Brief Primary Care Obesity Interventions: A Meta-analysis
Brief Primary Care Obesity Interventions: A Meta-analysis
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DOI：
10.1542/peds.2016-0149
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发表时间：
2016-10-01
期刊：
影响因子：
8
通讯作者：
Murad, M. Hassan
中科院分区：
文献类型：
--
作者：
Sim, Leslie A.;Lebow, Jocelyn;Murad, M. Hassan
背景：尽管实践指南建议初级保健提供者将BMI监测和咨询纳入儿童和青少年的常规实践，但这种实践的证据基础尚不清楚。目的：确定儿童体重管理的简短、初级保健干预对BMI的影响。数据来源：检索Medline， CENTRAL, Embase， PsycInfo和CINAHL，检索1976年1月至2016年3月的相关出版物，并与已发表的研究交叉引用。研究选择：符合条件的研究是随机对照试验和准实验研究，比较以办公室为基础的初级保健体重管理干预措施与任何对照干预措施对2至18岁儿童BMI百分比或BMI z评分的影响。资料提取：两位评审人员独立筛选来源，使用Cochrane和Newcastle-Ottawa偏倚风险工具提取参与者、干预措施和研究特征、z-BMI/百分比BMI、危害和研究质量的数据。结果：采用随机效应模型对符合条件的10项随机对照试验和2项准实验研究的效应量进行汇总。与常规护理或对照治疗相比，初级保健可行的简短干预与BMI z评分显著但较小的降低相关（-0.04，[95%可信区间，-0.08至-0.01];P = 0.02），对身体满意度的影响不显著（标准化平均差为0.00，[95%可信区间，-0.21至0.22];P = 0.98）。局限性：研究有方法学上的局限性，随访时间短，不良反应通常没有测量。结论：BMI监测和咨询对BMI有边际效应，强调需要修订实践指南和开发新的方法来解决这一问题。
CONTEXT: Although practice guidelines suggest that primary care providers working with children and adolescents incorporate BMI surveillance and counseling into routine practice, the evidence base for this practice is unclear.OBJECTIVE: To determine the effect of brief, primary care interventions for pediatric weight management on BMI.DATA SOURCES: Medline, CENTRAL, Embase, PsycInfo, and CINAHL were searched for relevant publications from January 1976 to March 2016 and cross-referenced with published studies.STUDY SELECTION: Eligible studies were randomized controlled trials and quasi-experimental studies that compared the effect of office-based primary care weight management interventions to any control intervention on percent BMI or BMI z scores in children aged 2 to 18 years.DATA EXTRACTION: Two reviewers independently screened sources, extracted data on participant, intervention, and study characteristics, z-BMI/percent BMI, harms, and study quality using the Cochrane and Newcastle-Ottawa risk of bias tools.RESULTS: A random effects model was used to pool the effect size across eligible 10 randomized controlled trials and 2 quasi-experimental studies. Compared with usual care or control treatment, brief interventions feasible for primary care were associated with a significant but small reduction in BMI z score (-0.04, [95% confidence interval, -0.08 to -0.01]; P = .02) and a nonsignificant effect on body satisfaction (standardized mean difference 0.00, [95% confidence interval, -0.21 to 0.22]; P = .98).LIMITATIONS: Studies had methodological limitations, follow-up was brief, and adverse effects were not commonly measured.CONCLUSIONS: BMI surveillance and counseling has a marginal effect on BMI, highlighting the need for revised practice guidelines and the development of novel approaches for providers to address this problem.