Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index A Randomized Clinical Trial
Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index A Randomized Clinical Trial
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DOI：
10.1001/jama.2018.9128
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发表时间：
2018-08-07
影响因子：
120.7
通讯作者：
Stevens, June
中科院分区：
文献类型：
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作者：
Barkin, Shari L.;Heerman, William J.;Stevens, June
预防儿童期肥胖对于服务不足人群的儿童至关重要，因为他们的肥胖患病率和慢性疾病风险最高。目的探讨多组分行为干预对有肥胖风险的学龄前儿童36个月以上体重指数（BMI，以体重公斤除以身高米的平方计算）生长轨迹的影响。设计、环境和参与者一项随机临床试验将来自田纳西州纳什维尔服务欠缺社区的610对父母和孩子分配到为期36个月的干预中，目标是健康行为或入学准备控制。符合条件的儿童年龄在3到5岁之间，有肥胖风险但尚未肥胖。入学时间为2012年8月至2014年5月；从2015年10月至2017年6月进行了36个月的随访。干预措施（n = 304对）是一个为期36个月的以家庭为基础、以社区为中心的项目，包括12周的技能培养课程，随后9个月的每月电话指导，以及为期24个月的可持续性阶段，为行动提供线索。对照组（306对）由纳什维尔公共图书馆在为期36个月的研究中提供的6次入学准备课程组成。主要结局和测量主要结局是36个月以上的儿童BMI轨迹。七个预先指定的次要结果包括父母报告的儿童饮食摄入量和社区中心使用情况。benjamin - hochberg程序对多重比较进行了修正。结果：参与者主要为拉丁裔（91.4%）。基线时，儿童平均（SD）年龄为4.3（0.9）岁；51.9%为女性。56.7%的家庭收入低于25,000美元。保留率为90.2%。36个月时，干预组儿童BMI均值（SD）为17.8(2.2)，对照组为17.8（2.1）。36个月BMI轨迹的主要转归无显著差异（P = 0.39）。干预组儿童的平均热量摄入（1227 kcal/d）低于对照组儿童（1323 kcal/d）（校正差为-99.4 kcal [95% CI, -160.7至-38.0]；校正后P = 0.003）。干预组家长带孩子去社区中心的比例高于对照组家长（干预组56.8%，对照组44.4%）（风险比1.29 [95% CI, 1.08 ~ 1.53]；校正后P = 0.006）。结论和相关性：与对照项目相比，在田纳西州纳什维尔，一项为期36个月的多组分行为干预并没有改变服务不足的学龄前儿童的BMI轨迹。其他类型的行为干预或在其他城市的实施是否有效，还需要进一步研究。
IMPORTANCE Prevention of obesity during childhood is critical for children in underserved populations, for whom obesity prevalence and risk of chronic disease are highest.OBJECTIVE To test the effect of a multicomponent behavioral intervention on child body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) growth trajectories over 36 months among preschool-age children at risk for obesity.DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial assigned 610 parent-child pairs from underserved communities in Nashville, Tennessee, to a 36-month intervention targeting health behaviors or a school-readiness control. Eligible children were between ages 3 and 5 years and at risk for obesity but not yet obese. Enrollment occurred from August 2012 to May 2014; 36-month follow-up occurred from October 2015 to June 2017.INTERVENTIONS The intervention (n = 304 pairs) was a 36-month family-based, community-centered program, consisting of 12 weekly skills-building sessions, followed by monthly coaching telephone calls for 9 months, and a 24-month sustainability phase providing cues to action. The control (n = 306 pairs) consisted of 6 school-readiness sessions delivered over the 36-month study, conducted by the Nashville Public Library.MAIN OUTCOMES AND MEASURES The primary outcome was child BMI trajectory over 36 months. Seven prespecified secondary outcomes included parent-reported child dietary intake and community center use. The Benjamini-Hochberg procedure corrected for multiple comparisons.RESULTS Participants were predominantly Latino (91.4%). At baseline, the mean (SD) child age was 4.3 (0.9) years; 51.9% were female. Household income was below $ 25 000 for 56.7% of families. Retention was 90.2%. At 36 months, the mean (SD) child BMI was 17.8 (2.2) in the intervention group and 17.8 (2.1) in the control group. No significant difference existed in the primary outcome of BMI trajectory over 36 months (P = .39). The intervention group children had a lower mean caloric intake (1227 kcal/d) compared with control group children (1323 kcal/d) (adjusted difference, -99.4 kcal [95% CI, -160.7 to -38.0]; corrected P = .003). Intervention group parents used community centers with their children more than control group parents (56.8% in intervention; 44.4% in control) (risk ratio, 1.29 [95% CI, 1.08 to 1.53]; corrected P = .006).CONCLUSIONS AND RELEVANCE A 36-month multicomponent behavioral intervention did not change BMI trajectory among underserved preschool-age children in Nashville, Tennessee, compared with a control program. Whether there would be effectiveness for other types of behavioral interventions or implementation in other cities would require further research.