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Title: A school-based intervention for diabetes risk reduction

Author
item FOSTER, G - Temple University
item LINDER, B - National Institute Of Diabetes And Digestive And Kidney Diseases
item BARANOWSKI, T - Children'S Nutrition Research Center (CNRC)
item COOPER, D - University Of California
item GOLDBERG, L - Oregon Health & Science University
item HARRELL, J - University Of North Carolina
item KAUFMAN, F - Children'S Hospital Los Angeles
item MARCUS, M - University Of Pittsburgh
item TREVINO, R - University Of Texas Health Science Center
item HIRST, K - George Washington University
item Thompson, Deborah - Debbe

Submitted to: New England Journal of Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/1/2010
Publication Date: 6/27/2010
Citation: The HEALTHY Study Group. 2010. A school-based intervention for diabetes risk reduction. New England Journal of Medicine. 363(5):443-453.

Interpretive Summary: HEALTHY was a large middle-school intervention trial to prevent type 2 diabetes and obesity among mostly lower income ethnic minority students. Researchers examined the impact of a school-based program that addressed the risk factor for diabetes in children that are high risk for obesity and type 2 diabetes. The treatment groups received a four component intervention (school food service, physical education, classroom education, and social marketing), which has been described in other publications. Researchers evaluated the percentage of students to go below the cut point of being overweight (85th percentile BMI). About 4% of students went below the cut point from 6th to 8th grades. The intervention group had a greater number of students go below the 95th percentile BMI, and had a greater decrease in fasting insulin. Thus, there were some, but weak, effects from this large comprehensive trial and more analysis is necessary to identify more effective obesity prevention interactions.

Technical Abstract: We examined the effects of a multicomponent, school-based program, addressing risk factors for diabetes among children whose race, or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes. Using a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools), or assessment only (control) (21 schools). A total of 4603 students participated (mean [+-SD] age, 11.3+-0.6 years; 54.2% Hispanic and 18.0% black; 52.7% girls). At the beginning of 6th grade and the end of 8th grade, students underwent measurements of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels. There was a decrease in the primary outcome, the combined prevalence of overweight and obesity, in both the intervention and control schools, with no significant difference between the school groups. The intervention schools had greater reductions in the secondary outcomes of BMI z score, percentage of students with waist circumference at or above the 90th percentile, fasting insulin levels (P = 0.04 for all comparisons), and prevalence of obesity (P = 0.05). Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline. Less than 3% of the students who were screened had an adverse event; the proportions were nearly equivalent in the intervention and control schools. The combined prevalence of overweight and obesity decreased in both the schools with the comprehensive intervention and the schools, in which only assessment was performed, although the comprehensive intervention was associated with greater improvements in indicators of adiposity, as well as, in blood insulin levels, among racially and ethnically diverse youth. These decreases may result in a reduction in the risk of type 2 diabetes.