McGovern Lauren, Johnson Jonathan N, Paulo Remberto, Hettinger Allison, Singhal Vibha, Kamath Celia, Erwin Patricia J, Montori Victor M
Department of Pediatrics, Mayo Clinic, W18A, 200 First Street SW, Rochester, Minnesota 55905, USA.
J Clin Endocrinol Metab. 2008 Dec;93(12):4600-5. doi: 10.1210/jc.2006-2409. Epub 2008 Sep 9.
The efficacy of treatments for pediatric obesity remains unclear.
We performed a systematic review of randomized trials to estimate the efficacy of nonsurgical interventions for pediatric obesity.
Librarian-designed search strategies of nine electronic databases from inception until February 2006, review of reference lists from published reviews, and content expert advice provided potentially eligible studies.
Eligible studies were randomized trials of overweight children and adolescents assessing the effect of nonsurgical interventions on obesity outcomes.
Independently and in duplicate, reviewers assessed the quality of each trial and collected data on interventions and outcomes.
Of 76 eligible trials, 61 had complete data for meta-analysis. Short-term medications were effective, including sibutramine [random-effects pooled estimate of body mass index (BMI) loss of 2.4 kg/m(2) with a 95% confidence interval (CI) of 1.8-3.1; proportion of between-study inconsistency not due to chance (I(2)) = 30%] and orlistat (BMI loss = 0.7 kg/m(2); CI = 0.3-1.2; I(2) = 0%). Trials that measured the effect of physical activity on adiposity (i.e. percent body fat and fat-free mass) found a moderate treatment effect (effect size = -0.52; CI = -0.73 to -0.30; I(2) = 0%), whereas trials measuring the effect on BMI found no significant effect (effect size = -0.02; CI = -0.21 to 0.18; I(2) = 0%), but reporting bias may explain this finding. Combined lifestyle interventions (24 trials) led to small changes in BMI.
Limited evidence supports the short-term efficacy of medications and lifestyle interventions. The long-term efficacy and safety of pediatric obesity treatments remain unclear.
儿童肥胖治疗方法的疗效仍不明确。
我们对随机试验进行了系统评价，以评估非手术干预对儿童肥胖的疗效。
由图书馆员设计的检索策略，检索了9个电子数据库自创建至2006年2月的数据，查阅已发表综述的参考文献列表，并征求内容专家意见以获取可能符合条件的研究。
符合条件的研究为针对超重儿童和青少年的随机试验，评估非手术干预对肥胖结局的影响。
评审人员独立且重复地评估每个试验的质量，并收集干预措施和结局的数据。
76项符合条件的试验中，61项有完整数据用于荟萃分析。短期药物治疗有效，包括西布曲明[体重指数（BMI）降低的随机效应合并估计值为2.4kg/m²，95%置信区间（CI）为1.8 - 3.1；研究间非偶然不一致比例（I²）= 30%]和奥利司他（BMI降低 = 0.7kg/m²；CI = 0.3 - 1.2；I² = 0%）。测量体育活动对肥胖程度（即体脂百分比和去脂体重）影响的试验发现有中度治疗效果（效应量 = -0.52；CI = -0.73至 -0.30；I² = 0%），而测量对BMI影响的试验未发现显著效果（效应量 = -0.02；CI = -0.21至0.18；I² = 0%），但报告偏倚可能解释了这一结果。综合生活方式干预（24项试验）导致BMI有小幅度变化。
有限的证据支持药物和生活方式干预的短期疗效。儿童肥胖治疗的长期疗效和安全性仍不明确。
