Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis.
Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis.
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DOI：
10.1093/advances/nmac032
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发表时间：
2022-10-02
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世卫组织委托进行的这项审查有助于更新补充喂养建议，综合了儿童不健康食品和饮料消费对超重和肥胖影响的证据。我们在PubMed(Medline)、Cochrane Central和Embase上搜索文章，不分语言和地理位置。纳入标准包括：1)随机对照试验(RCT)、非随机对照试验、队列研究和对照前/后研究；2)参与者在暴露于≤10.9岁时的年龄；3)报告与不食用或低摄入相比更多不健康食品/饮料的研究；4)评估人体测量和/或身体成分的研究；5)1971年≥发表日期。不健康的食品和饮料是使用基于营养和基于食物的方法来定义的。使用Robins-I(干预措施非随机化研究中的偏差风险版本I)和RoB2[Cochrane Rob(Version 2)]工具分别对非随机化和随机化研究进行偏倚风险评估。在适当的情况下，叙述性综合得到了元分析的补充。证据的确定性通过评估、发展和评估建议的分级进行评估。在确定的26542条引文中，纳入了71篇文章的60项研究。大多数研究是观察性的(59/60)，没有来自低收入国家的研究。根据Robins-I和RoB2工具的评估，证据基础质量较低。证据合成受到不同干预措施和不同研究比较者的限制。有证据表明，儿童时期食用含糖饮料(SSB)和不健康食品可能会增加BMI/BMI z-Score、体脂百分比或超重/肥胖的几率(证据确定性较低)。人工加糖饮料和100%果汁的摄入对BMI、体脂百分比或超重/肥胖结果几乎没有影响(证据的确定性很低)。对部分研究的荟萃分析表明，SSB摄入量与体脂百分比呈正相关，但与BMI和BMI z-Score的变化无关。需要进行高质量的流行病学研究，以评估儿童时期不健康的食物消费对超重/肥胖风险的影响，以便为设计政策建议提供更有力的证据基础。该协议在https://www.crd.york.ac.uk/PROSPERO注册为CRD42020218109。重要性声明：这项系统性审查首次综合了低收入、中等收入和高收入国家环境中≤10.9岁儿童食用不健康食品和饮料的影响的证据。这项审查发现了来自低收入和中等收入国家的主要证据差距。儿童时期食用含糖饮料和不健康食品可能会增加BMI、体脂百分比或超重/肥胖的几率，而食用人工加糖饮料和100%果汁对这些结果的影响较小。
This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL, and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs), non-RCTs, cohort studies, and pre/post studies with control; 2) participants aged ≤10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages compared with no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I (risk of bias in nonrandomized studies of interventions version I) and RoB2 [Cochrane RoB (version 2)] tools for nonrandomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSBs) and unhealthy foods in childhood may increase BMI/BMI z-score, percentage body fat, or odds of overweight/obesity (low certainty of evidence). Artificially sweetened beverages and 100% fruit juice consumption make little/no difference to BMI, percentage body fat, or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and percentage body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109. Statement of Significance: This systematic review was the first to synthesize evidence on the effects of consuming unhealthy foods and beverages in children aged ≤10.9 y across low-, middle-, and high-income country settings. This review identified a major evidence gap from low- and middle- income countries. Consumption of sugar-sweetened beverages and unhealthy foods in childhood may increase BMI, percentage body fat, or odds of overweight/obesity, whereas consumption of artificially sweetened beverages and 100% fruit juice has less demonstrable effects on these outcomes.