FitnessImprovementsamongchildreninoneAlbertaFirstNa7on
BRAID‐KidsBRAIDPreven1onofObesityandDiabetesin
ChildrenandFamilies(BRAID‐Kids)
Narratedby:KelliCampbell,ResearchAssistant/ProjectCoordinator
Paule=eCampiou,DiabetesCoordinator,Dri?pileFirstNaAonDr.EllenToth,PrincipalInvesAgator,UniversityofAlberta
BRAID=BelievingwecanReduceAboriginalIncidenceofDiabetes
ORIGINALBRAIDSTUDY(2003‐2006)
Collabora7onbetweenDri;pileandtheUniversityofAlberta.
Screenedthepopula7onofDri;pileforundiagnoseddiabetes(includingchildren)
Screeningresultsin89childrenandadolescents:
CommunitywantedtoworkonPREVENTION,involvingchildrenandtheirfamilies
Pre-diabetes 27% Probable diabetes 1.2%
Overweight 22%
Obese 44%
SeRng:
DRIFTPILECREENATIONis350kmsnorthwestofEdmonton,Alberta,ontheshoresofLesserSlaveLake.
Dri;pilehasapproximately1600BandMembers,ofwhomabout850liveonreserveland.
Dri;pileishometoapproximately200childrenandadolescentsages5‐17.
BRAID‐KidsSTUDYDESIGN
BRAID‐KidswasbasedontheKahnawakeSchoolsDiabetesPreven7onProgram(KSDPP)andtheSandyLakediabetespreven7onprogram,andusededuca7onalmaterialsandassessmenttoolsdevelopedbytheseprograms.
However,BRAID‐Kidsplannedtohaveanimprovedstudydesign–CreePride–basedonPimaPride:a“de‐colonizing”projectwhereexposuretoPimatradi7onandcultureimproveddiabetescontrol(Narayan,1998)
BRAID‐Kids
Hypothesis:Decoloniza7onmayenableFirstNa7onsfamiliestoavoidbehaviorsthatcontributetoobesityanddiabetesrisk.
PrimaryOutcome:assessphysicalac7vityanddietarychoicesamongstchildren,by:
Measuringclinical,anthropometricandfitnessoutcomesofpar7cipa7ngchildrennearthebeginningandendofeachschoolyear;
Administeringafoodfrequencyandphysicalac7vityques7onnaire;
Interven6on:
Implemen7nganin‐classroomdiabetespreven7oncurriculum;
Implemen7ngatradi7on‐based“CreePride”programaimedatparents/guardians/families.
MIHTATAKAW SIPIY (ELEMENTARY) SCHOOL, DRIFTPILE FIRST NATION
Builtintheshapeofaneaglefeather
RESULTS:
Recruitment:89childrenandtheirfamilieswererecruited,butthistookabout2years.
BRAID‐KidsProjectDie77anvisitedtheschoolandthecommunityregularly.
In‐classroomcurriculumnotfullyimplemented.
TheCreePrideinterven7oncomponentwasdevelopedasa6‐10sessionprogrambutitwasnotimplemented,duetocompe7ngac7vi7esandprogramsbeingcarriedoutbythecommunity,therecrea7ondepartment,thehealthcenterandschool.
Baseline clinical, anthropometric for all children measured by BRAID-Kids, N=72a
MEASUREMENT RESULTS
Gender, % female 47.2%
Mean age, years 7.9 (range: 4-15 years)
Fasting glucometer blood glucose, N=57
Mean (mmol/L) 5.4 (range: 4.3-7.8)
“Possible” diabetesb, # of children (%) 1 (1.8%)
“Possible” pre-diabetesc, # of children (%) 7 (12.3%) Body Mass Index (BMI), N=69
≥85th-<95th, overweightd, # of children (%) 13 (18.8%)
≥95th, obesityd, # of children (%) 35 (50.7%)
Central adipositye, N=67, # of children (%) 58 (86.6%)
Hypertensionf, N=52, # of children (%) 13 (25.0%)
a.21childrencompletedonlyfitnesstes1ng;b.fas7ngbloodglucose≥7.0mmol/L;c.fas7ngbloodglucose6.1‐6.9mmol/L;d.CDCpercen7lereferenceforageandgender;e.NHANESIII:centraladiposity=waistcircumference≥85thpercen7leforageandgender;f.CDCpercen7lereferenceforageandgender,hypertension:≥95thpercen7le
FitnessTes6ng:
20mMul7‐stageShufleRun“beeptest”(Leger,1984,1988) Measures“maximaloxygenuptake”,whichindicatesaerobicfitness.
