Noe C. Crespo

Results of a multi-level intervention to prevent and control childhood obesity among Latino children: The Aventuras para niños study

BackgroundCommunity-based interventions are needed to reduce the burden of childhood obesity.PurposeTo evaluate the impact of a multi-level promotora-based (Community Health Advisor) intervention to promote healthy eating and physical activity and prevent excess weight gain among Latino children.MethodsThirteen elementary schools were randomized to one of four intervention conditions: individual/family level (Family-only), school/community level (Community-only), combined (Family + Community), or a measurement-only condition. Participants were 808 Latino parents and their children enrolled in kindergarten through 2nd grade. Measures included parent and child body mass index (BMI) and a self-administered parent survey that assessed several parent and child behaviors.ResultsThere were no significant intervention effects on children’s BMI z-score. The family intervention changed several obesity-related child behaviors (e.g., fruit/vegetable consumption) and these were mediated by changes in parenting variables (e.g., parent monitoring).ConclusionA promotora-based behavioral intervention was efficacious at changing parental factors and child obesity-related health behaviors.

Leisure-Time Physical Activity in Elementary Schools: Analysis of Contextual Conditions.

BACKGROUND Little is known about childrens leisure-time physical activity (PA) at school and how it is associated with contextual variables. The purpose of this study was to objectively assess childrens voluntary PA during 3 daily periods and examine modifiable contextual factors. METHODS We conducted SOPLAY (System for Observing Play and Leisure Activity in Youth) observations before school, during recess, and at lunchtime in 137 targeted activity areas in 13 elementary schools over 18 months. During observations, each child was coded as Sedentary, Walking, or Vigorous, and simultaneous entries were made for area characteristics (accessibility, usability, presence of supervision, loose equipment, and organized activities). Logistic regression analysis was used to test associations between PA and area characteristics. RESULTS Assessors made 2349 area visits and observed 36,995 children. Boys had more moderate-to-vigorous physical activity (MVPA; 66.2 vs 60.0%, p < .001) and more vigorous PA (29.8 vs 24.6%; p < .001) than girls. Areas were typically accessible and usable, but provided organized activities infrequently (16.5%). Odds of engaging in MVPA were greater during lunch and recess than before school and in areas with play equipment (p < .05). CONCLUSIONS Children accrued a substantial amount of voluntary PA during leisure time at school. Their PA would likely be increased if school playground equipment was more readily available and if supervisors were taught to provide active games and promote PA rather than suppress it.

Dietary-Related and Physical Activity-Related Predictors of Obesity in Children: A 2-Year Prospective Study

BACKGROUND This observational study examined cross-sectional and 24-month longitudinal associations of physical activity and dietary behaviors with change in BMI and percent body fat among children aged 6–9 years old. METHODS Data were from the control group (n = 271; 48% Latino) of a community-based childhood obesity prevention program. Assessments were conducted at baseline and at 24 months and included height and weight, bioelectrical impedance–derived percent body fat, and 10 physical activity and dietary behaviors measured via parent report of their child. Cross-sectional analysis of variances (ANOVA) (normal weight, overweight, obese) and longitudinal mixed-effects linear regression models were used to investigate the relation of each physical activity and dietary behavior with BMI and percent body fat. RESULTS At baseline, obese children engaged in less physical activity and more sedentary behavior than normal-weight children (p < 0.05). Increased physical activity (p < 0.01) and number of breakfasts eaten with family (p < 0.05) were associated with decreased BMI z-score and percent body fat. Decreased sedentary behavior and sugar-sweetened beverage consumption were associated with decreased percent body fat (p < 0.05) but not BMI. CONCLUSIONS In this cohort of 271 children, increased physical activity and eating breakfast with family and reduced screen-based sedentary behaviors and sugar-sweetened beverage consumption were associated with more favorable trends in adiposity. Therefore, attention to these behaviors may be of particular importance. Results also suggest that future studies should include percent body fat as an outcome for a more precise assessment of the association of behavior with adiposity.

Childhood obesity prevention and control in city recreation centres and family homes: the MOVE/me Muevo Project

Child overweight and obesity is a significant public health problem. Mixed method strategies that involve parents and community organizations are promising approaches to prevent and control childhood obesity. Few studies have targeted city recreation centres to promote healthy eating and physical activity behaviours.

