Division of General Pediatrics, Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, California;
Division of Primary Care and Duke Center for Childhood Obesity Research, Department of Pediatrics, Medical Center, Duke University, Durham, North Carolina.
Pediatrics. 2021 May;147(5). doi: 10.1542/peds.2020-049866.
Children who become overweight by age 2 have greater risk of long-term obesity and health problems. The study aim was to assess the effectiveness of a primary care-based intervention on the prevalence of overweight at age 24 months.
In a cluster-randomized trial, sites were randomly assigned to the Greenlight intervention or an attention-control arm. Across 4 pediatric residency clinics, we enrolled infant-caregiver dyads at the 2-month well-child visit. Inclusion criteria included parent English- or Spanish-speaking and birth weight ≥1500 g. Designed with health-literacy principles, the intervention included a parent toolkit at each well-child visit, augmented by provider training in clear-health communication. The primary outcome was proportion of children overweight (BMI ≥85th percentile) at age 24 months. Secondary outcomes included weight status (BMI score).
A total of 459 intervention and 406 control dyads were enrolled. In total, 49% of all children were overweight at 24 months. Adjusted odds for overweight at 24 months (treatment versus control) was 1.02 (95% confidence interval [CI]: 0.63 to 1.64). Adjusted mean BMI score differences (treatment minus control) were -0.04 (95% CI: -0.07 to -0.01), -0.09 (95% CI: -0.14 to -0.03), -0.19 (-0.33 to -0.05), -0.20 (-0.36 to -0.03), -0.16 (95% CI: -0.34 to 0.01), and 0.00 (95% CI -0.21 to 0.21) at 4, 6, 12, 15, 18, and 24 months, respectively.
The intervention resulted in less weight gain through age 18 months, which was not sustained through 24 months. Clinic-based interventions may be beneficial for early weight gain, but greater intervention intensity may be needed to maintain positive effects.
2 岁时超重的儿童患长期肥胖症和健康问题的风险更大。本研究旨在评估基于初级保健的干预措施对 24 个月时超重患病率的影响。
在一项集群随机试验中，将研究地点随机分配到绿光干预组或对照组。在 4 个儿科住院医师诊所，我们在 2 个月的婴儿健康检查时招募了婴儿-照顾者二人组。纳入标准包括父母会讲英语或西班牙语，以及出生体重≥1500 克。该干预措施采用健康素养原则设计，每次儿童就诊时为父母提供一个工具包，并通过提供清晰的健康沟通培训来增强服务提供者的培训。主要结局是 24 个月时超重儿童（BMI≥85 百分位）的比例。次要结局包括体重状况（BMI 得分）。
共纳入 459 名干预组和 406 名对照组的婴儿-照顾者二人组。共有 49%的儿童在 24 个月时超重。24 个月时超重的调整后比值比（治疗组与对照组）为 1.02（95%置信区间[CI]：0.63 至 1.64）。调整后的平均 BMI 得分差异（治疗组减去对照组）分别为-0.04（95%CI：-0.07 至 -0.01）、-0.09（95%CI：-0.14 至 -0.03）、-0.19（-0.33 至 -0.05）、-0.20（-0.36 至 -0.03）、-0.16（95%CI：-0.34 至 0.01）和 0.00（95%CI：-0.21 至 0.21），分别在 4、6、12、15、18 和 24 个月时。
该干预措施导致 18 个月时体重增加减少，但在 24 个月时并未持续。基于诊所的干预措施可能对早期体重增加有益，但需要更大的干预强度来维持积极的效果。
