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Adolescent Health, Medicine and Therapeutics Volume 14, 2023 - Issue
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REVIEW

The Effectiveness of Indigenous Knowledge-Based Lifestyle Interventions in Preventing Obesity and Type 2 Diabetes Mellitus in Indigenous Children in Canada: A Systematic Review

Maya Kshatriya1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;2 Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada;3 Global Health Graduate Program, McMaster University, Hamilton, Ontario, CanadaORCID Iconhttps://orcid.org/0000-0002-0375-1251View further author information
ORCID Icon,
Kuan-Wen Wang1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;2 Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, CanadaORCID Iconhttps://orcid.org/0000-0002-4208-2046View further author information
ORCID Icon,
Julia Hildebrand1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;2 Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, CanadaView further author information
,
Rebecca Crawford1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;2 Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada;4 Indigenous Undergraduate Summer Research Program, McMaster University, Hamilton, Ontario, CanadaView further author information
,
Ajantha Nadarajah1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;2 Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada;3 Global Health Graduate Program, McMaster University, Hamilton, Ontario, CanadaView further author information
,
Michael Youssef1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;2 Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, CanadaView further author information
,
Angelica Rivas1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;2 Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada;5 Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, CanadaView further author information
,
Ashleen Kaushal1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;2 Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, CanadaView further author information
,
Laura E Banfield6 Health Sciences Library, McMaster University, Hamilton, Ontario, CanadaORCID Iconhttps://orcid.org/0000-0001-6123-1476View further author information
ORCID Icon,
Lehana Thabane7 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada;8 Biostatistics Unit, St. Joseph’s Healthcare-Hamilton, Hamilton, Ontario, Canada;9 Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada;10 Centre for Evaluation of Medicines, St. Joseph’s Health Care, Hamilton, Ontario, CanadaView further author information
&
M Constantine Samaan1 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;2 Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada;3 Global Health Graduate Program, McMaster University, Hamilton, Ontario, Canada;5 Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada;7 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, CanadaCorrespondence[email protected]
ORCID Iconhttps://orcid.org/0000-0002-6403-4715View further author information
ORCID Icon show all
Pages 175-193 | Received 14 Feb 2023, Accepted 20 Sep 2023, Published online: 28 Sep 2023
 
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Abstract

Background

Indigenous children in Canada have high rates of obesity and type 2 diabetes mellitus (T2DM). Culturally appropriate interventions, guided by an Indigenous knowledge-based view of health, are crucial to target these conditions. The objective of this systematic review was to assess the impact of indigenous Knowledge-based lifestyle interventions on the prevention of obesity and T2DM in Indigenous children in Canada.

Methods

Database searches were conducted from inception until February 22, 2022. The main outcomes were changes in Body Mass Index (BMI) z-score and the development of T2DM. The other outcomes included adiposity, metabolic, and lifestyle determinants of health. The GRADE approach was used to assess confidence in the evidence.

Results

Four non-randomized controlled trials (non-RCTs) and six uncontrolled studies were identified. Peer-led interventions led to a reduction in BMI z-score and waist circumference. GRADE assessment revealed very low quality of evidence due to a lack of randomization and small sample sizes. There were no diabetes-specific reported programs.

Conclusion

Limited evidence from non-randomized studies suggest that peer-led indigenous Knowledge-based lifestyle interventions improve BMI z-score and central adiposity. There is a need for community-owned and adequately powered randomized studies for interventions that aim to treat and prevent obesity and T2DM in Indigenous children in Canada.

Systematic Review Registration

PROSPERO CRD42017072781.

Acknowledgment

This project was presented as a poster at the European Society of Pediatric Endocrinology Conference, 2021 (https://abstracts.eurospe.org/hrp/0094/hrp0094p2-215).

Disclosure

The authors declare no competing interests.

Additional information

Funding

RC was funded by the Indigenous Undergraduate Summer Research Scholars program, McMaster University. KWW was funded by the Canada Graduate Scholarship-Masters, the Canadian Institutes of Health Research. The funding agencies had no input into the design, conduct, or reporting of the systematic review.
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