Narla A, Rehkopf D H
Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA USA.
Obes Sci Pract. 2019 Jan 16;5(2):177-186. doi: 10.1002/osp4.323. eCollection 2019 Apr.
Rank the importance of potentially modifiable psychosocial, dietary and environmental risk and protective factors for female adolescent obesity in order to target and inform public health prevention efforts. Utilizing the largest dataset available that captures the onset of the adolescent obesity surge in the USA, the study provides a more robust understanding of paediatric obesity risk factors.
Data were obtained from an observational, longitudinal study conducted between 1989 and 2001, the NHLBI Growth and Health Study. This study includes girls aged 9-19 years from three urban US locations, with Black and White girls generally represented equally. Data were analysed using multiple regression, random forest and propensity score matching to determine the strongest adiposity risk and protective factors during ages 9-12 predicting adiposity at age 19 with multiple methods to maximize the ability to identify possible public health interventions. Multiple linear regression and random forest analysis identified the strongest associations among 288 risk and protective factors selected from the study's literature review. For the 190 factors associated with follow-up adiposity from the data, propensity score matching was used to control for confounding of these factors.
Findings suggest that highest priority interventional targets across the domains surveyed are lowering specific nutrients; eating meals with others or during activities without skipping; parents fixing evening snacks; improving perceptions of non-extremes as the healthy weight; improving self-worth, physical activity and social competence; and limiting any negative impact of dieting relatives. Similar associations were observed for Black and White girls.
The clinical implications of these findings allow health practitioners to target behavioural change efforts and address social and environmental factors that have demonstrated higher prioritization value for early obesity interventional efforts for adolescents.
对女性青少年肥胖潜在可改变的心理社会、饮食和环境风险及保护因素的重要性进行排序，以便确定公共卫生预防工作的目标并提供相关信息。该研究利用可获得的最大数据集来捕捉美国青少年肥胖激增的开始情况，从而更深入地了解儿童肥胖的风险因素。
数据来自1989年至2001年进行的一项观察性纵向研究——美国国立心肺血液研究所生长与健康研究。该研究包括来自美国三个城市地区的9至19岁女孩，黑人和白人女孩的代表性大致相同。使用多元回归、随机森林和倾向得分匹配对数据进行分析，以确定9至12岁期间最强的肥胖风险和保护因素，这些因素可通过多种方法预测19岁时的肥胖情况，以最大限度地提高识别可能的公共卫生干预措施的能力。多元线性回归和随机森林分析确定了从该研究的文献综述中选出的288个风险和保护因素之间的最强关联。对于数据中与随访肥胖相关的190个因素，使用倾向得分匹配来控制这些因素的混杂情况。
研究结果表明，在所调查的各个领域中，最高优先级的干预目标是降低特定营养素的摄入量；与他人一起用餐或在活动期间用餐且不跳过；父母准备晚餐小吃；改善对非极端体重为健康体重的认知；提高自我价值、身体活动水平和社交能力；以及限制节食亲属的任何负面影响。黑人和白人女孩的情况类似。
这些研究结果的临床意义使卫生从业人员能够针对行为改变做出努力，并解决那些在青少年早期肥胖干预工作中已显示出更高优先级价值的社会和环境因素。