Feasibility of a home-based versus classroom-based nutrition intervention to reduce obesity and type 2 diabetes in Latino youth

OBJECTIVES The objectives of this pilot study were to compare the dietary, physiological and metabolic effects of 12-week modified carbohydrate nutrition intervention when disseminated in an individualized home-based format versus a group classroom-based format. METHODS Twenty-three overweight (>/=85(th) percentile BMI) Latina adolescent females (12-17 years of age) were randomized to a 12-week modified carbohydrate dietary intervention delivered in either an individualized home-based format (n = 11) or a group classroom-based format (n = 12). Anthropometrics, dietary intake by 3-day diet records, insulin dynamics by extended 3-hour Oral Glucose Tolerance test (OGTT) and body composition by Dual energy X-ray absorptiometry (DXA) were measured before and after intervention; 24-hour diet recalls were collected once or twice per month throughout the program. RESULTS Mixed modeling showed no significant differences in changes in dietary intake between intervention groups, but both groups significantly reduced intake of added sugar, sugary beverages and refined carbohydrates by 33%, 66%, and 35%, respectively, and dietary fiber significantly increased by 44% (p <0.01) throughout the 12 weeks. There was a significant time effect for BMI z-scores within each intervention group (p <0.05). There was no significant time*intervention group interaction for any of the physiological or metabolic variables, indicating that change over time was not significantly different between intervention groups. CONCLUSIONS Although a culturally tailored, modified carbohydrate dietary intervention led to significant improvements in dietary intake and BMI z-scores, the extremely intensive, individualized, home-based program was no more effective at improving diet, decreasing adiposity or reducing type 2 diabetes risk factors than the traditional classroom-based format.

Physical Activity Levels in U.S. Latino/Hispanic Adults: Results from the Hispanic Community Health Study/Study of Latinos

INTRODUCTION Physical activity (PA) prevalence among U.S. Latino/Hispanic adults of diverse backgrounds is not well known. This study describes PA among a representative sample of U.S. Latino/Hispanic adults. METHODS A population-based cohort of Hispanic/Latino adults (aged 18-74 years) participating in the Hispanic Community Health Study/Study of Latinos from March 2008 to June 2011 (N=16,415) was recruited in four urban areas from Miami, the Bronx, Chicago, and San Diego. Participants wore an Actical hip accelerometer for 1 week (n=12,253) and completed the Global Physical Activity Questionnaire (n=15,741). Data were analyzed in 2015. RESULTS Based on accelerometry, Hispanics/Latinos engaged in 23.8 minutes/day (10.3 minutes/day when only considering minutes from sustained 10-minute bouts) of moderate to vigorous PA (MVPA). Individuals of Puerto Rican and Dominican background had the most minutes/day of MVPA (32.1 and 29.1, respectively), whereas those of Cuban background had the fewest (15.3). Based on the Global Physical Activity Questionnaire, 65% of Hispanic/Latinos met the aerobic component of 2008 Physical Activity Guidelines for Americans. Men and individuals of Puerto Rican background had the most minutes/day of leisure-time MVPA (30.3 and 30.2, respectively). Individuals of Puerto Rican and Dominican background had the most minutes/day of transportation-related PA (48.7 and 39.7, respectively). Individuals of Mexican and Central American background had the most minutes/day of work-related MVPA (90.7 and 93.2, respectively). CONCLUSIONS Among Hispanics/Latinos, self-reported data provided information on the type of PA and helped explain variability identified from accelerometer-assessed PA. These findings highlight variability in PA among Hispanics from diverse ethnic backgrounds.

The relative contribution of layers of the Social Ecological Model to childhood obesity

OBJECTIVE The Social Ecological Model (SEM) has been used to describe the aetiology of childhood obesity and to develop a framework for prevention. The current paper applies the SEM to data collected at multiple levels, representing different layers of the SEM, and examines the unique and relative contribution of each layer to childrens weight status. DESIGN Cross-sectional survey of randomly selected households with children living in low-income diverse communities. SETTING A telephone survey conducted in 2009-2010 collected information on parental perceptions of their neighbourhoods, and household, parent and child demographic characteristics. Parents provided measured height and weight data for their children. Geocoded data were used to calculate proximity of a childs residence to food and physical activity outlets. SUBJECTS Analysis based on 560 children whose parents participated in the survey and provided measured heights and weights. RESULTS Multiple logistic regression models were estimated to determine the joint contribution of elements within each layer of the SEM as well as the relative contribution of each layer. Layers of the SEM representing parental perceptions of their neighbourhoods, parent demographics and neighbourhood characteristics made the strongest contributions to predicting whether a child was overweight or obese. Layers of the SEM representing food and physical activity environments made smaller, but still significant, contributions to predicting childrens weight status. CONCLUSIONS The approach used herein supports using the SEM for predicting child weight status and uncovers some of the most promising domains and strategies for childhood obesity prevention that can be used for designing interventions.

