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      Intervenciones aleatorias controladas basadas en las escuelas para prevenir la obesidad infantil: revisión sistemática de 2006 a 2009 Translated title: Randomized controlled school based interventions to prevent childhood obesity: systematic review from 2006 to 2009

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          Abstract

          La prevalencia de sobrepeso y obesidad en niños ha incrementado a niveles epidémicos. Diferentes autores sugieren que la escuela puede ser el espacio más apropiado para realizar programas efectivos de prevención. El propósito de esta revisión sistemática fue valorar la evidencia de estudios aleatorios controlados con un periodo de intervención a largo plazo (igual o mayor a 9 meses) en escuelas y publicados en la base de datos de MEDLINE/PubMed del 1º de enero de 2006 hasta el 28 de febrero de 2009. Se analizaron en total 10 artículos. En general, se puede observar una heterogeneidad en el diseño y los componentes de la intervención, la edad del grupo objetivo, el tiempo de intervención, el sistema educativo, las características culturales de la población y los resultados. Estos últimos son modestos. Los resultados indican un cambio positivo en el estilo de vida, incremento en el consumo de frutas y verduras, menor consumo de bebidas carbonatadas y azucaradas, reducción del comportamiento sedentario y reducción en adiposidad. En general no hubo reducción significativa del IMC. Los resultados demandan estrategias para lograr mayor compromiso de los padres y adherencia a los programas, así como más estudios en diferentes sistemas educativos y ambientes culturales, incluyendo los de Latinoamérica. Además se requieren seguimientos a más largo plazo.

          Translated abstract

          The prevalence of overweight and obesity in children has increased to epidemic levels. Several authors have suggested that school is the best place for effective prevention programs. The purpose of this systematic review was to assess the evidence of randomized controlled trials concerning long-term (equal to or more than 9 months) observations at schools and published in the database of MEDLINE/Pubmed from January 1st of 2006 to February 28 of 2009. Ten studies were analyzed. Overall, regarding the design, the intervention components, target population age, intervention periods, educational techniques, cultural characteristics of the population, and outcome measures were heterogeneous. The results were modest. The outcomes showed a positive impact on lifestyle as intakes of fruits and vegetables increased, consumption of sugar-sweetened carbonated beverages decreased, and sedentary behaviors and adiposity were reduced. Generally, there were no significant reductions for BMI. These results warrant more strategies to achieve parental involvement, reduction of dropouts, and additional studies assessing different educational systems and cultural environments, including those in Latin America. Longer follow-up periods are also required.

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          Environmental influences on energy balance-related behaviors: A dual-process view

          Background Studies on the impact of the 'obesogenic' environment have often used non-theoretical approaches. In this journal's debate and in other papers authors have argued the necessity of formulating conceptual models for differentiating the causal role of environmental influences on behavior. Discussion The present paper aims to contribute to the debate by presenting a dual-process view on the environment – behavior relationship. This view is conceptualized in the EnRG framework (Environmental Research framework for weight Gain prevention). In the framework, behavior is postulated to be the result of a simultaneous influence of conscious and unconscious processes. Environmental influences are hypothesized to influence behavior both indirectly and directly. The indirect causal mechanism reflects the mediating role of behavior-specific cognitions in the influence of the environment on behavior. A direct influence reflects the automatic, unconscious, influence of the environment on behavior. Specific personal and behavioral factors are postulated to moderate the causal path (i.e., inducing either the automatic or the cognitively mediated environment – behavior relation). In addition, the EnRG framework applies an energy balance-approach, stimulating the integrated study of determinants of diet and physical activity. Conclusion The application of a dual-process view may guide research towards causal mechanisms linking specific environmental features with energy balance-related behaviors in distinct populations. The present paper is hoped to contribute to the evolution of a paradigm that may help to disentangle the role of 'obesogenic' environmental factors.
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            A policy-based school intervention to prevent overweight and obesity.

