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dc.contributor.authorNguyen, Ngoc
dc.date.accessioned2020-06-04
dc.date.available2020-06-04
dc.date.submitted2019-08-01
dc.identifier.urihttps://hdl.handle.net/2123/22455
dc.description.abstractThe aim of this body of research is to provide scientific evidence of nutritional factors and context related to overweight and obesity in adolescents in HCMC and to design a locally feasible and effective intervention to help tackle adolescent overweight and obesity. Specific objectives are: 1/ Identify factors influencing children’ dietary and physical practices and the perceptions guiding these practices to prevent obesity through qualitative interviews with children, their parents and teachers in HCMC. 2/ Identify the patterns of consumptions of sugar-sweetened beverages (including soft drink) and their relationship with overweight and obesity in adolescents in HCMC. 3/ Identify the tracking of nutrient intakes and dietary behaviours and their association with overweight and obesity in adolescents in HCMC. 4/ Evaluate the effectiveness of peer-led program to prevent/reduce overweight and obesity in children and adolescents in the literature. 5/ Design a peer-led health program to prevent/reduce overweight and obesity in adolescents in HCMC. Chapter 3 revealed that the consumption of Sugar Sweetened Beverages (SSB) is popular in adolescents in Ho Chi Minh City, however, the total energy from SSB accounted about 10% of daily energy intake. Among these SSB, fresh milk plus sugar and condensed milk both demonstrated a protective effect against overweight and obesity. Specifically, every kcal of fresh milk plus sugar reduced the odd ratio of 0.995 (95%CI [0.992-0.998]), p<0.001. Every kcal of condensed milk reduced the odd of 0.996 (95%CI [0.992-1.000]), p=0.044. We did not find the relationship between other non-milk SSB with overweight and obesity. Chapter 4 assessed the Changes of nutrient intakes and dietary behaviours among adolescents. We found a significant increase in BMI and median energy, macronutrient intakes with increasing age, higher in boys than in girls (p <0.001). Tracking of energy and macronutrient nutrient intakes at the individual level was only poor to fair, lowest for the percentage energy from carbohydrate or percentage energy from protein and highest for fat intakes. The linear multilevel models showed two modest but significant positive associations with BMI. Specifically, every 100g higher of daily carbohydrate intake led to an increase of 0.61 unit of BMI in 5 years (p=0.001) and an increase of 100 minutes/week of screen time led to 0.14 unit of BMI increase in 5 years. Chapter 5 revealed diversified perceptions of obesity, diet and physical activity and the relationship of these factors with adolescent obesity. Findings indicated a low practice of physical activity among participants. The major barriers to obesity prevention included knowledge gaps, food environment in schools, devaluation of physical activity and academic burden. These invaluable inputs were collected using explorative detailed interviews with students, their parents, school PE teachers and a representative of the Department of Education of Ho Chi Minh City. All of the data was purposefully analyzed to find programmatic implications for a culturally appropriate and feasible intervention to tackle child and adolescent obesity. Chapter 6 is a systematic review and meta-analysis of peer-led interventions versus childhood obesity. A number of findings have been revealed. The review included 15 studies of moderate to high quality from high-income countries. The age of the participants ranged from 3 years to 17 years. The duration of the intervention ranged from 5 weeks to 28 months. The peer-led content targeted physical activity alone, or a mixture of healthy lifestyle modifications. The meta-analysis of BMI involved 2506 children from 9 studies and demonstrated that programs were effective with a mean difference in BMI of -0.15kg/m2 (95% confidence interval (CI) [-0.26, -0.03]), p=0.01. Heterogeneity was low (I2=28%, p=0.19) for the children in the intervention group. The mean difference varied with subgroups with significantly greater effects from interventions focused on physical activity and with longer duration of implementation of the intervention. Sensitivity analysis revealed similar significant findings to the primary meta-analysis. Chapter 7 is a proposal of the Peer Education and Peer Support Pilot (PEPS) study to evaluate to possibility and further specific requirement for full scale intervention. The pilot is still ongoing and planned to finish in late 2019. This chapter proposed a pilot school-setting programme of four weekly education sessions about healthy choices of food and drinks and usefulness of physical activities. The programme also included a school and online support system to help maintain the effect of education sessions. Both of the education and support stages would be led by students (as peer-leaders) to take advantage of peer influence among junior high school students. Chapter 8 is for Conclusion. A few appendices were also attached for further details.en_AU
dc.publisherUniversity of Sydneyen_AU
dc.publisherFaculty of Medicine and Healthen_AU
dc.publisherSchool of Public Healthen_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectobesityen_AU
dc.subjectadolescenten_AU
dc.subjectphysical Activityen_AU
dc.subjectnutritionen_AU
dc.subjectpeer-led Interventionen_AU
dc.subjectsystematic reviewen_AU
dc.titleOverweight and Obesity in Adolescents in Ho Chi Minh City: From qualitative and quantitative evidence to peer-led interventionen_AU
dc.typePhD Doctorateen_AU
dc.type.pubtypeDoctor of Philosophy Ph.D.en_AU


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