GReat-Child Trial™ based on social cognitive theory improved knowledge, attitudes and practices toward whole grains among Malaysian overweight and obese children

Abstract Background Studies have reported that improvement of dietary habits through increased whole grain foods consumption at an early age has the potential to lead to betterment in lifelong health and wellness. The GReat-Child Trial™ was a 12-week quasi-experimental study with 6 months follow-up investigating a multi-component whole grain intervention, which consisted of behavioral, personal and environmental factors based on Social Cognitive Theory (SCT). This study aimed to evaluate the feasibility and acceptability of the GReat-Child Trial™, as well as to determine the changes in knowledge, attitudes and practices (KAP) of whole grains consumption among overweight/obese children. Methods Two schools in Kuala Lumpur with similar socio-demographic characteristics were assigned as intervention (IG) and control (CG), respectively. Inclusion criteria were healthy Malaysian overweight/obese children aged 9 to 11 years who had no serious co-morbidity. Children who reported consuming whole grain foods in their 3-day diet-recall during recruitment were excluded. A total of 63 children (31 IG; 32 CG) completed the intervention. KAP questionnaire was self-administered at baseline [T0] and post intervention (at 3rd [T1] and 9th month [T2]). The baseline differences between the IG and CG across socio-demographics and scores of KAP toward whole grains were determined using chi-square and t-test, respectively. ANCOVA was performed to determine the effect of the GReat-Child Trial™ on KAP towards whole grains at post-intervention and follow-up. Baseline variables were considered as covariates. Results The IG attained significantly higher scores in knowledge (mean difference = 4.23; 95% CI: 3.82, 4.64; p < 0.001), attitudes (mean difference = 7.39; 95% CI: 6.36, 8.42; p < 0.001) and practice (mean difference = 6.13; 95% CI: 4.49, 7.77; p < 0.001) of whole grain consumption compared to the CG, after adjusting for confounders. The IG reported significantly higher scores in knowledge (mean difference = 6.84; 95% CI: 6.53, 7.15; p < 0.001), attitudes (mean difference = 9.16; 95% CI: 8.08, 10.24; p < 0.001) and practice (mean difference = 8.03; 95% CI: 5.34, 10.73; p < 0.001) towards whole grains at T2 compared to T0. Conclusions These findings indicate that this intervention made a positive impact on improving children’s KAP on whole grains. We anticipate the GReat-Child Trial™ to be a program that could be incorporated into school interventions to improve whole grain consumption among Malaysian children for obesity prevention.

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Healthy whole-grain choices for children and parents: a multi-component school-based pilot intervention

Public Health Nutrition ◽

10.1017/s1368980007001346 ◽

2008 ◽

Vol 11 (8) ◽

pp. 849-859 ◽

Cited By ~ 34

Author(s):

Teri L Burgess-Champoux ◽

Hing Wan Chan ◽

Renee Rosen ◽

Len Marquart ◽

Marla Reicks

Keyword(s):

Cognitive Theory ◽

Whole Grains ◽

Intervention School ◽

Whole Grain ◽

Post Intervention ◽

Role Modelling ◽

School Based ◽

Children And Parents ◽

Pilot Intervention ◽

Grain Foods

AbstractObjectiveThe aim of the present study was to pilot-test a school-based intervention designed to increase consumption of whole grains by 4th and 5th grade children.DesignThis multi-component school-based pilot intervention utilised a quasi-experimental study design (intervention and comparison schools) that consisted of a five-lesson classroom curriculum based on Social Cognitive Theory, school cafeteria menu modifications to increase the availability of whole-grain foods and family-oriented activities. Meal observations of children estimated intake of whole grains at lunch. Children and parents completed questionnaires to assess changes in knowledge, availability, self-efficacy, usual food choice and role modelling.Setting/sampleParent/child pairs from two schools in the Minneapolis metropolitan area; 67 in the intervention and 83 in the comparison school.ResultsWhole-grain consumption at the lunch meal increased by 1 serving (P< 0·0001) and refined-grain consumption decreased by 1 serving for children in the intervention school compared with the comparison school post-intervention (P< 0·001). Whole-grain foods were more available in the lunches served to children in the intervention school compared with the comparison school post-intervention (P< 0·0001). The ability to identify whole-grain foods by children in both schools increased, with a trend towards a greater increase in the intervention school (P= 0·06). Parenting scores for scales for role modelling (P< 0·001) and enabling behaviours (P< 0·05) were significantly greater for parents in the intervention school compared with the comparison school post-intervention.ConclusionsThe multi-component school-based programme implemented in the current study successfully increased the intake of whole-grain foods by children.

