以健康为重点的项目而非常规减肥项目对心血管风险因素的影响：系统评价和荟萃分析。
Health, not weight loss, focused programmes versus conventional weight loss programmes for cardiovascular risk factors: a systematic review and meta-analysis.
机构信息
Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
出版信息
Syst Rev. 2019 Aug 10;8(1):200. doi: 10.1186/s13643-019-1083-8.
BACKGROUND
Obesity is a cardiovascular disease risk factor. Conventional weight loss (CWL) programmes focus on weight loss, however 'health, not weight loss, focused' (HNWL) programmes concentrate on improved health and well-being, irrespective of weight loss. What are the differences in CVD risk outcomes between these programmes?
AIM
To conduct a systematic review and meta-analysis to compare the effects of HNWL with CWL programmes on cardiovascular disease risk factors.
METHODS
We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, clinical trial registers, commercial websites and reference lists for randomised controlled trials comparing the two programmes (initially searched up to August 2015 and searched updated to 5 April 2019). We used the Mantel-Haneszel fixed-effect model to pool results. Sub-group and sensitivity analyses that accounted for variations in length of follow-up, enhanced programmes and risk of bias dealt with heterogeneity.
RESULTS
Eight randomised controlled trials of 20,242 potential studies were included. Improvements in total cholesterol-HDL ratio (mean difference - 0.21 mmol/L, 95% confidence interval [- 3.91, 3.50]) and weight loss (- 0.28 kg [- 2.00, 1.44]) favoured HNWL compared to CWL programmes in the long term (53-104 week follow-up), whereas improvements in systolic (- 1.14 mmHg, [- 5.84, 3.56]) and diastolic (- 0.15 mmHg, [- 3.64, 3.34]) blood pressure favoured CWL programmes. These differences did not reach statistical significance. Statistically significant improvements in body satisfaction (- 4.30 [- 8.32, - 0.28]) and restrained eating behaviour (- 4.30 [- 6.77, - 1.83]) favoured HNWL over CWL programmes.
CONCLUSIONS
We found no long-term significant differences in improved CVD risk factors; however, body satisfaction and restrained eating behaviour improved more with HNWL compared to CWL programmes. Yet firm conclusions cannot be drawn from small studies with high losses to follow-up and data sometimes arising from a single small study.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42015019505.
背景
肥胖是心血管疾病的一个风险因素。传统的减重（CWL）计划侧重于体重减轻，而“关注健康而非体重减轻”（HNWL）计划则侧重于改善健康和幸福感，而不论体重减轻与否。这些计划在心血管疾病风险结果方面有何不同？
目的
进行系统评价和荟萃分析，比较 HNWL 与 CWL 计划对心血管疾病风险因素的影响。
方法
我们检索了 CENTRAL、MEDLINE、EMBASE、PsycINFO、CINAHL、ASSIA、临床试验注册处、商业网站和参考文献，以查找比较这两种计划的随机对照试验（最初检索截至 2015 年 8 月，更新检索截至 2019 年 4 月 5 日）。我们使用 Mantel-Haneszel 固定效应模型来汇总结果。亚组和敏感性分析考虑了随访时间长短、强化计划和偏倚风险的差异，以处理异质性。
结果
从 20242 项潜在研究中筛选出 8 项随机对照试验。与 CWL 计划相比，HNWL 计划在长期（53-104 周随访）更有利于降低总胆固醇/高密度脂蛋白比值（平均差值 -0.21mmol/L，95%置信区间 [-3.91，3.50]）和体重减轻（-0.28kg [-2.00，1.44]），而收缩压（-1.14mmHg [-5.84，3.56]）和舒张压（-0.15mmHg [-3.64，3.34]）的改善则有利于 CWL 计划。这些差异没有达到统计学意义。HNWL 计划在身体满意度（-4.30 [-8.32，-0.28]）和约束性饮食行为（-4.30 [-6.77，-1.83]）方面的改善明显优于 CWL 计划，但这些差异也没有达到统计学意义。
结论
我们没有发现改善 CVD 风险因素的长期显著差异；然而，与 CWL 计划相比，HNWL 计划在身体满意度和约束性饮食行为方面的改善更为显著。然而，由于高失访率和数据有时来自单一的小研究，因此无法得出确凿的结论。
系统评价注册
PROSPERO CRD42015019505。
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