Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, No.74 Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, People's Republic of China.
BMC Med. 2022 Sep 2;20(1):325. doi: 10.1186/s12916-022-02462-6.
Adolescent obesity has been reported to have deleterious consequences but is considered a promising modifiable risk factor. We aimed to investigate the optimal intervention for obese and overweight children and adolescents.
We searched the Medline (PubMed, 1946-December 2020), PsycINFO (Ovid, 1927-December 2020), Cochrane library (1966-December 2020), Web of Science (1900-December 2020), Embase (1974-December 2020), CINAHL (1937-December 2020), Chinese Biomedical Literature (1978-December 2020), and ClinicalTrials.gov (December 2020) databases. We included randomized controlled trials (RCTs) reporting the association between various interventions and obese/overweight children and adolescents. The quality of the included studies was judged by two independent reviewers using the Cochrane Collaboration Risk of Bias Tool. A Bayesian network meta-analysis was conducted to summarize the comparative effectiveness of interventions based on several outcomes.
We included 118 RCTs comprising 71,064 participants in our analyses. Based on the outcome of the body mass index (BMI), face-to-face physical activity (FTF PA) combined with dietary intervention (DI) (mean difference [MD] = - 0.98; 95% credible interval [CrI] - 1.19, - 0.77), FTF multi-lifestyle intervention (MLI) (MD = - 0.95; 95% CrI - 1.14, - 0.75), and mobile health (MH)-delivered MLI (MD = - 0.87; 95% CrI - 1.63, - 0.09) showed significant benefits over the named control group (NCG). For the outcome of BMI z-score, FTF PA+DI (MD = - 0.10; 95% CrI - 0.15, - 0.04) and MH-delivered PA+DI (MD = - 0.09; 95% CrI - 0.14, - 0.04) were more effective than the NCG. Sensitivity analyses revealed similar findings after exclusion of studies with < 12-month and 24-month outcome assessments for the intervention, which indicated the results were stable.
Based on limited quality evidence and limited direct evidence, our preliminary findings showed that FTF-PA+DI, FTF-MLI, and MH-delivered MLI improved the health-related parameters in obese adolescents, in comparison with NCG. Owing to the absence of strong, direct evidence of a significant difference between the various interventions for the four outcomes, we can only cautiously suggest that FTF-PA+DI is likely the most effective intervention.
青少年肥胖已被报道会产生有害后果，但被认为是一种有希望的可改变的风险因素。我们旨在研究针对肥胖和超重儿童和青少年的最佳干预措施。
我们检索了 Medline（PubMed，1946 年-2020 年 12 月）、PsycINFO（Ovid，1927 年-2020 年 12 月）、Cochrane 图书馆（1966 年-2020 年 12 月）、Web of Science（1900 年-2020 年 12 月）、Embase（1974 年-2020 年 12 月）、CINAHL（1937 年-2020 年 12 月）、中国生物医学文献（1978 年-2020 年 12 月）和 ClinicalTrials.gov（2020 年 12 月）数据库。我们纳入了报告各种干预措施与肥胖/超重儿童和青少年之间关联的随机对照试验（RCT）。两位独立评审员使用 Cochrane 协作风险偏倚工具评估纳入研究的质量。基于多项结局，我们进行了贝叶斯网状荟萃分析，以总结干预措施的相对有效性。
我们纳入了 118 项 RCT，包含 71064 名参与者。基于体重指数（BMI）的结局，面对面体力活动（FTF PA）联合饮食干预（DI）（平均差异[MD] = -0.98；95%可信区间[CrI] = -1.19，-0.77）、FTF 多生活方式干预（MLI）（MD = -0.95；95% CrI = -1.14，-0.75）和移动健康（MH）提供的 MLI（MD = -0.87；95% CrI = -1.63，-0.09）与命名对照组（NCG）相比均具有显著优势。对于 BMI z 分数的结局，FTF PA+DI（MD = -0.10；95% CrI = -0.15，-0.04）和 MH 提供的 PA+DI（MD = -0.09；95% CrI = -0.14，-0.04）比 NCG 更有效。敏感性分析显示，在排除干预措施的 <12 个月和 24 个月结局评估的研究后，结果相似，表明结果稳定。
基于有限的质量证据和有限的直接证据，我们的初步发现表明，与 NCG 相比，FTF-PA+DI、FTF-MLI 和 MH 提供的 MLI 改善了肥胖青少年的健康相关参数。由于缺乏四项结局中各种干预措施之间具有显著差异的有力、直接证据，我们只能谨慎地建议 FTF-PA+DI 可能是最有效的干预措施。
