柳叶刀 | 儿童肥胖问题严重，仅靠父母干预无法有效降低幼儿肥胖水平

发布时间：2025-09-17 17:35:22  浏览量：1

全球约有3700万5岁以下儿童面临超重或肥胖问题，《柳叶刀》（The Lancet）近日发表一项迄今为止关于“以父母为中心预防幼儿肥胖效果”主题的最大规模研究。结果显示，现有针对0至12个月婴幼儿实施的旨在预防儿童肥胖的父母行为干预项目，在改善两岁左右幼儿BMI方面效果有限。

这项涵盖17项试验、涉及9000多名幼儿的meta分析表明，以父母为中心的儿童早期肥胖预防项目对幼儿身体质量指数（BMI）无显著影响。

作者指出，这些发现凸显了重新审视当前预防幼儿肥胖的行为策略的必要性，并强调了采取更广泛、协调且资源充足的公共卫生行动的迫切需求。

全球约有3700万5岁以下儿童面临超重或肥胖问题[1]。儿童肥胖将对终生健康造成重大影响。为预防肥胖，许多专家认为关键在于早期干预，即在儿童早期尚未出现超重或肥胖前采取行动。世界卫生组织建议采取全生命周期预防策略，从孕期就开始降低肥胖风险，并倡导为父母/照护人提供关于儿童早期健康饮食、睡眠及身体活动的指导[2]。

因此，许多国家和地区将早期父母干预项目作为肥胖预防的核心策略，如社区育儿课程、家庭访问或通过SMS短信/邮件/应用程序分享信息等，重点提升父母在营养、身体活动和睡眠等领域的技能与知识。

然而，关于此类项目的有效性证据有限，这让政策制定者陷入两难境地，导致在证据不足的情况下，仍决定实施可能资源密集型的项目。

主要作者、澳大利亚悉尼大学的Kylie Hunter博士指出：“肥胖在很大程度上是由个人无法改变的环境和社会经济因素驱动的。父母虽扮演着关键角色，但我们的研究表明，仅靠父母无法有效降低儿童肥胖水平。”

“需要全社会采取更广泛、更协调的行动，让每个人无论居住何处都能更容易做出健康的选择。在支持父母的同时，我们需要制定协调一致的政策，以提高健康食品的可负担性，增加绿色空间的可及性，并规范不健康食品的营销，以应对儿童肥胖问题。”

作者组建了一个全球合作项目TOPCHILD，包含来自47家机构的70多名研究人员，整合了在10个国家开展的31项试验的数据。所有试验的研究人员协同工作并共享个体参与者数据，最终形成包含28825名参与者的大型数据集，用于评估旨在帮助父母培养幼儿健康营养、睡眠及活动模式的肥胖预防项目的干预效果。纳入meta分析的试验需满足：在妊娠期至12月龄期间启动，且需测量儿童体重相关指标。作者还在弗林德斯大学主导的补充研究中，厘清了干预措施的内容与实施方式的详细信息[3]。

在提供数据的31项试验中，有17项试验包含个体参与者数据，评估了两岁左右儿童的BMI，共计9128名参与者。这些试验采用不同的干预方法[3]，包括：

一项英国项目评估试验：该项目在儿童中心为8~10名父母组成的小组提供为期八周的周课程，重点关注包括食物供应和运动在内的行为模式。[4]

一项澳大利亚试验：在两年内对初产妇进行8次家庭访问，就母乳喂养、辅食添加时机、屏幕使用时间及身体活动等主题提供建议。[5]

一项美国试验：初级保健服务提供者在婴儿2~18个月期间的7次随访中，借助简单易懂的手册协助父母设定饮食、身体活动或屏幕使用时间目标。[6]

这项meta分析发现一项高度确定的结果：儿童早期肥胖预防项目对儿童两岁左右时的BMI无任何影响。

德国罗斯托克大学的资深作者Anna Lene Seidler教授指出：“当前针对幼儿肥胖的父母干预项目效果不显著，可能存在多种潜在解释。其中一个原因可能是幼儿出生的第一年对父母而言压力巨大，导致他们难以全身心投入行为改变。当儿童进入托育机构或学校等更广阔的社会环境后，直接在这些场所营造健康环境的项目可能更有效。”

“此外，受儿童肥胖影响最严重的家庭通常来自低收入群体，也是最不可能被以父母为中心的早期干预项目覆盖到的家庭。这些家庭常因资源匮乏或时间不足而难以参与并坚持这些项目，尤其是在当前的生活成本危机背景下。通过政策层面变革为所有儿童营造健康环境，才是惠及这些家庭的有效途径。”

作者承认研究存在一些局限性，其中，17项试验中有7项因数据缺失和/或干预组与对照组参与者数据缺失率不同而被评定为高偏倚风险。然而，当排除这些试验后，分析结果仍保持不变。 END

References

[1] https://data.unicef.org/resources/jme-report-2023/?utm_id=JME-2023

[2] https://www.who.int/publications/i/item/9789241510066

[3] Johnson BJ, Chadwick PM, Pryde S, Seidler AL, Hunter KE et al. Behavioural components and delivery features of early childhood Obesity prevention interventions: intervention coding of studies in the TOPCHILD Collaboration systematic review. IJBNPA. 2025;22:14.

