在中低收入国家实施干预措施以减少和预防儿童肥胖：系统评价和荟萃分析。

Interventions to reduce and prevent childhood obesity in low-income and middle-income countries: a systematic review and meta-analysis.

机构信息

Slum and Rural Health Initiative, Ibadan, Nigeria; University of North Carolina at Charlotte, Charlotte, NC, USA; College of Medicine, University of Ibadan, Ibadan, Nigeria.

Slum and Rural Health Initiative, Ibadan, Nigeria.

出版信息

Lancet Glob Health. 2023 Mar;11 Suppl 1:S16. doi: 10.1016/S2214-109X(23)00099-2.

DOI:10.1016/S2214-109X(23)00099-2

PMID:36866473

Abstract

BACKGROUND

70% of children with obesity and overweight live in low-income and middle-income countries. Several interventions have been done to reduce the prevalence of childhood obesity and prevent incident cases. Hence, we did a systematic review and meta-analysis to determine the effectiveness of these interventions in reducing and preventing childhood obesity.

METHODS

We conducted a search for randomised controlled trials and quantitative non-randomised studies published on MEDLINE, Embase, Web of Science, and PsycINFO databases between Jan 1, 2010, and Nov 1, 2022. We included interventional studies on the prevention and control of obesity in children up to age 12 years in low-income and middle-income countries. Quality appraisal was performed using Cochrane's risk-of-bias tools. We did three-level random-effects meta-analyses and explored the heterogeneity of studies included. We excluded critical risk-of-bias studies from primary analyses. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation.

FINDINGS

The search generated 12 104 studies, of which eight studies were included involving 5734 children. Six studies were based on obesity prevention, most of which targeted behavioural changes with a focus on counselling and diet, and a significant reduction in BMI was observed (standardised mean difference 2·04 [95% CI 1·01-3·08]; p<0·001). In contrast, only two studies focused on the control of childhood obesity; the overall effect of the interventions in these studies was not significant (p=0·38). The combined studies of prevention and control had a significant overall effect, with study-specific estimates ranging between 0·23 and 3·10, albeit with a high statistical heterogeneity (I>75%).

INTERPRETATION

Preventive interventions, such as behavioural change and diet modification, are more effective than control interventions in reducing and preventing childhood obesity.

FUNDING

None.

摘要

背景

70%的肥胖和超重儿童生活在低收入和中等收入国家。已经采取了多种干预措施来降低儿童肥胖的患病率并预防新发病例。因此，我们进行了系统评价和荟萃分析，以确定这些干预措施在降低和预防儿童肥胖方面的有效性。

方法

我们在 MEDLINE、Embase、Web of Science 和 PsycINFO 数据库中搜索了 2010 年 1 月 1 日至 2022 年 11 月 1 日期间发表的随机对照试验和定量非随机研究。我们纳入了在低收入和中等收入国家中针对 12 岁以下儿童肥胖预防和控制的干预性研究。使用 Cochrane 偏倚风险工具进行质量评估。我们进行了三级随机效应荟萃分析，并探讨了纳入研究的异质性。我们从主要分析中排除了具有关键偏倚风险的研究。我们使用推荐评估、制定与评价（GRADE）评估证据的确定性。

结果

搜索生成了 12104 项研究，其中 8 项研究纳入了 5734 名儿童。六项研究基于肥胖预防，其中大多数针对行为改变，重点是咨询和饮食，观察到 BMI 显著降低（标准化均数差 2.04 [95%CI 1.01-3.08]；p<0.001）。相比之下，只有两项研究专注于儿童肥胖的控制；这些研究中干预措施的总体效果不显著（p=0.38）。预防和控制的综合研究具有显著的总体效果，研究特异性估计值在 0.23 至 3.10 之间，尽管具有高度的统计学异质性（I>75%）。