Effectiveness of a multifaceted intervention for the improvement of nutritional status and nutrition knowledge of children in poverty-stricken areas in Shaanxi Province, China

Abstract

Objectives

Compare the differences between the intervention and control groups in changes of primary outcomes (body mass index [BMI] and waist-to-height ratio [WHtR]) and secondary outcomes (nutrition knowledge of children and parents), from baseline to the 6- and 12-month follow-ups; examine the associations of changes in nutrition knowledge of children and their parents with children's changes in BMI and WHtR.

Data sources

Data collected from four schools in two poverty-stricken counties in northern Shaanxi Province in 2020‒2021.

Methods

A multifaced intervention program targeted children (promoting healthy diet and nutrition education) and their parents (promoting nutrition knowledge) was conducted in the interventional group. Four schools, with two in each group, were randomly allocated to the intervention or control group, with 814 eligible children aged 7.1 to 12.8 years. The control group conducted myopia promotion. Differences in changes of BMI and WHtR between groups were compared with t-test. Mixed-effects model was used to examine the associations between changes in nutrition knowledge of children and parents with changes in children's BMI and WHtR.

Results

At the 6-month follow-up, the difference in changes in BMI between the intervention and control groups was 0.4 kg/m ² (P < 0.001). At the 12-month follow-up, the difference in changes in BMI and WHtR between intervention and control groups was 0.1 kg/m² (P < 0.001) and 0.01 kg/m² (P < 0.001). In the intervention group, the nutrition knowledge awareness rate of children increased from 16.9% (69/409) at baseline to 21.3% (87/409) at 6-month, and 22.7% (93/409) at 12-month. The awareness rate of nutrition knowledge of parents also fluctuated, from 5.6% (23/409) to 6.6% (27/409) and 5.4% (22/409). However, the difference in changes in nutrition knowledge between intervention and control groups was non-significant. The 6-month follow-up changes in children's nutrition knowledge scores were negatively associated with changes in BMI in girls (β = −0.26, 95% confidence interval [CI]: −0.38 to −0.14, P < 0.001), while positively associated with changes in WHtR in boys (β = 0.003, 95% CI: −0.0002 to 0.005, P = 0.035). The 12-month follow-up changes in children's nutrition knowledge scores were positively associated with changes in children's WHtR (β = 0.003, 95% CI: 0.0004 to 0.01, P = 0.018).

Conclusions

The intervention strategies did not reduce the BMI and WHtR of children, and the nutrition knowledge of children and parents increased after the intervention in intervention group. Changes in nutrition knowledge of children and their parents are associated with changes in children's BMI or WHtR. Interventions with a new focus on obesity are needed to help improve children's nutritional status in poverty-stricken areas in Shaanxi Province of China.