Kirk Shelley, Brehm Bonnie, Saelens Brian E, Woo Jessica G, Kissel Elizabeth, D'Alessio David, Bolling Christopher, Daniels Stephen R
Center for Better Health and Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
J Pediatr. 2012 Aug;161(2):320-7.e1. doi: 10.1016/j.jpeds.2012.01.041. Epub 2012 Feb 28.
To compare the effectiveness and safety of carbohydrate (CHO)-modified diets with a standard portion-controlled (PC) diet in obese children.
Obese children (n=102) aged 7-12 years were randomly assigned to a 3-month intervention of a low-CHO (LC), reduced glycemic load (RGL), or standard PC diet, along with weekly dietary counseling and biweekly group exercise. Anthropometry, dietary adherence, and clinical measures were evaluated at baseline and 3, 6, and 12 months. Analyses applied intention-to-treat longitudinal mixed models.
Eighty-five children (83%) completed the 12-month assessment. Daily caloric intake decreased from baseline to all time points for all diet groups (P<.0001), although LC diet adherence was persistently lower (P<.0002). At 3 months, body mass index z score was lower in all diet groups (LC, -0.27 ± 0.04; RGL, -0.20 ± 0.04; PC, -0.21 ± 0.04; P<.0001) and was maintained at 6 months, with similar results for waist circumference and percent body fat. At 12 months, participants in all diet groups had lower body mass index z scores than at baseline (LC, -0.21 ± 0.04; RGL, -0.28 ± 0.04; PC, -0.31 ± 0.04; P<.0001), and lower percent body fat, but no reductions in waist circumference were maintained. All diets demonstrated some improved clinical measures.
Diets with modified CHO intake were as effective as a PC diet for weight management in obese children. However, the lower adherence to the LC diet suggests that this regimen is more difficult for children to follow, particularly in the long term.
比较碳水化合物（CHO）改良饮食与标准定量控制（PC）饮食对肥胖儿童的有效性和安全性。
将102名7至12岁的肥胖儿童随机分配到低CHO（LC）、降低血糖负荷（RGL）或标准PC饮食的3个月干预组，同时每周进行饮食咨询，每两周进行一次集体锻炼。在基线、3个月、6个月和12个月时评估人体测量学、饮食依从性和临床指标。分析采用意向性治疗纵向混合模型。
85名儿童（83%）完成了12个月的评估。所有饮食组的每日热量摄入从基线到所有时间点均下降（P<0.0001），尽管LC饮食的依从性持续较低（P<0.0002）。在3个月时，所有饮食组的体重指数z评分均较低（LC组为-0.27±0.04；RGL组为-0.20±0.04；PC组为-0.21±0.04；P<0.0001），并在6个月时保持，腰围和体脂百分比结果相似。在12个月时，所有饮食组的参与者体重指数z评分均低于基线（LC组为-0.21±0.04；RGL组为-0.28±0.04；PC组为-0.31±0.04；P<0.0001），体脂百分比降低，但腰围未持续减小。所有饮食在一些临床指标上均有改善。
CHO摄入量改良的饮食在肥胖儿童体重管理方面与PC饮食同样有效。然而，LC饮食较低的依从性表明该方案对儿童来说更难遵循，尤其是长期而言。
