Individualized Dietetic Intervention-eating Habits in Obese Hispanic Children of Low Socioeconomic Status
Condition: Overweight; Obesity
MeSH terms: Overweight
Study type: Interventional

Summary: 
      The purpose of this study is to implement an individualized, face-to-face, parent supported
      and school-partnership dietetic intervention program to promote healthy eating habits in
      obese, Hispanic, children from low socioeconomic status due to the high predisposition to
      unhealthy eating habits and obesity in this population.
    

Detailed description: 
      Study Population An open invitation is made to children from eight public schools of low
      socioeconomic status (low SES), representative of all geographical areas of Monterrey, second
      largest city in México. From those that accept, children will be randomly selected and
      screened for overweight/obesity using BMI percentiles, and those who qualify for
      overweight/obesity will be invited to participate in the dietetic intervention program.

      Clinical Evaluation Based on the World Health Organization and the American Academy of
      Pediatrics criteria (BA, Spear, et al., 2007), overweight is considered as BMI > 85th and <
      95th percentiles and obesity as > 95th percentile according to age and sex. Anthropometric
      measurements will be performed in all participants at each school. Standing height will be
      determined to the nearest 0.5 cm (portable Seca® stadiometer, North America) and weight to
      the nearest 0.1 kg while children wear light clothing, no socks or shoes (TANITA TBF 300®
      scale, Arlington, Illinois). Waist circumference will be measured to the nearest 0.1 cm at
      the level of the umbilicus with a flexible fiberglass tape while the subjects are standing,
      after gently exhaling, and with no clothing on the area. BMI will be calculated by weight
      (kg) divided by the square of height (m). Measurements will be performed by the same three
      trained registered dietitians (RD) in all children to control the inter-observer variability.

      Dietetic Intervention The principal strategies for the change in energy and food groups
      consumption, are dietary modifications for the children and parental support, as recommended
      by national associations (SR, Daniels et al, 2009; TA, Nicklas, et al, 2008; BA, Spear, et
      al., 2007, A Report of the Panel on Macronutrients et al, 2005). Dietetic intervention will
      be given individually by a RD for every child at each school, every three weeks, for a total
      of 13 visits during the school-year. Children will leave the classroom to attend the
      30-minute nutrition counseling. Each child will be seen by the same RD throughout the
      school-year to favor compliance to the plan and to avoid inter-examiner bias. Each session
      will consist of: 1.) Anthropometric assessment; 2.) Dietetic assessment by means of 24-hour
      diet recalls, a standardized food frequency questionnaire that included Mexican foods, and
      food replicas to aid in estimation of portion sizes; 3.) Individualized energy restriction
      and balanced macronutrient dietary planning; 4.) Provision of structured, tailored-made daily
      menus and meals for the next three weeks for each child; and 5.) Information given to
      parents/care givers about healthy food, eating practices and portion sizes. Attendance of the
      parent/care giver is mandatory to help answer the 24-hour recalls and to assure commitment to
      follow the dietary recommendations at home. After each visit, the RD will record the
      information into the software (NutriKcal®VO software, Consinfo S.C., D.F., Mexico.), which
      determines energy intake and diet composition.

      Diet composition (macronutrients) is based on the most recent dietary recommended intake for
      children (A Report of the Panel on Macronutrients et al, 2005) : 25%-35% of total calories
      from fat; 45%-65% from carbohydrates and 10%-30% from protein. Additional recommendations for
      children or adolescents include a variety of foods low in saturated fat (<10% kcal), no trans
      fat and cholesterol <300 mg/day. The RDs will promote age appropriate serving sizes,
      including approximately >5 servings of fruit and vegetables, >3 servings of low fat milk or
      dairy products, >6 servings of whole-grain products per day; increase of dietary fiber and
      reduction of salt intake (US Department of Agriculture and US Department of Health and Human
      Services, 2010). As well, children will be advised to avoid overconsumption of energy dense,
      nutrient-poor foods and beverages (TA, Nicklas et al, 2008).

      Reduction in calorie intake is approached following the recommendations of the American Heart
      Association in which children > 4 years old with a BMI > 85th percentile to achieve BMI
      percentile reductions to <85th percentile with weight maintenance during linear growth (SR,
      Daniels, et al, 2009). As advised (BA, Spear, et al, 2007), progressive restriction of
      150-900 calories from actual intake throughout the school year is recommended so that obese
      children with BMI >95th percentile lose gradually 0.5 kilogram/month and those with BMI >99th
      percentile lose a maximum of 0.9 kilogram/week.

      Statistical Methods MINITAB version 16 (Minitab Inc., State College, Pennsylvania, USA) will
      be used to analyze the differences between anthropometric parameters and nutrient intake
      values at baseline and end of intervention; Microsoft Excel 2007 (Microsoft Corp., Redmond,
      Washington, USA) will be used to incorporate the input of data. The results will be expressed
      as mean ± standard deviation (s.d.) and their corresponding 95% confidence intervals (CI).
      Comparisons between groups for dependent variables will be made using paired Student's t-test
      for means. The mean comparisons between gender groups will be determined using t-test for
      independent samples. All tests will be interpreted based on two-tailed hypothesis. The
      significance level will be set at 0.05 in all cases.
    

Intervention name(s): Individualized dietetic intervention-eating habits
Intervention type(s): Behavioral
Intervention description(s): The school-year (12 months) dietetic intervention consisted of anthropometric measurements, dietetic assessment, energy restriction tailor-made daily menus, and parental education every three weeks at each school site.
Other intervention name(s): tailor-made dietetic intervention
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: obesity; dietetic intervention; eating behaviors; children; healthy eating; energy dense foods