Hassan Mohamed A, McDonough Daniel J, Ryu Suryeon, Zhou Wanjiang, Oginni John, Gao Zan
Department of Methods and Curriculum, Sports Science College, Helwan University, Cairo, Egypt.
School of Public Health, Division of Epidemiology and Community Health University of Minnesota-Twin Cities, Minneapolis, MN, United States.
Front Public Health. 2024 Dec 17;12:1504279. doi: 10.3389/fpubh.2024.1504279. eCollection 2024.
While many randomized controlled trials (RCTs) have demonstrated the positive effects of school-based programs in reducing body fat among children and teenagers, there is no conclusive evidence to indicate that one approach is superior to another, largely due to the lack of direct and indirect comparisons. This study evaluated the relative effectiveness of various school-based obesity prevention initiatives in improving body mass index (BMI) among children and adolescents using network meta-analysis.
Searches included four databases focusing on articles published in English between the years 2002 and 2024. The primary outcomes were the BMI and BMI z-scores (BMIz) (kg/m). The mean differences (MDs) for each outcome were calculated before and after treatment. The current systematic review synthesized 53 RCTs with a sample of 68,489 children and adolescents.
The results illustrated that the physical activity (PA) only arm was the most effective intervention in improving BMI (MD: -0.42, 95% credible interval (Crl) -0.79, -0.07; = 0.02), while the multiple-component intervention was the most effective in improving BMIz (MD: -0.08, 95% Crl: -0.16, -0.01; = 0.03). Inversely, PA and another component arm were the least effective interventions in improving BMI (MD: 0.64, 95% Crl: -0.23, 1.53; = 0.15). In addition, diet and nutrition only arm was the least effective intervention in improving BMIz (MD: 0.09, 95% Crl: -0.11, 0.28; = 0.36).
In conclusion, both PA-only and multiple-component arms are effective intervention tools/strategies for reducing BMI-related outcomes. However, further large-scale, well-designed studies are needed to investigate the elements of multiple-component arms.
https://www.crd.york.ac.uk/PROSPERO/ identifier CRD42021234742.
虽然许多随机对照试验（RCT）已证明以学校为基础的项目对减少儿童和青少年体脂具有积极作用，但尚无确凿证据表明一种方法优于另一种方法，这主要是由于缺乏直接和间接比较。本研究使用网络荟萃分析评估了各种以学校为基础的肥胖预防举措在改善儿童和青少年体重指数（BMI）方面的相对有效性。
检索了四个数据库，重点关注2002年至2024年间发表的英文文章。主要结局指标为BMI和BMI z评分（BMIz）（kg/m）。计算治疗前后各结局指标的平均差值（MD）。本系统评价综合了53项随机对照试验，样本包括68489名儿童和青少年。
结果表明，仅体育活动（PA）组是改善BMI最有效的干预措施（MD：-0.42，95%可信区间（Crl）-0.79，-0.07；P = 0.02），而多成分干预在改善BMIz方面最有效（MD：-0.08，95% Crl：-0.16，-0.01；P = 0.03）。相反，PA与另一成分组是改善BMI最无效的干预措施（MD：0.64，95% Crl：-0.23，1.53；P = 0.15）。此外，仅饮食和营养组是改善BMIz最无效的干预措施（MD：0.09，95% Crl：-0.11，0.28；P = 0.36）。
总之，仅PA组和多成分组都是降低与BMI相关结局的有效干预工具/策略。然而，需要进一步开展大规模、设计良好的研究来探究多成分组的具体要素。
