J Acad Nutr Diet. 2019 May;119(5):799-817.e43. doi: 10.1016/j.jand.2018.12.008. Epub 2019 Mar 2.
Nutrition specialists are considered key members of multicomponent pediatric weight management intervention teams, but to date, their contribution has not been quantified.
The purpose of this systematic review was to estimate the effectiveness of interventions provided by treatment teams that include a nutrition specialist on pediatric weight management outcomes, including body mass index (BMI), BMI z score, and waist circumference when compared with treatment teams that do not include a nutrition specialist.
The results of a comprehensive literature search and a systematic and more targeted update of that search were included in the meta-analyses: a search of controlled trials published between July 2005 and April 2012, conducted during the 2015 Pediatric Weight Management Update Project of the Academy of Nutrition and Dietetics Evidence Analysis Library, and an update search of controlled trials published between May 2012 and December 2015 focusing on a more specific topic within the previous search. Studies included overweight and/or obese patients aged 6 to 18 years receiving outpatient weight management treatment. Data extraction of all studies identified was performed using a standardized tool. The resulting data from the search and the systematic update were merged. Ninety-nine studies and 209 study arms were included in the analysis. An exploratory meta-analysis using alternative meta-analytic methods designed for complex, heterogenous interventions was conducted to identify relative contributions by intervention provider category at selected time points. Meta-regression analyses were used to evaluate significant differences from the reference category for each provider category.
The nutrition specialist-only condition resulted in increased reductions in BMI z score compared with behavioralist-only, combined nutrition specialist and behavioralist, and neither nutrition specialist or behavioralist category (reference) throughout the analysis. Meta-regression analysis indicated that the difference in BMI z score between the nutrition specialist-only category and the reference category was significant at 3 to <6 months, 6 months to <1 year, and 1-year to 2-year time points (P=0.01, P=0.05, and P=0.01, respectively). There were smaller increases in BMI over time for the nutrition specialist-only provider category compared with reference categories, and this difference was significant at the 3 to <6 months and 1-year to 2-years time points (P=0.001 and P=0.05, respectively). There were no significant differences among provider categories for waist circumference at any time point.
Indirect evidence indicated that pediatric weight management outcomes for BMI z score and BMI at selected time points appeared to be better when a nutrition specialist was involved in delivering care.
营养专家被认为是多组分儿科体重管理干预团队的关键成员，但迄今为止，他们的贡献尚未量化。
本系统评价的目的是评估包含营养专家的治疗团队与不包含营养专家的治疗团队在儿科体重管理结果（包括体重指数（BMI）、BMI z 评分和腰围）方面的干预效果。
综合文献检索的结果以及该检索的系统和更有针对性的更新结果都包含在荟萃分析中：对 2005 年 7 月至 2012 年 4 月间发表的对照试验进行检索，并在 2015 年营养与饮食学会循证分析图书馆的儿科学术体重管理更新项目中进行了系统更新，以及对 2012 年 5 月至 2015 年 12 月间发表的、聚焦于之前检索中更具体主题的对照试验进行更新检索。研究纳入了接受门诊体重管理治疗的年龄在 6 至 18 岁之间的超重和/或肥胖患者。使用标准化工具对所有研究进行数据提取。合并检索和系统更新的结果数据。分析共纳入 99 项研究和 209 个研究臂。采用专为复杂、异质性干预设计的替代荟萃分析方法进行探索性荟萃分析，以确定特定时间点干预提供者类别对体重管理结果的相对贡献。采用元回归分析评估每个提供者类别与参照类别之间的差异。
与行为学家单独干预、营养学家和行为学家联合干预以及既无营养学家也无行为学家干预（参照）相比，仅营养学家干预的条件导致 BMI z 评分的降低更大。整个分析过程中，元回归分析表明，营养学家单独干预类别与参照类别的 BMI z 评分差异在 3 至<6 个月、6 个月至<1 年和 1 年至 2 年时间点均具有统计学意义（P=0.01、P=0.05 和 P=0.01）。仅营养学家干预的提供者类别随时间推移 BMI 增加较小，且与参照类别相比差异在 3 至<6 个月和 1 年至 2 年时间点具有统计学意义（P=0.001 和 P=0.05）。在任何时间点，各提供者类别之间的腰围均无显著差异。
间接证据表明，在提供治疗时涉及营养专家时，BMI z 评分和特定时间点 BMI 的儿科体重管理结果似乎更好。
