Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, David Rubenstein Child Health Building, Baltimore, MD 21287, USA.
Pediatrics. 2013 Jul;132(1):e193-200. doi: 10.1542/peds.2013-0786. Epub 2013 Jun 10.
Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes.
We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library from inception through August 11, 2012. We included experimental and natural experimental studies with ≥1-year follow-up reporting weight-related outcomes and targeting children at home. Two independent reviewers screened studies and extracted data. We graded the strength of the evidence supporting interventions targeting diet, PA, or both for obesity prevention.
We identified 6 studies; 3 tested combined interventions (diet and PA), 1 used diet intervention, 1 combined intervention with primary care and consumer health informatics components, and 1 combined intervention with school and community components. Select combined interventions had beneficial effects on fruit/vegetable intake and sedentary behaviors. However, none of the 6 studies reported a significant effect on weight outcomes. Overall, the strength of evidence is low that combined home-based interventions effectively prevent obesity. The evidence is insufficient for conclusions about home-based diet interventions or interventions implemented at home in association with other settings.
The strength of evidence is low to support the effectiveness of home-based child obesity prevention programs. Additional research is needed to test interventions in the home setting, particularly those incorporating parenting strategies and addressing environmental influences.
儿童肥胖是一种全球性的流行疾病。尽管有关家庭和家庭环境对肥胖相关行为风险的作用已经有了新的研究，但家庭为基础的干预措施在预防肥胖方面的有效性的证据基础仍不确定。本研究的目的是系统地综述家庭为基础的干预措施对体重、中间结果（如饮食和身体活动[PA]）和临床结局的有效性。
我们检索了 Medline、Embase、PsychInfo、CINAHL、clinicaltrials.gov 和 Cochrane Library，检索时间截至 2012 年 8 月 11 日。我们纳入了随访时间至少 1 年、报告与体重相关结局并以家庭为目标的实验和自然实验研究。两名独立的评审员筛选研究并提取数据。我们对针对饮食、PA 或两者的肥胖预防干预措施的证据强度进行了分级。
我们共确定了 6 项研究；其中 3 项测试了联合干预（饮食和 PA），1 项采用了饮食干预，1 项联合干预结合了初级保健和消费者健康信息学的内容，1 项联合干预结合了学校和社区的内容。一些选择的联合干预措施对水果/蔬菜的摄入量和久坐行为有有益的影响。然而，6 项研究中没有一项报告体重结局有显著效果。总的来说，家庭为基础的综合干预措施有效预防肥胖的证据强度较低。家庭为基础的饮食干预或与其他环境相结合的家庭内干预措施的证据不足，无法得出结论。
家庭为基础的儿童肥胖预防计划的有效性的证据强度较低。需要进一步的研究来测试家庭环境中的干预措施，特别是那些纳入养育策略和解决环境影响的干预措施。