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The GReat-Child TrialTM: A Quasi-Experimental Dietary Intervention among Overweight and Obese Children

Nutrients ◽

10.3390/nu12102972 ◽

2020 ◽

Vol 12 (10) ◽

pp. 2972

Author(s):

Hui Chin Koo ◽

Bee Koon Poh ◽

Ruzita Abd. Talib

Keyword(s):

Childhood Obesity ◽

Primary Schools ◽

Cognitive Theory ◽

Whole Grains ◽

Mean Difference ◽

Whole Grain ◽

Obese Children ◽

Co Morbidity ◽

Quasi Experimental

Diet composition is a key determinant of childhood obesity. While whole grains and micronutrients are known to decrease the risk of obesity, there are no interventions originating from Southeast Asia that emphasize whole grain as a strategy to improve overall quality of diet in combating childhood obesity. The GReat-Child Trial aimed to improve whole grain intake and quality of diet among overweight and obese children. It is a quasi-experimental intervention based on Social Cognitive Theory. It has a 12-week intervention and 6-month follow-up, consisting of three components that address environmental, personal, and behavioral factors. The intervention consists of: (1) six 30 min lessons on nutrition, using the Malaysian Food Pyramid to emphasize healthy eating, (2) daily deliveries of wholegrain foods to schools so that children can experience and accept wholegrain foods, and (3) diet counseling to parents to increase availability of wholegrain foods at home. Two primary schools with similar demographics in Kuala Lumpur were assigned as control (CG) and intervention (IG) groups. Inclusion criteria were: (1) children aged 9 to 11 years who were overweight/obese; (2) who did not consume whole grain foods; and (3) who had no serious co-morbidity problems. The entire trial was completed by 63 children (31 IG; 32 CG). Study outcomes were measured at baseline and at two time points post intervention (at the 3rd [T1] and 9th [T2] months). IG demonstrated significantly higher intakes of whole grain (mean difference = 9.94, 95%CI: 7.13, 12.75, p < 0.001), fiber (mean difference = 3.07, 95% CI: 1.40, 4.73, p = 0.001), calcium (mean difference = 130.27, 95%CI: 74.15, 186.39, p < 0.001), thiamin (mean difference = 58.71, 95%CI: 26.15, 91.28, p = 0.001), riboflavin (mean difference = 0.84, 95%CI: 0.37, 1.32, p = 0.001), niacin (mean difference = 0.35, 95%CI: 1.91, 5.16, p < 0.001), and vitamin C (mean difference = 58.71, 95%CI: 26.15, 91.28, p = 0.001) compared to CG in T1, after adjusting for covariates. However, T1 results were not sustained in T2 when intervention had been discontinued. The findings indicate that intervention emphasizing whole grains improved overall short-term but not long-term dietary intake among schoolchildren. We hope the present trial will lead to adoption of policies to increase whole grain consumption among Malaysian schoolchildren.

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Intake of whole grain foods and risk of type 2 diabetes: results from three prospective cohort studies

BMJ ◽

10.1136/bmj.m2206 ◽

2020 ◽

pp. m2206 ◽

Cited By ~ 3

Author(s):

