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Effect of self‐esteem, diet and physical activity strategies on the risk factors for Type 2 diabetes mellitus (T2DM) in overweight African American children

Based on their geographical location, 102 overweight 9–10 y/o African American (AA) children (BMI >85th %) were recruited into a high‐intensity intervention (HII; higher integrated efforts to improve diet, physical activity (PA) and self‐esteem) or low‐intensity intervention group (LII) to assess the risk factors for T2DM and the effect of a community intervention trial on these factors. Fasting glucose (Gf) and insulin (If) were measured both at baseline (yr0) and after 1 year of intervention (yr1), and were used to determine insulin sensitivity (SI; QUICKI) and pancreatic function (HOMA‐B%) along with body fatness, diet intake, PA patterns, physical fitness (VO2 max), self‐esteem, family health and family environment. Adjusting for gender, age, Tanner (self‐assessed), socioeconomic index and family history of diabetes, multivariate regression analysis showed that at yr0, BMI z‐score (β = −0.024; p<0.001) and measures of PA levels (METs .min−1.day−1, β = 0.014, p= 0.008) correlated with indices of SI; while BMI z‐score (β =47.28; p =0.04) and VO2 max correlated with HOMA‐B% (β =10.24, p =0.01). At yr1, the HII showed a significant improvements in Gf (p<0.001) and QUICKI (p =0.017) compared to the LII, after accounting for yr0 differences. The decrease in If and HOMA‐B% in the HII after yr1 did not reach statistical significance. In this population of high BMI, AA children, greater BMI z‐score and lower PA and fitness correlated with SI and HOMA‐B% at yr0 and the HII exhibited improvement in SI after yr1.