Baseline fitness percentiles for age and gender, N=90a
Gender (% female) 45.6%
Mean Age (years) 8.0 (range: 4-15 years)
Fitness: percentile for age and genderb, N=67
# of children < 5th percentile (percent) 48 (71.6%)
# of children 5th to <10th percentile (percent) 5 (7.5%)
# of children 10th to <20th percentile (percent) 5 (7.5%)
# of children 20th to <30th percentile (percent) 4 (6.0%)
# of children 30th to <40th percentile (percent) 1 (1.5%)
# of children 40th to < 50th percentile (percent) 3 (4.5%)
# of children 50th to <60th percentile (percent) 1 (1.5%)
# of children below 20th percentilec (percent) 53 (79.1%)
BaselineFitnessresultsforchildrenwhounderwentfitnesstes1ngbyBRAID‐Kids
a.childrenundertheageof6wereexcluded,perLegerreference(Leger,1984)b.(Leger,1984)c.rela7vefitness=>20thpercen7le(Downs,2006)
Meanimprovementsinage‐and‐genderpercen1lesforchildrentestedat~1yearintervals(Leger,1984),N=19
*p<0.01frompairedt‐test
MeanVO2Maxvaluesforchildrentestedat~1yearintervals(n=24)
*p<0.01frompairedt‐test
RESULTSAFTER1YEAR
Welookedatchangesforchildrenwhohadrepeattestsundertakena;era~1yearinterval:
Significantimprovementsinfitnessscores(inage‐and‐genderpercen7lerankandVO2Max)
Nodifferencesglucose,weight,waistorBPexceptforanincreaseinthe%ofchildrenwithdiastolic(butnotsystolic)hypertension.
BASELINERESULTS
BaselineresultswereonceagainconsistentwithourveryhighratesofoverweightandobesityandverylowlevelsoffitnessreportedforsomeFirstNa7onscommuni7es.
FITNESSASSESSMENT:INTERPRETATION
ObservedimprovementsinfitnessarelikelynotadirectresultofBRAID‐Kidsalone:
Anewphysicaleduca7onprogramwithaspecificgymteacherattheschoolwasveryhelpful
Becauseofregular“beeptests”ingymclass,childrenbecameprac7cedattestprocedures
Increasedsurveillancecommunicatedafocusonfitnesstochildrenandtheirfamilies.
SincemanyBandCouncilscontroltheircommunity’seduca7onbudgetandpolicies,ourresultsmaybehelpfulinforma7onforLeadershipdecision‐making.
FOODFREQUENCY&PHYSICALACTIVITYQUESTIONNAIRE
• BRAID‐Kidsu7lizedthefoodfrequencyandphysicalac7vityques7onnairedevelopedandusedintheKahnewakeSchoolsDiabetesPreven7onProject(KSDPP)
• 91childrencompletedtheques7onnaireatleastonce,withassistancefromaparent/guardian
• 29follow‐upques7onnaireswerecompleteda;era~1yearinterval
JimenezM,ReceveurO,TrifonopoulosM,KuhnleinH,ParadisG,MacaulayAC.EvaluaAonofdietarychangeamongchildren(grades4–6)fromtheKahnawakeSchoolsDiabetesPrevenAonProject.JAmDietAssoc.,2003;103:1191–1194.
PHYSICALACTIVYTY
IndicatorsofAc1ve/Inac1veLifestyle
• Sumofphysicalac7vity:Thetotalnumberof15‐minuteepisodesof25sportsandotherphysicalac7vi7esduringandoutsideofschoolhours.
• Frequencyofsedentaryac7vi7es:Televisionwatchingandvideo/internetgamingonweekdaysandonSaturdays.
SallisJ,StrikmillerP,HarshaD,etal.ValidaAonofinterviewerandself‐administeredphysicalacAvitychecklistsforfi?hgradestudents.MedSciSportsExerc.1996;28:840–851
ParadisG,LévesqueL,MacaulayAC,etal.ImpactofaDiabetesPrevenAonProgramonBodySize,PhysicalAcAvity,andDietAmongKanien'kehá:ka(Mohawk)Children6to11YearsOld:8‐YearResultsFromtheKahnawakeSchoolsDiabetesPrevenAonProject.Pediatrics,2005;115:333‐339.
TelevisionViewingandVideoGaming
Valuesaremeans(SD).T‐testswereusedtoassessdifferences.
Questionnaire responses by gender (N = 91)
Females (SD) Males (SD) p-value
TV watching on school days 2.6 (1.1) 2.7 (1.3) 0.767
Video/internet gaming on school days 2.4 (1.0) 2.1 (0.9) 0.224
TV watching Saturday morning 2.6 (0.9) 2.4 (0.9) 0.203
TV watching Saturday afternoon 2.9 (0.8) 2.7 (1.0) 0.285
Video/internet gaming Saturday morning
3.3 (0.7) 2.8 (1.1) 0.019
Video/internet gaming Saturday afternoon
3.1 (0.8) 2.7 (1.0) 0.044
TelevisionViewingandVideoGaming
Valuesaremeans(SD).T‐testswereusedtoassessdifferences.
Responses to first and second questionnaires (N = 29)
1st Questionnaire (SD)
2nd Questionnaire (SD) p-value
TV watching on school days 2.7 (1.1) 2.5 (1.2) 0.537
Video/internet gaming on school days 2.2 (1.0) 2.2 (1.0) 0.981
TV watching Saturday morning 2.6 (0.8) 3.1 (0.9) 0.025
TV watching Saturday afternoon 3.0 (0.7) 2.9 (0.8) 0.489
Video/internet gaming Saturday morning
3.2 (0.8) 3.5 (0.7) 0.199
Video/internet gaming Saturday afternoon
3.1 (0.9) 3.2 (0.8) 0.621
SumofPhysicalAc1vityFrequency
ParadisG,LévesqueL,MacaulayAC,etal.ImpactofaDiabetesPrevenAonProgramonBodySize,PhysicalAcAvity,andDietAmongKanien'kehá:ka(Mohawk)Children6to11YearsOld:8‐YearResultsFromtheKahnawakeSchoolsDiabetesPrevenAonProject.Pediatrics,2005;115:333‐339.
