Get 'Em Young: CVD Health Promotion in Preschool Alters Lifestyle Habits and Behaviors

September 28, 2015

MADRID, SPAIN — A long-term cardiovascular health promotion program initiated in preschool with children as young as 3 years old had a significant beneficial effect on lifestyle-related behaviors and measures of adiposity, the results of a new study show[1].

Preschool-aged children exposed to the Spanish health-promotion program significantly improved their thinking and behavior related to diet, physical activity, and the body/heart, with the largest improvements observed in scores assessing physical activity. Children in the intervention arm also improved their knowledge, attitudes, and habits (KAH)—as assessed by a cumulative KAH score—related to diet but less so for body and heart health.

In the study, published in the October 6, 2015 issue of the Journal of the American College of Cardiology, the researchers, including Dr José Peñalvo (Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain) and Dr Valentin Fuster (Icahn School of Medicine at Mount Sinai, New York), explain the Salud Integral (SI)! Program was embedded in the school curriculum and delivered by preschool teachers in 12 schools in Madrid, Spain. The SI! Program included 12 preschools as a control arm in this cluster-randomized controlled intervention trial.

The improvement in the KAH score was observed during the first year of the intervention, but the effect increased as children were exposed to the health-promotion program in the second and third years. The difference in KAH scores vs the control arm peaked in the second year and was maintained thereafter, say investigators.

In addition to seeing changes in knowledge, attitudes, and habits related to diet, physical activity, and how the body and heart work, the researchers showed that children exposed to the program for the maximum 3 years—starting in their first year of preschool at 3 years of age until 5 years of age—also had a small but significant reduction in subscapular skinfold measurements using World Health Organization (WHO) standards.

The program, which included 2062 children, was designed to promote cardiovascular health among children using the school, teachers, and families as part of the intervention. Over the school year, trained teachers provided information and classroom material for a minimum of 20 hours on diet, physical activity, and the human body, as well as 10 hours on emotion management. The intervention also included activities for the family over the weekend.

Given the positive changes observed with the children, the researchers say the "wider adoption of such a program may have a meaningful effect on cardiovascular health promotion."

The improvement in KAH scores was influenced by parental education, with the largest changes observed in families where the parents had at least a high-school education, and by the family's income level.

Learning Heart-Healthy Behaviors Young

In an editorial[2], Drs Muthiah Vaduganathan, Atheendar Venkataramani, and Deepak Bhatt (Brigham and Women's Hospital, Boston, MA) note that while there are declining rates of cardiovascular disease in the US, the trend is countered by alarming rates of cardiovascular disease risk factors, such as dyslipidemia, hypertension, and diabetes, as well as poor health behaviors. In fact, studies suggest that just 2% of Americans meet all ideal health metrics outlined by the American Heart Association (AHA).

Given the lack of ideal heart health in the US and worldwide, the study by the SI! Program investigators "adds valuable new public-health data on the benefits of early childhood intervention," say the editorialists. In starting with preschoolers, the group targeted a critical age for the "biological underpinnings" of cardiovascular disease and learning heart-healthy behaviors.

"The observed benefits in Preschool SI! may be driven by behavioral modulation at the level of the student, school, or family," state the editorialists. "Understanding these behavioral changes will facilitate how this program can be scaled elsewhere and shed light on the exact mechanisms to inform the design of future global programs."

One of the large unknowns with the SI! Program is the effect early changes in knowledge, attitudes, and habits have on long-term risk factors and heart-healthy behaviors outside of the intervention period. The researchers say the SI! Program needs to be tested more widely to confirm its efficacy, but it is being developed for further application through childhood and adolescence.

The SI! Program investigators report no relevant financial relationships. Bhatt serves on the advisory board of Medscape Cardiology and has received honoraria from WebMD (continued medical education steering committees), among others. Full disclosures are available in the editorial. Vaduganathan and Venkataramani have no relevant financial relationships.

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