Cardiometabolic outcome of MyBFF@school intervention program among primary schoolchildren: a cluster randomized controlled trial

TL;DR

A school-based program improved cardiometabolic markers like insulin and HDL cholesterol in overweight and obese children over six months.

Contribution

The study demonstrates that a multi-component school-based intervention can effectively improve cardiometabolic health in overweight children.

Findings

The intervention group showed significant reductions in fasting insulin and HOMA-IR compared to the control group.

HDL cholesterol levels increased significantly in the intervention group compared to the control group.

The TG:HDL-C ratio decreased significantly in both groups, but the difference between groups was not significant.

Abstract

The increasing prevalence of obesity is associated with the increase in type 2 diabetes, dyslipidemia and hypertension among children. The MyBFF@school study aimed to assess the effectiveness of a 6-month intervention program on the cardiometabolic markers of the overweight and obese primary schoolchildren.

MyBFF@school is a cluster randomized controlled trial involving 23 of 1196 government schools in Malaysia. Schoolchildren aged \documentclass[12pt]{minimal}
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\begin{document}$$9-11$$\end{document}9-11 years with a body mass index (BMI) adjusted for gender and age (BMI z-score) > + 1 SD were recruited. This program (incorporating physical activity, nutrition and psychological components) was conducted during school hours. The effect of the intervention on cardiometabolic status was determined both within and between groups using repeated analysis of variance together with analysis of covariance. Out of 1397 schoolchildren, 683 (intervention = 390 and control = 293) had fasting blood taken at baseline and month-6.

At the end of the intervention, both the intervention and control groups had significantly increased BMI, however, when adjusted for gender and age, the BMI z-score in the intervention group showed no changes, whereas the control group had a significant increase in BMI z-score (mean difference of 0.03, 95% CI: 0.04, 0.06, p = 0.026). Fasting insulin showed significant reduction in the intervention group (˗3.16 μU/mL (95% CI: ˗4.07, ˗2.25), p < 0.001) vs control (˗1.05 μU/mL (95% CI: ˗2.28, 0.18), p = 0.095) (p < 0.001 between groups). A significantly greater reduction of HOMA-IR was observed in the intervention group [˗0.41 (95% CI: ˗ 0.63, ˗0.19), p < 0.001] vs control [˗0.17 (95% CI: ˗0.45, 0.11), p = 0.231)] (p < 0.001 between groups). HDL-C also showed significant increment of 0.34 mmol/L [(95% CI: 0.32, 0.36), p < 0.001] in the intervention and 0.11 mmol/L [(95% CI: 0.08, 0.14), p < 0.001] in the control group (p < 0.001 between groups). A significant reduction of TG: HDL-C ratio was observed in both the intervention [˗0.17 mmol/L (95% CI: ˗0.21, ˗0.12), p < 0.001] and control groups [˗0.12 mmol/L (95% CI: ˗0.17, ˗0.07), p < 0.001] (p = 0.524 between groups).

MyBFF@school resulted in significant improvements of fasting insulin, HOMA-IR and HDL-C in the intervention group. We recommend MyBFF@school program to improve the cardiometabolic markers of the overweight and obese primary schoolchildren.

Clinical trial number: NCT04155255, November 7, 2019 (Retrospective registered). National Medical Research Register: NMRR-13-439-16563. Registered July 23, 2013. The Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia and Educational Planning and Research Division (EPRD), Ministry of Education Malaysia approved the intervention program. It was funded by the Ministry of Health Malaysia.

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