儿少卫生

黑皮素4受体基因多态性与青少年肥胖的相关性研究;北京市中小学生肥胖及其相关因素分析;综合健康干预对肥胖儿童血糖血脂水平的影响;南通市儿童单纯性肥胖及其影响因素分析;儿童单纯性肥胖症的遗传和环境危险因素分析     

简述儿童少年单纯性肥胖的影响因素分析

目的：对儿童少年单纯性肥胖的影响因素进行分析。方法通过对我中心学生常见病督导检查所采集的数据进行统计来分析儿童少年单纯性肥胖的影响因素。在此基础上将1000例调查对象分为干预组500例以及对照组500例,干预组进行干预,对比干预后两组对象单纯性肥胖情况。结果干预组进行干预后肥胖率不断下降,而对照组（未进行干预）肥胖率有所上升,两组比较差异具有统计学意义（P〈0.05）。另外儿童少年单纯性肥胖影响因素主要来源于饮食习惯、遗传因素以及运动因素等方面,其中饮食习惯出现频率最高,为78.42%。结论采取有效的干预手段能从一定程度上控制儿童少年单纯性肥胖,特别是对饮食习惯以及运动因素等进行干预将能得到较好的效果。     

儿童超重、肥胖相关因素及干预措施分析

目的:分析儿童超重、肥胖的相关因素,调查实施干预措施后对儿童超重、肥胖的影响效果。方法:随机抽取本地区儿童356名(均为小学生),调查分析其超重、肥胖原因,并将其随机分为对照组(156名)和观察组(200名)。对照组不实施任何干预措施,观察组实施相应的干预措施,统计分析1年后两组儿童的超重、肥胖情况。结果:实施干预措施前,两组儿童肥胖、超重情况相近,差异无统计学意义(P>0.05);实施干预措施后,观察组儿童超重率(5.5%)和肥胖率(3.5%)明显低于对照组儿童超重率(11.5%)和肥胖率(7.7%),两组比较差异有统计学意义(P<0.05)。结论:遗传因素、出生体重、饮食习惯、睡眠时间及运动时间等都是影响儿童超重、肥胖的原因,实施相应的干预措施能够有效改善儿童超重、肥胖现状,值得各地区推广实施。     

分析肥胖儿潜在危害及护理干预效果

目的：分析探究肥胖对儿童的生长发育以及身心健康带来的潜在危害，并研究护理干预对肥胖儿童的临床效果。方法：随机选取159例3~15岁的肥胖儿童进行护理干预实验研究，并对其干预前后的相关数据进行比较分析，包括肥胖儿童的身高、体重、肥胖系数以及肺活量四个方面进行记录、分析。结果：肥胖儿童在护理干预前由于自身的肥胖因素伴随着运动量小、肺活量低等临床表现，而通过有效地护理干预使得研究儿童的体重有大幅度的降低、并且肺活量有很大的提高、身心健康也有很大的改善（P〈0．05）。结论：在青少年儿童的生长发育过程中，持续地进行护理干预对降低儿童肥胖的潜在危害有显著的临床效果，值得在临床上推广使用。     

多基因风险评分在儿童肥胖干预效果可持续性中的作用

目的 探索多基因风险评分(PRS)与儿童肥胖干预效果可持续性的关联，为未来开展基于遗传背景、可持续、个性化的儿童肥胖干预提供科学依据。方法 从一项研究儿童干预效果的整群随机对照试验(2018年9月—2021年4月)中，选取北京地区148名基线时处于超重肥胖的儿童作为研究对象，采集唾液进行全基因组测序。构建4个PRS:加权和未加权PRS₆₉,加权和未加权PRS₆₇。分析PRS与干预组别对干预效果可持续性(干预结束到最后一次随访期间肥胖相关指标变化)的交互作用。结果 PRS与干预组别对干预结束后儿童校正体质量指数(BMI)的腰围、校正BMI的腰臀比和收缩压的反弹程度存在交互作用。与对照组相比，干预组儿童加权PRS₆₉每增加一个单位(1个s),校正BMI的腰围(β=0.34,95%CI:0.05～0.63,P=0.020)和校正BMI的腰臀比(β=0.29,95%CI:0.03～0.56,P=0.031)在干预结束后反弹得越多；加权PRS₆₇和未加权PRS₆₇每增加一个单位(1个s)...     

