Educational intervention improved preschoolers' heart health

Issue: December 2013

DALLAS — Late-breaking clinical trial results showed that preschoolers in Bogotà, Colombia, demonstrated improvements in knowledge and attitudes toward healthy eating and living an active lifestyle after participation in a structured curriculum involving Sesame Street’s Health Habits for Life materials.

Results from the trial, which were presented at AHA 2013, also showed that the percentage of preschoolers at a healthy weight improved by 13% after participation in the program.

In 2006, principal investigator Valentin Fuster, MD, PhD, partnered with Sesame Workshop to develop a campaign to promote cardiovascular health education in developing countries, with Colombia serving as the pilot. Six-month data on the effects of the school-based intervention designed to present heart-healthy ideas and actions to children and their parents were promising, researchers said.

Valentin Fuster

“It all started with Cookie Monster, who used to eat the wrong foods daily. The first step is to eat the wrong foods no more than once a week. Now he’s eating vegetables and so forth,” Fuster, who is director of Mount Sinai Heart at the Mount Sinai Hospital in New York, said during a Google+ press conference. “The concept of Sesame, from 40 years of experience, is that our behavior as adults develops particularly between age 3 and 5 in the environment that we live. If you look at your own behavior, you will see how important those years were. Taking that into account, why wouldn’t we go into health as a priority and begin to teach children between age 3 and 5 that health is a priority?”

Study results

The study included 1,216 children aged 3 to 5 years and 928 parents in 14 preschools in underprivileged neighborhoods in Bogotá. The children were given 40 hours of instruction (20 hours theoretical and 20 hours practical) on how the body works, physical activity and proper nutrition. Parents were instructed individually and completed 4-6 hours of online training.

“One of the keys is we did the same with the parents. If we don’t involve the parents, I’m not sure if the results would have been so good,” Fuster said. “This is critical. They become aware of the epidemic of cardiovascular disease and what can happen to their children. Once they’re aware of this, they’re ready to work.”

At 36 months, compared with baseline, researchers found significant increases in the children’s mean knowledge (76.15 vs. 87.94; P<.001), attitudes (86.39 vs. 57.03; P<.001) and habits (66.29 vs. 48.72; P<.001). Similarly, knowledge (73.45 vs. 70.01; P<.001) and attitude (78.08 vs. 74.65; P<.001) scores increased among parents as well. The percentage of children at a healthy weight also increased from 62.1% at baseline to 75% (P<.0001).

Fuster also said they saw improvements in the parents’ health, but not as significant as the children.

“We surveyed the parents, and one of the main messages that we got was that the children correct them at home with what they should eat. … The greatest impact the children had on the parents was in the way they eat at home, and this was a fascinating finding,” Fuster said. “These children can be a tremendous instrument for what goes on at home.”

Once children understand the mechanisms of their bodies, they easily improve their level of physical activity and the foods they choose to eat, Fuster explained.

“Now all these children will be followed for 20 years. Why? Because the hypothesis I said at the beginning is that behavior as adults depends on what you teach and where you are between ages 1 and 3,” Fuster said. “We hope these children at age 20 or 25 will have different behavior than ours.”

For more information:

Céspedes J. Late breaking clinical trials II: Prevention: From schools to countries. Presented at: the American Heart Association Scientific Sessions; Nov. 16-20, 2013; Dallas.

Disclosure: The researchers report no relevant financial disclosures.