François P, Guyomard A, Baudet D, Dubois-Fabing D, Boussuges S, Perrin F, Seigneurin A
Unité d'évaluation médicale, pôle santé publique, pavillon Taillefer, CHU de Grenoble, BP 217, 38043 Grenoble, France; Laboratoire TIMC-IMAG CNRS, université Grenoble 1, pavillon Taillefer, CHU de Grenoble, BP 217, 38043 Grenoble, France.
Unité d'évaluation médicale, pôle santé publique, pavillon Taillefer, CHU de Grenoble, BP 217, 38043 Grenoble, France.
Arch Pediatr. 2014 Jul;21(7):727-35. doi: 10.1016/j.arcped.2014.04.026. Epub 2014 Jun 16.
Increasing prevalence of obesity particularly affects underprivileged families and children. This study aimed to estimate the efficiency of an obesity prevention program for school-aged children in deprived urban areas.
This was an intervention trial with a before-and-after comparison of a cohort of school-aged children in preschool and primary school in three deprived urban areas in Grenoble, France. All school-aged children in the first and third year of preschool and the third year of primary school during the 2008-2009 and 2009-2010 school years, whose parents agreed to participate in the study, were included. Children were seen again 2 years later. The staff of the school health service measured and weighed the children during a medical check-up, thus determining their body mass index (BMI) and Z score. A school doctor suggested specific care to the parents of overweight children. A lifestyle questionnaire was completed. The primary outcome was changes in BMI and the Z score over 2 years. The secondary outcome was changes in lifestyle and eating habits.
A total of 2434 children were included in the screening campaign. Of the 2434 children included in screening, 1824 children were reviewed and evaluated at 2 years. At inclusion, overweight prevalence increased with age, from 6.4% in the first year of preschool to 21.9% in the third year of primary school. More than 60% of overweight children had a high social vulnerability score. Prevalence of overweight increased from 13.8% to 21.5% in 2 years in the entire cohort (P<0.001). In the 252 overweight children, the mean BMI increased from 20 kg/m(2) to 21.8 kg/m(2) (P<0.001), as did the mean Z score, which increased from 2.72 to 2.9 (P<0.001). There was no significant interaction depending on whether the family physician was in private practice or employed by a health center. According to their eating habits, fewer of the overweight children had a snack in the morning and more had a school lunch. More than half of the children thought they had improved their eating habits. They played more sports (30% versus 49.5%).
This study failed to demonstrate that incentive for medical management of excess weight had an effect on the short-term (2 years) evolution of the children's corpulence.
肥胖患病率的不断上升对贫困家庭和儿童的影响尤为严重。本研究旨在评估一项针对城市贫困地区学龄儿童的肥胖预防计划的效果。
这是一项干预试验，对法国格勒诺布尔三个贫困城区的一组学龄前和小学学龄儿童进行前后对比。纳入了2008 - 2009学年和2009 - 2010学年学龄前第一年、第三年以及小学第三年的所有学龄儿童，其家长同意参与研究。两年后再次对这些儿童进行观察。学校卫生服务人员在体检时对儿童进行测量和称重，从而确定他们的体重指数（BMI）和Z评分。学校医生会给超重儿童的家长提出具体的护理建议。完成一份生活方式问卷。主要结局是两年内BMI和Z评分的变化。次要结局是生活方式和饮食习惯的变化。
共有2434名儿童纳入筛查活动。在纳入筛查的2434名儿童中，1824名儿童在两年后接受了复查和评估。纳入时，超重患病率随年龄增加，从学龄前第一年的6.4%增至小学第三年的21.9%。超过60%的超重儿童社会脆弱性得分较高。整个队列中超重患病率在两年内从13.8%增至21.5%（P<0.001）。在252名超重儿童中，平均BMI从20kg/m²增至21.8kg/m²（P<0.001），平均Z评分也从2.72增至2.9（P<0.001）。家庭医生是私人执业还是受雇于健康中心，这方面没有显著的交互作用。根据饮食习惯，超重儿童中早上吃零食的较少，吃学校午餐的较多。超过一半的儿童认为他们改善了饮食习惯。他们参加体育活动的更多了（30%对49.5%）。
本研究未能证明对超重进行医疗管理的激励措施对儿童肥胖的短期（两年）发展有影响。