家园结合模式对学龄前儿童单纯性肥胖的干预效果分析

[目的]家园结合的营养干预模式对改善学龄前儿童单纯性肥胖的效果研究。[方法]采用整群抽样的方法,抽取城区10间幼儿园913名儿童作为研究对象,进行幼儿的体格测量、幼儿园的膳食调查和家长的问卷调查,针对有效影响因素进行家园结合的营养干预,半年后观察其对儿童肥胖的干预效果。[结果]学龄前儿童肥胖检出率7.67%,利用家园结合方式的营养干预,半年后幼儿的肥胖发生率明显下降（P﹤0.05）。[结论]家园结合,对幼儿园的膳食干预和对家长喂养认知和行为干预可以有效改善幼儿的肥胖情况。     

杭州市西湖区188名肥胖儿童家庭干预情况分析

为探讨肥胖儿童家庭干预情况,研究儿童肥胖防治工作重点。本调查抽取25所幼儿园在园儿童健康体检资料,对筛选的188名肥胖儿童家庭干预情况进行调查。结果显示,西湖区3～7岁儿童肥胖发生率处于较高水平,且其中1/3已出现不同程度的临床症状。意识到肥胖危害并积极采取措施的家庭占调查总数的73.40%,有效者仅占调查总数的18.62%。由此得出结论,儿童肥胖家庭干预效果不佳,需要得到专家进一步指导,儿童肥胖重在预防。     

儿童青少年肥胖干预研究中的要素评析

随着儿童青少年肥胖问题的迅速蔓延,越来越多的研究者投入到对肥胖的预防和干预研究中,并提出建设性的建议.总的来讲,一个完整有效的干预研究包括干预理论、干预成分、干预对象的特征、干预情境、干预实施、干预期限、干预评估指标等要素.以往的研究及综述文章多只注重干预过程中的某一个或几个方面[1-2],缺乏系统性和整体性.因此,本文系统评述儿童青少年肥胖预防和干预研究过程中所涉及的主要要素,针对这些要素对以往研究中存在争议的方面进行讨论,并为未来儿童青少年肥胖干预研究提出相应的建议,以期为研究者对儿童青少年肥胖干预的设计、实施和评价提供参考,并提高干预效果.     

运动、营养联合干预对肥胖儿童的效果观察

目的观察运动和营养疗法联合干预对于肥胖儿童的临床效果。方法将我院100例单纯性肥胖儿童患者随机的分为对照组和实验组两组,每组各50例。对照组肥胖儿童采取单纯的运动或者营养疗法进行干预;实验组肥胖儿童采取运动和营养疗法进行共同干预,观察两组肥胖儿童的临床治疗效果。结果实验组总有效率显著高于对照组有效率(P<0.05),差异具有统计学意义。结论运动和营养疗法共同干预对于肥胖儿童的体重与形态方面具有比较好的效果,值得推广应用开来。     

小学教师在儿童肥胖群体干预实施中的潜力

无论发达国家还是发展中国家,肥胖已成为威胁儿童青少年健康的重大公共卫生问题[1-4]。儿童肥胖干预方法的探索也因此成为一个研究热点。国外很多研究的结果认为,学校是防治儿童肥胖的重要干预场所[5-8],有些基于学校的干预项目也取得了良好的效果[9-10]。但是总体而言,绝大多数干预项目有很多不完善处,特别是对于干预方案的有效实施方面有很大的困难。有研究提出,教师具备对儿童进行饮食和运动教育的最     

儿童肥胖干预场所研究进展

儿童肥胖已成为发达国家和发展中国家常见的公共卫生问题,适宜的干预措施和适宜的干预场所对于实施有效干预至关重要。本文从儿童肥胖干预场所的角度出发,综述儿童肥胖干预场所(学校、家庭、社区和多个场所联合)的干预研究进展,探讨各种场所进行干预的作用与局限性,发现更为有效且实施性强的干预方式。     

Management of Childhood Obesity—Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.     

School based interventions versus family based interventions in the treatment of childhood obesity- a systematic review

Background

The prevalence of childhood obesity, which has seen a rapid increase over the last decade, is now considered a major public health problem. Current treatment options are based on the two important frameworks of school- and family-based interventions; however, most research has yet to compare the two frameworks in the treatment of childhood obesity.The objective of this review is to compare the effectiveness of school-based intervention with family-based intervention in the treatment of childhood obesity.

Methods

Databases such as Medline, Pub med, CINAHL, and Science Direct were used to execute the search for primary research papers according to inclusion criteria. The review included a randomised controlled trial and quasi-randomised controlled trials based on family- and school-based intervention frameworks on the treatment of childhood obesity.

Results

The review identified 1231 articles of which 13 met the criteria. Out of the thirteen studies, eight were family-based interventions (n = 8) and five were school-based interventions (n = 5) with total participants (n = 2067). The participants were aged between 6 and 17 with the study duration ranging between one month and three years. Family-based interventions demonstrated effectiveness for children under the age of twelve and school-based intervention was most effective for those aged between 12 and 17 with differences for both long-term and short-term results.

