TY - JOUR
T1 - The SI! program for cardiovascular health promotion in early childhood: a cluster-randomized trial
AU - Penalvo, Jose L.
AU - Santos-Beneit, Gloria
AU - Sotos-Prieto, Mercedes
AU - Bodega, Patricia
AU - Oliva, Belen
AU - Orrit, Xavier
AU - Rodriguez, Carla
AU - Miguel Fernandez-Alvira, Juan
AU - Redondo, Juliana
AU - Vedanthan, Rajesh
AU - Bansilal, Sameer
AU - Gomez, Emilia
AU - Fuster, Valentin
PY - 2015
Y1 - 2015
N2 - 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. (C) 2015 by the American College of Cardiology Foundation.
AB - 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. (C) 2015 by the American College of Cardiology Foundation.
KW - adiposity
KW - attitudes
KW - behavior
KW - education
KW - knowledge
KW - preschool
KW - LIFE-STYLE INTERVENTION
KW - PRESCHOOL-CHILDREN
KW - PHYSICAL-ACTIVITY
KW - FOLLOW-UP
KW - ASSOCIATION
KW - OBESITY
KW - WEIGHT
KW - YOUNG
KW - ATHEROSCLEROSIS
KW - BALLABEINA
U2 - 10.1016/j.jacc.2015.08.014
DO - 10.1016/j.jacc.2015.08.014
M3 - A1: Web of Science-article
VL - 66
SP - 1525
EP - 1534
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 14
ER -