Department of Women and Children's Health, King's College London, London, UK.
Department of Nutritional Sciences, School of Life Course Sciences, King's College London, London, UK.
Matern Child Nutr. 2022 Jul;18(3):e13354. doi: 10.1111/mcn.13354. Epub 2022 Mar 25.
The prevalence of childhood obesity is increasing worldwide with long-term health consequences. Effective strategies to stem the rising childhood obesity rates are needed but systematic reviews of interventions have reported inconsistent effects. Evaluation of interventions could provide more practically relevant information when considered in the context of the setting in which the intervention was delivered. This systematic review has evaluated diet and physical activity interventions aimed at reducing obesity in children, from birth to 5 years old, by intervention setting. A systematic review of the literature, consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Three electronic databases were searched from 2010 up to December 2020 for randomised controlled trials aiming to prevent or treat childhood obesity in children up to 5 years old. The studies were stratified according to the setting in which the intervention was conducted. Twenty-eight studies were identified and included interventions in childcare/school (n = 11), home (n = 5), community (n = 5), hospital (n = 4), e-health (n = 2) and mixed (n = 1) settings. Thirteen (46%) interventions led to improvements in childhood obesity measures, including body mass index z-score and body fat percentage, 12 of which included both parental/family-based interventions in conjunction with modifying the child's diet and physical activity behaviours. Home-based interventions were identified as the most effective setting as four out of five studies reported significant changes in the child's weight outcomes. Interventions conducted in the home setting and those which included parents/families were effective in preventing childhood obesity. These findings should be considered when developing optimal strategies for the prevention of childhood obesity.
儿童肥胖症的患病率在全球范围内不断上升，对长期健康造成影响。需要采取有效的策略来遏制儿童肥胖率的上升，但系统评价干预措施的报告显示，干预效果不一致。当从干预实施的环境角度评估干预措施时，可以提供更具实际意义的信息。本系统评价评估了旨在通过干预环境减少儿童肥胖的饮食和体育活动干预措施，干预环境从儿童出生到 5 岁不等。根据《系统评价和荟萃分析的首选报告项目》（PRISMA）指南，对文献进行了系统综述。从 2010 年到 2020 年 12 月，对三个电子数据库进行了检索，以查找旨在预防或治疗 5 岁以下儿童肥胖的随机对照试验。研究按照干预实施的环境进行分层。确定了 28 项研究，并纳入了在儿童保育/学校（n=11）、家庭（n=5）、社区（n=5）、医院（n=4）、电子健康（n=2）和混合（n=1）环境中开展的干预措施。其中 13 项（46%）干预措施导致儿童肥胖测量指标的改善，包括体重指数 z 评分和体脂百分比，其中 12 项干预措施包括父母/家庭为基础的干预措施以及改变儿童的饮食和体育活动行为。家庭环境被认为是最有效的环境，因为五项研究中有四项报告了儿童体重结果的显著变化。在家庭环境中进行的干预措施以及那些包括父母/家庭的干预措施，对于预防儿童肥胖是有效的。在制定预防儿童肥胖的最佳策略时，应考虑这些发现。
