一项基于诊所的儿童肥胖生活方式干预：疗效及反应的行为和生化预测因素
A clinic-based lifestyle intervention for pediatric obesity: efficacy and behavioral and biochemical predictors of response.
作者信息
Madsen Kristine A, Garber Andrea K, Mietus-Snyder Michele L, Orrell-Valente Joan K, Tran Cam-Tu, Wlasiuk Lidya, Matos Renee I, Neuhaus John, Lustig Robert H
机构信息
Department Pediatrics, University of California, San Francisco, CA 94118, USA.
出版信息
J Pediatr Endocrinol Metab. 2009 Sep;22(9):805-14. doi: 10.1515/jpem.2009.22.9.805.
AIM
To examine efficacy and predictors of response to a lifestyle intervention for obese youth.
METHODS
Retrospective chart review of 214 children and adolescents aged 8-19 years. Linear regression identified baseline predictors of response (delta BMI z-score) at first and ultimate follow-up visits.
RESULTS
Mean delta BMI z-score from baseline was -0.04 (p < 0.001) at first follow-up and -0.09 (p < 0.001) at ultimate follow-up (median time 10 mo) among 156 children and adolescents. Higher baseline BMI z-score predicted poor response at first and ultimate follow-up, explaining 10% of variance in response. Fasting insulin explained 6% of response variance at first follow-up. delta BMI z-score at the first visit along with baseline BMI z-score explained up to 50% of variance in response at ultimate visit.
CONCLUSION
Clinic-based interventions improve weight status. Baseline variables predict only a small proportion of response; response at the first visit is a more meaningful tool to guide clinical decisions.
目的
研究针对肥胖青少年的生活方式干预的疗效及反应预测因素。
方法
对214名8至19岁的儿童及青少年进行回顾性病历审查。线性回归确定了首次及最终随访时反应（BMI z评分变化值）的基线预测因素。
结果
在156名儿童及青少年中，首次随访时BMI z评分自基线的平均变化值为-0.04（p<0.001），最终随访时为-0.09（p<0.001）（中位时间10个月）。较高的基线BMI z评分预测首次及最终随访时反应较差，可解释反应差异的10%。空腹胰岛素可解释首次随访时6%的反应差异。首次就诊时的BMI z评分变化值与基线BMI z评分共同可解释最终就诊时高达50%的反应差异。
结论
基于门诊的干预可改善体重状况。基线变量仅能预测一小部分反应；首次就诊时的反应是指导临床决策更有意义的工具。
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