Sugar-sweetened Beverage Intake Substitution by Water to Prevent Overweight in Mexican Children
Condition: Obesity, Childhood
MeSH terms: Pediatric Obesity
Study type: Interventional

Summary: 
      The prevalence of overweight and obesity in children have increased in recent years and this
      has been associated with replacing plain water intake by sugar-sweetened beverages.

      Because of this, the objective of the present study was to evaluate the impact of a
      school-based intervention that aimed to replace sugar-sweetened beverages by water.

      A randomized community trial including 314 children aged 9-11 years from three public schools
      of the State of Hidalgo, Mexico was performed. Schools were randomized to intervention (two
      schools from municipality of Apan; six classes with 146 participants) or control group (one
      school from municipality of Emiliano Zapata; six classes with 168 participants) and followed
      during 6 months. Intervention included to place water filters at school and classroom lessons
      to increase water consumption and decreasing sugar-sweetened beverages.
    

Detailed description: 
      This was a randomized community trial, that included children of both sexes belonging to
      public elementary schools, grades 4 and 5, in Hidalgo, Mexico, including the municipalities
      of Emiliano Zapata and Apan. It was excluded from school children with Type 1 Diabetes, heart
      failure, kidney or liver that limit fluid intake by medical prescription.

      A sample size of 334 (167 in each group) children would allow to detect a difference of 9% in
      water consumption between the two groups15, considering a loss to follow-up of 20%, a power
      of 85% and a significance level of 0.05.

      The selection of the schools of the two communes was based on the availability of a place to
      conduct physical assessments and intervention. Schools were randomly assigned to the
      intervention (IG) or control groups (CG). Each group included 3 classes of fourth grade and 3
      classes of fifth grade.

      Written informed consent was obtained from school principals, teachers, parents and students.
      The study was approved by the Ethics Committee of the Instituto Nacional de Ciencias Medicas
      y Nutrición Salvador Zubiran, in Mexico City.

      Measurements Study variables were measured at baseline and at 6 months after intervention.
      Weight was measured with a portable scale (SECA professional scale model 750, Seca North
      America East, Hanover, MD) with a capacity of 150 kg and a precision of 1kg, height (SECA
      model 280 portable stadiometer, Seca North America East, Hanover, MD) with an amplitude of
      220 cm and variation of 1 mm. Subjects were weighed and measured with minimal clothing and no
      shoes21. Body mass index (BMI) was calculated as weight (in kg) divided by stature2 (in m).
      Classification of nutritional status was based on z-scores of the BMI-for-age and sex from
      the distributions of the World Health Organization using the Anthro-Plus software22.

      Body composition was evaluated by bioelectric impedance, using multiple frequency equipment
      (RJL Systems, Detroit, MI). Resistance and reactance were obtained to estimate body fat and
      fat-free mass were estimated using equations23.

      Sugar-sweetened beverage and water plain consumption were measured at the beginning and end
      of the study through a 24-hour recall using ESHA Food software with an SQL processor (version
      7.9, ESHA Research, Salem, OR, 2001)., with face-to-face interviews in each phase.

      Intervention The intervention focused on encouraging students to change their drinking habits
      over 6 months (from January to June) in the school year of 2015.

      In the intervention group, reusable plastic water bottles and jugs were delivered at school
      and water filters were placed. Classroom lessons lasting 30 minutes were conducted weekly by
      trained nutritionists. These sessions included general nutritional recommendations,
      encouragement of simple water plain consumption and discouragement of consumption of
      sugar-sweetened beverages, through a manual of drinks, developed by nutritionists. In the
      control group only general nutritional recommendations were given.
    

Intervention name(s): Intervention; General nutritional recommendations
Intervention type(s): Behavioral; Behavioral
Intervention description(s): General nutritional recommendations, change drinking habits; Only general nutritional recommendations were given
Other intervention name(s): General nutritional recommendations, change drinking habits
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention