Abstract
Objective:
To examine the long-term effects of the ‘Cretan Health and Nutrition Education Program’ on blood pressure.
Subjects:
A representative population of 176 pupils (85 from the intervention schools and 91 from the control schools).
Design:
Blood pressure, dietary, anthropometrical and physical activity data were obtained at baseline (academic year 1992–1993) and at follow-up examination (academic year 2001–2002).
Results:
The findings of the current study revealed that the increase over the 10-year period in systolic (SBP) and diastolic blood pressure (DBP) was higher in the control group (CG) than in the intervention group (IG) (P=0.003 and P<0.001 respectively). Regarding dietary indices, the IG were found to have a significantly higher intake of potassium (P=0.018) and magnesium (P=0.011) compared to the CG. Furthermore, the decrease in body mass index (BMI) z-score observed in the IG was found to differentiate significantly from the increase observed in the CG (P=0.042). On the contrary, the increase in leisure time, moderate to vigorous physical activities (MVPA) observed in the IG, was found to differentiate significantly from the decrease observed in the CG (P=0.032). Intervention's effect on SBP was mediated by changes in MVPA (β=−0.20, P=0.030) and BMI (β=0.19, P=0.048). Similarly, intervention's effect on DBP was mediated by changes in MVPA (β=−0.18, P=0.048), BMI (β=0.26, P=0.007) and magnesium intake (β=−0.20, P=0.048).
Conclusion:
The findings of the current study are encouraging, indicating favorable changes in blood pressure, micronutrients intake, BMI and physical activity over the 10 years of follow-up and 4 years after program's cessation, thus providing some support for the effectiveness of school-based health education programs in successfully tackling certain chronic disease risk factors early in life.
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References
American Academy of Pediatrics (2004). Pediatric Nutrition Handbook 5th ed. Elk Grove, III.
Bao W, Threefoot SA, Srinivasan SR, Berenson GS (1995). Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the Bogalusa heart study. Am J Hypertens 8, 657–665.
Baron RM, Kenny DA (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51, 1173–1182.
Boreham C, Robson PJ, Gallagher AM, Cran GW, Savage JM, Murray LJ (2004). Tracking of physical activity, fitness, body composition and diet from adolescence to young adulthood: The Young Hearts Project, Northern Ireland. Int J Behav Nutr Phys Act 1, 14.
Burke V, Beilin LJ, Dunbar D (2001). Tracking of blood pressure in Australian children. J Hypertens 19, 1185–1192.
Committee of Experts on Sports Research (1988). EUROFIT. Edigraf Editoriale Grafica: Rome.
Contento I, Manning A, Shannon B (1992). Research perspective on school-based nutrition education. J Nutr Educ 24, 247–260.
Cornelissen VA, Fagard RH (2005). Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension 46, 667–675.
Gidding SS, Dennison BA, Birch LL, Daniels SR, Gilman MW, Lichtenstein AH et al. (2005). Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association. Circulation 112, 2061–2075.
Gillman MW, Cook NR, Rosner B, Evans DA, Keough ME, Taylor JO et al. (1993). Identifying children at high risk for the development of essential hypertension. J Pediatr 122, 837–846.
Gutin B, Owens S (1999). Role of exercise intervention in improving body fat distribution and risk profile in children. Am J Human Biol 11, 237–247.
Harrell JS, Gansky SA, McMurray RG, Bangdiwala SI, Frauman AC, Bradley CB (1998). School-based interventions improve heart health in children with multiple cardiovascular disease risk factors. Pediatrics 102, 371–380.
Harrell JS, McMurray RG, Bangdiwala SI, Frauman AC, Gansky SA, Bradley CB (1996). Effects of a school-based intervention to reduce cardiovascular disease risk factors in elementary-school children: the Cardiovascular Health in Children (CHIC) study. J Pediatr 128, 797–805.
Hayman LL, Williams CL, Daniels SR, Steinberger J, Paridon S, Dennison BA et al. (2004). Cardiovascular health promotion in the schools: a statement for health and education professionals and child health advocates from the Committee on Atherosclerosis, Hypertension, and Obesity in Youth (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 110, 2266–2275.
Hermansen K (2000). Diet, blood pressure and hypertension. Br J Nutr 83 (Suppl 1), S113–S119.
Janz KF, Dawson JD, Mahoney LT (2000). Tracking physical fitness and physical activity from childhood to adolescence: the muscatine study. Med Sci Sports Exerc 32, 1250–1257.
Kafatos APG (1998). Mortality rates in Greece and their relationship to the Mediterranean diet and ti health and nutrition education. Iatriki 73, 287–301.
Kelley GA, Kelley KS, Tran ZV (2003). The effects of exercise on resting blood pressure in children and adolescents: a meta-analysis of randomized controlled trials. Prev Cardiol 6, 8–16.
Kraemer HC, Wilson GT, Fairburn CG, Agras WS (2002). Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59, 877–883.
Kromhout D, Keys A, Aravanis C, Buzina R, Fidanza F, Giampaoli S et al. (1989). Food consumption patterns in the 1960s in seven countries. Am J Clin Nutr 49, 889–894.
Law M (2000). Dietary fat and adult diseases and the implications for childhood nutrition: an epidemiologic approach. Am J Clin Nutr 72, 1291S–1296S.
Lee IM, Sesso HD, Paffenbarger Jr RS (2000). Physical activity and coronary heart disease risk in men: does the duration of exercise episodes predict risk? Circulation 102, 981–986.
Li S, Chen W, Srinivasan SR, Bond MG, Tang R, Urbina EM et al. (2003). Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA 290, 2271–2276.
Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS, Stone EJ et al. (1996). Outcomes of a field trial to improve children's dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health. CATCH collaborative group. JAMA 275, 768–776.
Lytle LA, Stone EJ, Nichaman MZ, Perry CL, Montgomery DH, Nicklas TA et al. (1996). Changes in nutrient intakes of elementary school children following a school-based intervention: results from the CATCH Study. Prev Med 25, 465–477.
Manios Y, Kafatos A (1999). Health and nutrition education in elementary schools: changes in health knowledge, nutrient intakes and physical activity over a six year period. Public Health Nutr 2, 445–448.
Manios Y, Kafatos A, Mamalakis G (1998a). The effects of a health education intervention initiated at first grade over a 3 year period: physical activity and fitness indices. Health Educ Res 13, 593–606.
Manios Y, Kafatos A, Markakis G (1998b). Physical activity in 6-year-old children: validation of two proxy reports. Pediatr Exerc Sci 10, 176–188.
Manios Y, Moschandreas J, Hatzis C, Kafatos A (1999). Evaluation of a health and nutrition education program in primary school children of Crete over a three-year period. Prev Med 28, 149–159.
Manios Y, Moschandreas J, Hatzis C, Kafatos A (2002). Health and nutrition education in primary schools of Crete: changes in chronic disease risk factors following a 6-year intervention programme. Br J Nutr 88, 315–324.
McKenzie TL, Nader PR, Strikmiller PK, Yang M, Stone EJ, Perry CL et al. (1996). School physical education: effect of the child and adolescent trial for cardiovascular health. Prev Med 25, 423–431.
Mikkila V, Rasanen L, Raitakari OT, Pietinen P, Viikari J (2004). Longitudinal changes in diet from childhood into adulthood with respect to risk of cardiovascular diseases: the Cardiovascular Risk in Young Finns Study. Eur J Clin Nutr 58, 1038–1045.
Nader PR, Stone EJ, Lytle LA, Perry CL, Osganian SK, Kelder S et al. (1999). Three-year maintenance of improved diet and physical activity: the CATCH cohort. Child and Adolescent Trial for Cardiovascular Health. Arch Pediatr Adolesc Med 153, 695–704.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004). The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 555–576.
Nicklas TA, Dwyer J, Mitchell P, Zive M, Montgomery D, Lytle L et al. (1996). Impact of fat reduction on micronutrient density of children's diets: the CATCH Study. Prev Med 25, 478–485.
Nishio T, Mori C, Watanabe K, Haneda N, Kishida K, Hayashi Y et al. (1989). Quantitative analysis of systolic blood pressure tracking during childhood and adolescence using a tracking index: the Shimane Heart Study. J Hypertens Suppl 7, S35–S36.
Pitsavos C, Panagiotakos DB, Chrysohoou C, Skoumas J, Papaioannou I, Stefanadis C et al. (2002). The effect of Mediterranean diet on the risk of the development of acute coronary syndromes in hypercholesterolemic people: a case–control study (CARDIO2000). Coron Artery Dis 13, 295–300.
Pitsavos C, Panagiotakos DB, Chrysohoou C, Stefanadis C (2003). Epidemiology of cardiovascular risk factors in Greece: aims, design and baseline characteristics of the ATTICA study. BMC Public Health 3, 32.
Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N et al. (2003). Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 290, 2277–2283.
Raitakari OT, Porkka KV, Rasanen L, Ronnemaa T, Viikari JS (1994). Clustering and six year cluster-tracking of serum total cholesterol, HDL-cholesterol and diastolic blood pressure in children and young adults. The Cardiovascular Risk in Young Finns Study. J Clin Epidemiol 47, 1085–1093.
Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D et al. (2001). Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 344, 3–10.
Sesso HD, Paffenbarger Jr RS, Lee IM (2000). Physical activity and coronary heart disease in men: The Harvard Alumni Health Study. Circulation 102, 975–980.
Simons-Morton DG, Hunsberger SA, Van Horn L, Barton BA, Robson AM, McMahon RP et al. (1997). Nutrient intake and blood pressure in the Dietary Intervention Study in Children. Hypertension 29, 930–936.
Walter HJ, Wynder EL (1989). The development, implementation, evaluation, and future directions of a chronic disease prevention program for children: the ‘Know Your Body’ studies. Prev Med 18, 59–71.
Wei M, Kampert JB, Barlow CE, Nichaman MZ, Gibbons LW, Paffenbarger Jr RS et al. (1999). Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA 282, 1547–1553.
WHO (1999). Making a difference. The World Health Report 1999. In Health Millions pp 3–5.
Williams CL, Arnold CB, Wynder EL (1977). Primary prevention of chronic disease beginning in childhood. The ‘know your body’ program: design of study. Prev Med 6, 344–357.
Williams CL, Hayman LL, Daniels SR, Robinson TN, Steinberger J, Paridon S et al. (2002). Cardiovascular health in childhood: A statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 106, 143–160.
Acknowledgements
This study was supported by a research grant from Kellogg Europe, the Greek Ministry of Sports and the Greek Ministry of Education.
The Preventive Medicine & Nutrition Clinic Research Team include: Apostolaki Ioanna, Bervanaki Froso, Codrington Caroline, Flouri Sofia, Hatzis Christos, Kiriakakis Michalis, Linardakis Manolis, Mamalakis George, Markatji Irini, Sarri Katerina and Tsimbinos George.
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Kafatos, I., Manios, Y., Moschandreas, J. et al. Health and nutrition education program in primary schools of Crete: changes in blood pressure over 10 years. Eur J Clin Nutr 61, 837–845 (2007). https://doi.org/10.1038/sj.ejcn.1602584
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DOI: https://doi.org/10.1038/sj.ejcn.1602584
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