JAMA子刊:综合性健康干预降低儿童肥胖和黑棘皮症风险

创作:hx 审核:沈志勋 11月30日
纳入5个地区的27个社区,分为干预组和对照组,2次分别纳入4329和4042名2-8岁的儿童;
干预策略包括政策、环境、信息传递、能力建设中的19个方面,旨在干预睡眠、运动、屏幕时间、蔬果摄入、饮水、糖摄入6种行为;
干预组社区儿童的超重/肥胖、黑棘皮症的发病率以及腰围均减少;
在低龄(2-5岁)儿童中黑棘皮症发病率下降更加明显,但屏幕使用时间减少的效果不如6-8岁组;
全方位的综合干预措施可以减少儿童肥胖及黑棘皮症发病率。
延伸阅读

Effect of the Children’s Healthy Living Program on Young Child Overweight, Obesity, and Acanthosis Nigricans in the US-Affiliated Pacific Region: A Randomized Clinical Trial

儿童健康生活计划对美国附属太平洋地区儿童超重/肥胖及黑棘皮症发病率的影响:一项随机临床试验

10-26, Article, 10.1001/jamanetworkopen.2018.3896more

Abstract:
IMPORTANCE: Pacific Islanders have among the highest rates of obesity and type 2 diabetes in the world. Targeting children is critical for primary prevention.
OBJECTIVES: To prevent young child overweight and obesity and to improve health in the US-Affiliated Pacific region via the Children’s Healthy Living Program.
DESIGN, SETTING, AND PARTICIPANTS: In this multijurisdictional, multilevel, multicomponent community randomized clinical trial, where all evaluable children were analyzed according to the random assignment of their community, hierarchical difference-in-difference models accounted for the community randomization, community clustering with jurisdictions, and these models were adjusted for the age and sex distribution of the community. The setting was 27 communities in 5 jurisdictions (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Guam, and Hawaii). Participants were 4329 children (time 1) and 4042 children (time 2) aged 2 to 8 years in 27 selected communities from October 7, 2012, to October 25, 2015. Data analysis was completed in June 2018.
INTERVENTIONS: Nineteen activities addressed policy, environment, messaging, training, and 6 target behaviors (sleep time, screen time, physical activity, fruits and vegetables, water, and sugarsweetened beverages).
MAIN OUTCOMES AND MEASURES: Primary outcomes were body size measurements. Secondary outcomes were acanthosis nigricans, sleep quality and duration, dietary intake, physical activity, and other questionnaire reponses.
RESULTS: The study included 27 communities and 8371 evaluable children (mean [SD] age, 5.4 [1.8] years; 50.9% male [n = 4264]). Data analysis included 952 children in the intervention group and 930 children in the control group aged 2 to 5 years at time 1; 825 children in the intervention group and 735 children in the control group aged 2 to 5 years at time 2; 565 children in the intervention group and 561 children in the control group aged 6 to 8 years at time 1; and 517 children in the intervention group and 560 children in the control group aged 6 to 8 years at time 2. The intervention communities showed significant improvement compared with control communities in overweight and obesity prevalence (effect size [d] = −3.95%; 95% CI, −7.47% to −0.43%), waist circumference (d = −0.71 cm; 95% CI, −1.37 to −0.05 cm), and acanthosis nigricans prevalence (d = −2.28%; 95% CI, −2.77% to −1.57%). Age and sex subgroup analysis revealed greater difference among the intervention communities in acanthosis nigricans prevalence in the group aged 2 to 5 years (−3.99%) vs the group aged 6 to 8 years (−3.40%), and the interaction was significant (d = 0.59%, P < .001), as well as the smaller difference in the group aged 2 to 5 years (−0.10%) vs the group aged 6 to 8 years (−1.07%) in screen time (d = −0.97 hour per day, P = .01).
CONCLUSIONS AND RELEVANCE: The intervention reduced the prevalence of young child overweight and obesity and acanthosis nigricans. Comprehensive, effective, and sustainable interventions are needed to improve child health in the US-Affiliated Pacific region.

First Authors:
Rachel Novotny

Correspondence Authors:
Rachel Novotny

All Authors:
Rachel Novotny,James Davis,Jean Butel,Carol J. Boushey,Marie Kainoa Fialkowski,Claudio R. Nigg,Kathryn L. Braun,Rachael T. Leon Guerrero,Patricia Coleman,Andrea Bersamin,Aufai Apulu Ropeti Areta,Leroy R. Barber Jr,Tayna Belyeu-Camacho,Joshua Greenberg,Travis Fleming,Elise Dela Cruz-Talbert,Ashley Yamanaka,Lynne R. Wilkens