Screening for Obesity and Intervention for Weight Management in Children and Adolescents Evidence Report and Systematic Review for the US Preventive Services Task Force
Screening for Obesity and Intervention for Weight Management in Children and Adolescents Evidence Report and Systematic Review for the US Preventive Services Task Force
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DOI：
10.1001/jama.2017.0332
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发表时间：
2017-06-20
影响因子：
120.7
通讯作者：
Lozano, Paula
中科院分区：
文献类型：
--
作者：
O'Connor, Elizabeth A.;Evans, Corinne V.;Lozano, Paula
重要性肥胖在美国儿童和青少年中很常见，与负面健康影响相关，并增加成年后肥胖的可能性。目的系统地回顾儿童和青少年肥胖和超重筛查和治疗的益处和危害，以告知美国预防服务工作组。数据来源MEDLINE，PubMed，PsycINFO，科克伦合作对照试验注册，和教育资源信息中心至2016年1月22日;相关出版物的参考;政府网站。监测持续至2016年12月5日。研究选择关于筛查或治疗的益处或危害的英语试验（基于行为的，奥利司他，二甲双胍）用于2至18岁儿童的超重或肥胖，在卫生保健机构进行或从卫生保健机构招募。然后从公平和高质量的试验中提取数据。随机效应荟萃分析被用来评估基于生活方式的项目和二甲双胍的益处。主要结果和指标：体重或超重（例如，体重指数[BMI]; BMI z评分，测量年龄和性别的BMI中位数的标准差），心脏代谢结果，生活质量，其他健康结果，harms. ResultsTherewas没有直接证据表明筛查儿童和青少年超重的益处或危害。在42项基于生活方式的干预措施以减少超重的试验中（N = 6956），与常规护理或其他对照组相比，估计接触26小时或更长时间的试验在6至12个月后一致显示超重平均减少，没有造成伤害的证据。一般来说，干预组显示BMI z评分绝对降低0.20或更多，并将其基线体重平均保持在约5磅范围内，而对照组显示BMI z评分小幅增加或无变化，通常平均增加5至17磅。在26项接触时间较少的干预措施中，只有3项显示出减轻体重的益处。与安慰剂相比，使用二甲双胍（8项研究，n = 616）和奥利司他（3项研究，n = 779）与更大的BMI降低相关：二甲双胍为-0.86（95%CI，-1.44至-0.29; 6项研究; I2 = 0%），奥利司他为-0.50至-0.94。与对照组相比，接受基于生活方式的干预（提供52小时或更长时间的接触）的组显示出更大的血压改善：-6.4 mmHg（95% CI，-8.6至-4.2; 6项研究; I-2 = 51%）收缩压和-4.0 mmHg舒张压（95% CI，-5.6至-2.5; 6项研究; I-2 = 17%）。胰岛素或血糖指标的结果不一，血脂指标无获益。药物对心脏代谢结局（包括空腹血糖水平）的获益较小或无获益。非严重危害与药物使用有关，尽管由于不良反应而停药的比例通常低于5%。结论和相关性基于生活方式的减肥干预与26小时或更长时间的干预接触可能有助于减少儿童和青少年的超重。药物使用的小益处的临床意义尚不清楚。
IMPORTANCE Obesity is common in children and adolescents in the United States, is associated with negative health effects, and increases the likelihood of obesity in adulthood.OBJECTIVE Tosystematically reviewthebenefitsandharmsof screeningandtreatment forobesity and overweight in children and adolescents to inform the US Preventive Services Task Force.DATA SOURCES MEDLINE, PubMed, PsycINFO, Cochrane Collaboration Registry of Controlled Trials, and the Education Resources Information Center through January 22, 2016; references of relevant publications; governmentwebsites. Surveillance continued through December 5, 2016.STUDY SELECTION English-language trials of benefits or harms of screening or treatment (behavior-based, orlistat, metformin) for overweight or obesity in children aged 2 through 18 years, conducted in or recruited from health care settings.DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles, then extracted data from fair-and good-quality trials. Random-effects meta-analysis was used to estimate the benefits of lifestyle-based programs and metformin. MAINOUTCOMES AND MEASURES Weight or excessweight (eg, body mass index [BMI]; BMI z score, measuring the number of standard deviations from the median BMI for age and sex), cardiometabolic outcomes, quality of life, other health outcomes, harms.RESULTS Therewas no direct evidence on the benefits or harms of screening children and adolescents for excessweight. Among 42 trials of lifestyle-based interventions to reduce excess weight (N = 6956), those with an estimated 26 hours or more of contact consistently demonstrated mean reductions in excessweight compared with usual care or other control groups after 6 to 12 months, with no evidence of causing harm. Generally, intervention groups showed absolute reductions in BMI z score of0.20or more and maintained their baselineweight within a mean of approximately 5 lb, while control groups showed small increases or no change in BMI z score, typically gaining a mean of 5 to 17 lb. Only 3 of 26 interventions with fewer contact hours showed a benefit inweight reduction. Use ofmetformin (8 studies, n = 616) and orlistat (3 studies, n = 779) were associated with greater BMI reductions compared with placebo: -0.86 (95% CI, -1.44 to -0.29; 6 studies; I2 = 0%) formetformin and -0.50 to -0.94 for orlistat. Groups receiving lifestyle-based interventions offering 52 or more hours of contact showed greater improvements in blood pressure than control groups: -6.4 mmHg (95% CI, -8.6 to -4.2; 6 studies; I-2 = 51%) for systolic blood pressure and -4.0 mmHg (95% CI, -5.6 to -2.5; 6 studies; I-2 = 17%) for diastolic blood pressure. Therewere mixed findings for insulin or glucose measures and no benefit for lipids. Medications showed small or no benefit for cardiometabolic outcomes, including fasting glucose level. Nonserious harmswerecommonwith medication use, although discontinuation due to adverse effectswas usually less than 5%.CONCLUSIONS AND RELEVANCE Lifestyle-based weight loss interventions with 26 or more hours of intervention contact are likely to help reduce excess weight in children and adolescents. The clinical significance of the small benefit of medication use is unclear.