Yang Hu ◽

Ming Ding ◽

Laura Sampson ◽

Walter C Willett ◽

JoAnn E Manson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Brown Rice ◽

Whole Grains ◽

Health Study ◽

Whole Grain ◽

Breakfast Cereal ◽

Hazard Ratios ◽

Grain Foods

Abstract Objective To examine the associations between the intake of total and individual whole grain foods and the risk of type 2 diabetes. Design Prospective cohort studies. Setting Nurses’ Health Study (1984-2014), Nurses’ Health Study II (1991-2017), and Health Professionals Follow-Up Study (1986-2016), United States. Participants 158 259 women and 36 525 men who did not have type 2 diabetes, cardiovascular disease, or cancer at baseline. Main outcome measures Self-reports of incident type 2 diabetes by participants identified through follow-up questionnaires and confirmed by a validated supplementary questionnaire. Results During 4 618 796 person years of follow-up, 18 629 participants with type 2 diabetes were identified. Total whole grain consumption was categorized into five equal groups of servings a day for the three cohorts. After adjusting for lifestyle and dietary risk factors for diabetes, participants in the highest category for total whole grain consumption had a 29% (95% confidence interval 26% to 33%) lower rate of type 2 diabetes compared with those in the lowest category. For individual whole grain foods, pooled hazard ratios (95% confidence intervals) for type 2 diabetes in participants consuming one or more servings a day compared with those consuming less than one serving a month were 0.81 (0.77 to 0.86) for whole grain cold breakfast cereal, 0.79 (0.75 to 0.83) for dark bread, and 1.08 (1.00 to 1.17) for popcorn. For other individual whole grains with lower average intake levels, comparing consumption of two or more servings a week with less than one serving a month, the pooled hazard ratios (95% confidence intervals) were 0.79 (0.75 to 0.83) for oatmeal, 0.88 (0.82 to 0.94) for brown rice, 0.85 (0.80 to 0.90) for added bran, and 0.88 (0.78 to 0.98) for wheat germ. Spline regression showed a non-linear dose-response association between total whole grain intake and the risk of type 2 diabetes where the rate reduction slightly plateaued at more than two servings a day (P<0.001 for curvature). For whole grain cold breakfast cereal and dark bread, the rate reduction plateaued at about 0.5 servings a day. For consumption of popcorn, a J shaped association was found where the rate of type 2 diabetes was not significantly raised until consumption exceeded about one serving a day. The association between higher total whole grain intake and lower risk of type 2 diabetes was stronger in individuals who were lean than in those who were overweight or obese (P=0.003 for interaction), and the associations did not vary significantly across levels of physical activity, family history of diabetes, or smoking status. Conclusion Higher consumption of total whole grains and several commonly eaten whole grain foods, including whole grain breakfast cereal, oatmeal, dark bread, brown rice, added bran, and wheat germ, was significantly associated with a lower risk of type 2 diabetes. These findings provide further support for the current recommendations of increasing whole grain consumption as part of a healthy diet for the prevention of type 2 diabetes.

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The effects of whole grain intake on anthropometric measures in overweight and obese children: a crossover randomised clinical trial

British Journal Of Nutrition ◽

10.1017/s000711452100026x ◽

2021 ◽

pp. 1-7

Author(s):

Parisa Hajihashemi ◽

Leila Azadbakht ◽

Mahin Hashemipour ◽

Roya Kelishadi ◽

Parvane Saneei ◽

...

Keyword(s):

Clinical Trial ◽

Waist Circumference ◽

Intervention Group ◽

Randomised Clinical Trial ◽

Slight Reduction ◽

Whole Grain ◽

Obese Children ◽

Anthropometric Measures ◽

Before And After ◽

Grain Foods

Abstract Whole-grain foods have been reported to affect body weight and satiety. However, we are aware of no study in this regard among children. The present study aimed to determine the effects of whole grain consumption on anthropometric measures in overweight or obese children. In this randomised crossover clinical trial, forty-four overweight or obese girls participated. After a 2-week run-in period, subjects were randomly assigned to either intervention (n 44) or non-intervention (n 44) groups. Subjects in the intervention group were given a list of whole-grain foods and were asked to obtain half of their grain servings from these foods each day for 6 weeks. Individuals in the non-intervention group were asked not to consume any of these foods. A 4-week washout period was applied. Then, participants were crossed over to the alternate arm. The measurements were done before and after each phase. Mean age, weight and BMI of participants were 11·2 (sd 1·49) years, 51·2 (sd 10·2) kg and 23·5 (sd 2·5) kg/m2, respectively. Despite the slight reduction in weight and BMI, there were no significant differences in changes in these anthropometric measures. We found a significant effect of whole grain intake on waist circumference (−2·7 v. 0·3 cm, P = 0·04). No significant changes in hip circumference were observed. Changes in the prevalence of overweight, obesity and abdominal obesity were not significantly different. This study indicated a beneficial effect of whole-grain foods on waist circumference in overweight children; however, these foods did not influence weight and BMI.

