陪伴强化多方面体重管理对中国肥胖成年人的有效性：一项为期6个月的多中心随机临床试验

Effectiveness of companion-intensive multi-aspect weight management in Chinese adults with obesity: a 6-month multicenter randomized clinical trial.

作者信息

Jiang Wanzi, Huang Shushu, Ma Shuai, Gong Yingyun, Fu Zhenzhen, Zhou Li, Hu Wen, Mao Guofang, Ma Zhimin, Yang Ling, Tang Guangfeng, Sun Xiaofang, Zhang Ping, Bai Jianling, Chen Lei, Shi Bimin, Ye Xinhua, Zhou Hongwen

机构信息

Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.

Department of Geriatrics, The Affiliated Hospital of Nantong University, Nantong, 226001, China.

出版信息

Nutr Metab (Lond). 2021 Feb 3;18(1):17. doi: 10.1186/s12986-020-00511-6.

DOI:10.1186/s12986-020-00511-6

PMID:33536048

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7856778/

Abstract

BACKGROUND

Obesity is a globally increasing health epidemic requiring early lifestyle intervention. Our main objective was to examine the effectiveness of companion-intensive multi-aspect weight management (CIMWM) in Chinese adults with obesity.

METHODS

In this 6-month, prospective, open-label, multicenter, randomized controlled clinical trial, we recruited 272 obese adults aged 18-50 years with a body mass index (BMI) ≥ 28.0 kg/m and capable of using smartphones. CIMWM (n = 136) offered both daily online instructions and monthly face-to-face guidance by physicians, dietitians, and health managers along with the provision of meal replacements in the first 3 months. Traditional multi-aspect weight management (TMWM, n = 136) provided monthly face-to-face guidance by the same panel of professionals and the same meal replacements as CIMWM group, but required subjects to complete daily self-monitoring instead of offering daily online instructions. Body composition and metabolic parameters were assessed at baseline, 1, 2, 3, and 6 months by physicians. The primary outcomes were clinically-significant weight loss and changes in BMI and body composition.

RESULTS

Participants in both groups showed significantly reduced BMI, body fat mass (BFM), visceral fat area (VFA), and HOMA-IR (p < 0.05). CIMWM was shown to be superior to TMWM in the improvement of clinically-significant weight loss, BMI, total cholesterol (TC), the body composition parameters BFM and the skeletal muscle mass-to-visceral fat area ratio (S/V) (p < 0.05). The non-alcoholic fatty liver disease score (NFS) was negatively related to S/V at baseline. After weight management, NFS was lowered among individuals with levels in the highest tertile (p < 0.05). Metabolic memory in terms of the continuous reduction of BMI, BFM, and TC was retained up to 6 months in spite of participants transferring to self-monitoring assessment in the final 3 months.

CONCLUSIONS

The CIMWM strategy in obese Chinese adults is proved to be more effective than TMWM in weight loss, and motivates greater adherence to intervention and lifestyle reprogramming. Trial registration Chinese Clinical Trial Registry, ChiCTR1800017463, Registered July 31, 2018. http://www.chictr.org.cn/showproj.aspx?proj=29649 .

摘要

背景

肥胖是一种在全球范围内日益严重的健康问题，需要早期进行生活方式干预。我们的主要目标是研究同伴强化多方面体重管理（CIMWM）对中国肥胖成年人的有效性。

方法

在这项为期6个月的前瞻性、开放标签、多中心随机对照临床试验中，我们招募了272名年龄在18至50岁之间、体重指数（BMI）≥28.0kg/m²且能够使用智能手机的肥胖成年人。CIMWM组（n = 136）提供每日在线指导以及医生、营养师和健康管理人员每月一次的面对面指导，并在前3个月提供代餐。传统多方面体重管理组（TMWM，n = 136）由同一专业团队提供每月一次的面对面指导，并提供与CIMWM组相同的代餐，但要求受试者完成每日自我监测，而不是提供每日在线指导。医生在基线、第1、2、3和6个月评估身体成分和代谢参数。主要结局是具有临床意义的体重减轻以及BMI和身体成分的变化。

结果

两组参与者的BMI、体脂量（BFM）、内脏脂肪面积（VFA）和HOMA-IR均显著降低（p < 0.05）。在改善具有临床意义的体重减轻、BMI、总胆固醇（TC）、身体成分参数BFM以及骨骼肌质量与内脏脂肪面积比（S/V）方面，CIMWM被证明优于TMWM（p < 0.05）。非酒精性脂肪肝病评分（NFS）在基线时与S/V呈负相关。体重管理后，处于最高三分位数水平的个体的NFS降低（p < 0.05）。尽管参与者在最后3个月转为自我监测评估，但在长达6个月的时间里，BMI（身体质量指数）、BFM（体脂肪量）和TC（总胆固醇）持续下降所体现的代谢记忆仍然存在。

结论

事实证明，肥胖中国成年人的CIMWM策略在减肥方面比TMWM更有效，并且能促使人们更好地坚持干预措施和重新规划生活方式。试验注册中国临床试验注册中心，ChiCTR1800017463，2018年7月31日注册。http://www.chictr.org.cn/showproj.aspx?proj=29649 。