運用健康生活型態方案於兒童肥胖防治成效評估──系統性文獻回顧

Effectiveness Evaluation of Healthy Lifestyle Interventions in Childhood Obesity Prevention: A Systematic Review

背景：藉由不同場域或方案進行兒童肥胖防治之實驗性研究均各自表述未有定論，為預防成年期肥胖及慢性病年輕化，本系統性文獻回顧期使統合實證依據提供兒童肥胖防治策略之依據。目的：藉由系統性文獻查證方式探討以健康生活型態介入對於肥胖兒童肥胖防治之成效。方法：電子資料庫檢索2001年至2011年5月間之實驗性研究，以「兒童肥胖（childhood obesity）、防治措施（preventive intervention）或護理措施（nursing intervention）、健康生活型態（healthy lifestyle）」為關鍵字，目標族群為5- 14歲肥胖兒童，以面對面進行健康生活型態策略之隨機分派或具控制對照組之實驗性研究。健康生活型態包括：飲食衛教、運動介入、靜態活動改善等方案，介入時間在4週以上；主要成效評估包括：型態學、飲食、靜態活動等三項指標，評估期間在6個月以上。檢視其研究方法、品質及成效後共納入11篇文獻進行整合研究結果。結果：無論各研究方案之場域、命名各有歧異，但歸納發現健康生活型態介入，以型態學指標：體重、BMI（body mass index）、皮層厚度、身體質塊及臀圍之體重控制有顯著改善。每日的飲食營養指導應具有文化及族裔之敏感性，設計具個別文化特色食材製作健康餐點，介入時間每週15分鐘以上，可以讓兒童及家庭建立正確飲食習慣；同時每日30-60分鐘之中度費力運動，並降低靜態行為，對兒童肥胖防治有實質助益。結論／實務應用：應針對臺灣文化飲食特性、加強學童日常體能活動訓練及減少日常靜態活動之健康生活型態方案，可促進我國兒童正常體位發展。

Background: There is significant reporting on evidence-based research in the literature regarding lifestyle modification programs. There is a need to review and synthesize results in order to develop childhood obesity prevention and intervention strategy recommendations.Purpose: Main purposes of the present review were to update the systematic review and critical appraisal of recent evidence in this area and assess the efficacy and quality of published research studies.Methods: Studies included in this review incorporated the following inclusion criteria: obese children participants 5 to 14 years of age; a face-to-face randomized-controlled study with a 4-week intervention period; and anthropometry, physical activity, sedentary behavior evaluated as primary outcomes after ＞6 months. Eleven studies met the 3 inclusion criteria. All were found using the following key word string: RCT or CCT interventional study researches, childhood obesity, overweight, preventive intervention, healthy lifestyle”.Results: Evidence from these studies showed that all interventions varied in terms of approach and settings. Most provided a healthy lifestyle program duration of more than 15 minutes per week. Those that included culturally sensitive diet education and 30-60 minutes of moderate-intensity exercise everyday significantly enhanced childhood obesity prevention in terms of both anthropometry and dietary habits and decreased sedentary behavior.Conclusions / Implications for Practice: Results suggest that effective healthy lifestyle programs for childhood obesity prevention in Taiwan should provide dietary guidance sensitive to Taiwanese dietary habits, encourage daily physical activities, and decrease sedentary behavior.