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Whole grain food intake elevates serum enterolactone

British Journal Of Nutrition ◽

10.1079/bjn2002601 ◽

2002 ◽

Vol 88 (2) ◽

pp. 111-116 ◽

Cited By ~ 53

Author(s):

David R. Jacobs ◽

Mark A. Pereira ◽

Katariina Stumpf ◽

Joel J. Pins ◽

Herman Adlercreutz

Keyword(s):

Food Intake ◽

Washout Period ◽

Random Order ◽

Whole Grains ◽

Whole Grain ◽

Feeding Study ◽

Grain Foods ◽

Reduced Risk

Both intake of whole grain and higher levels of serum enterolactone have been related to reduced risk for CHD and some cancers. Because lignans are prevalent in the outer layers of grains, these findings may be related. We carried out a crossover feeding study in which overweight, hyperinsulinaemic, non-diabetic men (n5) and women (n6) ate, in random order, wholegrain foods or refined-grain foods in a diet with 30% energy from fat. The dominant whole grain was wheat, followed by oats and rice. All food was supplied by the investigators and each diet lasted for 6 weeks, with an intervening washout period of 6–9 weeks. Serum enterolactone concentrations were higher when eating the wholegrain than the refined-grain diet by 6·2 (within person SE 1·7) nmol/l (P=0·0008). Most of the increase in serum enterolactone when eating the wholegrain diet occurred within 2 weeks, though the serum enterolactone difference between wholegrain and refined-grain diets continued to increase through 6 weeks. Serum enterolactone concentrations can be raised by eating a diet rich in whole grains.

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WIC Households’ Bread and Cold Cereal Purchases: When They Use Benefits Versus Paying Out of Pocket

American Journal of Health Promotion ◽

10.1177/0890117118778243 ◽

2018 ◽

Vol 33 (1) ◽

pp. 79-86

Author(s):

Hayden Stewart ◽

Patrick W. McLaughlin ◽

Diansheng Dong ◽

Elizabeth Frazão

Keyword(s):

Nutrition Education ◽

Positive Association ◽

Whole Grains ◽

Whole Grain ◽

Payment Methods ◽

Food Purchases ◽

The Us ◽

Women And Children ◽

Supplemental Nutrition Program ◽

Grain Foods

Purpose: The US Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) seeks to improve the health of participating women and children by providing nutrition education and a monthly package of supplemental foods including whole grain bread and cereal. While some studies confirm that participants consume more whole grains, others find no effect. In this study, we hypothesize that the positive association between WIC and whole grains is being reduced in size and consistency by several factors. Design/Setting/Participants: American households were surveyed about their food purchases. Overall response rate was 45.6%. A total of 4826 households completed the survey including 471 WIC households. Measures: The survey recorded households’ purchases of refined and whole grains in bread and cereal over 1 week. Analysis: T tests were used to compare the bread and cereal purchases of WIC and eligible, non-WIC households. Probit models were also estimated to assess a WIC household’s likelihood to choose whole grain foods when using benefits versus other payment methods. Results: On average, WIC households acquired more whole grains in bread than eligible, non-WIC households (1.33 vs 0.72 ounce equivalents per household member aged 1 year or older; P < .05). No difference is found for cereal ( P > .10). Moreover, when using payment methods other than WIC benefits, WIC participants are 19% less likely than other households to choose whole grain bread ( P < .05) and 20% less likely to choose a whole grain cold cereal ( P < .05), which suggests that WIC-provided foods may replace some whole grains participants would otherwise buy for themselves. Conclusion: WIC is positively associated with whole grains. However, the association is stronger for bread than cereal. Moreover, foods provided through the program may partially replace whole grains that WIC households would otherwise buy for themselves.

