Margetin Cheryl A, Rigassio Radler Diane, Thompson Kyle, Ziegler Jane, Dreker Margaret, Byham-Gray Laura, Chung Mei
Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University Biomedical and Health Sciences, Newark, New Jersey,USA.
Department of Nutrition and Health Care Management, Appalachian State University, Boone, North Carolina, USA.
J Am Nutr Assoc. 2022 Feb;41(2):207-229. doi: 10.1080/07315724.2020.1852982. Epub 2021 Apr 27.
This systematic review and meta-analysis evaluated the effect of telehealth (TH) weight management interventions compared to usual care on anthropometric outcomes in children and adolescents with overweight and obesity. Comprehensive searches were conducted identifying randomized controlled trials (RCTs) published between January 1, 2005 and June 1, 2019. Studies using a web-based, smartphone or email TH intervention in children between 2-18 years of age were included. Outcome measures of interest included body mass index (BMI) z-score, BMI percentile, waist circumference (WC) and waist-to-hip-ratio (WHR). The Grade Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to rate strength of evidence (SOE) and a random-effects meta-analysis was performed when five or more RCTs reported the same outcome. Thirteen RCTs met the inclusion criteria for the systematic review. Random effects meta-analysis of 10 RCTs detected a small effect for TH interventions compared to usual care in reducing BMI z-score (pooled net change in BMI z-score = -0.04; 95% CI -0.07, 0.00: I2 = 12%). No significant differences were found between groups for other outcomes. Strength of evidence ratings were low or very low in part due to concerns with heterogeneity in study designs, intervention durations, ages of participants, the type of TH used and risk of bias (ROB) of included studies. There is a low strength of evidence that TH had a small effect on anthropometric outcomes compared to usual care. Future RCTs should be well designed to minimize clinical heterogeneity and ROB. Studies of longer intervention duration with adequate, statistically powered analyses should be conducted.Key teaching pointsStudies using TH with pediatric weight management interventions may be effective to improve health of children with overweight and obesity.Future RCTs should consider clinical heterogeneity of study design for setting, age-group of children, preferences for type of TH and ROB.Studies that include children with severe obesity (<95th%) may need more sensitive outcome measures.Studies of longer duration are needed to better understand long-term weight management success.
本系统评价和荟萃分析评估了远程医疗（TH）体重管理干预措施与常规护理相比，对超重和肥胖儿童及青少年人体测量学指标的影响。进行了全面检索，以识别2005年1月1日至2019年6月1日期间发表的随机对照试验（RCT）。纳入了对2至18岁儿童使用基于网络、智能手机或电子邮件的TH干预措施的研究。感兴趣的结局指标包括体重指数（BMI）z评分、BMI百分位数、腰围（WC）和腰臀比（WHR）。采用推荐意见分级、评估、制定与评价（GRADE）方法对证据强度（SOE）进行评级，当五项或更多RCT报告相同结局时，进行随机效应荟萃分析。十三项RCT符合系统评价的纳入标准。对10项RCT的随机效应荟萃分析发现，与常规护理相比，TH干预措施在降低BMI z评分方面有较小效果（BMI z评分的合并净变化=-0.04；95%CI -0.07，0.00：I2=12%）。其他结局指标在组间未发现显著差异。证据强度评级为低或非常低，部分原因是担心研究设计、干预持续时间、参与者年龄、所使用的TH类型以及纳入研究的偏倚风险（ROB）存在异质性。与常规护理相比，TH对人体测量学指标有较小影响的证据强度较低。未来的RCT应精心设计，以尽量减少临床异质性和ROB。应开展干预持续时间更长且有充分统计学效力分析的研究。关键要点使用TH进行儿科体重管理干预措施的研究可能对改善超重和肥胖儿童的健康有效。未来的RCT应考虑研究设计在环境、儿童年龄组、TH类型偏好和ROB方面的临床异质性。纳入重度肥胖儿童（<第95百分位数）的研究可能需要更敏感的结局指标。需要开展持续时间更长的研究，以更好地了解长期体重管理的成效。