            The prevalence and seriousness of childhood obesity has prompted calls for broad public health solutions that reach beyond clinic settings. Schools are ideal settings for population-based interventions to address obesity. The purpose of this work was to examine the effects of a multicomponent, School Nutrition Policy Initiative on the prevention of overweight (85.0th to 94.9th percentile) and obesity (> 95.0th percentile) among children in grades 4 through 6 over a 2-year period. Participants were 1349 students in grades 4 through 6 from 10 schools in a US city in the Mid-Atlantic region with > or = 50% of students eligible for free or reduced-price meals. Schools were matched on school size and type of food service and randomly assigned to intervention or control. Students were assessed at baseline and again after 2 years. The School Nutrition Policy Initiative included the following components: school self-assessment, nutrition education, nutrition policy, social marketing, and parent outreach. The incidences of overweight and obesity after 2 years were primary outcomes. The prevalence and remission of overweight and obesity, BMI z score, total energy and fat intake, fruit and vegetable consumption, body dissatisfaction, and hours of activity and inactivity were secondary outcomes. The intervention resulted in a 50% reduction in the incidence of overweight. Significantly fewer children in the intervention schools (7.5%) than in the control schools (14.9%) became overweight after 2 years. The prevalence of overweight was lower in the intervention schools. No differences were observed in the incidence or prevalence of obesity or in the remission of overweight or obesity at 2 years. A multicomponent school-based intervention can be effective in preventing the development of overweight among children in grades 4 through 6 in urban public schools with a high proportion of children eligible for free and reduced-priced school meals.
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              Systems for grading the quality of evidence and the strength of recommendations II: Pilot study of a new system

              Background Systems that are used by different organisations to grade the quality of evidence and the strength of recommendations vary. They have different strengths and weaknesses. The GRADE Working Group has developed an approach that addresses key shortcomings in these systems. The aim of this study was to pilot test and further develop the GRADE approach to grading evidence and recommendations. Methods A GRADE evidence profile consists of two tables: a quality assessment and a summary of findings. Twelve evidence profiles were used in this pilot study. Each evidence profile was made based on information available in a systematic review. Seventeen people were given instructions and independently graded the level of evidence and strength of recommendation for each of the 12 evidence profiles. For each example judgements were collected, summarised and discussed in the group with the aim of improving the proposed grading system. Kappas were calculated as a measure of chance-corrected agreement for the quality of evidence for each outcome for each of the twelve evidence profiles. The seventeen judges were also asked about the ease of understanding and the sensibility of the approach. All of the judgements were recorded and disagreements discussed. Results There was a varied amount of agreement on the quality of evidence for the outcomes relating to each of the twelve questions (kappa coefficients for agreement beyond chance ranged from 0 to 0.82). However, there was fair agreement about the relative importance of each outcome. There was poor agreement about the balance of benefits and harms and recommendations. Most of the disagreements were easily resolved through discussion. In general we found the GRADE approach to be clear, understandable and sensible. Some modifications were made in the approach and it was agreed that more information was needed in the evidence profiles. Conclusion Judgements about evidence and recommendations are complex. Some subjectivity, especially regarding recommendations, is unavoidable. We believe our system for guiding these complex judgements appropriately balances the need for simplicity with the need for full and transparent consideration of all important issues.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                alan
                Archivos Latinoamericanos de Nutrición
                ALAN
                Sociedad Latinoamericana de Nutrición (Caracas )
                0004-0622
                September 2009
                : 59
                : 3
                : 253-259
                Affiliations
                [1 ] Universidad Autónoma de Baja California México
                Article
                S0004-06222009000300004
                3f496805-0efe-4eb0-be22-d2332f9032a9

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0004-0622&lng=en
                Categories
                NUTRITION & DIETETICS

                Nutrition & Dietetics
                Randomized controlled school based interventions,childhood obesity,prevention,Intervenciones aleatorias controladas basadas en las escuelas,obesidad infantil,prevención

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