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Whole grain, bran and cereal fibre consumption and CVD: a systematic review

British Journal Of Nutrition ◽

10.1017/s000711451900031x ◽

2019 ◽

Vol 121 (8) ◽

pp. 914-937 ◽

Cited By ~ 6

Author(s):

Eden M. Barrett ◽

Marijka J. Batterham ◽

Sumantra Ray ◽

Eleanor J. Beck

Keyword(s):

Epidemiological Studies ◽

Whole Grains ◽

Fibre Content ◽

Future Research ◽

Protective Effects ◽

Whole Grain ◽

Cvd Risk ◽

Methodical Approach ◽

Grain Foods ◽

Whole Grain Cereal

AbstractWhole grain intake is associated with lower CVD risk in epidemiological studies. It is unclear to what extent cereal fibre, located primarily within the bran, is responsible. This review aimed to evaluate association between intake of whole grain, cereal fibre and bran and CVD risk. Academic databases were searched for human studies published before March 2018. Observational studies reporting whole grain and cereal fibre or bran intake in association with any CVD-related outcome were included. Studies were separated into those defining whole grain using a recognised definition (containing the bran, germ and endosperm in their natural proportions) (three studies, seven publications) and those using an alternative definition, such as including added bran as a whole grain source (eight additional studies, thirteen publications). Intake of whole grain, cereal fibre and bran were similarly associated with lower risk of CVD-related outcomes. Within the initial analysis, where studies used the recognised whole grain definition, results were less likely to show attenuation after adjustment for cereal fibre content. The fibre component of grain foods appears to play an important role in protective effects of whole grains. Adjusting for fibre content, associations remained, suggesting that additional components within the whole grain, and the bran component, may contribute to cardio-protective association. The limited studies and considerable discrepancy in defining and calculating whole grain intake limit conclusions. Future research should utilise a consistent definition and methodical approach of calculating whole grain intake to contribute to a greater body of consistent evidence surrounding whole grains.

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An Online Physical Activity Intervention for Youth With Physical Disabilities: A Pilot Study

Frontiers in Rehabilitation Sciences ◽

10.3389/fresc.2021.651688 ◽

2021 ◽

Vol 2 ◽

Author(s):

Ritu Sharma ◽

Amy E. Latimer-Cheung ◽

John Cairney ◽

Kelly P. Arbour-Nicitopoulos

Keyword(s):

Physical Activity ◽

Pilot Study ◽

Self Efficacy ◽

Social Cognitive ◽

Cognitive Theory ◽

Physical Disabilities ◽

Self Regulation ◽

Implementation Fidelity ◽

Post Intervention ◽

Feedback Questionnaire

Background: Physical activity (PA) interventions are limited in number and reach for youth with physical disabilities (YPD) who experience systemic barriers that may preclude their in-person participation. Further, a lack of theory in the development and evaluation of PA interventions impedes our understanding and replication of active components of behavior change. These limitations pose challenges in the effective promotion of PA in YPD. Theory-based and more inclusive methods of PA intervention delivery must be explored in our efforts to promote PA and overall health in YPD.Methods: A pilot study was conducted to evaluate the feasibility and outcomes of an online, 4-week social cognitive theory-based PA intervention for YPD. Intervention feasibility (implementation fidelity, intervention compliance, and intervention acceptability) was evaluated through manual documentation, weekly feedback questionnaires, and open-ended feedback at 1-month post-intervention. Targeted social cognitive (outcome expectations, self-efficacy [task, self-regulatory, barrier] and self-regulation) and PA behavior outcomes were self-reported at baseline and 1-week and 1-month post-intervention.Results: Sixteen YPD (Mage = 17.4 ± 2.7 years, 69% female) completed the study. Intervention feasibility was supported by high implementation fidelity (100%), high intervention compliance (>90%), and positive ratings on indicators of acceptability for all weeks of the intervention (weekly feedback questionnaire means ranging from 5.74 to 6.19 out of 7). Through open-ended feedback, participants indicated the intervention was easy to use and understand, favorably shifted their self-awareness and personal meaning of PA, and provided value and potential for future use pertaining to the learned self-regulation skills and strategies. Participants also provided formatting and content recommendations for intervention improvement. Repeated measures ANOVAs showed significant and large effect sizes for changes in participants' task (p = 0.01, n2p = 0.28) and barrier (p = 0.02, n2p = 0.24) self-efficacy, goal-setting and planning and scheduling behaviors (ps < 0.001, n2ps = 0.42), and self-reported PA behavior (p = 0.02, n2p = 0.26).Conclusions: An online PA intervention for YPD is feasible and may offer potential benefit through the enhancement of self-efficacy, self-regulation, and PA behavior. Continued research is necessary to understand the efficacy and longer-term outcomes of online, theory-based interventions for YPD as a PA promotion strategy.