Effects of standing and light-intensity activity on ambulatory blood pressure

PURPOSE This study aimed to compare ambulatory blood pressure (ABP) response to accumulated standing (STAND), cycling (CYCLE), and walking (WALK) to a sitting-only (SIT) day in adults. METHODS Nine overweight or obese (body mass index, 28.7 ± 2.7 kg · m(-2)) adults (30 ± 15 yr) participated in this randomized crossover full-factorial study. Four conditions (WALK, STAND, CYCLE, and SIT) were randomly performed 1 wk apart. WALK, STAND, and CYCLE conditions consisted of progressively increasing activity time to accumulate 2.5 h during an 8-h simulated workday. WALK (1.0 mph) and STAND (0.0 mph) were completed on a treadmill placed underneath a standing-height desk. During CYCLE, participants pedaled on a Monark cycle ergometer at a cadence and energy expenditure equivalent to WALK. Participants remained seated during the SIT condition. Participants wore an ABP cuff from 0800 h until 2200 h on all conditions. Linear mixed models were used to test condition differences in systolic (SBP) and diastolic (DBP) blood pressure. Chi-square was used to detect frequency difference of BP load. RESULTS There was a whole-day (during and after work hours) SBP and DBP treatment effect (P < 0.01). Systolic blood pressure during STAND (132 ± 17 mm Hg), WALK (133 ± 17 mm Hg), and CYCLE (130 ± 16 mm Hg) were lower compared with that during SIT (137 ± 17 mm Hg) (all P < 0.01). CYCLE was lower than STAND (P = 0.04) and WALK (P < 0.01). For DBP, only CYCLE (69 ± 12 mm Hg) was lower than SIT (71 ± 13 mm Hg; P < 0.01). Compared with SIT, WALK, STAND, and CYCLE reduced SBP load by 4%, 4%, and 13%, respectively (all P < 0.01). CONCLUSIONS Compared with sitting, accumulating 2.5 h of light-intensity physical activity or standing during an 8-h workday may reduce ABP during and after work hours.

Socio-demographic disparities of childhood asthma.

Childhood asthma is particularly prevalent among disadvantaged children and is associated with greater functional consequences. This study described factors associated with childhood asthma in a sample of Latino and non-Latino children. Data were from baseline measures of 791 parent and child dyads involved in a childhood obesity prevention study. Parents completed a self-administered survey assessing childhood factors, demographics, acculturation and child asthma diagnosis. Multivariate mixed effects logistic regression analyses tested for correlates of child asthma and ethnicity interactions. Children were 4–10 years old, half were female, 86.0 percent were US-born and 45.7 percent were overweight or obese. The prevalence of childhood asthma was 11.5 percent. In multivariate analyses, the odds of childhood asthma were greater among children of non-Latino descent (OR = 4.1, CI: 1.8, 9.2), who had health insurance (OR = 11.1, CI: 2.7, 46.4), were male (OR = 1.8; CI: 1.1, 3.1) and born pre-term (OR = 3.0, CI: 1.4, 6.3). This study supports socio-demographic disparities in childhood asthma and evidence of their independent effects.

Effects of Standing and Light-Intensity Walking and Cycling on 24-h Glucose.

PURPOSE This study aimed to compare 24-h and postprandial glucose responses to incremental intervals of standing (STAND), walking (WALK), and cycling (CYCLE) to a sit-only (SIT) condition. METHODS Nine overweight/obese (body mass index = 29 ± 3 kg·m) adults (30 ± 15 yr) participated in this randomized crossover full-factorial study, with each condition performed 1 wk apart. STAND, CYCLE, and WALK intervals increased from 10 to 30 min·h (2.5 h total) during an 8-h workday. WALK (1.0 mph) and STAND were matched for upright time, and WALK and CYCLE were matched for energy expenditure (~2 METs). Continuous interstitial glucose monitoring was performed for 24 h to include the 8-h workday (LAB), after-work evening hours (EVE), and sleep (SLEEP). Three 2-h postprandial periods were also analyzed. Linear mixed models were used to test for condition differences. RESULTS Compared with SIT (5.7 ± 1.0 mmol·L), mean 24-h glucose during STAND (5.4 ± 0.9 mmol·L) and WALK (5.3 ± 0.9 mmol·L) were lower, and CYCLE (5.1 ± 1.0 mmol·L) was lower than all other conditions (all P < 0.001). During LAB and EVE, mean glucose was lower for STAND, WALK, and CYCLE compared with SIT (P < 0.001). During SLEEP, the mean glucose for CYCLE was lower than all other conditions (P < 0.001). Compared with SIT, cumulative 6-h postprandial mean glucose was 5%-12% lower (P < 0.001) during STAND, WALK, and CYCLE, and 6-h postprandial glucose integrated area under the curve was 24% lower during WALK (P < 0.05) and 44% lower during CYCLE (P < 0.001). CONCLUSIONS Replacing sitting with regular intervals of standing or light-intensity activity during an 8-h workday reduces 24-h and postprandial glucose. These effects persist during evening hours, with CYCLE having the largest and most sustained effect.