Effect Evaluation of , a Lebanese Secondary School-Based Nutrition Intervention: A Cluster Randomised Trial

Overview

Journal Front Nutr

Specialty Nutritional Sciences

Date 2022 Apr 4

PMID 35369051

Authors

Liliane Said

Jessica S Gubbels

Stef P J Kremers

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the effectiveness of on dietary knowledge and adherence to dietary guidelines in Lebanese adolescents.

Design/setting: A cluster randomised controlled trial was conducted in public and private secondary schools located in urban and rural regions in Lebanon.

Participants: Sixteen secondary schools including 1,572 adolescents were randomly assigned to the intervention ( = 739) or control group ( = 833).

Intervention: is an educational school-based intervention dedicated to improving dietary adherence to nutritional guidelines, increasing the level of dietary knowledge, and preventing the development of obesity during adolescence. It was systematically designed based on the Intervention Mapping framework. The total length of the intervention was around seven educational sessions, until all of the 11 lessons were covered. Each education session lasted 20-40 min.

Main Outcome Measures: Dietary knowledge and adherence levels were measured at baseline and post-intervention using validated questionnaires.

Statistical Analysis: Multivariate multilevel regression models were used to examine intervention effects on outcomes, controlled for background characteristics (i.e., age, gender, location, type of school, grade, BMI -score).

Results: The intervention group showed significant improvements in total dietary knowledge ( = 12.74, < 0.001) and intake of healthy items ( = 1.89, < 0.001), compared to the control group. Intake of unhealthy items decreased significantly ( = -1.43, < 0.001), compared to the control group. These results were adjusted for age, gender, type of school, location, BMI -score, study group, and score at baseline.

Conclusion And Implications: is an effective and culturally appropriate school-based intervention for targeting diet among a variety of Lebanese adolescents.

Citing Articles

COVID-19, economic crisis, and food insecurity worsen the double burden of malnutrition in Lebanon.

Al Khatib A Front Public Health. 2024; 12:1333565.

PMID: 38504679 PMC: 10948441. DOI: 10.3389/fpubh.2024.1333565.

Commentary: Effect evaluation of , a Lebanese secondary school-based nutrition intervention: a cluster randomised trial.

Siddique A, Brown A, Golzarri-Arroyo L, Allison D Front Nutr. 2023; 10:1241165.

PMID: 37829727 PMC: 10565801. DOI: 10.3389/fnut.2023.1241165.

References

Suresh K . An overview of randomization techniques: An unbiased assessment of outcome in clinical research. J Hum Reprod Sci. 2011; 4(1):8-11. PMC: 3136079. DOI: 10.4103/0974-1208.82352. View

Shah P, Misra A, Gupta N, Hazra D, Gupta R, Seth P . Improvement in nutrition-related knowledge and behaviour of urban Asian Indian school children: findings from the 'Medical education for children/Adolescents for Realistic prevention of obesity and diabetes and for healthy aGeing' ( MARG).... Br J Nutr. 2010; 104(3):427-36. DOI: 10.1017/S0007114510000681. View

Kelsey M, Zaepfel A, Bjornstad P, Nadeau K . Age-related consequences of childhood obesity. Gerontology. 2014; 60(3):222-8. DOI: 10.1159/000356023. View

Naja F, Hwalla N, Fossian T, Zebian D, Nasreddine L . Validity and reliability of the Arabic version of the Household Food Insecurity Access Scale in rural Lebanon. Public Health Nutr. 2014; 18(2):251-8. PMC: 10271416. DOI: 10.1017/S1368980014000317. View

Jones R, Lubans D, Morgan P, Okely A, Parletta N, Wolfenden L . School-based obesity prevention interventions: practicalities and considerations. Obes Res Clin Pract. 2014; 8(5):e497-510. DOI: 10.1016/j.orcp.2013.10.004. View

