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      The GReat-Child™ Trial: A Quasi-Experimental Intervention on Whole Grains with Healthy Balanced Diet to Manage Childhood Obesity in Kuala Lumpur, Malaysia

      research-article
      1 , 2 , 1 , 1 , *
      Nutrients
      MDPI
      childhood obesity, intervention, Malaysia, whole grain

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          Abstract

          Background: The GReat-Child Trial was a quasi-experimental intervention that has emphasized whole grain as a strategy to manage childhood obesity. Methods: Two schools in Kuala Lumpur with similar demographic characteristics were assigned as intervention (IG) and control (CG). Eligibility criteria were overweight/obese children aged 9 to 11 years who had no serious co-morbidity. Children who reported consuming wholegrain foods in their 3-day diet-recall during screening were excluded. A total of 63 children (31 IG; 32 CG) completed the entire intervention program. The IG children underwent six 30-min nutrition education lessons and had school delivery of wholegrain food on a daily basis over a 12-week period. Parents of IG children attended 1-h individual diet counseling. Anthropometric outcomes including BMI-for-age z-score (BAZ), body fat percentage and waist circumference were measured at baseline [T0], post-intervention [T1] (3rd month) and follow-up [T2] (9th month). Results: IG showed significantly lower BAZ (weighted difference: −0.12; 95% CI: −0.21, −0.03; p = 0.009), body fat percentage (weighted difference: −2.6%; 95% CI: −3.7, −1.5; p < 0.001) and waist circumference (weighted difference: −2.4 cm; 95% CI: −3.8, −1.0; p = 0.001) compared to CG. IG reported significantly lower body fat percentage (weighted difference: −3.4%; 95% CI: 1.8, 5.0; p < 0.001) and waist circumference (weighted difference: −2.1 cm; 95% CI: −3.7, −0.5; p = 0.014) at T1 compared to T0. Conclusions: The GReat-Child Trial made a positive impact in managing childhood obesity. It can be incorporated into childhood obesity intervention programs that are being implemented by the policy makers.

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          Most cited references47

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          Effect of school-based physical activity interventions on body mass index in children: a meta-analysis.

          The prevalence of childhood obesity is increasing at an alarming rate. Many local governments have enacted policies to increase physical activity in schools as a way to combat childhood obesity. We conducted a systematic review and meta-analysis to determine the effect of school-based physical activity interventions on body mass index (BMI) in children. We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials up to September 2008. We also hand-searched relevant journals and article reference lists. We included randomized controlled trials and controlled clinical trials that had objective data for BMI from before and after the intervention, that involved school-based physical activity interventions and that lasted for a minimum of 6 months. Of 398 potentially relevant articles that we identified, 18 studies involving 18 141 children met the inclusion criteria. The participants were primarily elementary school children. The study duration ranged from 6 months to 3 years. In 15 of these 18 studies, there was some type of co-intervention. Meta-analysis showed that BMI did not improve with physical activity interventions (weighted mean difference -0.05 kg/m(2), 95% confidence interval -0.19 to 0.10). We found no consistent changes in other measures of body composition. School-based physical activity interventions did not improve BMI, although they had other beneficial health effects. Current population-based policies that mandate increased physical activity in schools are unlikely to have a significant effect on the increasing prevalence of childhood obesity.
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            Childhood obesity.

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              Video game play, child diet, and physical activity behavior change a randomized clinical trial.

              Video games designed to promote behavior change are a promising venue to enable children to learn healthier behaviors. Evaluate outcome from playing "Escape from Diab" (Diab) and "Nanoswarm: Invasion from Inner Space" (Nano) video games on children's diet, physical activity, and adiposity. Two-group RCT; assessments occurred at baseline, immediately after Diab, immediately after Nano, and 2 months later. Data were collected in 2008-2009, and analyses were conducted in 2009-2010. 133 children aged 10-12 years, initially between 50th percentile and 95th percentile BMI. Treatment group played Diab and Nano in sequence. Control Group played diet and physical activity knowledge-based games on popular websites. Servings of fruit, vegetable, and water; minutes of moderate to vigorous physical activity. At each point of assessment: 3 nonconsecutive days of 24-hour dietary recalls; 5 consecutive days of physical activity using accelerometers; and assessment of height, weight, waist circumference, and triceps skinfold. A repeated measures ANCOVA was conducted (analyzed in 2009-2010). Children playing these video games increased fruit and vegetable consumption by about 0.67 servings per day (p<0.018) but not water and moderate-to-vigorous physical activity, or body composition. Playing Diab and Nano resulted in an increase in fruit and vegetable intake. Research is needed on the optimal design of video game components to maximize change. Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                30 January 2018
                February 2018
                : 10
                : 2
                : 156
                Affiliations
                [1 ]Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia; hckoo@ 123456tarc.edu.my (H.C.K.); pbkoon@ 123456ukm.edu.my (B.K.P.)
                [2 ]Department of Bioscience, Faculty of Applied Sciences, Tunku Abdul Rahman University College, 50300 Kuala Lumpur, Malaysia
                Author notes
                [* ]Correspondence: rzt@ 123456ukm.edu.my ; Tel.: +603-9289-7512; Fax: +603-2691-4304
                Article
                nutrients-10-00156
                10.3390/nu10020156
                5852732
                29385769
                cdc6563e-3f1f-472b-9f24-37721c9fba2a
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 03 January 2018
                : 18 January 2018
                Categories
                Article

                Nutrition & Dietetics
                childhood obesity,intervention,malaysia,whole grain
                Nutrition & Dietetics
                childhood obesity, intervention, malaysia, whole grain

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