Article

The effects of a comprehensive community trial on cardiometabolic risk factors in adolescents: Isfahan Healthy Heart Program

Professor, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
ARYA Atherosclerosis 01/2012; 7(4):184-190.
Source: PubMed

ABSTRACT

BACKGROUND:
This study aimed to assess the effects of a 6-year-long community-participatory program including school-based interventions on mean values and prevalence of cardiometabolic risk factors among adolescents.

METHODS:
The interventions of this community trial, conducted from 2000 to 2007 in Iran, targeted the whole population (of nearly two millions) living in two cities considered as the intervention area (IA) in comparison with a reference area (RA). Data from surveys conducted before and after interventions was used to compare the differences between the secondary school students of the IA and RA.

RESULTS:
The prevalence of hypercholesterolemia and hypertriglyceridemia declined significantly in girls and boys in the IA (P < 0.01). The prevalence of high LDL-C decreased significantly in the girls in the RA (P = 0.002). Among both sexes in the IA, the prevalence of low HDL-C increased significantly (P < 0.001), whereas it decreased in the girls and boys in the RA (P = 0.04). Although in the IA, the prevalence of overweight and obesity decreased significantly in girls (P = 0.001), it increased in boys (P = 0.001) as well as in the girls of the RA (P = 0.01).

CONCLUSION:
By performing school-based interventions, our study was successful, at least in part, in controlling some cardiometabolic risk factors in adolescents. Such modifications may have long-term impacts on non-communicable diseases prevention in adulthood.

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    • "The present sub-study is a part of Heart Health Promotion from Childhood (HHPC) Project, which was performed as one of interventional projects of a comprehensive community-based program IHHP with school-based approach to improve lifestyle behavior and cardio-metabolic risk factors among students in junior high school and high schools.[8] Briefly, HHPC public education was done through mass media, pamphlets, booklets, face-to-face meetings, proposing role models among students, arranging different competitions with the subject of healthy heart, serving healthy snacks, establishing healthy heart buffets, reinforcing healthy eating habits in schools, and gathering parents at least yearly to train healthy nutrition.[8] "
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    ABSTRACT: Background: Metabolic syndrome (MetS) is more prevalent among Iranian adolescences. This study aimed to find the relationship between obesity and MetS among different education grades of Iranian adolescence. Materials and Methods: Overall, 1039 junior high school and 953 high school students were selected using multistage random sampling. Fasting blood sugar, total cholesterol, triglyceride (TG), and high-density lipoprotein cholesterol (HDL) were measured. Trained individuals measured waist circumference and blood pressure. MetS was defined according to the De Ferranti definition. Results: The prevalence of overweight and obesity was 12.6% and 6.2% in junior and 11.5% and 4.3% in high school students, respectively. Obese subjects in both grades have higher waist circumference, systolic and diastolic blood pressure, and triglyceride than comparable groups. Multiple logistic regression models showed that overweight and obesity were strongly associated with MetS components analyzed. Compared to normal-weight children, overweight and obese in junior high school students were 1.47 and 2.23 times more likely to be having high TG, respectively, whereas overweight and obese in high school-students were also more likely to have elevated TG [ORs 1.94 (1.28-2.94), 4.96 (2.39-10.3) respectively]. Conclusion: Obese children have the highest prevalence of MetS. Prevalence of MetS-related components has reached high level among Iranian adolescences that were overweight or obese.
    Full-text · Article · Jul 2014
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    • "While our study showed that the main reason for sustainable interventions according to the schoolchildren view points in all grades were their acceptance of the intervention followed by authorities approval and their families support. One of the important reasons that led to the sustainability of HHPC interventions is the fact that IHHP projects were performed simultaneously22 which helped to increase the dose of interventions and had a booster effect.26 Furthermore, the managers of each project involved the directors or chiefs of cooperating offices or organizations in the planning, implementation, and evaluation of interventions, a strategy that later helped in institutionalizing these interventions and saving the study funds to perform the research part of the whole program.28 "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND Sustainability is the core of a successful health-related intervention program. This study was conducted to evaluate the sustainability of interventions of the Heart Health Promotion from Childhood (HHPC) project, one of the 10 interventional projects of the Isfahan Healthy Heart Program. METHODS The evaluation of HHPC included administrating surveys to 500 elementary and middle, and 500 high school students. The study participants were randomly selected from all schools in Isfahan. The questionnaires were administered by interviews to evaluate the sustainability of interventions. RESULTS The results of interviews showed that interventions were sustainable in 100% of elementary school, 99% of middle school, and 87% of high school students. Training of healthy lifestyle behaviors was significantly higher in all-girls middle schools (P < 0.001). Daily morning exercise was more frequent in girls high schools (P < 0.001), while selling unhealthy food was more frequent in boys high schools (P < 0.001). The participants attributed the success of the program mostly to students’ agreement and cooperation. CONCLUSION Even though 5 years have passed since the end of the HHPC project, many of the interventions have been continued at the schools, often because healthy behaviors have become institutionalized in the target population. However, now all schools have the same level of sustainability, especially the middle and high schools, and all-boys schools. Therefore, it is important for future projects to place additional emphasis on these institutions for future school-based interventions.
    Full-text · Article · Mar 2014 · ARYA Atherosclerosis
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    • "HHPC project was performed as one of interventional projects of a comprehensive community-based program IHHP with school-based approach to improve lifestyle behavior and cardiometabolic risk factors among students in middle and high schools [16]. Briefly, HHPC public education was done through mass media, pamphlets, booklets, face-to-face meetings, proposing role models among students, arranging different competitions with the subject of healthy heart, serving healthy snacks, establishing healthy heart buffets, reinforcing healthy eating habits in schools, and gathering parents at least yearly to train healthy nutrition [16]. "
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    ABSTRACT: Aim . The present population-based study aimed to assess prevalence of metabolic syndrome and itsrelated components in Iranian youth in the different sex, age, and residential subgroups. Method . Overall, 1039 junior high school and 953 high school students were selected using multistage random sampling. Fasting blood sugar, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were determined. Trained individuals measured waist circumference and blood pressure. Subjects with MetS were selected according to two definitions provided by the IDF and de Ferranti. Results . Among girls in intervention area, hypertriglyceridemia was more prevalent in rural than in urban areas using IDF definition. Significant differences were observed between boys in rural and urban areas regarding some components of metabolic syndrome including hypertriglyceridemia and high waist circumference. Besides, boys who are residents in urban areas had higher blood pressure, as well as higher waist circumference, than boys in rural areas. Conclusion . Our youth population is at significant risk of developing metabolic syndrome, and the pattern of this phenomenon seems to be discrepant in boys as well as in rural and urban areas probably due to the different lifestyle aspects, genetic factors, and racial differences.
    Full-text · Article · May 2013 · Journal of Diabetes Research
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