EFFECT OF THE SCHOOL-BASED HEALTH PROMOTION INTERVENTION ACTIVITAL ON DIETARY INTAKE AND WAIST CIRCUMFERENCE: A CLUSTER RANDOMIZED CONTROLLED TRIAL

Background and objectives: Unhealthy diet and abdominal obesity during childhood are important risk factors for chronic diseases at adulthood. We report the effect of a school-based intervention on the nutritional value of dietary intake and waist circumference after 28 months; and explore if the effect varied within important subgroups (weight and socioeconomic status). Methods: A cluster randomized controlled trial (10 intervention/10 control schools) including 1430 adolescents (12-14 years old) was conducted in Ecuador. The intervention aimed to decrease adolescents sugar intake and unhealthy competitive food (rich in sodium, fat or added sugar) intake, as well as to promote fruit and vegetable intake (primary outcomes). Waist circumference was a secondary outcome. Primary outcomes were estimated by means of two twenty-four-hour recall. All outcomes were measured before and after the intervention. The interventions consisted of healthy eating classes with adolescents, healthy eating workshops with parents and canteen staff, and social events. The effect of the intervention was assessed using linear mixed effects models. A subgroup analysis by weight and socioeconomic status was performed including all the outcomes with a significant intervention effect. Results: The analysis involved data from 1046 adolescents. Students from the intervention group consumed less unhealthy competitive food during snacks (-23.32 g; 95% CI: -45.25,-1.37) and less added sugar (-5.66g; 95% CI: -9.63,-1.65). Daily fruit and vegetable intake decreased compared to baseline, albeit significantly less in the intervention group (23.88 g; 95% CI: 7.36, 40.40). Waist circumference (-0.84 cm; 95% CI: -1.68, 0.28) was lower in the intervention group. The intervention effect on fruit, vegetables, added sugar, and, competitive food was independent of the weight and socioeconomic status of the participants. The effect on waist circumference, was larger among overweight-obese (-1.35 cm; 95% CI: -2.25, -0.45) but similar for different socioeconomic backgrounds. Conclusions: ACTIVITAL had positive effects on dietary risk factors for chronic diseases, i.e. fruit and vegetable intake and the consumption of competitive unhealthy foods. The trial has the potential to be effective among adolescents regardless of their socioeconomic background.