Dietary Habits and Metabolic Response in Obese Children Whose Mothers Received an Intervention to Promote Healthy Eating
Dietary Habits and Metabolic Response in Obese Children Whose Mothers Received an Intervention to Promote Healthy Eating
Unhealthy eating habits inside and outside the home lead to developing obesity, leading to
 clinical and metabolic disorders, such as insulin resistance, metabolic syndrome, and chronic
 degenerative diseases, which are the leading causes of death in adult life. The present study
 compared changes in dietary habits, behaviors and metabolic profiles of obese children whose
 mothers attended group sessions, with those who received the usual nutritional consultation.

 The hypotheses were:

 1. The mother's training in healthy eating methods, eliminating foods and nutrients that
 represent metabolic and cardiovascular risk, will change the consumption of these foods
 in the family, reducing them by 20% and increasing the consumption of food in the same
 proportion. beneficial, compared to the family of the child who only receives individual
 consultation.

 2. Children with obesity who modify or eliminate metabolic and cardiovascular risk foods
 and nutrients from their normal diet will have a weight loss of -1.5 BMI compared to
 children who only receive the usual consultation.

 Randomized clinical trial, 177 mother/obese child pairs participated, 90 in the intervention
 group (IG) and 87 in the control group (CG). The intervention group attended six group
 education sessions to promote healthy eating and 87 received the usual nutritional
 consultation, over a three-month period. Frequency of food consumption, behaviors during
 feeding in the house and metabolic profile was evaluated. Data was compared using Student's t
 or X2.
The aim of this study is evaluate the change in eating behaviors, metabolic condition, and
 nutritional status measured by anthropometry, in children with obesity who were prescribed a
 diet to reduce their body weight in the usual nutritional consultation, in comparison to
 children whose mothers participated in an intervention of six group sessions to acquire
 healthy dietary habits.

 Methods. Design. The Obesity Clinic at Federico Gómez Children's Hospital of Mexico conducted
 a randomized clinical trial between January 2011 and December 2014 with approval from the
 hospital's Research, Ethics and Biosecurity Committee. After providing written consent, 177
 children with obesity (BMI ≥ 95 pc) of age 5-11 years and their mothers were randomly
 assigned to participate in the intervention group (IG) or the control group (CG). None of the
 participating children were receiving pharmacological treatment for obesity, were morbidly
 obese or were associated with a genetic syndrome. Intervention group mothers (n = 90)
 attended six weekly group sessions, which were led by nutritionists and lasted 90 minutes.

 The key message was that healthy dietary habits and health risks are acquired at home and
 that opportunities for change can be identified in the processes that surround meal times. It
 begins with selecting and purchasing food, followed by preparation and consumption behaviors.
 Mothers were encouraged to participate in the sessions which involved the use of food models,
 videos, slides, and, in some cases, real food. Upon completing each session, mothers were
 given printed material to add to a home consultation manual. Children in this group were not
 prescribed diets to reduce their body weight. Control group mothers and children (n = 87)
 were given the usual nutritional consultation and were prescribed diets that covered their
 energy requirements according to their age and sex. Similarly, CG mother/child pairs received
 information regarding food groups and portion sizes, were trained in the use of the food
 equivalence system to encourage variation, and were instructed on how to prepare the diet at
 home. Neither group of children received physical activity programs. Upon concluding
 consultations and group sessions, mother/child pairs from both groups were asked to return
 for monthly follow-ups over the next three months.

 The assignment to intervention or control groups was made using a block randomization with 8
 mother/child pairs in each block to assure equal allocation to groups. One of coworkers not
 involved in data collection produced a computer-generated randomization list using the Stata
 11.0 program. Children were randomized at the end of the baseline examination. Taking
 experiences from the published studies the sample size calculation was based on to expect
 differences of at less 20% in eating habits between the mothers/children dyad of the
 intervention or control groups, to detect differences with significant level of 5% and 80%
 power; the size of sample required was 72 mother/children pairs per group and to allow for
 20% drop-out during the follow-up, the investigators aimed at recruiting 86 mother/children
 dyad per group.

