Vestische Kinderklinik Datteln, Institute of Pediatric Nutrition Medicine, University of Witten-Herdecke, Datteln, Germany.
Am J Clin Nutr. 2010 May;91(5):1165-71. doi: 10.3945/ajcn.2009.28705. Epub 2010 Mar 10.
Long-term outcome after lifestyle interventions in obese children is largely unknown but important to improving intervention.
The aim was to identify predictors of long-term changes in body mass index (BMI) after lifestyle intervention.
Annual changes in the BMI SD score (BMI-SDS) over 5 y in 663 obese children (aged 4-16 y) motivated to participate in an outpatient lifestyle intervention were analyzed. Child-specific longitudinal curves based on multilevel growth curve models (MLMs) over 5 y were estimated depending on patient characteristics (age and sex).
The mean decrease in BMI-SDS was 0.36 (95% CI: 0.33, 0.39) at the end of the 1-y intervention and 0.46 (95% CI: 0.36, 0.55) 4 y after the intervention. Change in BMI-SDS in the intervention period predicted long-term outcome after 5 y (P < 0.001). MLMs identified age but not sex as a predictor of the outcome: the youngest children (<8 y) at the onset of the intervention had the greatest decrease in BMI-SDS over 5 y, and the oldest children (>13 y) had the least decrease in BMI-SDS (P < 0.05). Whereas there was a larger reduction in BMI-SDS during the intervention in children aged 8-10 y than in children aged 11-12 y, long-term decrease in BMI-SDS was greater in 11-12-y-old children (P < 0.001).
Younger age was associated with the best long-term outcome after participation in the lifestyle intervention, which supports the need for early intervention in childhood obesity. Children aged 8-10 y may need modified intervention, because BMI-SDS increased more in the older children in the long term. However, mean BMI-SDS was significantly lower 4 y after the end of the intervention than at baseline in all age groups. This study was registered at clinicaltrials.gov as NCT00435734.
肥胖儿童生活方式干预的长期结果尚不清楚，但对于改善干预措施非常重要。
旨在确定生活方式干预后体重指数（BMI）长期变化的预测因素。
分析了 663 名肥胖儿童（年龄 4-16 岁）参与门诊生活方式干预的意愿，这些儿童在 5 年内每年 BMI-SDS 的变化情况。根据患者特征（年龄和性别），基于多层次增长曲线模型（MLMs）估计了 5 年内的儿童特定纵向曲线。
1 年干预结束时 BMI-SDS 平均下降 0.36（95%CI：0.33，0.39），干预后 4 年下降 0.46（95%CI：0.36，0.55）。干预期间 BMI-SDS 的变化预测了 5 年后的长期结果（P < 0.001）。MLMs 确定年龄而非性别是结果的预测因素：干预开始时年龄最小的（<8 岁）儿童在 5 年内 BMI-SDS 下降幅度最大，年龄最大的（>13 岁）儿童 BMI-SDS 下降幅度最小（P < 0.05）。8-10 岁儿童在干预期间 BMI-SDS 下降幅度大于 11-12 岁儿童，但 11-12 岁儿童长期 BMI-SDS 下降幅度更大（P < 0.001）。
参与生活方式干预后，年龄较小与长期结果最佳相关，这支持了儿童肥胖早期干预的必要性。8-10 岁的儿童可能需要进行修改后的干预，因为长期来看，较大的儿童 BMI-SDS 增加更多。然而，在所有年龄组中，干预结束后 4 年的平均 BMI-SDS 均显著低于基线。本研究在 clinicaltrials.gov 注册为 NCT00435734。
