Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial.
Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial.
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DOI：
10.1136/bmj.b3308
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发表时间：
2009-09-03
期刊：
影响因子：
--
通讯作者：
Ukoumunne OC
中科院分区：
文献类型：
--
作者：
Wake M;Baur LA;Gerner B;Gibbons K;Gold L;Gunn J;Levickis P;McCallum Z;Naughton G;Sanci L;Ukoumunne OC
目的确定通过监测确定儿童肥胖，然后在初级保健中进行结构化的二级预防，是否能改善超重或轻度肥胖儿童的结局。设计：随机对照试验，嵌套在一个基线横断面调查的体重指数（BMI）。随机化和结果测量，但不是参与者，对组分配不知情。在澳大利亚的墨尔本设置45个家庭诊所（66名全科医生）。 参与者3958名儿童访问他们的全科医生在2005年5月至2006年7月进行了调查的BMI。其中，258名年龄5岁0个月至10岁生日的超重或肥胖儿童（根据国际肥胖工作组标准）被随机分配到干预组（n=139）或对照组（n=119）。排除了非常肥胖的儿童（英国BMI z评分≥3.0）。 干预措施在12周内进行四次标准咨询，以改变营养、体育活动和久坐行为为目标，并得到专门设计的家庭材料的支持。 主要指标是随机分组后6个月和12个月的BMI。次要指标为7天加速度计的平均活动计数/分钟、4天简略食物频率日记的营养评分和儿童健康相关生活质量。根据社会经济状况、年龄、性别和基线BMI调整差异。结果在781名合格儿童中，258名（33%）进入试验; 6个月时的损耗率为3.1%，12个月时为6.2%。校正平均差异（干预-对照）6个月和12个月时的BMI为-0.12（95% CI −0.40至0.15，P=0.4）和−0.11（−0.45至0.22，P=0.5）;对于体力活动（计数/分钟），24（−4至52，P=0.09）和11（−26至49，P=0.6）;营养评分为0.2（−0.03至0.4，P=0.1）和0.1（−0.1至0.4，P=0.2）。没有证据表明孩子受到伤害。干预arm. Conclusions初级保健筛查，随后进行简短的咨询并没有改善体重指数，体力活动，或营养超重或轻度肥胖的5-10奥尔兹，这将是非常昂贵的，如果普遍实施。这些发现与美国、英国和澳大利亚等国的国家政策不一致。 试验注册ISRCTN 52511065（www.isrctn.org）
Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children. Design Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment. Setting 45 family practices (66 general practitioners) in Melbourne, Australia. Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score ≥3.0) were excluded. Intervention Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials. Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI. Results Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention − control) at 6 and 12 months were, for BMI, −0.12 (95% CI −0.40 to 0.15, P=0.4) and −0.11 (−0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (−4 to 52, P=0.09) and 11 (−26 to 49, P=0.6); and, for nutrition score, 0.2 (−0.03 to 0.4, P=0.1) and 0.1 (−0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm. Conclusions Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia. Trial registration ISRCTN 52511065 (www.isrctn.org)
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影响因子：
158.5
作者：
GORTMAKER, SL;MUST, A;DIETZ, WH
通讯作者：
DIETZ, WH
影响因子：
2
作者：
COLE, TJ;GREEN, PJ
通讯作者：
GREEN, PJ
影响因子：
8
作者：
Hughes, Adrienne R.;Stewart, Laura;Reilly, John J.
通讯作者：
Reilly, John J.
影响因子：
--
作者：
Schwartz, Robert P.;Hamre, Robin;Resnicow, Kenneth A.
通讯作者：
Resnicow, Kenneth A.
影响因子：
8
作者：
Krebs, NF;Baker, RD;Jacobson, MS
通讯作者：
Jacobson, MS