Dietary Habits and Metabolic Response in Obese Children Whose Mothers Received an Intervention to Promote Healthy Eating
Condition: Obesity; Child Obesity
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      Unhealthy eating habits inside and outside the home lead to developing obesity, leading to
      clinical and metabolic disorders, such as insulin resistance, metabolic syndrome, and chronic
      degenerative diseases, which are the leading causes of death in adult life. The present study
      compared changes in dietary habits, behaviors and metabolic profiles of obese children whose
      mothers attended group sessions, with those who received the usual nutritional consultation.

      The hypotheses were:

        1. The mother's training in healthy eating methods, eliminating foods and nutrients that
           represent metabolic and cardiovascular risk, will change the consumption of these foods
           in the family, reducing them by 20% and increasing the consumption of food in the same
           proportion. beneficial, compared to the family of the child who only receives individual
           consultation.

        2. Children with obesity who modify or eliminate metabolic and cardiovascular risk foods
           and nutrients from their normal diet will have a weight loss of -1.5 BMI compared to
           children who only receive the usual consultation.

      Randomized clinical trial, 177 mother/obese child pairs participated, 90 in the intervention
      group (IG) and 87 in the control group (CG). The intervention group attended six group
      education sessions to promote healthy eating and 87 received the usual nutritional
      consultation, over a three-month period. Frequency of food consumption, behaviors during
      feeding in the house and metabolic profile was evaluated. Data was compared using Student's t
      or X2.
    

Detailed description: 
      The aim of this study is evaluate the change in eating behaviors, metabolic condition, and
      nutritional status measured by anthropometry, in children with obesity who were prescribed a
      diet to reduce their body weight in the usual nutritional consultation, in comparison to
      children whose mothers participated in an intervention of six group sessions to acquire
      healthy dietary habits.

      Methods. Design. The Obesity Clinic at Federico Gómez Children's Hospital of Mexico conducted
      a randomized clinical trial between January 2011 and December 2014 with approval from the
      hospital's Research, Ethics and Biosecurity Committee. After providing written consent, 177
      children with obesity (BMI ≥ 95 pc) of age 5-11 years and their mothers were randomly
      assigned to participate in the intervention group (IG) or the control group (CG). None of the
      participating children were receiving pharmacological treatment for obesity, were morbidly
      obese or were associated with a genetic syndrome. Intervention group mothers (n = 90)
      attended six weekly group sessions, which were led by nutritionists and lasted 90 minutes.

      The key message was that healthy dietary habits and health risks are acquired at home and
      that opportunities for change can be identified in the processes that surround meal times. It
      begins with selecting and purchasing food, followed by preparation and consumption behaviors.
      Mothers were encouraged to participate in the sessions which involved the use of food models,
      videos, slides, and, in some cases, real food. Upon completing each session, mothers were
      given printed material to add to a home consultation manual. Children in this group were not
      prescribed diets to reduce their body weight. Control group mothers and children (n = 87)
      were given the usual nutritional consultation and were prescribed diets that covered their
      energy requirements according to their age and sex. Similarly, CG mother/child pairs received
      information regarding food groups and portion sizes, were trained in the use of the food
      equivalence system to encourage variation, and were instructed on how to prepare the diet at
      home. Neither group of children received physical activity programs. Upon concluding
      consultations and group sessions, mother/child pairs from both groups were asked to return
      for monthly follow-ups over the next three months.

      The assignment to intervention or control groups was made using a block randomization with 8
      mother/child pairs in each block to assure equal allocation to groups. One of coworkers not
      involved in data collection produced a computer-generated randomization list using the Stata
      11.0 program. Children were randomized at the end of the baseline examination. Taking
      experiences from the published studies the sample size calculation was based on to expect
      differences of at less 20% in eating habits between the mothers/children dyad of the
      intervention or control groups, to detect differences with significant level of 5% and 80%
      power; the size of sample required was 72 mother/children pairs per group and to allow for
      20% drop-out during the follow-up, the investigators aimed at recruiting 86 mother/children
      dyad per group.

      Measurements at the beginning and end of the study. Anthropometry. The weight, height and
      waist circumference of children in both groups were measured according to international
      procedures. Weight was measured on a mechanical scale (Seca model-700, SECA Corp., Hamburg,
      Germany) with 50 g precision. Height was measured on a stadiometer (SECA model-225, SECA
      Corp., Hamburg, Germany) 0.1 cm precision. Meanwhile, waist circumference was measured at the
      end of an exhalation with non-elastic flexible tape (Seca model-200, SECA Corp., Hamburg,
      Germany) in a standing position at the midpoint between the lower costal border and the iliac
      crest. Body Mass Index (BMI) and percentile value were calculated using CDC data for
      reference, children with a BMI ≥ 95 pc were categorized with obesity.

