Seral-Cortes M, De Miguel-Etayo P, Zapata P, Miguel-Berges M L, Moreno L A
Growth, Exercise, NUtrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria, Aragón (IIS Aragón), Universidad de Zaragoza, 50009, Zaragoza, Spain.
Department of Psychiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain.
BMC Public Health. 2021 Feb 12;21(1):348. doi: 10.1186/s12889-021-10297-8.
Obesity in children is one of the most severe public health challenges of the current century and Type 2 Diabetes Mellitus (T2DM) frequency is also escalating. More so, the importance of process evaluation (PE) in complex interventions is increasingly recognized. The present review, aims to identify the effectiveness in terms of body composition parameters in a generation of articles to prevent obesity and T2DM in children. We hypothesise that those studies reporting PE applying the latest implementation guidelines suggested by the researchers would potentially show positive changes in body composition compared to those not reporting it. Additionally, we will evaluate the implementation degree of PE in those articles considering it and describe the PE subcomponents. Lastly, we aim to assess the intervention target used and its results.
A literature review was performed in parallel by 2 independent reviewers. A final number of 41 studies were selected for inclusion criteria.
Meta-analysis of BMI and zBMI found non-significant effects of the proposed interventions. Sub-group analysis revealed only a significant effect in studies which performed PE. Moreover, PE was reported in 42% effective studies and 57% non-effective studies. Fidelity and satisfaction were the most implemented PE subcomponents, although there was a generally low grade of PE use (7/41). The highest proportion of effectiveness (83%) was shown in interventions of physical activity alone while the intervention most used was 3-arm target (diet, PA and BS).
Overall, obesity and T2DM prevention studies included in this review are not effective in terms of BMI and zBMI. Those studies performing PE reported to be effective in terms of BMI, while studies not reporting PE did not have positive results in terms of BMI and zBMI. In addition, none of the intervention studies included all PE indicators and most studies, which included PE in their interventions, did not provide full report of the PE components, according to the guidelines used for the present review. PROSPERO registration number: CRD42018093667.
儿童肥胖是本世纪最严峻的公共卫生挑战之一，2型糖尿病（T2DM）的发病率也在不断上升。此外，过程评估（PE）在复杂干预措施中的重要性日益得到认可。本综述旨在确定一系列预防儿童肥胖和T2DM的文章在身体成分参数方面的有效性。我们假设，与未报告PE的研究相比，那些报告了采用研究人员建议的最新实施指南进行PE的研究可能会在身体成分方面显示出积极变化。此外，我们将评估那些考虑了PE的文章中PE的实施程度，并描述PE的子成分。最后，我们旨在评估所使用的干预目标及其结果。
由2名独立评审员并行进行文献综述。最终选定41项研究纳入标准。
对BMI和zBMI的荟萃分析发现，所提出的干预措施没有显著效果。亚组分析显示，仅在进行了PE的研究中有显著效果。此外，在42%的有效研究和57%的无效研究中报告了PE。保真度和满意度是实施最多的PE子成分，尽管PE的总体使用程度较低（7/41）。单独体育活动干预的有效性比例最高（83%），而最常用的干预是三臂目标（饮食、体育活动和行为策略）。
总体而言，本综述中纳入的肥胖和T2DM预防研究在BMI和zBMI方面无效。那些进行了PE的研究报告在BMI方面有效，而未报告PE的研究在BMI和zBMI方面没有积极结果。此外，根据本综述所使用的指南，没有一项干预研究包括所有的PE指标且大多数在干预中纳入了PE的研究没有提供PE成分的完整报告。PROSPERO注册号：CRD42018093667。
