo, Sonora, México. C.P. 83000.

Profesor. Investigador. Departamento de Ciencias Químico Biológicas. Universidad de Sonora.

References

REFERENCIAS

Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-60, doi: 10.23750/abm.v91i1.9397.

Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeu-tic opportunities. Clin Chim Acta. 2020;508:254-66, doi: 10.1016/j.cca.2020.05.044.

UNESCO. Education: From disruption to recovery. [accedido 6 julio 2021]. Disponible en: https://en.unesco.org/covid19/educationresponse.

UNICEF. COVID-19: Más del 95 por ciento de niños y niñas está fuera de las escuelas de Amé-rica Latina y el Caribe. [accedido 6 julio 2021]. Disponible en: https://www.unicef.org/mexico/comunicados-prensa/covid-19-m%C3%A1s-del-95-por-ciento-de-ni%C3%B1os-y-ni%C3%B1as-est%C3%A1-fuera-de-las-escuelas-de.

UNESCO. Adverse consequences of school closures. [accedido 6 julio 2021]. Disponible en: https://en.unesco.org/covid19/educationresponse/consequences.

von Hippel PT, Workman J. From Kindergarten Through Second Grade, U.S. Children’s Obesi-ty Prevalence Grows Only During Summer Vacations. Obesity (Silver Spring). 2016;24(11):2296-300, doi: 10.1002/oby.21613.

Díaz-Zavala RG, Castro-Cantú MF, Valencia ME, Álvarez-Hernández G, Haby MM, Esparza-Romero J. Effect of the Holiday Season on Weight Gain: A Narrative Review. J Obes. 2017;2017:2085136, doi: 10.1155/2017/2085136.

Brazendale K, Beets MW, Weaver RG, Pate RR, Turner-McGrievy GM, Kaczynski AT, et al. Un-derstanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. Int J Behav Nutr Phys Act. 2017;14(1):100, doi: 10.1186/s12966-017-0555-2.

Pietrobelli A, Pecoraro L, Ferruzzi A, Heo M, Faith M, Zoller T, et al. Effects of COVID-19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitu-dinal Study. Obesity (Silver Spring). 2020;28(8):1382-5, doi: 10.1002/oby.22861

Ruiz-Roso MB, de Carvalho Padilha P, Mantilla-Escalante DC, Ulloa N, Brun P, Acevedo-Correa D, et al. Covid-19 Confinement and Changes of Adolescent’s Dietary Trends in Italy, Spain, Chile, Colombia and Brazil. Nutrients. 2020;12(6):E1807, doi: 10.3390/nu12061807.

World Health Organization. Obesity and overweight. [accedido 6 julio 2021]. Disponible en: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.

INEGI, Instituto Nacional de Salud Pública. Encuesta Nacional de Salud y Nutrición 2018. 2019. Disponible en: https://ensanut.insp.mx/encuestas/ensanut2018/doctos/informes/ensanut_2018_presentacion_resultados.pdf

Sharma V, Coleman S, Nixon J, Sharples L, Hamilton-Shield J, Rutter H, et al. A systematic review and meta-analysis estimating the population prevalence of comorbidities in children and adolescents aged 5 to 18 years. Obes Rev. 2019;20(10):1341-9, doi: 10.1111/obr.12904.

Park MH, Falconer C, Viner RM, Kinra S The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev. 2012;13(11):985-1000, doi: 10.1111/j.1467-789X.2012.01015.x.

INSP, GISAMAC, FAO, OPS, UNICEF. Prevención de mala nutrición en niñas y niños en México ante la pandemia de COVID-19. Recomendaciones dirigidas a tomadores de decisiones. Mé-xico; 2020.

World Health Organization Global difusion of eHealth: making universal health coverage achievable. Report of the third global survey on eHealth. Geneva: World Health Organization; 2016.

UNICEF SOWC: Children in a Digital World. USA: UNICEF Division of Communication; 2017.

Horzum MB, Bektas M. Examining the Internet Use Aim and Internet Parental Style of Prima-ry School Students in Terms of Various Variables. Croatian Journal of Education : Hrvatski Časopis Za Odgoj i Obrazovanje. 2014;16(3):745-78.