      Blood pressure. Blood pressure was measured on children's right arm with a mercury
      sphygmomanometer (ALPK2, Tokyo, Japan) using a cuff that suited arm length and perimeter and
      following 2004 National High Blood Pressure Education Program guidelines.

      Questionnaires. A questionnaire of socio demographic data was applied to the mothers at
      baseline. In addition, a survey of family feeding habits at home at baseline and three months
      was applied, the mother was asked about the child's breakfast habit and bring lunch to
      consume at school, family feeding habits at the time of sitting at the table (place the salt
      shaker, sugar and sweetened soft drinks on the table, fill the plate, repeat saucer, force
      the child to finish the meal, accept the exchange of food to what the child wants), frequency
      of consumption of food (fried, roasted, fruits and vegetables) and drinks (simple water,
      sugary drinks prepared at home, natural juice, industrialized juice and soft drinks). The
      amounts of food consumption were not evaluated. A survey of physical activity and sedentary
      activities was applied; no physical activity intervention was performed during this study.

      Blood sample. 5 mL venous blood samples after 12 h fasting periods were drawn to determine
      glucose (mg/dL)(hexokinase method Dimension RxL Max, Siemens Euro, DPC, Llanberis, UK),
      insulin (mIU/mL) (chemiluminescence IMMULITE 1000, Siemens), HDL cholesterol (mg/dl)
      (enzymatic reaction/catalase, using ADVIA ® 1800 equipment), and triglycerides (mg/dl) (ILAB
      300, Instrumentation Laboratory, Barcelona Spain). Participating children's HOMA-IR index was
      obtained through glucose and insulin data (If xGf/22.5).

      Statistical analysis. Central tendency measures were used to describe the study population's
      baseline characteristics. Student's t-test for independent samples was used to compare
      continuous variables, such as socio-demographic data, dietary habits, feeding behaviors, and
      biochemical and anthropometric data. Pearson X2 test was used to compare proportions between
      groups. Continuous data without normal distribution was managed using logarithmic
      transformation or square root. Student's t-test for related samples was used to identify
      differences before and after the intervention in each group or its non-parametric Wilcoxon
      equivalent. The equal proportions test was used to assess the difference in proportions in
      dietary habits and behaviors between groups. Statistical significance was considered at P <
      0.05. Analyses were carried out with STATA SE v.12.0 (Stata Corp, CollegeStation, TX, USA).
    

Intervention name(s): Family intervention; Usual nutritional consultation
Intervention type(s): Behavioral; Other
Intervention description(s): Topics covered in each session with intervention group mothers.
Dietary and physical activity habits and their link to obesity and cardio-metabolic diseases. Children learn about healthy eating habits and health risks at home.
Food-preparation processes. Selecting and purchasing food and beverages; importance of food groups and their impact on health; importance of fruit and vegetables. Balance between food groups, source of foods, organic or industrialized. Family menu preparation.
Habits and behaviors surrounding eating processes identified as health or risk factors, such as energy density, portion-size control, controlling emotional eating.
Beverages. Water versus sugar-sweetened drinks prepared at home or purchased at the store.
Preventing the risk of cardiovascular diseases by learning healthy eating habits and practicing these habits at home.
Integration. Practicing the skills learned during the intervention in each stage of preparing food and eating; Control group mothers and children (n = 87) were given the usual nutritional consultation and were prescribed diets that covered their energy requirements according to their age and sex. CG mother/child pairs received information regarding food groups and portion sizes, were trained in the use of the food equivalence system to encourage variation, and were instructed on how to prepare the diet at home.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: After providing written consent, 177 children with obesity (BMI ≥ 95 pc) of age 5-11 years and their mothers were randomly assigned to participate in the intervention group (IG) or the control group (CG). None of the participating children were receiving pharmacological treatment for obesity, were morbidly obese or were associated with a genetic syndrome. Intervention group mothers (n = 90) attended six weekly group sessions, which were led by nutritionists and lasted 90 minutes.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Feeding behavior; Intervention; Insulin resistance; Dietary habits; Childhood obesity