Effectiveness of a complex, pre-conception intervention to reduce the risk of diabetes by reducing adiposity in young adults in Malaysia: The Jom Mama project - A randomised controlled trial.

Autor:	Hanafiah AN; Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia., Aagaard-Hansen J; Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark.; SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Ch Cheah J; School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia., Norris SA; SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Karim ZB; Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia., Skau JK; SA MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa., Ali ZM; Negeri Sembilan State Health Department, Seremban, Negeri Sembilan, Malaysia.; Universiti Teknologi Malaysia Kuala Lumpur, Kuala Lumpur, Malaysia., Biesma R; Global Health Unit, Department of Health Sciences, Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands., Matzen P; Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK., Sulaiman LH; Office of the Deputy Director General of Health (Public Health), Ministry of Health, Putrajaya, Malaysia.; Institute for Research, Development and Innovation, International Medical University Malaysia, Kuala Lumpur, Malaysia., Hanson M; Institute of Developmental Sciences, British Heart Foundation Professor of Cardiovascular Sciences, Faculty of Medicine and NIHR Biomedical Research Centre, University of Southampton, Southampton, UK.
Jazyk:	angličtina
Zdroj:	Journal of global health [J Glob Health] 2022 Aug 17; Vol. 12, pp. 04053. Date of Electronic Publication: 2022 Aug 17.
DOI:	10.7189/jogh.12.04053
Abstrakt:	Background: Pre-conception interventions have the potential to lower non-communicable disease risk in prospective parents and reduce transmission of risk factors such as obesity to the next generation. The Jom Mama project in Malaysia investigated the effectiveness of a combined behaviour change communication and e-health intervention in young married couples prior to first pregnancy. This paper reports the evaluation of the effectiveness of this trial. Methods: Jom Mama was a non-blinded, randomised controlled trial (RCT) conducted in Seremban, Malaysia, over a period of 33 weeks, covering six contact points between trained community health workers and newly married couples before the conception of a first child. Out of 2075 eligible nulliparous women, 549 participated and 305 completed the intervention, with 145 women in the intervention and 160 in the control group. The intervention group received a complex behavioural change intervention, combining behaviour change communication provided by community health promoters and access to a habit formation mobile application, while the control group received the standard care provided by public health clinics in Malaysia. The primary outcome was a change in the woman's waist circumference. Secondary outcomes were anthropometric and metabolic measures, dietary intake (Food Frequency Questionnaire, FFQ), physical activity (International Physical Activity Questionnaire, IPAQ) and mental health (Depression Anxiety Stress Scale, DASS 21). An extensive process evaluation was conducted alongside the trial in order to aid the interpretation of the main findings. Results: There were no significant differences of change in the woman's waist circumference between intervention and control groups at the start and end of the intervention. While the weight, waist circumference and Body Mass Index (BMI) of women in both groups increased, there was a significantly lower increase in the intervention vs the control group over the period of the trial among women who are obese (0.1 kg vs 1.7 kg; P = 0.023, in the intervention and control group respectively). In terms of BMI, the obese intervention subgroup showed a slight reduction (0.01) compared to the obese control subgroup whose BMI increased by 0.7 (P = 0.015). There were no changes in the other secondary outcomes. Conclusions: The Jom Mama pre-conception intervention did not lead to a reduction in waist circumference or significant changes in other secondary outcomes over the eight months prior to conception. However, there was a significantly smaller weight gain in the intervention vs the control group, predominantly in women with pre-existing obesity. Competing Interests: Competing interests: The study is a part of the Jom Mama project in Malaysia. The Jom Mama project is a public-private partnership with the Ministry of Health Malaysia, Novo Nordisk (Denmark), the University of Southampton (UK), the University of Witwatersrand (South Africa), and the Steno Diabetes Center (Denmark) to address diabetes prevention in Malaysia. The development of the intervention package, project management and the costs of the CRO have been funded by an unrestricted grant from Novo Nordisk. The Ministry of Health Malaysia is providing the funding for human resources and trial implementation. JS and JCHC are employed by Novo Nordisk. MAH is supported by the British Heart Foundation. The authors completed the ICMJE Unified Competing Interest Form (available upon request from the corresponding author) and declare no further conflicts of interest. (Copyright © 2022 by the Journal of Global Health. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu