The CHIRPY DRAGON intervention in preventing obesity in Chinese primary-school--aged children: A cluster-randomised controlled trial


Autoři: Bai Li aff001;  Miranda Pallan aff002;  Wei Jia Liu aff003;  Karla Hemming aff002;  Emma Frew aff002;  Rong Lin aff003;  Wei Liu aff003;  James Martin aff002;  Mandana Zanganeh aff002;  Kiya Hurley aff002;  Kar Keung Cheng aff002;  Peymane Adab aff002
Působiště autorů: Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Beacon House, Queens Road, Bristol, United Kingdom aff001;  Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom aff002;  School Health Unit, Guangzhou Centre of Disease Control and Prevention, Guangzhou, P.R.China aff003
Vyšlo v časopise: The CHIRPY DRAGON intervention in preventing obesity in Chinese primary-school--aged children: A cluster-randomised controlled trial. PLoS Med 16(11): e32767. doi:10.1371/journal.pmed.1002971
Kategorie: Research Article
doi: 10.1371/journal.pmed.1002971

Souhrn

Background

In countries undergoing rapid economic transition such as China, rates of increase in childhood obesity exceed that in the West. However, prevention trials in these countries are inadequate in both quantity and methodological quality. In high-income countries, recent reviews have demonstrated that school-based prevention interventions are moderately effective but have some methodological limitations. To address these issues, this study evaluated clinical- and cost- effectiveness of the Chinese Primary School Children Physical Activity and Dietary Behaviour Changes Intervention (CHIRPY DRAGON) developed using the United Kingdom Medical Research Council complex intervention framework to prevent obesity in Chinese primary-school–aged children.

Methods and findings

In this cluster-randomised controlled trial, we recruited 40 state-funded primary schools from urban districts of Guangzhou, China. A total of 1,641 year-one children with parent/guardian consent took part in baseline assessments prior to stratified randomisation of schools (intervention arm, 20 schools, n = 832, mean age = 6.15 years, 55.6% boys; control arm n = 809, mean age = 6.14 years, 53.3% boys). The 12-month intervention programme included 4 school- and family-based components delivered by 5 dedicated project staff. We promoted physical activity and healthy eating behaviours through educational and practical workshops, family activities, and supporting the school to improve physical activity and food provision. The primary outcome, assessed blind to allocation, was between-arm difference in body mass index (BMI) z score at completion of the intervention. A range of prespecified, secondary anthropometric, behavioural, and psychosocial outcomes were also measured. We estimated cost effectiveness based on quality-adjusted life years (QALYs), taking a public sector perspective. Attrition was low with 55 children lost to follow up (3.4%) and no school dropout. Implementation adherence was high. Using intention to treat analysis, the mean difference (MD) in BMI z scores (intervention − control) was −0.13 (−0.26 to 0.00, p = 0.048), with the effect being greater in girls (MD = −0.18, −0.32 to −0.05, p = 0.007, p for interaction = 0.015) and in children with overweight or obesity at baseline (MD = −0.49, −0.73 to −0.25, p < 0.001, p for interaction < 0.001). Significant beneficial intervention effects were also observed on consumption of fruit and vegetables, sugar-sweetened beverages and unhealthy snacks, screen-based sedentary behaviour, and physical activity in the intervention group. Cost effectiveness was estimated at £1,760 per QALY, with the probability of the intervention being cost effective compared with usual care being at least 95% at a willingness to pay threshold of £20,000 to 30,000 per QALY. There was no evidence of adverse effects or harms. The main limitations of this study were the use of dietary assessment tools not yet validated for Chinese children and the use of the UK value set to estimate QALYS.

Conclusions

This school- and family-based obesity prevention programme was effective and highly cost effective in reducing BMI z scores in primary-school–aged children in China. Future research should identify strategies to enhance beneficial effects among boys and investigate the transferability of the intervention to other provinces in China and countries that share the same language and cultures.

Trial registration

ISRCTN Identifier ISRCTN11867516.

Klíčová slova:

Behavior – Body mass index – Childhood obesity – Children – Chinese people – Parenting behavior – Physical activity – Schools


Zdroje

1. International Food Policy Research Institute. Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030. Washington, D.C, 2016.

