1 Universidad de Cuenca, Cuenca, Ecuador; 2 Institute of Tropical Medicine, Bélgium; 3 International Food Policy Research Institute, Washington DC, Estados Unidos de América.
Background: Unhealthy diet and low physical activity are risk factors for non-communicable diseases. We report the effectiveness of a school-based intervention to improve dietary intake of adolescents in Ecuador. Methods: A pair-matched cluster randomized controlled trial including 1430 adolescents (12-14 years old) was conducted in urban Ecuador (Cuenca). The program aimed at improving dietary intake and physical activity (primary outcomes), body mass index, waist circumference and blood pressure (secondary outcomes). The outcomes were reported after 28-months, and at the first 17-months (stage one) and the last 11-months (stage two). Two educational toolkits, healthy eating workshops with parents and canteen staff, and a process evaluation were implemented in two different stages. In stage one, extra stakeholders’ participatory workshops and active involvement of research staff took place. Data from 1079 adolescents in 20 schools were analyzed. Daily fruit and vegetable [23.4g, 95% CI: 7.28, 40.3] intake increased, while processed food intake during snacks [-15.7g, 95% CI: -25.2,-6.16] and added sugar [-5.6g; 95% CI:-9.80,-1.68] intake decreased during the trial. Waist circumference, [-0.84 cm; 95% CI: -1.68, 0.28], systolic [-3.64 mmHg; 95% CI: -4.48,-2.52] and diastolic blood pressure [-1.96 mmHg; 95% CI: -3.08,-0.84] decreased after 28 months. The effect of the intervention was mainly observed at stage one and attenuated at stage two. Delivery and response were also higher at stage one. Conclusions: The trial improved several risk factors after 28 months. More intensive coverage, active participation of stakeholders and involvement of researchers might enhance the effect. Future studies should determine the effectiveness under normal school circumstances. Trial identifier ClinicalTrial.gov-NCT01004367.