家庭治疗可能对严重儿童肥胖患者有效


  October 13, 2009 — 根据一项于10月号小儿医学期刊发表的研究结果,家庭为主的治疗可能对于严重儿童肥胖患者有效。
  
  来自宾州匹兹堡大学医学院Melissa A. Kalarchian博士与其同事们写到,体重管理计画与学龄儿童中度减重及健康好处有关,但是很少有研究针对严重肥胖的儿童进行。我们评估以家庭为主,严重儿童肥胖的行为体重控制效果。
  
  总共有192个年龄介于8至12岁的肥胖儿童家庭被随机分派接受介入或一般常规性照护,且在试验前、6、12与18个月后接受评估。平均年龄为10.2±1.2岁,而年龄与性别的平均身体质量指数(BMI)百分位数为99.18 ± 0.72。
  
  过重百分比(性别与年龄超过BMI中位数的百分比)是试验的主要终点,其它的预后评量包括血压变化、身体组成、腰围、以及与健康相关的生活质量,同时也评估计画出席率与其它影响儿童过重百分比的因素。
  
  相较于日常照护,介入显著地与6个月时儿童过重百分比显著降低有关。根据意向分析,介入在6个月时与儿童过重百分比降低7.58%有关,日常照护则是0.66%。然而,这些组与组之间的差异在12与18个月时并未达到统计上显著差异。在6与12个月时,医疗预后有微小但显著的改善。
  
  介入讲习出席率至少75%的儿童,在18个月的时间之内,过重比例持续下降。其它与介入组6个月时儿童过重百分比显著下降较多有关的因素,包括试验前过重百分比较低、出席率较高、收入较高、以及双亲BMI下降较多。
  
  研究作者们写到,介入与肥胖短期显著下降,以及医学参数的改善有关,且赋予出席75%以上讲习之儿童长期的体重改变好处。虽然还需要未来的研究来了解出席率与体重控制的关系,目前这些发现代表促进与提高计画顺从性潜在重要性的策略。
  
  这项研究的限制包括无法将结果归因为家庭为主介入的特定部分;缺乏应用到西班牙裔,或是其它没有参加大学为主研究计划的应用性;最后是意向分析中的遗失数据。
  
  研究作者们的结论是,在6个月时,以家庭为主的体重行为控制计画与严重肥胖的学龄儿童过重百分比显著降低、以及医疗危险因子改善有关。虽然过重比例改变地有限,考虑到肥胖的严重性,介入的显著健康好处代表进一步最佳化家庭为基础介入计画预后的努力是有必要的。
  
  国家卫生研究院、匹兹堡大学肥胖与营养研究中心、匹兹堡儿童医院综合临床研究中心、以及匹兹堡临床与转译科学机构赞助这项研究。研究作者们表示已无相关资金上的往来。
  

Family-Based Treatment May Be Effective in Severe Pediatric Obesity

By Laurie Barclay, MD
Medscape Medical News

October 13, 2009 — Family-based treatment may be effective in severe pediatric obesity, according to the results of a study reported in the October issue of Pediatrics.

"Weight management programs are associated with moderate weight losses and health benefits for school-aged children, but few studies have focused on severely obese children," write Melissa A. Kalarchian, PhD, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues. "We evaluated the efficacy of family-based, behavioral weight control in the management of severe pediatric obesity."

Families of 192 severely obese children aged 8.0 to 12.0 years were randomly assigned to the intervention or to usual care, and evaluations were performed at baseline and at 6, 12, and 18 months. Mean age was 10.2 ± 1.2 years, and average body mass index (BMI) percentile for age and sex was 99.18 ± 0.72.

Percent overweight (percent over the median BMI for age and sex) was the main study endpoint, and other outcome measures were changes in blood pressure, body composition, waist circumference, and health-related quality of life. Session attendance and other factors associated with changes in child percent overweight were also assessed.

Compared with usual care, the intervention was associated with significant decreases in child percent overweight at 6 months. The intervention was associated with a 7.58% decrease in child percent overweight at 6 months vs a 0.66% decrease with usual care, based on intent-to-treat analyses. However, these between-group differences were not significant at 12 or 18 months. At 6 and 12 months, there were small but significant improvements in medical outcomes.

Children who attended at least 75% of the intervention sessions maintained their decreases in percent overweight through 18 months. Other factors associated with significantly greater reductions in child percent overweight at 6 months among intervention participants were lower baseline percent overweight, better attendance, higher income, and greater reduction in parental BMI.

"Intervention was associated with significant short-term reductions in obesity and improvements in medical parameters and conferred longer-term weight change benefits for children who attended ? 75% of sessions," the study authors write. "Although future work is needed to understand the relationship between attendance and weight control, the present findings suggest the potential importance of strategies to promote and to facilitate program adherence."

Limitations of this study include inability to attribute outcomes to the specific components of the family-based intervention; lack of generalizability to Hispanics or to those not participating in university-based, research programs; and missing data in intent-to-treat analyses.

"A 6-month, family-based, behavioral weight management program was associated with significant decreases in percent overweight and improvements in medical risk factors in severely obese, school-aged children," the study authors conclude. "Although the changes in percent overweight were modest, given the severity of obesity, the significant health benefits of the intervention suggest that further efforts to optimize the outcomes of family-based intervention programs are warranted."

The National Institutes of Health, the University of Pittsburgh Obesity and Nutrition Research Center, Children's Hospital of Pittsburgh General Clinical Research Center, and the University of Pittsburgh Clinical and Translational Science Institute supported this study. The study authors have disclosed no relevant financial relationships.

Pediatrics. 2009;124:1060-1068.

    
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