Effects of Health Promotion Since Childhood

All clinical practice guidelines indicate healthy lifestyle recommendations and, as cardiologists, we have slowly but surely implemented such practice.

promoción de los hábitos saludables desde la niñez

However, patients come to us once they have had health problems. What would happen if people had these recommendations at an earlier stage in their life? Would that prevent them from ever becoming patients?

There was some logic to that idea, but it had to be tested in the long term to see if the lifestyle change provoked was sustained over time and if new interventions were necessary.

That is why this study tested the long-term impact of health promotion on preschool children in an urban low-income area of Colombia (phase 1). Additionally, researchers assessed the effects of a new community intervention (phase 2).

In phase 1, researchers conducted an analysis of knowledge, attitudes, and habits toward a healthy lifestyle, and ideal cardiovascular health scores in 1216 children. Among them, 596 had previously received health promotion recommendations at 3 to 5 years old. The remaining 620 subjects had not taken part in any prior intervention.

In phase 2, all children were randomized 1:1 to undergo either an additional 4-month educational intervention (the SI! Program) or no other intervention (the control group).

The primary endpoint were the changes from baseline in healthy lifestyle and ideal cardiovascular health scores.

In phase 1, about 85% of children did not have a healthy lifestyle. Those who had previously taken part in a preschool intervention at 3 to 5 years old showed a practically negligible residual effect compared with those who took part in an intervention at 9 to 13 years old.

In phase 2, there was no difference between the 4-month intervention group and the control group.

All of that notwithstanding, there was a dose-response effect. The maximal benefit was observed in children who attended >75% of the scheduled intervention program.

The difference in healthy lifestyle changes between the high- and low-adherence groups was 3.72 points (p < 0.001).

Conclusion

While there were no significant differences between the intervention and control groups, high adherence rates to health promotion interventions might improve future cardiovascular health.

New interventions may be required at multiple stages to induce sustained health promotion effects.

Original Title: Sustainability of and Adherence to Preschool Health Promotion Among Children 9 to 13 Years Old.

Reference: Rodrigo Fernández-Jiménez et al. J Am Coll Cardiol 2020;75:1565–78.