Treatment of overweight and obesity in children and youth: asystematic review and meta-analysis.
Treatment of overweight and obesity in children and youth: asystematic review and meta-analysis.
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DOI：
10.9778/cmajo.20140047
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发表时间：
2015-01-01
期刊：
影响因子：
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通讯作者：
Raina, Parminder
中科院分区：
文献类型：
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作者：
Peirson, Leslea;Fitzpatrick-Lewis, Donna;Raina, Parminder
背景：儿童肥胖是一个公共卫生问题。北美三分之一的儿童和青年超重或肥胖。我们回顾了行为和药物体重管理干预对体重指数(BMI)、BMI z评分以及儿童和青少年超重和肥胖患病率的证据。方法：我们更新了先前综述的搜索结果。截至2013年8月，我们搜索了4个数据库。我们纳入了与初级保健相关的行为(饮食、运动、生活方式)和药物(奥利司他)干预2-18岁儿童和青年超重和肥胖的随机试验，如果提供了6个月后基线后的BMI、BMI z评分或超重和肥胖患病率的数据。此外，我们还检查了二次健康结果，如血脂和血糖水平、血压、生活质量和身体健康。我们纳入了所有报告危害的研究。我们在可能的情况下进行Meta分析，并检查显示出益处的干预措施的特征。结果：纳入31项研究(29项行为研究，2项药理学研究和行为研究)。两种干预方式对BMI或BMI z分均有显著影响(行为学：标准化均数差[SMD]-0.54，95%可信区间[CI]-0.73~-0.36；奥利司他加行为学：SMD-0.43，95%CI-0.60~-0.25)。研究报告称，在超重或超重和肥胖患病率降低的可能性方面，两组之间没有显著差异。对血压和生活质量的综合估计显示出有利于治疗的显著好处(收缩压平均差[MD]-3.42，95%CI-6.65至-0.29；舒张压MD-3.39，95%CI-5.17至-1.60；生活质量MD 2.10，95%CI 0.60至3.60)。服用奥利司他的青年患者胃肠功能障碍较对照组更为常见(风险比3.77，95%可信区间2.56~5.55)。我们发现有效干预措施的差异很大。干预：低到中等质量的证据表明，行为治疗与降低BMI或BMI z分数方面的中等效果相关，而药物-行为干预联合治疗显示出较小的效果。未来的研究应该评估青少年中积极的体重维持干预措施，并进行更长时间的随访，并检查联合药物和行为干预的有效性。CRD42012002754。
BACKGROUND: Childhood obesity is a public health concern. One-third of North American children and youth are overweight or obese. We reviewed the evidence of behavioural and pharmacological weight-management interventions on body mass index (BMI), BMI z-score and the prevalence of overweight and obesity in children and youth.METHODS: We updated the search of a previous review. We searched 4 databases up to August 2013. We included randomized trials of primary care-relevant behavioural (diet, exercise, lifestyle) and pharmacological (orlistat) interventions for treating overweight and obesity in children and youth aged 2-18years if 6-month post-baseline data were provided for BMI, BMI z-score or prevalence of overweight and obesity. In addition, we examined secondary health outcomes such as lipid and glucose levels, blood pressure, quality of life and physical fitness. We included any study reporting harms. We performed meta-analyses when possible, and we examined the features of interventions that showed benefits.RESULTS: Thirty-one studies (29behavioural, 2pharmacological and behavioural) were included. Both intervention types showed a significant effect on BMI or BMI z-score in favour of treatment (behavioural: standardized mean difference [SMD] -0.54, 95% confidence interval [CI] -0.73 to -0.36; orlistat plus behavioural: SMD -0.43, 95% CI -0.60 to -0.25). Studies reported no significant difference between groups in the likelihood of reduced prevalence of overweight or overweight and obesity. Pooled estimates for blood pressure and quality of life showed significant benefits in favour of treatment (systolic blood pressure mean difference [MD] -3.42, 95% CI -6.65 to -0.29; diastolic blood pressure MD -3.39, 95% CI -5.17 to -1.60; quality of life MD 2.10, 95% CI 0.60 to 3.60). Gastrointestinal difficulties were more common in youth taking orlistat than in the control group (risk ratio 3.77, 95% CI 2.56 to 5.55). We saw much variability across efficacious interventions.INTERPRETATION: Low- to moderate-quality evidence suggests behavioural treatments are associated with a medium effect in terms of reduced BMI or BMI z-score compared with a small effect shown by combined pharmacological-behavioural interventions. Future research should evaluate active weight maintenance interventions in adolescents with longer follow-up and examine the effectiveness of combined pharmacological and behavioural interventions.REGISTRATION: PROSPERO no. CRD42012002754.