Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.
JAMA Pediatr. 2013 Aug 1;167(8):759-68. doi: 10.1001/jamapediatrics.2013.1453.
Diet and exercise represent the mainstays of obesity treatment. No systematic review has been conducted comparing the effect of dietary and exercise intervention in reducing metabolic risks in overweight children.
To compare the effects of diet-only intervention with those of diet plus exercise or exercise only on weight loss and metabolic risk reduction in overweight children.
English-language articles from 1975 to 2010 available from 7 databases were reviewed. One person searched the databases. Two independent reviewers assessed abstracts and articles against the following eligibility criteria: randomized controlled trials conducted in overweight and obese children aged 18 years or younger, comparing dietary intervention with a diet plus exercise program or an exercise-only program. Study quality was critically appraised by 2 reviewers using established criteria. The main outcome measures were body mass index, body fat percentage, lean body mass, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, fasting glucose, and fasting insulin.
Fifteen studies were identified and included. Based on the small number of short-term trials currently available, both diet-only and diet plus exercise interventions resulted in weight loss and metabolic profile improvement. However, the addition of exercise to dietary intervention led to greater improvements in levels of high-density lipoprotein cholesterol (3.86 mg/dL [to convert to millimoles per liter, multiply by 0.0259]; 95% CI, 2.70 to 4.63), fasting glucose (-2.16 mg/dL [to convert to millimoles per liter, multiply by 0.0555]; 95% CI, -3.78 to -0.72), and fasting insulin (-2.75 μIU/mL [to convert to picomoles per liter, multiply by 6.945]; 95% CI, -4.50 to -1.00) over 6 months. The diet-only intervention caused greater reductions in levels of triglycerides (at the end of active intervention) and low-density lipoprotein cholesterol (at subsequent follow-up).
This review provides insights into the impact of dietary and exercise interventions on metabolic risk reduction in the pediatric population. However, further studies are required to confirm the evidence with rigorous design, appropriate sample size, longer duration of follow-up, and better strategies to improve compliance and achieve long-term sustainability.
饮食和运动是肥胖治疗的主要方法。目前还没有系统的综述比较饮食干预和运动干预在降低超重儿童代谢风险方面的效果。
比较单纯饮食干预与饮食加运动或单纯运动干预在减轻超重儿童体重和降低代谢风险方面的效果。
从 7 个数据库中检索到 1975 年至 2010 年发表的英文文章。由 1 人检索数据库。2 位独立评审员根据以下纳入标准评估摘要和文章：在 18 岁或以下的超重和肥胖儿童中进行的比较饮食干预与饮食加运动方案或单纯运动方案的随机对照试验。2 位评审员使用既定标准对研究质量进行严格评估。主要结局指标为体重指数、体脂百分比、瘦体重、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、空腹血糖和空腹胰岛素。
确定了 15 项研究并纳入分析。基于目前短期试验数量较少的情况，单纯饮食干预和饮食加运动干预均导致体重减轻和代谢指标改善。然而，将运动加入饮食干预中可使高密度脂蛋白胆固醇（3.86mg/dL[换算为毫摩尔/升，乘以 0.0259]；95%置信区间，2.70 至 4.63）、空腹血糖（-2.16mg/dL[换算为毫摩尔/升，乘以 0.0555]；95%置信区间，-3.78 至 -0.72）和空腹胰岛素（-2.75μIU/mL[换算为皮摩尔/升，乘以 6.945]；95%置信区间，-4.50 至 -1.00）在 6 个月内得到更大程度的改善。单纯饮食干预可更大程度地降低甘油三酯（在积极干预结束时）和低密度脂蛋白胆固醇（在随后的随访中）水平。
本综述提供了饮食和运动干预对儿科人群代谢风险降低影响的见解。然而，需要进一步的研究以具有严格设计、适当的样本量、更长的随访时间和更好的策略来提高依从性并实现长期可持续性的研究来证实这一证据。
