随着时间的推移，儿童期肥胖预防试验效果的可持续性：健康开端试验的进一步 3 年随访。

Sustainability of Effects of an Early Childhood Obesity Prevention Trial Over Time: A Further 3-Year Follow-up of the Healthy Beginnings Trial.

机构信息

Sydney School of Public Health and Sydney Medical School, The University of Sydney, Sydney, Australia2Health Promotion Service, Sydney Local Health District, New South Wales, Sydney, Australia3Department of Endocrinology and Metabolism, Shanghai 10th Peop.

Sydney School of Public Health and Sydney Medical School, The University of Sydney, Sydney, Australia4Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.

出版信息

JAMA Pediatr. 2015 Jun;169(6):543-51. doi: 10.1001/jamapediatrics.2015.0258.

DOI:10.1001/jamapediatrics.2015.0258

PMID:25893283

Abstract

IMPORTANCE

Little evidence exists on whether effects of an early obesity intervention are sustainable.

OBJECTIVE

To assess the sustainability of effects of a home-based early intervention on children's body mass index (BMI) and BMI z score at 3 years after intervention.

DESIGN, SETTING, AND PARTICIPANTS: A longitudinal follow-up study of the randomized clinical Healthy Beginnings Trial was conducted with 465 participating mothers consenting to be followed up at 3 years after intervention until their children were age 5 years. This study was conducted in socially and economically disadvantaged areas of Sydney, Australia, from March 2011 to June 2014.

INTERVENTIONS

No further intervention was carried out in this Healthy Beginnings Trial phase 2 follow-up study. The original intervention in phase 1 comprised 8 home visits from community nurses delivering a staged home-based intervention, with one visit in the antenatal period and 7 visits at 1, 3, 5, 9, 12, 18, and 24 months after birth.

MAIN OUTCOMES AND MEASURES

Primary outcomes were children's BMI and BMI z score. Secondary outcomes included dietary behaviors, quality of life, physical activity, and TV viewing time of children and their mothers.

RESULTS

In total, 369 mothers and their children completed the follow-up study, a phase 2 completion rate of 79.4% (80.9% for the intervention group and 77.7% for the control group). The differences between the intervention and control groups at age 2 years in children's BMI and BMI z score disappeared over time. At age 2 years, the difference (intervention minus control) in BMI (calculated as weight in kilograms divided by height in meters squared) was -0.41 (95% CI, -0.71 to -0.10; P = .009), but by age 5 years it was 0.03 (95% CI, -0.30 to 0.37). No effects of the early intervention on dietary behaviors, quality of life, physical activity, and TV viewing time were detected at age 5 years.

CONCLUSIONS AND RELEVANCE

The significant effect of this early life home-visiting intervention on child BMI and BMI z score at age 2 years was not sustained at age 5 years without further intervention. Obesity prevention programs need to be continued or maintained during the early childhood years.

摘要

重要性

关于早期肥胖干预效果的可持续性，目前证据有限。

目的

评估基于家庭的早期干预对儿童体重指数（BMI）和干预后 3 年 BMI z 评分的影响是否可持续。

设计、地点和参与者：这是一项针对随机对照临床试验“健康开端试验”的纵向随访研究，共有 465 名参与母亲同意在干预后 3 年进行随访，直到她们的孩子 5 岁。该研究于 2011 年 3 月至 2014 年 6 月在澳大利亚悉尼社会经济劣势地区进行。

干预措施

在本阶段 2 随访研究中，“健康开端试验”没有进一步的干预措施。第一阶段的原始干预措施包括社区护士进行的 8 次家访，提供分阶段的家庭干预，其中一次家访在产前进行，7 次家访分别在产后 1、3、5、9、12、18 和 24 个月进行。

主要结局和测量指标

主要结局是儿童的 BMI 和 BMI z 评分。次要结局包括儿童及其母亲的饮食行为、生活质量、身体活动和电视观看时间。

结果

共有 369 名母亲及其子女完成了随访研究，完成率为 79.4%（干预组为 80.9%，对照组为 77.7%）。随着时间的推移，干预组和对照组儿童在 2 岁时 BMI 和 BMI z 评分的差异逐渐消失。2 岁时，BMI 的差值（干预组减去对照组）为-0.41（95%CI，-0.71 至-0.10；P =.009），但到 5 岁时为 0.03（95%CI，-0.30 至 0.37）。在 5 岁时，未发现早期干预对饮食行为、生活质量、身体活动和电视观看时间有影响。