Aychiluhm Setognal B, Mondal Utpal K, Isaac Vivian, Ross Allen G, Ahmed Kedir Y
Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia.
Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
JAMA Netw Open. 2025 Apr 1;8(4):e254331. doi: 10.1001/jamanetworkopen.2025.4331.
The rapid rise in childhood central obesity and its cardiometabolic complications in adulthood highlight the urgent need for targeted global interventions.
To examine the association of lifestyle, behavioral, and pharmacological interventions with childhood central obesity.
MEDLINE, Embase, CINHAL, PsycINFO, PubMed, Academic Search Database, and ProQuest from inception to September 25, 2024.
Inclusion criteria included (1) randomized clinical trials (RCTs) focusing on children aged 5 to 18 years with overweight or obesity at baseline and (2) measured central obesity as a primary or secondary outcome.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was followed. Two authors independently extracted data. Risk of bias was assessed using the revised Cochrane risk-of-bias tool (RoB 2.0). A random-effects meta-analysis was conducted to pool standardized mean differences (SMD) from individual studies. Sensitivity analysis, meta-regression, and subgroup analyses were also conducted.
The main outcome was childhood central obesity measured using waist circumference (WC), waist-to-height ratio, waist-to-hip ratio, and WC z score.
This review included 34 RCTs, involving 8183 children aged 5 to 18 years. Twelve studies had a low risk of bias, whereas 8 were deemed to have a higher risk of bias. The meta-analysis of 2 RCTs examining low-fat lunchboxes and a Mediterranean diet along with physical activity (lasting up to 150 minutes per week over 6 to 9 months) showed a significant association with WC (standard mean difference [SMD], -0.38 [95% CI, -0.58 to -0.19]). Five additional RCTs involved behavioral interventions on dietary education to reduce unhealthy snacks, increase fruit and vegetable intake, promote daily physical activity, and limit screen time, supported by online resources also showed a significant association with WC (SMD, -0.54 [95% CI, -1.06 to -0.03]). However, standalone dietary, physical activity, pharmacotherapy, dietary supplements, motivational interviewing, and combined dietary, physical activity, and behavioral methods did not show a significant association with WC.
In this meta-analysis of RCTs, combining dietary changes with physical activity, as well as using behavioral strategies alone, were associated with reduced central obesity in children from high- and middle-income countries. Findings from this study have policy implications for Sustainable Development Goals of ending all forms of malnutrition and reducing premature mortality from noncommunicable diseases.
儿童期中心性肥胖及其成年期心血管代谢并发症的迅速增加凸显了全球针对性干预措施的迫切需求。
研究生活方式、行为和药物干预与儿童期中心性肥胖之间的关联。
从创刊至2024年9月25日的MEDLINE、Embase、CINHAL、PsycINFO、PubMed、学术搜索数据库和ProQuest。
纳入标准包括：（1）针对基线时超重或肥胖的5至18岁儿童的随机临床试验（RCT）；（2）将中心性肥胖作为主要或次要结局进行测量。
遵循系统评价和Meta分析的首选报告项目（PRISMA）报告指南。两位作者独立提取数据。使用修订后的Cochrane偏倚风险工具（RoB 2.0）评估偏倚风险。进行随机效应Meta分析以汇总各研究的标准化均数差（SMD）。还进行了敏感性分析、Meta回归和亚组分析。
主要结局是使用腰围（WC）、腰高比、腰臀比和WC z评分测量的儿童期中心性肥胖。
本综述纳入34项RCT，涉及8183名5至18岁儿童。12项研究偏倚风险较低，而8项被认为偏倚风险较高。对2项RCT的Meta分析显示，低脂午餐盒、地中海饮食以及体育活动（在6至9个月内每周持续长达150分钟）与WC存在显著关联（标准化均数差[SMD]，-0.38[95%CI，-0.58至-0.19]）。另外5项RCT涉及饮食教育方面的行为干预，以减少不健康零食、增加水果和蔬菜摄入量、促进日常体育活动以及限制屏幕时间，并得到在线资源支持，也显示与WC存在显著关联（SMD，-0.54[95%CI，-1.06至-0.03]）。然而，单独的饮食、体育活动、药物治疗、膳食补充剂、动机性访谈以及饮食、体育活动和行为相结合的方法与WC均未显示出显著关联。
在这项RCT的Meta分析中，将饮食改变与体育活动相结合以及单独使用行为策略与中高收入国家儿童中心性肥胖的降低相关。本研究结果对实现消除一切形式营养不良和降低非传染性疾病过早死亡率的可持续发展目标具有政策意义。