Verrotti A, Penta L, Zenzeri L, Agostinelli S, De Feo P. Childhood obesity: prevention and strategies of intervention. A systematic review of school-based interventions in primary schools. J Endocrinol Invest. 2014;37(12):1155-64, doi: 10.1007/s40618-014-0153-y.

Hamel LM, Robbins LB. Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review. J Adv Nurs. 2013;69(1):16-30, doi: 10.1111/j.1365-2648.2012.06086.x.

Ramírez-Rivera DL, Martínez-Contreras T, Villegas-Valle RC, Henry-Mejia G, Quizán-Plata T, Haby MM, et al. Preliminary Results of the Planet Nutrition Program on Obesity Parameters in Mexican Schoolchildren: Pilot Single-School Randomized Controlled Trial. Int J Environ Res Public Health. 2021;18(2):E790, doi: 10.3390/ijerph18020790.

Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 expla-nation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586, doi: 10.1136/bmj.e7586.

Bonvecchio A, Fernández AC, Plazas M, Kaufer-Horwitz M, Pérez AB, Rivera JÁ. Guías alimentarias y de actividad física en contexto de sobrepeso y obesidad en la población mexicana. Academia Nacional de Medicina, México DF, México. 2015

World Health Organization Growth reference 5-19 years - BMI-for-age (5-19 years). [accedido 6 julio 2021]. Disponible en: https://www.who.int/tools/growth-reference-data-for-5to19-years/indicators/bmi-for-age.

Gibson R. Principles of Nutritional Assessment. New York: Oxford University Press; 1990.

Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in na-tionally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr. 2004;145(4):439-44, doi: 10.1016/j.jpeds.2004.06.044.

Ramírez E, Valencia ME, Bourges H, Espinosa T, Moya-Camarena SY, Salazar G, et al. Body composition prediction equations based on deuterium oxide dilution method in Mexican children: a national study. Eur J Clin Nutr. 2012;66(10):1099-103, doi: 10.1038/ejcn.2012.89.

Marfell-Jones M, Olds T, Stewart A, Carter L. International Atandards for Anthropometric Assessment. ISAK, Editor. Potchefstroom, South Africa; 2006.

Woolcott OO, Bergman RN. Relative Fat Mass as an estimator of whole-body fat percentage among children and adolescents: A cross-sectional study using NHANES. Sci Rep. 2019;9(1):15279, doi: 10.1038/s41598-019-51701-z.

Hernández M, Rivera J, Shamah T, Cuevas T. Encuesta Nacional de Salud y Nutrición de Medio Camino 2016. Instituto Nacional de Salud Pública. Cuernavaca México; 2016.

Currie C, Griebler R, Inchley J, Theunissen A, Molcho M, Samdal O, et al. Health Behaviour in School-aged Children (HBSC) Study Protocol: Background , Methodology and Mandatory Items for the 2009 /10 Survey. Edinburgh; 2010.

Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39(8):800-12, doi: 10.1097/00005650-200108000-00006.

World Health Organization. WHO Guideline: recommendations on digital interventions for health system strengthening. Geneva: World Health Organization; 2019.

Miesperä A, Ahonen S-M, Reponen J Ethical aspects of eHealth - systematic review of open access articles. Finnish Journal of eHealth and eWelfare. 2013;5(4):165-71.

Published

2021-10-10

How to Cite

Ramírez-Rivera, D. L., Martínez-Contreras, T., Ruelas, A. L., Henry-Mejia, G., Quizán-Plata, T., Esparza-Romero, J., Haby, M. M., & Díaz-Zavala, R. G. (2021). Effect of an online lifestyle intervention on the BMI z-score of Mexican school children: a protocol for an outcome assessor-blinded pilot randomized controlled trial during the COVID-19 pandemic. Spanish Journal of Human Nutrition and Dietetics, 25(Supl. 2). https://doi.org/10.14306/renhyd.25.S2.1320

Most read articles by the same author(s)