ESPE2021 ePoster Category 2 Fat, metabolism and obesity (59 abstracts)
The Effectiveness of Indigenous Knowledge-Based Lifestyle Interventions in Preventing Obesity and Type 2 Diabetes Mellitus in Indigenous Children in Canada
Maya Kshatriya 1,2 , Kuan-Wen Wang 1,2,3 , Julia Hildebrand 1,2 , Rebecca Crawford 1,2 , Ajantha Nadarajah 1,2 , Michael Youssef 1,2 , Angelica Rivas 1,2,4 , Ashleen Kaushal 1,2 , Laura Banfield 5 , Lehana Thabane 1,6,7,8,9 & Constantine Samaan 1,2,4,6
1Department of Pediatrics, McMaster University, Hamilton, Canada; 2Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Canada; 3Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada; 4Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada; 5Health Sciences Library, McMaster University, Hamilton, Canada; 6Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; 7Department of Anesthesia, McMaster University, Hamilton, Canada; 8Centre for Evaluation of Medicines, St. Joseph’s Health Care, Hamilton, Canada; 9Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, Canada
Background & Objective: Indigenous children in Canada have higher rates of obesity and type 2 diabetes mellitus (T2DM) and diabetes-related complications when compared to non-Indigenous children. Indigenous knowledge-based view of health encompasses a holistic approach with physical, mental, emotional, and spiritual health dimensions. This view of health will likely impact their engagement in interventions targeting obesity and T2DM. This systematic review and meta-analysis aimed to assess the impact of Indigenous Knowledge-based lifestyle interventions to prevent obesity and T2DM in Indigenous children in Canada.
Methods: We conducted literature searches across multiple databases up to May 2020. Changes in Body Mass Index (BMI) z-score and the diagnosis of T2DM were the primary outcomes. Adiposity, metabolic, and lifestyle determinants of health were set as the secondary outcomes. We used the chi-square test of homogeneity and inconsistency index (I2) to evaluate the heterogeneity of the meta-analysis results. GRADE was used to assess the quality of evidence.
Results: Four non-randomized controlled trials (non-RCTs) and six uncontrolled studies were included. Two non-RCT’s with peer-led components (intervention: n = 169; control: n = 161) met the eligibility criteria for the meta-analysis, revealing a reduction in BMI z-score (-0.10, 95% CI: -0.16,-0.04) and waist circumference (WC) (-2.10, 95% CI: -3.69,-0.50) with the interventions. One uncontrolled study (n = 133) found no change in BMI z-score and an increase in WC with the intervention. However, another uncontrolled study (n = 35) reported an increase in BMI z-score (p-value 0.001) and WC (p-value <0.001) with the intervention. The GRADE assessment revealed low heterogeneity and a very low quality of evidence due to lack of randomization and small sample sizes. There were no reports of diabetes-related prevention programs.
Conclusions: Peer-led Indigenous Knowledge-based lifestyle interventions for pediatric obesity may lead to improved BMI z-score and WC. Obesity and type 2 diabetes prevention programs should engage in community-based participatory action to enhance partnerships with communities and strengthen implementation. Future studies should assess the impact of Indigenous Knowledge-based lifestyle interventions on preventing T2DM and improving glucose homeostasis.
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