Health and nutrition education program in primary schools of Crete: changes in blood pressure over 10 years

Objective: To examine the long-term effects of the `Cretan Health and Nutrition Education Program' on blood pressure. Subjects: A representative population of 176 pupils (85 from the intervention schools and 91 from the control schools). Design: Blood pressure, dietary, anthropometrical and physical activity data were obtained at baseline ( academic year 1992 1993) and at follow-up examination (academic year 2001-2002). Results: The findings of the current study revealed that the increase over the 10-year period in systolic (SBP) and diastolic blood pressure (DBP) was higher in the control group (CG) than in the intervention group (IG) (P = 0.003 and P < 0.001 respectively). Regarding dietary indices, the IG were found to have a significantly higher intake of potassium (P = 0.018) and magnesium (P = 0.011) compared to the CG. Furthermore, the decrease in body mass index (BMI) z-score observed in the IG was found to differentiate significantly from the increase observed in the CG (P = 0.042). On the contrary, the increase in leisure time, moderate to vigorous physical activities (MVPA) observed in the IG, was found to differentiate significantly from the decrease observed in the CG (P = 0.032). Intervention's effect on SBP was mediated by changes in MVPA (beta = -0.20, p = 0.030) and BMI (beta = 0.19, P = 0.048). Similarly, intervention's effect on DBP was mediated by changes in MVPA (beta = 0.18, P = 0.048), BMI (beta = 0.26, P = 0.007) and magnesium intake (beta = -0.20, P = 0.048). Conclusion: The findings of the current study are encouraging, indicating favorable changes in blood pressure, micronutrients intake, BMI and physical activity over the 10 years of follow-up and 4 years after program's cessation, thus providing some support for the effectiveness of school-based health education programs in successfully tackling certain chronic disease risk factors early in life.