Department of Nutrition and Diet, School of Health Sciences, Faculty of Health, University of Newcastle, NSW, 2308, Australia.
Pediatrics. 2011 Apr;127(4):619-27. doi: 10.1542/peds.2010-1518. Epub 2011 Mar 28.
Outcomes of childhood obesity interventions are rarely reported beyond 1 year. We hypothesized that the impact on the BMI z score from a child-centered physical-activity program in combination with a parent-centered dietary-modification program would be greater than either program conducted alone at 24 months' after baseline.
A total of 165 overweight prepubertal children (68 boys, aged 5.5-9.9 years, mean BMI z score: 2.8) were randomly assigned to either a child-centered physical-activity program, a parent-centered dietary-modification program, or both conducted together in an assessor-blinded 6-month intervention.
Using linear mixed models, all groups reduced their mean (95% confidence interval) BMI z score at 24 months from baseline (P < .001) (the activity and diet group: -0.24 [-0.35 to -0.13]; the diet-only group: -0.35 [-0.48 to -0.22]; activity-only group -0.19 [-0.30 to -0.07]). There was a significant group-by-time interaction (P = .04) with the activity + diet and the diet-only groups showing a greater reduction than the activity-only group. For waist z score and waist-to-height ratio, there was a significant time effect (P < .0001) at 24 months but no between-group differences (P > .05). Some metabolic outcomes improved at 24 months, although there were no between-group differences (P > .05).
A reduction in BMI z score was sustained at 24 months by treatment with either program combination. The greatest effects were achieved through inclusion of a parent-centered diet program, indicating the importance of targeting parents within treatment and the possibility of targeting them exclusively in treating obese prepubertal children.
儿童肥胖干预的结果很少有超过 1 年的报道。我们假设，与单一的儿童为中心的身体活动项目或单一的父母为中心的饮食调整项目相比，结合两种方法的以儿童为中心的身体活动项目和以父母为中心的饮食调整项目在基线后 24 个月时对 BMI z 评分的影响更大。
共有 165 名超重的青春期前儿童（68 名男孩，年龄 5.5-9.9 岁，平均 BMI z 评分：2.8）被随机分配到以儿童为中心的身体活动项目、以父母为中心的饮食调整项目或两者结合的评估者盲法 6 个月干预组。
使用线性混合模型，所有组在 24 个月时均降低了其 BMI z 评分的平均值（95%置信区间）（P<0.001）（活动+饮食组：-0.24 [-0.35 至 -0.13]；饮食调整组：-0.35 [-0.48 至 -0.22]；仅活动组：-0.19 [-0.30 至 -0.07]）。存在组间时间交互作用（P=0.04），活动+饮食组和饮食调整组的降幅大于仅活动组。对于腰围 z 评分和腰围身高比，在 24 个月时存在显著的时间效应（P<0.0001），但组间无差异（P>0.05）。一些代谢结果在 24 个月时得到改善，尽管组间无差异（P>0.05）。
治疗方案的组合可使 BMI z 评分在 24 个月时持续降低。最大的效果是通过包含以父母为中心的饮食计划实现的，这表明在治疗中针对父母的重要性以及仅针对肥胖青春期前儿童的父母进行治疗的可能性。
