Department of Nutrition, University of Tennessee Knoxville, Knoxville, TN, USA.
Cherokee Health Systems, Knoxville, TN, USA.
Child Obes. 2022 Jun;18(4):254-265. doi: 10.1089/chi.2021.0071. Epub 2021 Nov 12.
This proof-of-concept trial examined a 6-month Prevention Plus (PP) intervention implemented in a federally qualified health center on child standardized BMI (ZBMI), using a planned clinical effect threshold of -0.16 ZBMI. The relationship between food security status and PP delivered with caregiver goals (PP+) and without caregiver goals (PP-) on energy balance behaviors (, fruits and vegetables, physical activity) and child ZBMI was explored. Seventy-three, underserved children, 4-10 years of age with a BMI ≥85th percentile, were randomized to one of two interventions, PP+ and PP-, both providing 2.5 hours of contact time, implemented in five clinics by behavioral health consultants (BHCs). Outcomes were child anthropometrics (included 9-month follow-up), implementation data collected from electronic health records, and caregiver and BHC evaluations. Children were 57.5% female and 78.1% Hispanic, with 32.9% from food-insecure households and 58.9% from households with an annual income of less than $20,000. Child ZBMI significantly ( < 0.05) decreased at 6 and 9 months (-0.08 ± 0.24 and -0.12 ± 0.43), with only PP+ reaching the clinical threshold at 9 months (PP+: -0.20 ± 0.42 vs. PP-: -0.05 ± 0.42). Sixty-four percent of families attended ≥50% of the sessions, and BHCs delivered 78.5% ± 23.5% of components at attended sessions. Caregivers were satisfied with the intervention and BHCs found the intervention helpful/useful. No relationship with food insecurity status and outcomes was found. PP+ when delivered by a primary care provider to underserved families showed promise for producing a clinically meaningful effect. Families and providers felt the intervention was a viable treatment option.
这项概念验证试验考察了在一家符合联邦资格的健康中心实施的为期 6 个月的预防加（PP）干预措施，该措施使用了 -0.16 ZBMI 的计划临床效果阈值来衡量儿童标准化 BMI（ZBMI）的变化。研究了食品保障状况与 caregiver 目标（PP+）和无 caregiver目标（PP-）的 PP 干预措施对能量平衡行为（、水果和蔬菜、身体活动）和儿童 ZBMI 的关系。共有 73 名服务不足的 4-10 岁儿童，BMI≥85 百分位，被随机分配到两种干预措施中的一种，PP+和 PP-，两种干预措施都提供 2.5 小时的接触时间，由行为健康顾问（BHC）在五家诊所实施。结果包括儿童人体测量学（包括 9 个月的随访）、从电子健康记录中收集的实施数据以及 caregiver 和 BHC 的评估。儿童中 57.5%为女性，78.1%为西班牙裔，32.9%来自食品不安全家庭，58.9%来自年收入低于 20,000 美元的家庭。儿童 ZBMI 在 6 个月和 9 个月时显著（ < 0.05）下降（-0.08 ± 0.24 和 -0.12 ± 0.43），只有 PP+在 9 个月时达到了临床阈值（PP+：-0.20 ± 0.42 与 PP-：-0.05 ± 0.42）。64%的家庭参加了≥50%的课程，BHC 在参加的课程中提供了 78.5%±23.5%的课程内容。Caregivers 对干预措施感到满意，BHCs 认为干预措施有帮助/有用。没有发现与食品不安全状况和结果之间存在关系。当由初级保健提供者向服务不足的家庭提供 PP+时，显示出产生临床有意义效果的潜力。家庭和提供者认为该干预措施是一种可行的治疗选择。
