Hodder Rebecca K, O'Brien Kate M, Lorien Sasha, Wolfenden Luke, Moore Theresa H M, Hall Alix, Yoong Sze Lin, Summerbell Carolyn
Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Longworth Avenue, Wallsend, NSW 2287, Australia.
College of Health Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
EClinicalMedicine. 2022 Oct 19;54:101635. doi: 10.1016/j.eclinm.2022.101635. eCollection 2022 Dec.
Childhood obesity remains a global public health priority due to the enormous burden it generates. Recent surveillance data suggests there has been a sharp increase in the prevalence of childhood obesity during the COVID-19 pandemic. The Cochrane review of childhood obesity prevention interventions (0-18 years) updated to 2015 is the most rigorous and comprehensive review of randomised controlled trials (RCTs) on this topic. A burgeoning number of high quality studies have been published since that are yet to be synthesised.
An update of the Cochrane systematic review was conducted to include RCT studies in school-aged children (6-18 years) published to 30 June 2021 that assessed effectiveness on child weight (PROSPERO registration: CRD42020218928). Available cost-effectiveness and adverse effect data were extracted. Intervention effects on body mass index (BMI) were synthesised in random effects meta-analyses by setting (school, after-school program, community, home), and meta-regression examined the association of study characteristics with intervention effect.
Meta-analysis of 140 of 195 included studies (183,063 participants) found a very small positive effect on body mass index for school-based studies (SMD -0·03, 95%CI -0·06,-0·01; trials = 93; participants = 131,443; moderate certainty evidence) but not after-school programs, community or home-based studies. Subgroup analysis by age (6-12 years; 13-18 years) found no differential effects in any setting. Meta-regression found no associations between study characteristics (including setting, income level) and intervention effect. Ten of 53 studies assessing adverse effects reported presence of an adverse event. Insufficient data was available to draw conclusions on cost-effectiveness.
This updated synthesis of obesity prevention interventions for children aged 6-18 years, found a small beneficial impact on child BMI for school-based obesity prevention interventions. A more comprehensive assessment of interventions is required to identify mechanisms of effective interventions to inform future obesity prevention public health policy, which may be particularly salient in for COVID-19 recovery planning.
This research was funded by the National Health and Medical Research Council (NHMRC), Australia (Application No APP1153479).
儿童肥胖因其造成的巨大负担，仍然是全球公共卫生的重点问题。近期的监测数据表明，在新冠疫情期间，儿童肥胖的患病率急剧上升。截至2015年更新的Cochrane关于儿童肥胖预防干预措施（0至18岁）的综述，是对该主题随机对照试验（RCT）最严格、最全面的综述。自那时以来，已有大量高质量研究发表，但尚未进行综合分析。
对Cochrane系统综述进行更新，纳入截至2021年6月30日发表的针对学龄儿童（6至18岁）的RCT研究，这些研究评估了对儿童体重的影响（PROSPERO注册号：CRD42020218928）。提取了可用的成本效益和不良反应数据。通过设置（学校、课后项目、社区、家庭），在随机效应荟萃分析中综合干预对体重指数（BMI）的影响，荟萃回归分析研究特征与干预效果之间的关联。
对195项纳入研究中的140项（183,063名参与者）进行的荟萃分析发现，基于学校的研究对体重指数有非常小的正向影响（标准化均值差 -0·03，95%置信区间 -0·06，-0·01；试验 = 93；参与者 = 131,443；中等确定性证据），但课后项目、社区或家庭为基础的研究没有。按年龄（6至12岁；13至18岁）进行的亚组分析在任何设置中均未发现差异效应。荟萃回归分析发现研究特征（包括设置、收入水平）与干预效果之间没有关联。在评估不良反应的53项研究中，有10项报告存在不良事件。没有足够的数据得出关于成本效益的结论。
这项针对6至18岁儿童肥胖预防干预措施的更新综合分析发现，基于学校的肥胖预防干预措施对儿童BMI有微小的有益影响。需要对干预措施进行更全面的评估，以确定有效干预措施 的机制，为未来的肥胖预防公共卫生政策提供信息，这在新冠疫情恢复规划中可能尤为重要。
本研究由澳大利亚国家卫生与医学研究委员会（NHMRC）资助（申请编号APP1153479）。
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