Raynor H A, Osterholt K M, Hart C N, Jelalian E, Vivier P, Wing R R
Department of Nutrition, University of Tennessee, Knoxville, TN 37996-1920, USA.
Pediatr Obes. 2012 Feb;7(1):28-38. doi: 10.1111/j.2047-6310.2011.00005.x. Epub 2011 Dec 13.
The objective of this study was to examine the efficacy of U.S. primary care paediatric obesity treatment recommendations, within two randomized trials.
Between November 2005 to September 2007, 182 families (children aged 4-9 years, body mass index [BMI] ≥85th percentile) were recruited for two separate trials and randomized within trial to a 6-month intervention. Each trial had one intervention that increased child growth-monitoring frequency and feedback to families (GROWTH MONITORING). Each trial also had two interventions, combining GROWTH MONITORING with an eight-session, behavioural, parent-only intervention targeting two energy-balance behaviours (Trial 1: reducing snack foods and sugar-sweetened beverages [DECREASE], and increasing fruits, vegetables and low-fat dairy [INCREASE]; Trial 2: decreasing sugar-sweetened beverages and increasing physical activity [TRADITIONAL] and increasing low-fat milk consumption and reducing television watching [SUBSTITUTES]). Child standardized BMI (ZBMI) and energy intake were assessed at 0, 6 and 12 months.
In both trials, main effects of time were found for ZBMI, which decreased at 6 and 12 months (P < 0.01). In Trial 1, ZBMI reduced from 0 to 6 months, which was maintained from 6 to 12 months (ΔZBMI 0 to 12 months = -0.12 ± 0.22). In Trial 2, ZBMI reduced from 0 to 6 and from 6 to 12 months (ΔZBMI 0-12 months = -0.16 ± 0.31). For energy intake, main effects of time were found in both trials and intake reduced from 0 to 6 months (P < 0.05), with Trial 1 reducing intake from 0 to 12 months (P < 0.05).
All interventions improved weight status. Future research should examine effectiveness and translatability of these approaches into primary care settings.
本研究的目的是在两项随机试验中检验美国初级保健儿科肥胖治疗建议的疗效。
2005年11月至2007年9月期间，182个家庭（4至9岁儿童，体重指数[BMI]≥第85百分位数）被招募参加两项独立试验，并在试验中随机分配接受为期6个月的干预。每项试验都有一种增加儿童生长监测频率并向家庭提供反馈的干预措施（生长监测）。每项试验还有两种干预措施，将生长监测与针对两种能量平衡行为的八节仅针对家长的行为干预相结合（试验1：减少休闲食品和含糖饮料[减少]，增加水果、蔬菜和低脂乳制品[增加]；试验2：减少含糖饮料并增加身体活动[传统]，增加低脂牛奶消费并减少看电视[替代]）。在0、6和12个月时评估儿童标准化BMI（ZBMI）和能量摄入。
在两项试验中，均发现ZBMI有时间主效应，在6个月和12个月时下降（P < 0.01）。在试验1中，ZBMI从0个月降至6个月，并在6个月至12个月保持（0至12个月的ΔZBMI = -0.12±0.22）。在试验2中，ZBMI从0个月降至6个月以及从6个月降至12个月（0至12个月的ΔZBMI = -0.16±0.31）。对于能量摄入，两项试验均发现有时间主效应，且摄入量从0个月降至6个月（P < 0.05），试验1中摄入量从0个月降至12个月（P < 0.05）。
所有干预措施均改善了体重状况。未来的研究应检验这些方法在初级保健环境中的有效性和可转化性。
