Dabravolskaj Julia, Montemurro Genevieve, Ekwaru John Paul, Wu Xiu Yun, Storey Kate, Campbell Sandra, Veugelers Paul J, Ohinmaa Arto
School of Public Health, University of Alberta, Edmonton, Canada.
John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada.
Prev Med Rep. 2020 Jun 1;19:101138. doi: 10.1016/j.pmedr.2020.101138. eCollection 2020 Sep.
Childhood obesity and associated modifiable risk factors exert significant burden on the health care system. The goal of this systematic review and meta-analysis was to examine the effectiveness of school-based intervention types perceived by Canadian stakeholders in health and education as feasible, acceptable and sustainable in terms of improving physical activity (PA), fruit and vegetable intake, and body weight. We searched multiple databases for studies that evaluated school-based interventions to prevent obesity and associated risk factors (i.e., unhealthy diet, physical inactivity, sedentary behaviour) in children aged 4-18 years from January 1, 2012 to January 28, 2020. From 10,871 identified records, we included 83 and 80 studies in our systematic review and meta-analysis, respectively. Comprehensive School Health (CSH) and interventions which focused on modifications to school nutrition policies showed statistically significant positive effects on fruit intake of 0.13 (95% CI: 0.04, 0.23) and 0.30 (95% CI: 0.1, 0.51) servings per day, respectively. No intervention types showed statistically significant effect on vegetable intake. CSH, modifications to physical education (PE) curriculum, and multicomponent interventions showed statistically significant difference in BMI of -0.26 (95% CI: -0.40, -0.12), -0.16 (95% CI: -0.3, -0.02), and -0.18 (95% CI: -0.29, -0.07), respectively. CSH interventions showed positive effect on step-count per day, but no other types of interventions showed significant effect on any of PA outcome measures. Thus, the results of this systematic review and meta-analysis suggest that decision-makers should carefully consider CSH, multicomponent interventions, modifications to PE curricula and school nutrition policies to prevent childhood obesity.
儿童肥胖及相关的可改变风险因素给医疗保健系统带来了沉重负担。本系统评价和荟萃分析的目的是，考察加拿大卫生与教育领域的利益相关者认为在改善身体活动（PA）、水果和蔬菜摄入量以及体重方面可行、可接受且可持续的校本干预类型的有效性。我们在多个数据库中检索了2012年1月1日至2020年1月28日期间评估4至18岁儿童预防肥胖及相关风险因素（即不健康饮食、缺乏身体活动、久坐行为）的校本干预措施的研究。从10,871条检索到的记录中，我们分别纳入了83项和80项研究进行系统评价和荟萃分析。综合学校健康（CSH）及侧重于修改学校营养政策的干预措施，分别对每日水果摄入量产生了显著的积极影响，增加量分别为0.13份（95%置信区间：0.04, 0.23）和0.30份（95%置信区间：0.1, 0.51）。没有干预类型对蔬菜摄入量产生显著影响。CSH、体育（PE）课程修改及多组分干预措施在体重指数（BMI）方面分别产生了显著差异，变化量分别为-0.26（95%置信区间：-0.40, -0.12）、-0.16（95%置信区间：-0.3, -0.02）和-0.18（95%置信区间：-0.29, -0.07）。CSH干预措施对每日步数产生了积极影响，但没有其他类型的干预措施对任何PA结果指标产生显著影响。因此，本系统评价和荟萃分析的结果表明，决策者应认真考虑CSH、多组分干预措施、PE课程修改和学校营养政策，以预防儿童肥胖。
