What childhood obesity prevention programmes work? A systematic review and meta-analysis.
What childhood obesity prevention programmes work? A systematic review and meta-analysis.
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DOI：
10.1111/obr.12277
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发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Segal J
中科院分区：
文献类型：
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作者：
Wang Y;Cai L;Wu Y;Wilson RF;Weston C;Fawole O;Bleich SN;Cheskin LJ;Showell NN;Lau BD;Chiu DT;Zhang A;Segal J
以前对儿童肥胖预防的审查主要集中在学校，结果不一致。在美国卫生保健研究和质量机构（AHRQ）和美国国立卫生研究院的资助下，我们系统地评估了在高收入国家进行的儿童肥胖预防计划的有效性，并在各种环境中实施。我们检索了MEDLINE®、Embase、PsycINFO、CINAHL®、ClinicalTrials.gov和科克伦图书馆从开始到2013年4月22日的相关研究，包括随机对照试验、准实验研究和自然实验，针对饮食、体育活动或两者，在高收入国家的2-18岁儿童中进行。两名评审员独立提取数据。支持干预措施的证据强度（SOE）按每个研究环境（如家庭、学校）进行分级。使用随机效应模型对判定为足够相似且适合合并的研究进行荟萃分析。本文报告了我们对各种肥胖相关结局的研究结果。我们确定了147篇文章（139项干预研究），其中115项研究主要是以学校为基础的，尽管可能涉及其他环境。大多数是在美国和过去十年内进行的。SOE是高的体育活动，只有在学校与家庭参与或结合饮食，体育活动的干预措施，在学校与家庭和社区的组成部分。以学校为基础的干预措施，以饮食或体育活动为目标，在学校与家庭或社区组成部分或在社区与学校组成部分提供的综合干预措施的SOE是中等的。在儿童保育或家庭环境中的综合干预措施的SOE较低。其他干预措施的证据不足。总之，至少有适度强有力的证据支持以学校为基础的干预措施对预防儿童肥胖的有效性。需要进行更多的研究，以评价其他环境或其他设计类型的方案，特别是环境、政策和消费者健康信息导向的干预措施。
Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health, we systematically evaluated the effectiveness of childhood obesity prevention programmes conducted in high-income countries and implemented in various settings. We searched MEDLINE®, Embase, PsycINFO, CINAHL®, ClinicalTrials.gov and the Cochrane Library from inception through 22 April 2013 for relevant studies, including randomized controlled trials, quasi-experimental studies and natural experiments, targeting diet, physical activity or both, and conducted in children aged 2–18 in high-income countries. Two reviewers independently abstracted the data. The strength of evidence (SOE) supporting interventions was graded for each study setting (e.g. home, school). Meta-analyses were performed on studies judged sufficiently similar and appropriate to pool using random effect models. This paper reported our findings on various adiposity-related outcomes. We identified 147 articles (139 intervention studies) of which 115 studies were primarily school based, although other settings could have been involved. Most were conducted in the United States and within the past decade. SOE was high for physical activity-only interventions delivered in schools with home involvement or combined diet–physical activity interventions delivered in schools with both home and community components. SOE was moderate for school-based interventions targeting either diet or physical activity, combined interventions delivered in schools with home or community components or combined interventions delivered in the community with a school component. SOE was low for combined interventions in childcare or home settings. Evidence was insufficient for other interventions. In conclusion, at least moderately strong evidence supports the effectiveness of school-based interventions for preventing childhood obesity. More research is needed to evaluate programmes in other settings or of other design types, especially environmental, policy and consumer health informatics-oriented interventions.