Conclusions

The evidence shows that family- and school-based interventions have a considerable effect on treating childhood obesity. However, the effectiveness of the interventional frameworks depends on factors such as age, short- or long-term outcome, and methodological quality of the trials. Further research studies are required to determine the effectiveness of family- and school-based interventions using primary outcomes such as weight, BMI, percentage overweight and waist circumference in addition to the aforementioned factors.     

Key stakeholders' perspectives towards childhood obesity treatment: a qualitative study

Over the past three decades, there has been a dramatic global increase in childhood obesity. A better understanding of stakeholders' perceptions of intervention requirements could contribute to developing more effective interventions for childhood obesity. This study provides a qualitative, in-depth, analysis of stakeholders' (children, parents and health professionals) perspectives toward the efficacy of childhood obesity treatment interventions. Twenty-six stakeholders were recruited using purposive sampling; semi-structured interviews were adopted to explore stakeholders' perceptions with data analysed using a framework approach. Stakeholders concurred that treatment should be family-based incorporating physical activity, nutrition and psychological components, and be delivered in familiar environments to recipients. However, incongruence existed between stakeholders towards the sustainability of obesity treatment interventions. Parents and children reported needing ongoing support to sustain behavioural changes made during treatment, while health professionals suggested interventions should aim to create autonomous individuals who exit treatment and independently sustain behaviour change. This study provides an insight into issues of stakeholder involvement in the obesity intervention design and delivery process. To promote long-term behaviour change, there needs to be increased congruence between the delivery and receipt of childhood obesity treatment interventions. Interventions need to incorporate strategies that promote autonomous and self-regulated motivation, to enhance families' confidence in sustaining behaviour change independent of health professional support.     

Role of prevention in the contention of the obesity epidemic

Obesity has become one of the major health burdens of the westernized world with an increasing number of people affected at any age. Although genetic factors explain around 40% of individual susceptibility to the disease, obesity may and should be controlled through interventions on the individual behaviour and on the social environment. Very promising to this aim is the role of prevention. Several levels of action have been established as well as different types of interventions according to the targeted population. Of special importance is the contention of childhood obesity with home and school as privileged settings for intervention. Despite a general acknowledging of the urgency for effective preventive measures at social, economic and political level to contrast the increasing prevalence of obesity, no clear nationwide policies have yet been established, and the educational and public health measures adopted so far lack that coordination and integration that the magnitude of the situation requires.     

An economic perspective on childhood obesity: recent findings on cost of illness and cost effectiveness of interventions

ObjectiveThis review aims to put an economic perspective on childhood and adolescent obesity by providing an overview on the latest literature on obesity-related costs and the cost effectiveness of interventions to prevent or manage the problem.MethodsThe review is based on a comprehensive PubMed/Medline search performed in October 2011.ResultsFindings on the economic burden of childhood obesity are inconclusive. Considering the different cost components and age groups, most but not all studies found excess health care costs for obese compared with normal-weight peers. The main limitations relate to short study periods and the strong focus on health care costs, neglecting other components of the economic burden of childhood obesity. The results of the economic evaluations of childhood and adolescent obesity programs support the expectation that preventive and management interventions with acceptable cost effectiveness do exist. Some interventions may even be cost saving. However, owing to the differences in various methodologic aspects, it is difficult to compare preventive and treatment approaches in their cost effectiveness or to determine the most cost-effective timing of preventive interventions during infancy and adolescence.ConclusionTo design effective public policies against the obesity epidemic, a better understanding and a more precise assessment of the health care costs and the broader economic burden are necessary but, critically, depend on the collection of additional longitudinal data. The economic evaluation of childhood obesity interventions poses various methodologic challenges, which should be addressed in future research to fully use the potential of economic evaluation as an aid to decision making.     