 Measurements at the beginning and end of the study. Anthropometry. The weight, height and
 waist circumference of children in both groups were measured according to international
 procedures. Weight was measured on a mechanical scale (Seca model-700, SECA Corp., Hamburg,
 Germany) with 50 g precision. Height was measured on a stadiometer (SECA model-225, SECA
 Corp., Hamburg, Germany) 0.1 cm precision. Meanwhile, waist circumference was measured at the
 end of an exhalation with non-elastic flexible tape (Seca model-200, SECA Corp., Hamburg,
 Germany) in a standing position at the midpoint between the lower costal border and the iliac
 crest. Body Mass Index (BMI) and percentile value were calculated using CDC data for
 reference, children with a BMI ≥ 95 pc were categorized with obesity.

 Blood pressure. Blood pressure was measured on children's right arm with a mercury
 sphygmomanometer (ALPK2, Tokyo, Japan) using a cuff that suited arm length and perimeter and
 following 2004 National High Blood Pressure Education Program guidelines.

 Questionnaires. A questionnaire of socio demographic data was applied to the mothers at
 baseline. In addition, a survey of family feeding habits at home at baseline and three months
 was applied, the mother was asked about the child's breakfast habit and bring lunch to
 consume at school, family feeding habits at the time of sitting at the table (place the salt
 shaker, sugar and sweetened soft drinks on the table, fill the plate, repeat saucer, force
 the child to finish the meal, accept the exchange of food to what the child wants), frequency
 of consumption of food (fried, roasted, fruits and vegetables) and drinks (simple water,
 sugary drinks prepared at home, natural juice, industrialized juice and soft drinks). The
 amounts of food consumption were not evaluated. A survey of physical activity and sedentary
 activities was applied; no physical activity intervention was performed during this study.

 Blood sample. 5 mL venous blood samples after 12 h fasting periods were drawn to determine
 glucose (mg/dL)(hexokinase method Dimension RxL Max, Siemens Euro, DPC, Llanberis, UK),
 insulin (mIU/mL) (chemiluminescence IMMULITE 1000, Siemens), HDL cholesterol (mg/dl)
 (enzymatic reaction/catalase, using ADVIA ® 1800 equipment), and triglycerides (mg/dl) (ILAB
 300, Instrumentation Laboratory, Barcelona Spain). Participating children's HOMA-IR index was
 obtained through glucose and insulin data (If xGf/22.5).

 Statistical analysis. Central tendency measures were used to describe the study population's
 baseline characteristics. Student's t-test for independent samples was used to compare
 continuous variables, such as socio-demographic data, dietary habits, feeding behaviors, and
 biochemical and anthropometric data. Pearson X2 test was used to compare proportions between
 groups. Continuous data without normal distribution was managed using logarithmic
 transformation or square root. Student's t-test for related samples was used to identify
 differences before and after the intervention in each group or its non-parametric Wilcoxon
 equivalent. The equal proportions test was used to assess the difference in proportions in
 dietary habits and behaviors between groups. Statistical significance was considered at P <
 0.05. Analyses were carried out with STATA SE v.12.0 (Stata Corp, CollegeStation, TX, USA).
Inclusion Criteria:

 -  Children and their families who come to the obesity clinic of the Federico Gómez
 Children's Hospital in Mexico who live in Mexico City or in the metropolitan area.

 -  Aged 5 to 11 years, both sexes.

 -  Children who can attend a consultation on a monthly basis for 3 months.

 -  Children and parents who have given their informed consent and assent in writing.

 Exclusion Criteria:

 -  Children with obesity who receive medications that alter their body composition such
 as steroids, antiretrovirals and appetite stimulants.

 -  Children who are already under nutritional, medical or pharmacological treatment for
 their obesity.

 -  Children with syndromes whose body composition is altered, such as Cushing and other
 genetics.