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