Socio-cultural determinants of adiposity and physical activity in preschool children: A cross-sectional study

BACKGROUND: Both individual socio-cultural determinants such as selected parental characteristics (migrant background, low educational level and workload) as well as the regional environment are related to childhood overweight and physical activity (PA). The purpose of the study was to compare the impact of distinct socio-cultural determinants such as the regional environment and selected parental characteristics on adiposity, PA and motor skills in preschool children. METHODS: Forty preschools (N = 542 children) of two culturally different urban regions (German and French speaking part of Switzerland) participated in the study (Ballabeina Study). Outcome measures included adiposity (BMI and skinfold thickness), objectively measured sedentary activities and PA (accelerometers) and agility performance (obstacle course). Parental characteristics (migrant status, educational level and workload) were assessed by questionnaire. RESULTS: Children from the French speaking areas had higher adiposity, lower levels of total and of more intense PA, were more sedentary and less agile than children from the German speaking regions (percent differences for all outcome parameters except for BMI ≥10%; all p ≤ 0.04). Differences in skinfold thickness, sedentary activities and agility, but not in PA, were also found between children of Swiss and migrant parents, though they were ≤8% (p ≤ 0.02). While paternal workload had no effect, maternal workload and parental education resulted in differences in some PA measures and/or agility performance (percent differences in both: ≤9%, p ≤ 0.008), but not in adiposity or sedentary activities (p = NS). Regional differences in skinfold thickness, PA, sedentary activities and agility performance persisted after adjustment for parental socio-cultural characteristics, parental BMI and, where applicable, children's skinfolds (all p ≤ 0.01). CONCLUSIONS: The regional environment, especially the broader social environment, plays a prominent role in determining adiposity, PA and motor skills of young children and should be implicated in the prevention of obesity and promotion of PA in children