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Assessing Academic Advising Outcomes Using Social Cognitive Theory: A Validity and Reliability Study

NACADA Journal ◽

10.12930/0271-9517-32.2.68 ◽

2012 ◽

Vol 32 (2) ◽

pp. 68-84 ◽

Cited By ~ 1

Author(s):

Richard J. Erlich ◽

Darlene F. Russ-Eft

Keyword(s):

Social Cognitive Theory ◽

Self Efficacy ◽

Social Cognitive ◽

Cognitive Theory ◽

Student Survey ◽

Validity And Reliability ◽

Post Intervention ◽

Academic Planning ◽

Self Regulated Learning ◽

Regulated Learning

The validity and reliability of three instruments, the Counselor Rubric for Gauging Student Understanding of Academic Planning, micro-analytic questions, and the Student Survey for Understanding Academic Planning, all based on social cognitive theory, were tested as means to assess self-efficacy and self-regulated learning in college academic planning. The rubric assessed pre- and post-intervention self-regulated learning of academic-planning strategy levels. The micro-analytic questions assessed self-regulated learning during forethought and self-reflection phases. Post-intervention self-efficacy in academic planning and retrospectively evaluated pre-intervention self-efficacy were measured by the survey. All three instruments showed strong validity and reliability, but the survey did not distinguish between different self-efficacy challenge levels.

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The Effectiveness of Social Cognitive Theory-based Educational Intervention on School Children’s Breakfast Consumption

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2019/v29i430080 ◽

2019 ◽

pp. 1-11

Author(s):

Amin Mirzaei ◽

Fazlollah Ghofranipour ◽

Zeinab Ghazanfari

Keyword(s):

Social Cognitive Theory ◽

Educational Intervention ◽

Eating Behaviors ◽

Social Cognitive ◽

Cognitive Theory ◽

Intervention Group ◽

Control Group ◽

Breakfast Consumption ◽

Breakfast Eating

Introduction: Breakfast consumption has a lot of beneficial effects on nutritional status and cognitive activities of school-aged children's. This study aimed to examine the efficacy of social cognitive theory–based education on schoolchildren breakfast eating behaviors. Methods: Two schools with similar socio-demographic characteristics were selected from 20 public primary schools of Ilam city (west of Iran) and randomly assigned as intervention or control school. Fifty school children from 3rd, 4th and 5th grades of each school participated in this study. Educational intervention was performed during 6-weeks and was focused on enhancing the self-efficacy, social support and self-regulation mediators to promote the school children’s breakfast consumption. Data were collected at baseline and 8-weeks after intervention using a 57-item questionnaire and a breakfast food diary and analyzed using Nutritionist IV food processor software and IBM SPSS statistics data editor. Results: The findings showed that mean scores of all Social Cognitive Theory (SCT) constructs as well as breakfast eating behaviors in intervention group significantly increased at 8-weeks after intervention (p < 0.05). Also, there was a significant increase in mean score of knowledge in control group at 8 weeks follow-up (p < 0.05). Moreover, the results showed that mean scores of energy and all measured macro and micronutrients intakes significantly increased at follow-up in intervention group (p < 0.05). Also, there were significant increases in mean scores of energy, zinc, calcium and vitamin D intakes in control group at 8-weeks follow-up (p < 0.05). Conclusions: The findings of the present study showed that social cognitive theory is an effective framework to planning and implementation of the educational intervention to promotion of male school children’s breakfast consumption.

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