[4] Bryant M, Collinson M, Burton W, et al. Cluster randomised controlled feasibility study of HENRY: a community-based intervention aimed at reducing obesity rates in preschool children. Pilot and Feasibility Studies 2021; 7(1): 59.

[5] Wen LM, Baur LA, Simpson JM, Rissel C, Wardle K, Flood VM. Effectiveness of home-based early intervention on children’s BMI at age 2: randomised controlled trial. BMJ 2012; 344:e3732

[6] Sanders LM, Perrin EM, Yin HS, et al. A health-literacy intervention for early childhood obesity prevention: a cluster-randomized controlled trial. Pediatrics 2021; 147(5).

Declaration of interests

KEH declares support for the current study as an investigator from the Australian National Health and Medical Research Council (NHMRC; GNT1186363 and GNT2006999) and had travel supported by the EPOCH-Translate Centre of Research Excellence (CRE; 2023 and 2024). RKG declares support for the current study as an investigator from the NHMRC (GNT1186363, GNT2006999, and GNT1101675, and for BJJ salary support). LAB and LMW declare grant funding from the NHMRC (393112 and 1003780) and the NHMRC CRE (1101675 and 2006999). JXS is supported by an NHMRC Postgraduate Research Scholarship. LW declares salary support from the NHMRC Investigator Grant Scheme. RWT declares salary support from the Karitane Products Society. PJG is supported by the UK Medical Research Council (MC_UU_00004/06). LMS declares funding for their included trial Greenlight from the Patient-Centered Outcomes Research Institute (PCORI). KPR declares support from the NHMRC (Investigator Grant 2025-2029). VB declares support for the current study as an investigator from the NHMRC (GNT2006999). AJH declares payments to their institution from the NHMRC (GNT1186363). KDH declares grant funding from the NHMRC (GNT425801 and GNT1008879), and Future Leader Fellowship funding from the Heart Foundation Australia . LA declares support for the current study as an investigator from the NHMRC (GNT1186363 and GNT2006999). MB declares salary support as the Principal Investigator of their included trial HENRY from the National Institute for Health and Care Research (NIHR) and has a role as member of the Board of Trustees, UK Association for the Study of Obesity (Chair 2019–22). AGF declares grants or contracts from the US National Institutes of Health (NIH), PCORI, and Agency for Healthcare Research and Quality (AHRQ); received consulting fees from the University of California, Los Angeles (UCLA), Rutgers, PCORI, and Duke University; was paid for presentations by Emory University; had travel supported by the NIH and PCORI; participated on the Data and Safety Monitoring Board for NIH trials; has a role in the American Academy of Pediatrics; and declares funding for their included trial from University Research Council faculty grant at the University of Cincinnati. KKO declares programme funding from the UK Medical Research Council (MC_UU_00006/2) and has a role as Chair of the Maternal and Child Nutrition Subgroup of the UK Scientific Advisory Committee on Nutrition. LK declares support from the Behavioural Science Institute, Radboud University. JKL declares salary and included trial support from Fonds NutsOhra (100.939). AML declares funding for their included trial from the NIH (UL1TR000117 and UL1TR001998). EO declares they are the recipient of a grant from the NIH. MJM declares support for their included trail from the US Department of Agriculture (USDA) National Institute of Food and Agriculture (2011-68001-30207 and 2017-68001-26350). IMP declares that payment to support their time was received from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK; R01DK088244) and received consulting fees from Danone North America. EAR declares they are the recipient of a grant from the NIH and is President of the Southern Nursing Research Society. RLR declares funding for their included trials Greenlight from the NIH and Greenlight Plus from the PCORI and has received grants or contracts from the AHRQ, PCORI, NIH, US Centers for Disease Control and Prevention (CDC), and Cardiohealth Alliance. TMR declares funding for their included trial THRIVE from NIDDK (T32 DK063929) and declares they have received grants or contracts from the NIDDK (R01DK135497), Cincinnati Children’s Hospital Medical Center. HMW declares funding for their included trial Mothers and Others from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; R01HD073237) and declares their time was funded by the NIDDK (K01DK111793). ALT declares funding for their included trial Mothers and Others from the NICHD (R01HD073237). HX declares support for the trial Healthy Beginnings involvement was provided by Sydney Local Health District (SLHD). KJJ declares salary support as the Principal Investigator of their included trial from the NIH. KdlH declares funding for their involvement from the NICHD (1R01HD092483). BC declares funding for their included trial HENRY III from the NIHR (NIHR135081). RSG declares support and has received funding from the NIH and USDA. JB declares funding and travel support from the Hawaii Community Foundation, USDA, and Kellog Foundation; and payments for presentations through various organisations. ALS declares support for the current study as an investigator from the NHMRC (GNT1186363, GNT1101675, GNT2006999, and GNT2009432). All other authors declare no competing interests.

中文翻译仅供参考，所有内容以英文原文为准。

https://doi.org/10.1016/S0140-6736(25)01144-4