2. Ma GM, Mi J, Ma J. Report on Childhood Obesity in China. Beijing: People’s Medical Publishing House, 2017 (in Chinese).

3. The State Council of China. The Healthy China 2030 Planning Outline. Beijing: The People’s Republic of China, 2016.

4. Feng L, Wei DM, Lin ST, Maddison R, Ni Mhurchu C, Jiang Y, et al. Systematic review and meta-analysis of school-based obesity interventions in mainland China. PLoS ONE. 2017;12:e0184704. doi: 10.1371/journal.pone.0184704 28910362

5. Uijtdewilligen L, Waters CN, Müller-Riemenschneider F, Lim YW. Preventing childhood obesity in Asia: an overview of intervention programmes. Obes Rev. 2016;17:1103–15. doi: 10.1111/obr.12435 27427411

6. Li B, Liu WJ, Cheng KK, Pallan M, Hemming K, Frew E, et al. Development of the theory-based Chinese primary school children physical activity and dietary behaviour changes intervention (CHIRPY DRAGON): development of a cluster-randomised controlled trial, Lancet-CAMS Health Summit. The Lancet. 2016;388:S51.

7. Li B, Adab P, Cheng KK. The role of grandparents in childhood obesity in China—evidence from a mixed methods study. Int J Behav Nutr Phys Act. 2015;12:91. doi: 10.1186/s12966-015-0251-z 26122955

8. Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F, et al. Designing and evaluating complex interventions to improve health care. BMJ. 2007;334:455–59. doi: 10.1136/bmj.39108.379965.BE 17332585

9. Li B, Liu WJ, Adab P, Pallan M, Hemming K, Frew E, et al. Cluster-randomised controlled trial to assess the effectiveness and cost effectiveness of an obesity prevention programme for Chinese primary school-aged children: the CHIRPY DRAGON study protocol. BMJ Open. 2017;7: e018415. doi: 10.1136/bmjopen-2017-018415 29196485

10. Caille A, Kerry S, Tavernier E, Leyrat C, Eldridge S, Giraudeau B. Timeline cluster: a graphical tool to identify risk of bias in cluster randomised trials. BMJ. 2016;354:i4291. doi: 10.1136/bmj.i4291 27530617

11. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007; 85: 660–7. doi: 10.2471/BLT.07.043497 18026621

12. Roberts K FS. Review of dietary assessment methods in public health Oxford: National Obesity Observatory. Oxford: National Obesity Observatory, 2010.

13. Godin G, Shephard RJ. Godin Leisure-Time Exercise Questionnaire. Med Sci Sports Exerc. 1997;29:S36–S38

14. Chen YM, He LP, Mai JC, Hao YT, Xiong LH, Chen WQ, et al. Validity and reliability of Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales in Chinese children and adolescents. Chinese Journal of Epidemiology(Zhonghua Liu Xing Bing Xue Za Zhi).2008;29:560–63 (in Chinese). 19040037

15. Stevens KJ. Working With Children to Develop Dimensions for a Preference-Based, Generic, Pediatric, Health-Related Quality-of-Life Measure. Qual Health Res. 2010;20:340–51 doi: 10.1177/1049732309358328 20054040

16. Ravens-Sieberer U, Duer W, Fuerth K, Czemy L, Auquier P, Simeoni MC, et al. The KIDSCREEN-52 Quality of Life Measure for Children and Adolescents: Psychometric Results from a cross-Cultural Survey in 13 European Countries. Value Health. 2008;11:645–58. doi: 10.1111/j.1524-4733.2007.00291.x 18179669

17. Phillips LR, Parfitt G, Rowlands AV. Calibration of the GENEA accelerometer for assessment of physical activity intensity in children. J Sci Med Sport. 2013;16:124–28. doi: 10.1016/j.jsams.2012.05.013 22770768

18. Fairclough SJ, Noonan R, Rowlands AV, Van Hees V, Knowles Z, Boddy LM. Wear Compliance and Activity in Children Wearing Wrist- and Hip-Mounted Accelerometers. Med Sci Sports Exerc. 2016;48:245–53. doi: 10.1249/MSS.0000000000000771 26375253

19. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350:h1258. doi: 10.1136/bmj.h1258 25791983

20. Xu F, Chen G, Stevens K, Zhou H, Qi S, Wang Z, et al. Measuring and Valuing Health-Related Quality of Life among Children and Adolescents in Mainland China—A Pilot Study. PLoS ONE. 2014;9: e89222. doi: 10.1371/journal.pone.0089222 24586607

21. Gosden TB, Torgerson DJ. Economics notes: Converting international cost effectiveness data to UK prices. BMJ. 2002;325:275–76. doi: 10.1136/bmj.325.7358.275 12153929

22. National Institute for Health and Care Excellence. Methods for the Development of NICE Public Health Guidance. London: National Institute for Health and Care Excellence, 2012.

23. Pannier A, Dunn JD. AMCP Format for Formulary Submissions, version 4.0. J Manag Care Spec Pharm. 2016;22:448. doi: 10.18553/jmcp.2016.16092 27123908

24. Li B, Adab P, Cheng KK. Family and neighborhood correlates of overweight and obesogenic behaviors among Chinese children. Int J Behav Med. 2014;21:700–709. doi: 10.1007/s12529-013-9333-y 24057407

25. Kolsgaard ML, Joner G, Brunborg C, Anderssen SA, Tonstad S, Andersen LF. Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo Adiposity Intervention Study—a hospital/public health nurse combined treatment. BMC Pediatr. 2011;11:47. doi: 10.1186/1471-2431-11-47 21619652

26. Brown T, Moore THM, Hooper L, Gao Y, Zayegh A, Ijaz S, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2019, doi: 10.1002/14651858.CD001871.pub4 31332776

27. Wang Y, Cai L, Wu Y, Wilson RF, Weston C, Fawole O, et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev. 2015;16:547–65. doi: 10.1111/obr.12277 25893796

28. Adab P, Pallan MJ, Lancashire ER, Hemming K, Frew E, Barrett T, et al. Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study). BMJ. 2018;360:k211. doi: 10.1136/bmj.k211 29437667

29. Lloyd J, Creanor S, Logan S, Green C, Dean SG, Hillsdon M, et al. Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial. Lancet Child Adolesc Health. 2018;2:35–45. doi: 10.1016/S2352-4642(17)30151-7 29302609

30. Kipping RR, Howe LD, Jago R, Campbell R, Wells S, Chittleborough CR, et al. Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial. BMJ. 2014;348:g3256. doi: 10.1136/bmj.g3256 24865166

31. Baranowski T, Cullen KW, Nicklas T, Thompson D, Baranowski J. School-based Obesity Prevention: A Blueprint for Taming the Epidemic. Am J Health Behav. 2002;26:486–93. 12437023

32. Wang Z, Xu F, Ye Q, Tse LA, Xue H, Tan Z, et al. Childhood obesity prevention through a community-based cluster randomized controlled physical activity intervention among schools in china: the health legacy project of the 2nd world summer youth olympic Games (YOG-Obesity study). Int J Obes (Lond). 2018;42:625–33.

33. Liu AL, Hu XQ, Ma GS, Cui ZH, Pan YP, Chang SY, et al. Report on childhood obesity in China (6) evaluation of a classroom-based physical activity promotion program. Biomed Environ Sci. 2007;20:19–23. 17458137

34. Cao Z, Hua J, Zhang D, Thapa JR, Wang SM. A cohort study assessing the sustainable long-term effectiveness of a childhood-obesity intervention in China. Int J Epidemiol. 2018; 48:108–115.

35. Kobes A, Kretschmer T, Timmerman G, Schreuder P. Interventions aimed at preventing and reducing overweight/obesity among children and adolescents: a meta-synthesis. Obes Rev. 2018;19:1065–1079. doi: 10.1111/obr.12688 29671938

36. Lidgate ED, Li B, Lindenmeyer A. A Qualitative Insight into Informal Childcare and Childhood Obesity in pre-schoolers in the UK. 2018; BMC Public Health, 8:1229.

Štítky
Interní lékařství

Článek vyšel v časopise

PLOS Medicine


2019 Číslo 11

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