University of Lorraine, EA 4360 APEMAC, Nancy Metz, France.
CHRU-Nancy, INSERM, University of Lorraine, CIC-1433 Clinical Epidemiology, Nancy, France.
Int J Obes (Lond). 2020 Apr;44(4):895-907. doi: 10.1038/s41366-020-0520-z. Epub 2020 Jan 22.
A high prevalence of overweight/obesity among low socioeconomic status adolescents contributes to health inequalities. However, evidence-based interventions for reducing social inequalities in adolescent weight are lacking. We aimed to investigate whether strengthened care management for adolescents with low socioeconomic status has an equivalent effect in reducing overweight as standard care management in adolescents with high status.
PRALIMAP-INÈS was a multicentre trial including 35 state-run high and middle schools in the north-eastern France. A population-based sample of 1639 adolescents aged 13-18 years with screened and clinically confirmed overweight/obesity were proposed for inclusion and divided into two groups by the Family Affluence Scale score: advantaged (score > 5), receiving standard care management (A.S) and less-advantaged randomly assigned to two groups (1:2 ratio): standard care management (LA.S) and standard and strengthened care management (LA.S.S). Interventions were based on the proportionate universalism principle: universal standard care for all groups and proportionate care for the LA.S.S group. Main outcome was body mass index z-score (BMIz) assessed before and 1 year after inclusion.
A total of 1419 adolescents were included and 1143 followed up at 1 year: 649 in A.S, 158 in LA.S and 336 in LA.S.S groups. BMIz decreased significantly for boys (-0.11 [95% CI, -0.13 to -0.08]; p < 0.0001) and girls (-0.05 [-0.08 to -0.03]; p < 0.0001). No equivalence between LA.S.S and A.S groups was evidenced. For girls, the trend to superiority for LA.S.S was confirmed by the more favourable change (-0.06 [-0.11 to -0.01]; p = 0.01) observed on superiority analysis, with no differential change for boys (0.02 [-0.03 to 0.08]; p = 0.41).
A public health school-based intervention using the proportionate universalism principle may be effective in not worsening or even reducing overweight social inequalities in adolescents, especially for girls. Overcoming social barriers may help health professionals dealing with the burden and inequalities of overweight in adolescents.
社会经济地位较低的青少年中普遍存在超重/肥胖现象，这导致了健康不平等。然而，目前缺乏针对减少青少年体重方面社会不平等的循证干预措施。我们旨在研究强化对社会经济地位较低的青少年的护理管理是否与对高社会经济地位青少年的标准护理管理具有同等效果，以减少超重。
PRALIMAP-INÈS 是一项多中心试验，纳入了法国东北部 35 所国立高中和中学。根据家庭富裕程度评分（Family Affluence Scale score），对筛查出并经临床确诊为超重/肥胖的 1639 名 13-18 岁青少年进行了基于人群的抽样，将他们分为两组：优势组（得分>5），接受标准护理管理（A.S），劣势组随机分为两组（1:2 比例）：标准护理管理（LA.S）和标准及强化护理管理（LA.S.S）。干预措施基于比例普遍主义原则：为所有组提供普遍的标准护理，为 LA.S.S 组提供比例护理。主要结局指标是入组前和入组后 1 年的体重指数 z 评分（BMIz）。
共纳入 1419 名青少年，1143 名青少年在 1 年后进行了随访：A.S 组 649 名，LA.S 组 158 名，LA.S.S 组 336 名。男孩的 BMIz 显著下降（-0.11 [95% CI，-0.13 至-0.08]；p<0.0001），女孩的 BMIz 也显著下降（-0.05 [-0.08 至-0.03]；p<0.0001）。没有证据表明 LA.S.S 组与 A.S 组之间具有等效性。对于女孩，通过优势分析证实了 LA.S.S 组的改善趋势更为有利，其 BMIz 变化值为-0.06 [-0.11 至-0.01]；p=0.01），而男孩的 BMIz 变化值无差异（0.02 [-0.03 至 0.08]；p=0.41）。
使用比例普遍主义原则的公共卫生学校干预措施可能在减少青少年超重方面的社会不平等方面是有效的，特别是对女孩而言。克服社会障碍可能有助于卫生专业人员应对青少年超重的负担和不平等。
