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Family-based intervention using face-to-face sessions and social media to improve Malay primary school children's adiposity: a randomized controlled field trial of the Malaysian REDUCE programme
Ahmad N, Shariff ZM, Mukhtar F, Lye M-S
Nutrition Journal 2018 Aug 2;17(74):Epub
clinical trial
8/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Social media may be an effective medium by which parents could be trained to promote healthy eating behaviour and physical activity for their children. This trial evaluates the effectiveness of a family-based intervention using social media in combination with face-to-face sessions -- the REDUCE (REorganise Diet, Unnecessary sCreen time and Exercise) programme -- on adiposity of Malay children. METHODS: Five primary schools in an urban area in Selangor, Malaysia participated in this two-arm randomized controlled field trial. Participants were parents (n = 134) and their primary school-going children 8 to 11 years of age who were either overweight or obese. These parent-child dyads were randomly allocated to intervention and wait-list control groups and were blinded to group assignment. The intervention was a four-week training programme using two face-to-face sessions and two Facebook sessions followed by weekly booster sessions over a three-month period using WhatsApp. The primary outcome was body mass index (BMI) z-score. Height, body weight, waist circumference and percentage of body fat were measured by blinded assessors. Data were collected at baseline (T1), immediately post-training (T2) and at three- (T3) and six-month post training (T4) and were analysed using generalized linear mixed modelling adjusted for covariates to estimate the intervention effects. Subgroup analysis was conducted for overweight and obese children. RESULTS: Ninety-one percent of parents completed the study, 64 in intervention group and 58 in wait-list group. At the sixth month post-training, BMI z-scores were significantly reduced in the intervention group compared to the wait-list group, for the all children (overweight and obese children) and within the obese subgroup (F[6,517] = 2.817, p = 0.010 and F[6,297] = 6.072, p < 0.001 respectively. For waist circumference percentile and body fat percentage, the intervention group experienced a significant reduction compared to the wait-list group, within the obese subgroup (F[6,297] = 3.998, p = 0.001) and within the overweight subgroup (F[6,201] = 2.526, p = 0.022). CONCLUSIONS: The four-month REDUCE intervention programme was effective in reducing childhood adiposity. Further research using this approach needs to be conducted including cost-effectiveness studies before implementing it in a child obesity prevention programme. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000844347 (7 June 2017 retrospectively registered). National Medical Research Register, Ministry of Health Malaysia: NMRR-14-685-21,874 (July 2014).

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