Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California; California Center for Population Research, Los Angeles, California.
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California; California Center for Population Research, Los Angeles, California; UCLA Center for Health Policy Research, Los Angeles, California; Department of Statistics, UCLA College of Letters and Science, Los Angeles, California.
Am J Prev Med. 2018 Dec;55(6):795-802. doi: 10.1016/j.amepre.2018.07.014. Epub 2018 Oct 19.
Little is known about what interventions worked or did not work in slowing the obesity epidemic. The long-term comparative effectiveness of environmental and behavioral public health interventions for obesity and type 2 diabetes prevention over an individual's life course is relatively unexplored. The potential impact and long-term collective effectiveness of environmental and behavioral interventions on obesity and type 2 diabetes throughout the life course was evaluated.
The Virtual Los Angeles Obesity Model developed in 2016 was used to estimate the incidence and prevalence of obesity and type 2 diabetes under current and hypothetical interventions among 98,000 individuals born in 2009 and followed from birth to age 65 years. Analyses were performed in 2016 and completed in 2018.
The 48-year risk of type 2 diabetes was 0.533 (95% CI=0.446, 0.629) under the natural course, 0.451 (95% CI=0.334, 0.570) under the physical activity intervention, and 0.443 (95% CI=0.389, 0.495) under the fast-food intervention. The 64-year risk of obesity was 0.892 (95% CI=0.879, 0.903) under the natural course, 0.876 (95% CI=0.850, 0.899) under the physical activity intervention, and 0.864 (95% CI=0.856, 0.873) under the fast-food intervention. The other interventions had little or no long-term effects. When all the interventions were applied, the population risk ratios were 0.942 (95% CI=0.914, 0.967) and 0.634 (95% CI=0.484, 0.845) for obesity and type 2 diabetes, respectively.
Implementing health interventions continuously throughout the life span and in combination with other interventions could substantially halt the obesity and the type 2 diabetes epidemics.
对于哪些干预措施可以减缓肥胖流行，我们知之甚少。个体生命过程中，环境和行为公共卫生干预措施在肥胖和 2 型糖尿病预防方面的长期比较效果相对较少被探索。本研究评估了环境和行为干预措施对整个生命周期肥胖和 2 型糖尿病的潜在影响和长期集体效果。
使用 2016 年开发的虚拟洛杉矶肥胖模型，估计了 2009 年出生的 98000 名个体在当前和假设干预下肥胖和 2 型糖尿病的发生率和患病率，并从出生到 65 岁进行随访。分析于 2016 年进行，于 2018 年完成。
在自然病程下，个体在 48 岁时 2 型糖尿病的发病风险为 0.533（95%CI=0.446, 0.629），在体力活动干预下为 0.451（95%CI=0.334, 0.570），在快餐干预下为 0.443（95%CI=0.389, 0.495）。在自然病程下，个体在 64 岁时肥胖的发病风险为 0.892（95%CI=0.879, 0.903），在体力活动干预下为 0.876（95%CI=0.850, 0.899），在快餐干预下为 0.864（95%CI=0.856, 0.873）。其他干预措施的长期效果较小或没有。当所有干预措施同时实施时，肥胖和 2 型糖尿病的人群风险比分别为 0.942（95%CI=0.914, 0.967）和 0.634（95%CI=0.484, 0.845）。
在整个生命周期内持续实施健康干预措施，并与其他干预措施相结合，可能会大大遏制肥胖和 2 型糖尿病的流行。
