儿童和青少年超重与肥胖的预防：一项系统评价与荟萃分析
Prevention of overweight and obesity in children and youth: a systematic review and meta-analysis.
作者信息
Peirson Leslea, Fitzpatrick-Lewis Donna, Morrison Katherine, Ciliska Donna, Kenny Meghan, Usman Ali Muhammad, Raina Parminder
机构信息
McMaster Evidence Review and Synthesis Centre, McMaster University, Hamilton, Ont. ; School of Nursing, Master University, Hamilton, Ont.
Department of Pediatrics, McMaster University, Hamilton, Ont.
出版信息
CMAJ Open. 2015 Jan 13;3(1):E23-33. doi: 10.9778/cmajo.20140053. eCollection 2015 Jan-Mar.
BACKGROUND
One-third of Canadian children are overweight or obese. This problem carries considerable concern for negative impacts on current and future health. Promoting healthy growth and development is critical. This review synthesized evidence on the effectiveness of behavioural interventions for preventing overweight and obesity in children and adolescents.
METHODS
We updated the search of a previous Cochrane review. Five databases were searched up to August 2013. Randomized trials of primary care-relevant behavioural (diet, exercise and lifestyle) interventions for preventing overweight and obesity in healthy normal- or mixed-weight children or youth aged 0-18 years were included if 12-week postbaseline data were provided for body mass index (BMI), BMI z-score, or prevalence of overweight or obesity. Any study reporting harms was included. Meta-analyses were performed if possible. Features of interventions showing significant benefits were examined.
RESULTS
Ninety studies were included, all with mixed-weight populations. Compared with controls, interventions showed a small but significant effect on BMI and BMI z-score (standardized mean difference -0.07, 95% confidence interval [CI] -0.10 to -0.03, I (2) = 74%), a reduction in BMI (mean difference -0.09 kg/m(2), 95% CI -0.16 to -0.03, I (2) = 76%) and a reduced prevalence of overweight and obesity (risk ratio [RR]; RRintervention - RRcontrol 0.94, 95% CI 0.89 to 0.99, I (2) = 0%; number needed to treat 51, 95% CI 29 to 289). Little evidence was available on harms. There was variability across efficacious interventions, although many of the interventions were short-term, involved school-aged children and were delivered in educational settings.
INTERPRETATION
Behavioural prevention interventions are associated with small improvements in weight outcomes in mixed-weight populations of children and adolescents. No intervention strategy consistently produced benefits.
REGISTRATION
PROSPERO no. CRD42012002754.
背景
三分之一的加拿大儿童超重或肥胖。这一问题引发了对当前及未来健康负面影响的极大关注。促进健康成长和发育至关重要。本综述综合了关于行为干预对预防儿童和青少年超重及肥胖有效性的证据。
方法
我们更新了之前Cochrane综述的检索。截至2013年8月检索了五个数据库。纳入针对0至18岁健康正常体重或混合体重儿童或青少年预防超重和肥胖的与初级保健相关的行为（饮食、运动和生活方式）干预的随机试验，条件是提供了基线后12周的体重指数（BMI）、BMI z评分或超重或肥胖患病率的数据。任何报告不良事件的研究均纳入。若可能则进行荟萃分析。对显示出显著益处的干预措施的特征进行了研究。
结果
纳入90项研究，均为混合体重人群。与对照组相比，干预措施对BMI和BMI z评分有小但显著的影响（标准化均数差值-0.07，95%置信区间[CI]-0.10至-0.03，I² = 74%），BMI降低（均数差值-0.09kg/m²，95%CI-0.16至-0.03，I² = 76%），超重和肥胖患病率降低（风险比[RR]；RR干预-RR对照0.94，95%CI 0.89至0.99，I² = 0%；需治疗人数51，95%CI 29至289）。关于不良事件的证据很少。有效干预措施存在差异，尽管许多干预措施是短期的，涉及学龄儿童且在教育环境中实施。
解读
行为预防干预与儿童和青少年混合体重人群的体重结果有小幅改善相关。没有一种干预策略能始终产生益处。
注册信息
PROSPERO编号CRD42012002754。
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