近日，澳大利亚悉尼大学Louise A Baur团队研究了以父母为中心的行为干预预防幼儿肥胖（TOPCHILD）：系统综述和个体参与者数据荟萃分析。这一研究成果发表在2025年9月10日出版的《柳叶刀》杂志上。

儿童肥胖是一个全球性的公共卫生问题，这促使各国政府投资于预防规划。该研究旨在全球范围内调查以家长为中心的儿童早期肥胖预防干预措施的有效性。

研究组进行了系统综述和个体参与者数据荟萃分析。对个体参与者的数据进行检查、协调，并评估其完整性和偏倚风险。研究组排除了准随机、仅调查妊娠干预或未收集任何儿童体重相关结果的试验。主要终点为24个月（±6个月）时BMI Z评分。研究组进行了意向治疗、两阶段随机效应荟萃分析，以检查总体效应和预先指定的亚组效应。使用推荐评估、发展和评价分级来评估证据的确定性。该研究已注册为PROSPERO， CRD42020177408。

19990份确定的记录中，47项（0.24%）试验完成并符合条件。其中，18项（38%）评估了研究组的主要结局，BMI Z评分。研究组共获得了18项试验（n=9383）中17项（94%;n=9128）的个体受试者数据，占符合条件受试者的97%。在这9128名参与者中，4549名（50%）是男孩，4415名（48%）是女孩，164名（2%）性别不明。研究组没有发现干预措施对24月龄BMI Z评分有影响的证据（±6个月；平均差- 0.01；高确定性证据，τ2= 0.01; n=6505；缺失2623）。研究结果对预先指定的敏感性分析（例如，不同的分析方法和缺失的数据）是稳健的，没有发现对包括优先人群和试验水平因素在内的预先指定的亚组有差异干预效果的证据。

这些发现表明，以父母为中心的行为干预措施不足以预防24个月（±6个月）的肥胖。这一证据强调了重新思考儿童肥胖预防方法的必要性。

附：英文原文

Title: Parent-focused behavioural interventions for the prevention of early childhood obesity (TOPCHILD): a systematic review and individual participant data meta-analysis

Author: Kylie E Hunter, David Nguyen, Sol Libesman, Jonathan G Williams, Mason Aberoumand, Jannik Aagerup, Brittany J Johnson, Rebecca K Golley, Angie Barba, James X Sotiropoulos, Nipun Shrestha, Talia Palacios, Samantha J Pryde, Luke Wolfenden, Rachael W Taylor, Peter J Godolphin, Karen Matvienko-Sikar, Lee M Sanders, Kristy P Robledo, Vicki Brown, Charles T Wood, Sarah Taki, H Shonna Yin, Alison J Hayes, Denise A OConnor, Wendy Smith, David e Espinoza, Lisa Askie, Paul M Chadwick, Chris Rissel, Angela C Webster, Kylie D Hesketh, Maria Bryant, Jessica L Thomson, Rajalakshmi Lakshman, Alexander G Fiks, Christine Helle, Cathleen Odar Stough, Ken K Ong, Eliana M Perrin, Levie Karssen, Junilla K Larsen, Ana M Linares, Mary Jo Messito, Li Ming Wen, Emily Oken, Nina Cecilie verby, Cristina Palacios, Ian M Paul, Finn E Rasmussen, Elizabeth A Reifsnider, Russell L Rothman, Rebecca A Byrne, Tiffany M Rybak, Sarah-Jeanne Salvy, Heather M Wasser, Amanda L Thompson, Ata Ghaderi, Barry J Taylor, Claudio Maffeis, Huilan Xu, Jennifer S Savage, Kaumudi J Joshipura, Kayla de la Haye, Margrethe Red, Bethan Copsey, Natalia Golova, Rachel S Gross, Stephanie Anzman-Frasca, Jinan Banna, Louise A Baur

Issue&Volume: 2025-09-10

Abstract:

Background

Childhood obesity is a global public health issue, which has prompted governments to invest in prevention programmes. We aimed to investigate the effectiveness of parent-focused early childhood obesity prevention interventions globally.

Methods

We did a systematic review and individual participant data meta-analysis. We searched databases and trial registries (MEDLINE, Embase, CENTRAL, CINAHL, PsycInfo, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform) from inception until Sept 30, 2024, for randomised controlled trials commencing before 12 months of age examining parent-focused behavioural interventions to prevent obesity in children, compared with usual care, no intervention, or attention control. Individual participant data were checked, harmonised, and assessed for integrity and risk of bias. We excluded trials that were quasi-randomised, investigated pregnancy-only interventions, or did not collect any child weight-related outcomes. The primary outcome was BMI Z score at age 24 months (±6 months). We did an intention-to-treat, two-stage, random effects meta-analysis to examine effects overall and for prespecified subgroups. We assessed certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation. This study is registered with PROSPERO, CRD42020177408.

Findings

Of 19990 identified records, 47 (0·24%) trials were completed and eligible. Of these, 18 (38%) assessed our primary outcome, BMI Z score. We obtained individual participant data for 17 (94%; n=9128) of these 18 trials (n=9383), representing 97% of eligible participants. Of these 9128 participants, 4549 (50%) were boys, 4415 (48%) were girls, and 164 (2%) had unknown sex. We found no evidence of an effect of interventions on BMI Z score at age 24 months (±6 months; mean difference –0·01 [95% CI –0·08 to 0·05]; high certainty evidence, τ2=0·01; n=6505; 2623 missing). Findings were robust to prespecified sensitivity analyses (eg, different analysis methods and missing data), and we found no evidence of differential intervention effects for prespecified subgroups including priority populations and trial-level factors.

Interpretation

These findings indicate that examined parent-focused behavioural interventions are insufficient to prevent obesity at age 24 months (±6 months). This evidence highlights a need to re-think childhood obesity prevention approaches.

DOI: 10.1016/S0140-6736(25)01144-4

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01144-4/abstract