基于基因与环境交互作用的儿童肥胖病因研究进展

儿童肥胖是全球性的公共健康问题,不仅危害儿童自身健康,还是成年期慢性病发病的重要诱因。近年来,随着精准医学研究的深入开展,越来越多的研究证据指明环境、行为因素,如早期宫内环境、儿童饮食、体力活动等,与儿童自身基因风险对肥胖的发病具有显著的交互作用,可以促进或抑制儿童肥胖的发生发展。本文对该领域现有研究进行综述,总结基因风险和环境暴露因素对儿童肥胖发病的交互作用及潜在机制,为不同遗传背景儿童的肥胖精准防控提供参考依据。     

Health promotion in kindergarten children: an assessment of evaluated projects in Germany

Aim Health problems in childhood, which can be altered by basic preventive measures, are dramatically increasing. Therefore, effective primary prevention programmes beginning in early childhood are increasingly regarded as important. In this field a great deal of action, activities and interventions exist. The kindergarten setting is a particular field for integrated intervention. The special public health focus is to involve not only the children but also their parents, siblings, and teachers.Methods The aim of the project was to establish an inventory of health promotion measures as well as prevention programmes in kindergartens in Germany. The objective was a stock-taking and a critical assessment of evaluated programmes for preschool children with a main focus on obesity prevention, promotion of physical activity and nutrition education. This complete overview involved extensive literature research, internet research and interviews with experts.Results Regarding obesity prevention intervention programmes, only 13 evaluated measures were identified. Concerning promotion of physical activity and nutrition education, 41 measures were listed. A programme evaluation has been carried out very rarely. Only nine projects have had a documented qualified evaluation. With regard to cooperation with a research institution, the evaluation were competent. Nevertheless, the proportion of integrated projects with a sustainable character was quite small. For the most part, interventions are aimed at prevention at the behavioural level; activities at the conditional level are uncommon.Conclusion The results show an enormous demand on evaluated intervention programmes for kindergarten children, their relatives, and teachers. For future intervention programmes an evaluation is obligatory. Standardized measures are justified, because only such evaluated interventions were proved effective and successful. It is necessary to link existing projects, and not to create new programmes. A scientific analysis has shown that success is possible.     

Lack of evidence on diets for obesity for children: a systematic review

BACKGROUND: The prevalence of obesity has increased rapidly in most developed countries in the last decades, and this rise is now spreading to developing countries. Childhood obesity is also increasing. The UK government has set a target to halt the rise in childhood obesity by 2010. Dietary recommendations are a central component of any comprehensive weight-loss programme. A low-fat energy-restricted diet is the conventional therapy for obesity, but alternative dietary interventions have been proposed in recent years. METHODS: We conducted a systematic review to assess dietary intervention studies designed to reduce weight in childhood and adolescence. The studies included overweight or obese children or adolescents in which there was a comparison group and change in body weight or BMI was reported. RESULTS: We identified only nine such studies, seven of which were randomized. Six were conducted in the USA, two in Cuba, and one in France. Low-carbohydrate and low-glycaemic-index diets appeared to be at least as effective as energy-restricted low-fat diets for short-term weight loss, but most studies were too small to be informative, and none provided evidence on long-term weight control. CONCLUSIONS: There is a marked mismatch between the public health importance of childhood obesity and the number and quality of the studies conducted so far to assess dietary interventions for weight reduction in childhood and adolescence, and little evidence to support the current recommendation of a low-fat energy-restricted diet. There is an urgent need for well-designed intervention studies of the long-term effectiveness of alternative diets to provide a basis for evidence-based recommendations.     

Local Spatial Analysis and Dynamic Simulation of Childhood Obesity and Neighbourhood Walkability in a Major Canadian City

Body weight is an important indicator of current and future health and it is even more critical in children, who are tomorrow''s adults. This paper analyzes the relationship between childhood obesity and neighbourhood walkability in Calgary, Canada. A multivariate analytical framework recognizes that childhood obesity is also associated with many factors, including socioeconomic status, foodscapes, and environmental factors, as well as less measurable factors, such as individual preferences, that could not be included in this analysis. In contrast with more conventional global analysis, this research employs localized analysis and assesses need-based interventions. The one-size-fit-all strategy may not effectively control obesity rates, since each neighbourhood has unique characteristics that need to be addressed individually. This paper presents an innovative framework combining local analysis with simulation modeling to analyze childhood obesity. Spatial models generally do not deal with simulation over time, making it cumbersome for health planners and policy makers to effectively design and implement interventions and to quantify their impact over time. This research fills this gap by integrating geographically weighted regression (GWR), which identifies vulnerable neighbourhoods and critical factors for childhood obesity, with simulation modeling, which evaluates the impact of the suggested interventions on the targeted neighbourhoods. Neighbourhood walkability was chosen as a potential target for localized interventions, owing to the crucial role of walking in developing a healthy lifestyle, as well as because increasing walkability is relatively more feasible and less expensive then modifying other factors, such as income. Simulation results suggest that local walkability interventions can achieve measurable declines in childhood obesity rates. The results are encouraging, as improvements are likely to compound over time. The results demonstrate that the integration of GWR and simulation modeling is effective, and the proposed framework can assist in designing local interventions to control and prevent childhood obesity.