Wijndaele Katrien, Lakshman Rajalakshmi, Landsbaugh Jill R, Ong Ken K, Ogilvie David
MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, United Kingdom.
J Am Diet Assoc. 2009 Dec;109(12):2017-28. doi: 10.1016/j.jada.2009.09.003.
Introduction of complementary foods (weaning) before 4 to 6 months of age and unmodified cow's milk before age 12 months are associated with several health risks. To develop effective interventions to discourage these practices, evidence of their determinants is needed. This systematic review identified documents from seven electronic databases (database inception 2008) and reference lists, and by contacting authors. Seventy-eight studies in developed countries, published between 1976 and 2008, quantifying the association between either feeding practice and its potential determinants were included. Study quality was systematically assessed in terms of representativeness, sample size, method of outcome ascertainment, and approach to statistical analysis. The distribution of evidence for each determinant was visualized in a harvest plot showing the strength and direction of associations found and the quality of relevant studies. The strength of evidence for each determinant was summarized as strong, moderate, limited, or inconclusive, using an algorithm based on the consistency of the results of studies of the highest available quality. Strong evidence denoted that the determinant was examined in three or more high-quality studies and >/=75% of results were consistent. Strong evidence was found for six determinants of early weaning (ie, young maternal age, low maternal education, low socioeconomic status, absence or short duration of breastfeeding, maternal smoking, and lack of information or advice from health care providers) and for two determinants of early introduction of unmodified cow's milk (ie, low maternal education and low socioeconomic status). Of these determinants, improving advice given by health care providers appears the most tractable area for intervention in the short term.
4至6个月前引入辅食（断奶）以及12个月前食用未改性牛奶与多种健康风险相关。为制定有效的干预措施来劝阻这些行为，需要了解其决定因素的证据。本系统评价通过检索七个电子数据库（数据库起始时间为2008年）及其参考文献列表，并与作者联系来确定相关文献。纳入了1976年至2008年间发表的78项发达国家的研究，这些研究量化了喂养行为与其潜在决定因素之间的关联。从代表性、样本量、结局确定方法和统计分析方法等方面对研究质量进行了系统评估。每个决定因素的证据分布在一个收获图中直观呈现，该图展示了所发现关联的强度和方向以及相关研究的质量。使用基于现有最高质量研究结果一致性的算法，将每个决定因素的证据强度总结为强、中、有限或不确定。强证据表明该决定因素在三项或更多高质量研究中得到检验，且≥75%的结果一致。发现早期断奶的六个决定因素（即母亲年龄小、母亲教育程度低、社会经济地位低、母乳喂养缺失或持续时间短、母亲吸烟以及缺乏医疗保健提供者的信息或建议）和未改性牛奶早期引入的两个决定因素（即母亲教育程度低和社会经济地位低）有强证据支持。在这些决定因素中，改善医疗保健提供者提供的建议似乎是短期内最易于干预的领域。
