Summerbell C D, Waters E, Edmunds L D, Kelly S, Brown T, Campbell K J
School of Health and Social Care, University of Teesside, Parkside West, Middlesbrough, Teesside, UK, TS1 3BA.
Cochrane Database Syst Rev. 2005 Jul 20(3):CD001871. doi: 10.1002/14651858.CD001871.pub2.
Obesity prevention is an international public health priority. The prevalence of obesity and overweight is increasing in child populations throughout the world, impacting on short and long-term health. Obesity prevention strategies for children can change behaviour but efficacy in terms of preventing obesity remains poorly understood.
To assess the effectiveness of interventions designed to prevent obesity in childhood through diet, physical activity and/or lifestyle and social support.
MEDLINE, PsycINFO, EMBASE, CINAHL and CENTRAL were searched from 1990 to February 2005. Non-English language papers were included and experts contacted.
Randomised controlled trials and controlled clinical trials with minimum duration twelve weeks.
Two reviewers independently extracted data and assessed study quality.
Twenty-two studies were included; ten long-term (at least 12 months) and twelve short-term (12 weeks to 12 months). Nineteen were school/preschool-based interventions, one was a community-based intervention targeting low-income families, and two were family-based interventions targeting non-obese children of obese or overweight parents. Six of the ten long-term studies combined dietary education and physical activity interventions; five resulted in no difference in overweight status between groups and one resulted in improvements for girls receiving the intervention, but not boys. Two studies focused on physical activity alone. Of these, a multi-media approach appeared to be effective in preventing obesity. Two studies focused on nutrition education alone, but neither were effective in preventing obesity. Four of the twelve short-term studies focused on interventions to increase physical activity levels, and two of these studies resulted in minor reductions in overweight status in favour of the intervention. The other eight studies combined advice on diet and physical activity, but none had a significant impact. The studies were heterogeneous in terms of study design, quality, target population, theoretical underpinning, and outcome measures, making it impossible to combine study findings using statistical methods. There was an absence of cost-effectiveness data.
AUTHORS' CONCLUSIONS: The majority of studies were short-term. Studies that focused on combining dietary and physical activity approaches did not significantly improve BMI, but some studies that focused on dietary or physical activity approaches showed a small but positive impact on BMI status. Nearly all studies included resulted in some improvement in diet or physical activity. Appropriateness of development, design, duration and intensity of interventions to prevent obesity in childhood needs to be reconsidered alongside comprehensive reporting of the intervention scope and process.
预防肥胖是一项国际公共卫生重点工作。全球儿童群体中肥胖和超重的患病率正在上升，对短期和长期健康都有影响。针对儿童的肥胖预防策略可以改变行为，但在预防肥胖方面的效果仍知之甚少。
评估通过饮食、体育活动和/或生活方式及社会支持来预防儿童肥胖的干预措施的有效性。
检索了1990年至2005年2月期间的MEDLINE、PsycINFO、EMBASE、CINAHL和CENTRAL数据库。纳入了非英文论文并联系了专家。
随机对照试验和对照临床试验，最短持续时间为12周。
两名评审员独立提取数据并评估研究质量。
纳入了22项研究；10项长期研究（至少12个月）和12项短期研究（12周至12个月）。19项是以学校/幼儿园为基础的干预措施，1项是以低收入家庭为目标的社区干预措施，2项是以肥胖或超重父母的非肥胖儿童为目标的家庭干预措施。10项长期研究中有6项将饮食教育和体育活动干预相结合；5项研究结果显示两组超重状况无差异，1项研究结果显示接受干预的女孩超重状况有所改善，但男孩没有。2项研究仅关注体育活动。其中，一种多媒体方法似乎对预防肥胖有效。2项研究仅关注营养教育，但均未有效预防肥胖。12项短期研究中有4项关注增加体育活动水平的干预措施，其中2项研究结果显示干预组超重状况略有下降。其他8项研究将饮食和体育活动建议相结合，但均未产生显著影响。这些研究在研究设计、质量、目标人群、理论基础和结局指标方面存在异质性，因此无法使用统计方法合并研究结果。缺乏成本效益数据。
大多数研究是短期的。关注饮食和体育活动相结合方法的研究并未显著改善体重指数（BMI），但一些关注饮食或体育活动方法的研究对BMI状况显示出虽小但积极的影响。几乎所有纳入的研究都使饮食或体育活动有了一些改善。需要重新考虑预防儿童肥胖干预措施的制定、设计、持续时间和强度的适宜性，同时要全面报告干预范围和过程。
