Abstract
BackgroundIn Ecuador, adolescents’ food intake does not comply with guidelines for a healthy diet. Together with abdominal obesity adolescent’s inadequate diets are risk factors for non-communicable diseases. We report the effectiveness of a school-based intervention on the dietary intake and waist circumference among Ecuadorian adolescents.MethodsA pair-matched cluster randomized controlled trial including 1430 adolescents (12–14 years old) was conducted. The program aimed at improving the nutritional value of dietary intake, physical activity (primary outcomes), body mass index, waist circumference and blood pressure (secondary outcomes). This paper reports: (i) the effect on fruit and vegetable intake, added sugar intake, unhealthy snacking (consumption of unhealthy food items that are not in line with the dietary guidelines eaten during snack time; i.e. table sugar, sweets, salty snacks, fast food, soft drinks and packaged food), breakfast intake and waist circumference; and, (ii) dose and reach of the intervention. Dietary outcomes were estimated by means of two 24-h recall at baseline, after the first 17-months (stage one) and after the last 11-months (stage two) of implementation. Dose and reach were evaluated using field notes and attendance forms. Educational toolkits and healthy eating workshops with parents and food kiosks staff in the schools were implemented in two different stages. The overall effect was assessed using linear mixed models and regression spline mixed effect models were applied to evaluate the effect after each stage.ResultsData from 1046 adolescents in 20 schools were analyzed. Participants from the intervention group consumed lower quantities of unhealthy snacks (−23.32 g; 95% CI: −45.25,-1.37) and less added sugar (−5.66 g; 95% CI: −9.63,-1.65) at the end of the trial. Daily fruit and vegetable intake decreased in both the intervention and control groups compared to baseline, albeit this decrease was 23.88 g (95% CI: 7.36, 40.40) lower in the intervention group. Waist circumference (−0.84 cm; 95% CI: −1.68, 0.28) was lower in the intervention group at the end of the program; the effect was mainly observed at stage one. Dose and reach were also higher at stage one.ConclusionsThe trial had positive effects on risk factors for non-communicable diseases, i.e. decreased consumption of unhealthy snacks. The program strategies must be implemented at the national level through collaboration between the academia and policy makers to assure impact at larger scale.Trial registrationClinicalTrial.gov-NCT01004367.
Highlights
In Ecuador, adolescents’ food intake does not comply with guidelines for a healthy diet
Unhealthy snacking at school was defined by identifying consumers of unhealthy foods prepared at school according to the following procedure: (i) from the list of recipes classified as unhealthy foods, we identified those prepared at school; (ii) the participants were classified as 0 = non-consumers, if they had not reported any of the school-prepared items in the 24-h recalls, and 1 = consumers if at least one of the school-prepared item was reported in any recall
Fruit and vegetable intake decreased in both the intervention and control groups compared to baseline (Table 3), but the decrease was 23.88 g lower among the intervention group
Summary
In Ecuador, adolescents’ food intake does not comply with guidelines for a healthy diet. The risk of obesity and other non-communicable diseases (NCDs) is attenuated by reducing blood pressure, increasing physical activity, supporting diets rich in fruit, vegetables, grains and nuts, and restricting the intake of sugared beverages and sweets [3,4,5,6,7]. Schoolbased interventions have not been performed in Andean States such as Colombia, Bolivia, Ecuador and Perú, where the ethnic, cultural and social context differs in comparison with other Latin American countries [18, 19]. This is especially important as health promotion success rates rely on context considerations [20]
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