Valuesaremeans(SD).T‐testswereusedtoassessdifferences.
Questionnaire responses by gender (N = 91)
Females (SD) Males (SD) p-value
Total physical activity in past 7 days 32.0 (17.9) 24.2 (17.7) 0.04
Responses to first and second questionnaires (N = 29 )
1st Questionnaire (SD)
2nd Questionnaire (SD) p-value
Total physical activity in past 7 days 35.7 (3.8) 21.3 (2.4) <0.001
FOODFREQUENCY
• Nutri7ondatawerecollectedbya7‐dayfood‐frequencyques7onnaireadaptedfromO’Loughlinetal.(2000)
• Ques7onsaskedhowo;enchildrenate51differentfoods
• Jimenezetal.(2003)developedthree3‐itemsubscalesofindicatorsof:
• keyhigh‐sugarfoodconsump7on(so;drink,candy,andsugaredcereal)
• keyhigh‐fatfoodconsump7on(hotdogs,fries,chips)
• fruitandvegetableconsump7on(includingfruitandvegetablejuices)
O’LoughlinJ,ParadisG,RenaudL,MeshefedjianG,Gray‐DonaldK.PrevalenceandcorrelatesofoverweightamongelementaryschoolchildreninmulAethnic,lowincome,inner‐cityneighbourhoodsinMontreal,Canada.AnnEpidemiol.2000;8:422–432
JimenezM,ReceveurO,TrifonopoulosM,KuhnleinH,ParadisG,MacaulayAC.EvaluaAonofdietarychangeamongchildren(grades4–6)fromtheKahnawakeSchoolsDiabetesPrevenAonProject.JAmDietAssoc.2003;103:1191–1194
KeyIndicatorsofConsump1onofHigh‐sugarFoods,High‐fatFoods,FruitandVegetables
†so;drink,candy,andsweetenedcereal§hotdogs,fries,chips‡includesfruitandvegetablejuices
Valuesaremeans(SD)scoredfrom1(didnoteat)to5(6daystoeveryday).Pairedt‐testswereusedtoassessdifferences.
Seven-day food frequency responses by gender (N = 90)
Females (SD) Males (SD) p-value
Key high-sugar food consumption† 4.0 (1.2) 4.2 (1.4) 0.395
Key high-fat food consumption§ 3.5 (1.3) 3.5 (1.1) 0.967
Fruit and vegetable consumption‡ 4.9 (0.5) 4.9 (0.4) 0.948
KeyIndicatorsofConsump1onofHigh‐sugarFoods,High‐fatFoods,FruitandVegetables
†so;drink,candy,andsweetenedcereal§hotdogs,fries,chips‡includesfruitandvegetablejuices
Valuesaremeans(SD)scoredfrom1(didnoteat)to5(6daystoeveryday).Pairedt‐testswereusedtoassessdifferences.
First and second seven-day food frequency responses (N = 27)
1st Questionnaire (SD)
2nd Questionnaire (SD) p-value
Key high-sugar food consumption† 4.0 (1.2) 4.1 (1.2) 0.780
Key high-fat food consumption§ 3.1 (1.1) 3.4 (1.1) 0.188
Fruit and vegetable consumption‡ 4.9 (0.2) 4.7 (0.6) 0.019
INSUMMARY:KEYFINDINGS
Ager~1yearinterval:
• Anincreaseinthe%ofchildrenwithdiastolic(butnotsystolic)hypertension.
• Improvementinfitnessscores.
• Sumphysicalac7vitydecreased.Thiscontradictstheobservedimprovementsinfitnessscores.
• TelevisionwatchingonSaturdaymorningsincreased.
• Fruitandvegetableconsump7ondecreased.
• Nochangeinhigh‐sugarandhigh‐fatfoodconsump7on.
POSITIVECOMMUNITYENGAGEMENT/ACTION
• Somefamiliesreporthavingchangedtheirea7nghabits;
• BRAID‐KidsProjectDie77anvisi7ngDri;pileregularly;
• Full‐7meschoolgymteacher;
• Numerouscommunityeffortsatpromo7ngpreven7onandhealthyliving;and,
• CREEPRIDE
DrigpilePowwow
DrigpileCadets
DrigpileYouthBaseball
Tradi1onalHandGames
Acknowledgements:
LawsonFounda7on
AlbertaCenterforChild,FamilyandCommunityResearch
ChiefRoseLaboucanHealthDirectorFlorenceWillier
ResearchAssistants:TrinaScofTessiraeSasakamoosePriscillaLalonde
UofAsupport:KelliCampbell
Die77an:KarieQuinn
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