Physical activity in preschoolers

Summary: The health benefits of physical activity are clearly established. Physical activity is also thought to be beneficial for children, although morbidity and mortality are established only later in life. One of the most important benefits of physical activity is maintaining a healthy weight and it thus contributes to prevent the development of obesity. However, physical activity is also thought to be related to both aerobic fitness, a strong predictor of cardiovascular disease, and to different motor skills. As there is a gap on research investigating those relationships in preschool children, cross-sectional and longitudinal analyses were done to examine children’s physical activity behaviours and their correlates. In addition, it was analysed if physical activity is associated with socio-cultural characteristics. Finally, the effects of a physical activity intervention on adiposity and fitness were evaluated, especially in preschoolers of migrant or low educated families. This research is based on the Ballabeina Study, a multidimensional lifestyle intervention study aimed at reducing BMI and increasing fitness in preschool children. The cluster-randomized trial was conducted in German and French speaking regions in Switzerland with a high prevalence of migrant populations. The intervention targeted four lifestyle behaviours during one school year: an increase in physical activity, a balanced nutrition, sufficient sleep and a reduction in media use. In the cross-sectional analyses, substantial differences in physical activity and in adiposity were found between the German and French speaking part of Switzerland. On the other hand, parental sociocultural characteristics (migrant status or educational level) had less impact on physical activity and adiposity. The cross-sectional analyses also revealed a relationship between physical and body fat, aerobic fitness and motor skills. The cross-sectional analyses also revealed a relationship between physical and body fat, aerobic fitness and motor skills. The longitudinal analyses also showed an association of baseline physical activity with prospective changes in aerobic fitness and in motor skills, but not in body fat. These findings contribute to the current understanding of the relationships of physical activity with fitness and adiposity and strengthen the benefits of being active from early childhood. The intervention led to improvements in aerobic fitness, but not in BMI, the two primary outcomes. It also led to improvements in body fat and agility. In view of the substantial decrease in children’s fitness and the increase in obesity over the last 20 years, the improvements in aerobic fitness and in body fat in favor of the intervention group are most relevant. Moreover, children of migrant or low educated parents benefitted equally from the intervention compared to their respective counterparts. These results are encouraging, as these children have been less accessible in previous interventions. Thus, using strategies to target a multicultural population might represent a promising approach to reduce body fat and increase fitness in these high-risk groups. In conclusion, Ballabeina is an intensive intervention, but offers an effective school-based intervention program to reduce body fat and increase fitness in preschool children. Physical activity in preschoolers. ---------- Zusammenfassung: Der gesundheitliche Nutzen von körperlicher Aktivität ist unbestritten. Dies gilt auch für Kinder, auch wenn sich die positiven Effekte meist erst im späteren Leben zeigen. Körperliche Aktivität ist wichtig, um ein gesundes Körpergewicht zu halten und dadurch einen Beitrag zur Übergewichtsprävention zu leisten. Körperliche Aktivität scheint aber auch mit aerober Ausdauer, einem wichtigen Einflusswert für kardiovaskuläre Krankheiten, und mit motorischen Fertigkeiten assoziiert zu sein. Da diese Zusammenhänge im Vorschulalter noch nicht ausreichend untersucht worden sind, haben wir die körperliche Aktivität von Vorschulkindern und dessen Wechselbeziehungen mit Adipositas und Fitness genauer unter die Lupe genommen. Zudem haben wir untersucht, inwiefern körperliche Aktivität und Adipositas mit sozio-kulturellen Faktoren assoziiert sind. Schlussendlich haben wir auch die Effekte einer schulbasierten Intervention in Bezug auf Adipositas und Fitness evaluiert, speziell bei Kindern aus Familien mit Migrationshintergrund oder tiefem Bildungsniveau. Die Grundlage dieser Forschungsarbeit bildet die Ballabeina Studie, eine in der Schweiz durchgeführte Interventionsstudie bei Kindergartenkindern. Diese cluster-randomisierte Studie wurde in Regionen mit einem hohen Ausländeranteil in der Deutschschweiz sowie in der Romandie durchgeführt. Ziel der Studie war, den BMI zu senken und die aerobe Fitness zu verbessern. Die vier wichtigsten Elemente der Intervention waren: eine Erhöhung der täglichen Aktivität, eine ausgewogene Ernährung, genügend Schlaf und eine Reduktion des Medienkonsums. Die Querschnittuntersuchungen zeigten, dass körperliche Aktivität mit Körperfett, Ausdauer und motorischen Fertigkeiten assoziiert war. Dabei stellten wir bedeutende Unterschiede in Bezug auf körperliche Aktivität und Adipositas zwischen der Deutschen und Französischen Schweiz fest. Auf der anderen Seite schienen elterliche Merkmale wie Migrationshintergrund oder Bildungsniveau weniger Einfluss auf diese Parameter zu haben. In den Längsschnittuntersuchungen konnten wir einen Zusammenhang zwischen körperlicher Aktivität und Verbesserungen in der Fitness aufzeigen, jedoch nicht beim Körperfett. Diese Erkenntnisse entsprechen früher gefundenen Zusammenhänge von körperlicher Aktivität, Adipositas und Fitness und unterstreichen somit die Wichtigkeit, bereits im frühen Kindesalter körperlich aktiv zu sein. Die Intervention führte zu einer Verbesserung der aeroben Fitness, nicht aber zu einer Reduktion des BMI’s. Zusätzlich erzielten wir eine Abnahme des Körperfetts und eine Verbesserung bei den motorischen Fertigkeiten. Da die Fitness bei Kindern über die letzten 20 Jahren stetig abgenommen und das Übergewicht stetig zugenommen hat, sind diese positiven Resultate besonders wichtig. Darüber hinaus konnten Kinder aus Familien mit Migrationshintergrund oder tiefem Bildungsniveau ebenso viel von der Intervention profitieren wie alle anderen Kindern. Dies ist besonders betonenswert, da diese Kinder in früheren Interventionen weniger erreicht werden konnten. Der Ansatz, eine multikulturelle Population einzubeziehen, stellt einen vielversprechenden Lösungsansatz dar, um Übergewicht und Fitness auch bei benachteiligten Kindern zu verbessern. Schlussfolgernd kann gesagt werden, dass Ballabeina ein intensives, aber erfolgreiches schulbasiertes Interventionsprogramm darstellt, mit welchem Körperfett und Fitness von Kindergartenkindern verbessert werden kann

Effect of a lifestyle intervention on adiposity and fitness in socially disadvantaged subgroups of preschoolers: a cluster-randomized trial (Ballabeina)

OBJECTIVE: A multidimensional lifestyle intervention performed in 652 preschoolers (72% of migrant, 38% of low educational level (EL) parents) reduced body fat, but not BMI and improved fitness. The objective of this study is to examine whether the intervention was equally effective in children of migrant and/or low EL parents. METHODS: Cluster-randomized controlled single blinded trial, conducted in 2008/09 in 40 randomly selected preschools in Switzerland. The culturally tailored intervention consisted of a physical activity program and lessons on nutrition, media use and sleep. Primary outcomes included BMI and aerobic fitness. Secondary outcomes included %body fat, waist circumference and motor agility. RESULTS: Children of migrant parents benefitted similarly from the intervention compared to their counterparts (p for interaction≥ 0.09). However, children of low EL parents benefitted less, although these differences did not reach statistical significance (p for interaction≥ 0.06). Average intervention effect sizes for BMI were -0.10, -0.05, -0.11 and 0.04 kg/m(2) and for aerobic fitness were 0.55, 0.20, 0.37 and -0.05 stages for children of non-migrant, migrant, middle/high EL and low EL parents, respectively. CONCLUSIONS: This intervention was similarly effective among preschoolers of migrant parents compared to their counterparts, while children of low EL parents benefitted less