Stok F, Hoffmann S, Volkert D, Boeing H, Ensenauer R, Stelmach-Mardas M . The DONE framework: Creation, evaluation, and updating of an interdisciplinary, dynamic framework 2.0 of determinants of nutrition and eating. PLoS One. 2017; 12(2):e0171077. PMC: 5289713. DOI: 10.1371/journal.pone.0171077. View

Becker P, Carney L, Corkins M, Monczka J, Smith E, Smith S . Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutr Clin Pract. 2014; 30(1):147-61. DOI: 10.1177/0884533614557642. View

Habib-Mourad C, Ghandour L, Moore H, Nabhani-Zeidan M, Adetayo K, Hwalla N . Promoting healthy eating and physical activity among school children: findings from Health-E-PALS, the first pilot intervention from Lebanon. BMC Public Health. 2014; 14:940. PMC: 4167260. DOI: 10.1186/1471-2458-14-940. View

Chenot J . [Cluster randomised trials: an important method in primary care research]. Z Evid Fortbild Qual Gesundhwes. 2009; 103(7):475-80. DOI: 10.1016/j.zefq.2009.07.004. View

10.

Al-Yateem N, Rossiter R . Nutritional knowledge and habits of adolescents aged 9 to 13 years in Sharjah, United Arab Emirates: a crosssectional study. East Mediterr Health J. 2017; 23(8):551-558. View

11.

Kresic G, Kendel Jovanovic G, Pavicic Zezel S, Cvijanovic O, Ivezic G . The effect of nutrition knowledge on dietary intake among Croatian university students. Coll Antropol. 2010; 33(4):1047-56. View

12.

Dreyhaupt J, Mayer B, Keis O, Ochsner W, Muche R . Cluster-randomized Studies in Educational Research: Principles and Methodological Aspects. GMS J Med Educ. 2017; 34(2):Doc26. PMC: 5450430. DOI: 10.3205/zma001103. View

13.

Ochoa-Aviles A, Verstraeten R, Huybregts L, Andrade S, Van Camp J, Donoso S . A school-based intervention improved dietary intake outcomes and reduced waist circumference in adolescents: a cluster randomized controlled trial. Nutr J. 2017; 16(1):79. PMC: 5725778. DOI: 10.1186/s12937-017-0299-5. View

14.

Nihiser A, Lee S, Wechsler H, McKenna M, Odom E, Reinold C . Body mass index measurement in schools. J Sch Health. 2007; 77(10):651-71. DOI: 10.1111/j.1746-1561.2007.00249.x. View

15.

Livingston E, Cassidy L . Statistical power and estimation of the number of required subjects for a study based on the t-test: a surgeon's primer. J Surg Res. 2005; 126(2):149-59. DOI: 10.1016/j.jss.2004.12.013. View

16.

Hoelscher D, Kirk S, Ritchie L, Cunningham-Sabo L . Position of the Academy of Nutrition and Dietetics: interventions for the prevention and treatment of pediatric overweight and obesity. J Acad Nutr Diet. 2013; 113(10):1375-94. DOI: 10.1016/j.jand.2013.08.004. View

17.

Nasreddine L, Naja F, Akl C, Chamieh M, Karam S, Sibai A . Dietary, lifestyle and socio-economic correlates of overweight, obesity and central adiposity in Lebanese children and adolescents. Nutrients. 2014; 6(3):1038-62. PMC: 3967177. DOI: 10.3390/nu6031038. View

18.

Gidding S, Dennison B, Birch L, Daniels S, Gillman M, Gilman M . Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation. 2005; 112(13):2061-75. DOI: 10.1161/CIRCULATIONAHA.105.169251. View

19.

Said L, Gubbels J, Kremers S . Development of Dietary Knowledge and Adherence Questionnaires for Lebanese Adolescents and Their Parents. Int J Environ Res Public Health. 2019; 17(1). PMC: 6982025. DOI: 10.3390/ijerph17010147. View

20.

de Onis M, Onyango A, Borghi E, Siyam A, Nishida C, Siekmann J . Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007; 85(9):660-7. PMC: 2636412. DOI: 10.2471/blt.07.043497. View