Effects of the Preschool-Based Family-Involving DAGIS Intervention Program on Children's Energy Balance-Related Behaviors and Self-Regulation Skills: A Clustered Randomized Controlled Trial.

Carola Ray,Katri Sääksjärvi,Pauliina Hiltunen,Eva Roos,Nina Sajaniemi,Essi Skaffari,Maijaliisa Erkkola,Henna Vepsäläinen,Reetta Lehto,Liisa Korkalo,Taina Sainio,Rejane Figuereido,Elviira Lehto,Riikka Pajulahti

doi:10.3390/nu12092599

Abstract

The study examines the effects of a preschool-based family-involving multicomponent intervention on children’s energy balance-related behaviors (EBRBs) such as food consumption, screen time and physical activity (PA), and self-regulation (SR) skills, and whether the intervention effects differed among children with low or high parental educational level (PEL) backgrounds. The Increased Health and Wellbeing in Preschools (DAGIS) intervention was conducted as a clustered randomized controlled trial, clustered at preschool level, over five months in 2017–2018. Altogether, 802 children aged 3–6 years in age participated. Parents reported children’s consumption of sugary everyday foods and beverages, sugary treats, fruits, and vegetables by a food frequency questionnaire, and screen time by a 7-day diary. Physical activity was assessed by a hip-worn accelerometer. Cognitive and emotional SR was reported in a questionnaire by parents. General linear mixed models with and without repeated measures were used as statistical methods. At follow-up, no differences were detected in EBRBs or SR skills between the intervention and control group, nor did differences emerge in children’s EBRBs between the intervention and the control groups when stratified by PEL. The improvement in cognitive SR skills among low PEL intervention children differed from low PEL control children, the significance being borderline. The DAGIS multicomponent intervention did not significantly affect children’s EBRBs or SR. Further sub-analyses and a comprehensive process evaluation may shed light on the non-significant findings.

Highlights

Young children’s food intake, screen time, and physical activity (PA), commonly referred to as energy balance-related behaviors (EBRBs) [1], are of importance since they can predict the future weight status and health of children [2,3,4]
Even though most characteristics were similar in the groups, a higher percentage of children with high educational level parents were found in the control group
Changes in children’s EBRBs according to parental educational level (PEL) did not differ between the intervention and control groups at follow-up, a borderline significant result emerged in low PEL children in the intervention group, improving their cognitive SR

Summary

Introduction

Young children’s food intake, screen time, and physical activity (PA), commonly referred to as energy balance-related behaviors (EBRBs) [1], are of importance since they can predict the future weight status and health of children [2,3,4]. A socio-economic status (SES) gradient exists already in preschoolers’ EBRBs; those with low SES family backgrounds tend to have less healthy EBRBs such as higher intake of sugary foods or beverages and excessive screen time [5,6,7]. Preschool-based family-involving interventions have been reported to be promising [12,13,14,15], some studies show no effects on EBRBs [12,14,16]. This has raised discussion on intervention design and implementation in families [12]. Promoting several EBRBs simultaneously is challenging, as the aim can be to both promote healthy behaviors and discourage unhealthy behaviors

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Discussion

Conclusion