Larson Nicole, Ward Dianne S, Neelon Sara Benjamin, Story Mary
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA.
J Am Diet Assoc. 2011 Sep;111(9):1343-62. doi: 10.1016/j.jada.2011.06.007.
Given the widespread use of out-of-home child care and an all-time high prevalence of obesity among US preschool-aged children, it is imperative to consider the opportunities that child-care facilities may provide to reduce childhood obesity. This review examines the scientific literature on state regulations, practices and policies, and interventions for promoting healthy eating and physical activity, and for preventing obesity in preschool-aged children attending child care. Research published between January 2000 and July 2010 was identified by searching PubMed and MEDLINE databases, and by examining the bibliographies of relevant studies. Although the review focused on US child-care settings, interventions implemented in international settings were also included. In total, 42 studies were identified for inclusion in this review: four reviews of state regulations, 18 studies of child-care practices and policies that may influence eating or physical activity behaviors, two studies of parental perceptions and practices relevant to obesity prevention, and 18 evaluated interventions. Findings from this review reveal that most states lack strong regulations for child-care settings related to healthy eating and physical activity. Recent assessments of child-care settings suggest opportunities for improving the nutritional quality of food provided to children, the time children are engaged in physical activity, and caregivers' promotion of children's health behaviors and use of health education resources. A limited number of interventions have been designed to address these concerns, and only two interventions have successfully demonstrated an effect on child weight status. Recommendations are provided for future research addressing opportunities to prevent obesity in child-care settings.
鉴于美国学龄前儿童的家庭外托儿服务广泛使用，且肥胖率一直居高不下，考虑托儿设施在减少儿童肥胖方面可能提供的机会势在必行。本综述考察了关于州法规、实践和政策以及促进健康饮食和身体活动、预防接受托儿服务的学龄前儿童肥胖的干预措施的科学文献。通过检索PubMed和MEDLINE数据库以及查阅相关研究的参考文献，确定了2000年1月至2010年7月期间发表的研究。尽管综述重点关注美国的托儿环境，但也纳入了在国际环境中实施的干预措施。总共确定了42项研究纳入本综述：四项关于州法规的综述、18项关于可能影响饮食或身体活动行为的托儿实践和政策的研究、两项关于与肥胖预防相关的家长认知和实践的研究以及18项评估过的干预措施。本综述的结果显示，大多数州在与健康饮食和身体活动相关的托儿环境方面缺乏有力的法规。最近对托儿环境的评估表明，在改善提供给儿童的食物的营养质量、儿童进行身体活动的时间以及照顾者对儿童健康行为的促进和健康教育资源的使用方面存在机会。为解决这些问题设计的干预措施数量有限，只有两项干预措施成功证明对儿童体重状况有影响。针对未来研究提出了建议，以探讨在托儿环境中预防肥胖的机会。
