The results of most school-based health promotion initiatives are inconclusive. This trial assessed the effect of time-varying exposures to a multicomponent school-based health promotion intervention (SI! Program) on adiposity markers. A total of 48 schools in Madrid (Spain) were cluster randomized to receive the SI! Program through elementary education grades 1 to 6 (E1-6, 12 schools, 459 children), 1 to 3 (E1-3, 12 schools, 513 children), or 4 to 6 (E4-6, 12 schools, 419 children) or to receive the standard curriculum (control, 12 schools, 379 children). The primary endpoint was the between-group difference at 3- and 6-year follow-up in the change from baseline in adiposity markers and the overall knowledge-attitudes-habits (KAH) score. At 3-year follow-up, children who had the intervention showed significantly lower increases than the control group in -scores for body mass index (BMI), waist-to-height ratio (WHtR), and waist circumference (WC) (BMI: −0.09; 95% CI: −0.16 to −0.03; = 0.003; WC and WHtR: −0.19; 95% CI: −0.28 to −0.10; < 0.001). At 6-year follow-up, the beneficial trend in WC and WHtR was maintained in the E1-6 and E1-3 groups: difference WC control vs E1-6 (−0.19; 95% CI: −0.36 to −0.03; = 0.020), control vs E1-3 (−0.22; 95% CI: −0.38 to −0.06; = 0.009); difference WHtR control vs E1-6 (−0.24; 95% CI: −0.41 to −0.06; = 0.009), and control vs E1-3 (−0.29; 95% CI: −0.47 to −0.11; = 0.001). No significant between-group differences were found in the change of overall KAH score. Early elementary school interventions may be more effective than later interventions on abdominal adiposity. Further research should assess the sustainability effects of school-based health promotion programs.

中文翻译：

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随时间变化的学校健康促进活动对儿童肥胖的影响


大多数以学校为基础的健康促进举措的结果都是不确定的。该试验评估了随时间变化的基于学校的多成分健康促进干预措施（SI！计划）对肥胖标志物的影响。马德里（西班牙）共有 48 所学校随机分组获得 SI！基础教育课程 1 至 6 年级（E1-6，12 所学校，459 名儿童）、1 至 3 年级（E1-3，12 所学校，513 名儿童）或 4 至 6 年级（E4-6，12 所学校，419 名儿童）或接受标准课程（对照，12 所学校，379 名儿童）。主要终点是 3 年和 6 年随访时肥胖标志物相对于基线的变化以及总体知识-态度-习惯 (KAH) 评分的组间差异。在 3 年随访中，接受干预的儿童在体重指数 (BMI)、腰围身高比 (WHtR) 和腰围 (WC) 方面的得分增幅显着低于对照组 (BMI) ：-0.09；95% CI：-0.16 至 -0.03；= 0.003；WC 和 WHtR：-0.19；95% CI：-0.28 至 -0.10；在 6 年随访中，E1-6 和 E1-3 组中 WC 和 WHtR 的有益趋势得以维持：WC 对照与 E1-6 组的差异（−0.19；95% CI：−0.36 至 −0.03；= 0.020），对照与 E1-3（-0.22；95% CI：-0.38 至 -0.06；= 0.009）； WHtR 对照与 E1-6 的差异（-0.24；95% CI：-0.41 至 -0.06；= 0.009），以及对照与 E1-3 的差异（-0.29；95% CI：-0.47 至 -0.11；= 0.001）。整体 KAH 评分的变化没有发现显着的组间差异。对于腹部肥胖，小学早期干预可能比后期干预更有效。进一步的研究应该评估以学校为基础的健康促进计划的可持续性影响。