生活方式干预对肥胖儿童而及青少年膳食、身体活动和健康的影响

Effects of lifestyle intervention on diet,physical activities and health outcomes of obese children and adolescents

目的经1年的生活方式干预和定期随访观察,评估对肥胖儿童及青少年膳食、身体活动和健康的影响及干预方法的有效性。方法选取2015年6月至2017年6月在我科就诊、体重指数(BMI)>同年龄、同性别的第95百分位数,家长同意并签署知情同意书的肥胖儿童及青少年153例。根据干预方案,每3个月随访一次,持续1年,期间监测和评估其膳食、身体活动、体格生长及并发症改善情况。结果完成持续1年的4次定期随访肥胖儿童和青少年52例(34.0%)为随访1年组;随访3~9个月后失访101例(66.0%)为随访<1年组。随访1年组干预后能量[(8524.5±2068.6)kJ比(6464.0±1586.9)kJ,P<0.05]、蛋白质[(75.5±20.7)g比(64.2±16.8)g,P<0.05]、脂肪[(79.0±18.8)g比(60.3±14.2)g,P<0.05]、碳水化合物[(257.1±83.6)g比(188.9±63.8)g,P<0.05]的摄入量减少,每天进行至少20 min中高等强度身体活动的人数增加(0比32.7%,P<0.05);干预后BMI标准差[(3.15±0.85)比(2.46±0.81),P<0.05]、腰围身高比[(0.60±0.04)比(0.56±0.06),P<0.05]、体脂百分比(FMP)[(39.9%±5.4%)比(33.0%±7.4%),P<0.05]下降,而骨骼肌率上升[(32.1%±3.2%)比(36.0%±4.3%),P<0.05];干预后胰岛素抵抗、血脂异常、非酒精性脂肪肝检出率明显减少(P<0.05)。干预后随访1年组体脂下降及骨骼肌增加更加明显(P<0.05)。结论生活方式干预和定期随访1年可以减少肥胖儿童及青少年的能量摄入,增加身体活动,改善临床结局,降低肥胖并发症的发生率,值得临床推广。

Objective To observe the effects of lifestyle intervention on diet, physical activities and health outcomes in obese children and adolescents during one year of follow up.Methods A total of 153 obese children and adolescents with body mass index more than 95th percentage of the same age and sex were recruited consecutively from June 2015 to June 2017 in our hospital whose parents had signed the informed consent forms. The children were followed-up once every three months and their diet and physical activities, anthropometric measurement and metabolic indicators were assessed on research scheme, which lasted for one year. Results A total of 52 obese children completed four visits plan in 12 months (34.0%, one year group), 101 children (66.0%) dropped from 3 to 9 months (66.0%, less than one year group). The intake of total energy [(8 524.5±2 068.6)kJ vs (6 464.0±1 586.9)kJ, P<0.05], dietary protein [(75.5±20.7)g vs (64.2±16.8)g, P<0.05], fat [(79.0±18.8)g vs (60.3±14.2)g, P<0.05], carbohydrates [(257.1±83.6)g vs (188.9±63.8)g, P<0.05] decreased after one year intervention in one year group. Moreover, the numbers of physical activity of medium to high intensity increased in obese children (0 vs 32.7%, P<0.05). BMI-SDS [(3.15±0.85) vs (2.46±0.81), P<0.05], WHtR [(0.60±0.04) vs (0.56±0.06), P<0.05] and FM% [(39.9±5.4) vs (33.0±7.4), P<0.05] were reduced, while SMM% [(32.1±3.2) vs (36.0±4.3), P<0.05] increased significantly in one year group. The detection rate of insulin resistance, dyslipidemia and nonalcoholic fatty liver disease (NAFLD) were reduced in one year group at the end of follow up (P<0.05). The decrease of body fat and the increase of skeletal muscle were more obvious in one-year follow up group(P<0.05).Conclusion Children and adolescent have less energy intake, more physical activities, good clinical outcomes and less complications of obesity through lifestyle intervention and follow up for one year, so it is worthy of being promoted.