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소아청소년 비만 예방의 근거: 기존 체계적 문헌고찰과 메타분석 활용

Evidence of Interventions for Preventing Obesity of Children and Adolescents Using Existing Systematic Reviews and Meta-Analyses

성은주|유선미|김설혜
대한임상건강증진학회 (Korean Society For Health Promotion And Disease Prevention)|2016.12|Korean Journal of Health Promotion|제16권 제4호|pp. 231-250|DOI http://dx.doi.org/10.15384/kjhp.2016.16.4.231

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청소년Adolescent예방Child비만Obesity소아체계적 고찰ReviewPrevention and control
주제분류기타자연과학

초록

연구배경: 소아비만은 전 세계적인 보건 문제이며, 우리나라 또한 예외가 아니다. 국내에서도 소아비만 예방 사업이 산발적으로 진행되고 있으나, 근거에 기반한 사업모형이나 적절한 평가 없이 비슷한 사업이 반복되고 있다. 본연구는 소아비만 예방 프로그램의 연구 및 개발에 앞서, 기존의 소아비만 예방을 위한 체계적 종설과 메타분석을 모아 서술적으로 분석하여 효과적인 비만 예방을 위한 중재의 특성을 파악하고자 하였다. 방법: 전자저널 데이터베이스인 PubMed에서 2005년 1월이후부터 2015년 11월까지 발표된 소아ㆍ청소년 비만 예방중재 또는 프로그램을 다룬 체계적 종설 및 메타분석을 검색하였다. 포함된 논문에서 인용된 참고문헌 목록을 점검하여 연구 대상에 추가하였고, 미출판논문에 대한 검색은시행하지 않았다. 연구 대상 포함 기준은 비만 예방을 위한 중재를 대상으로 한 체계적 종설이나 메타분석일 것, 2세이상 18세 미만의 소아ㆍ청소년을 대상으로 한 연구일 것, 영어로 된 논문일 것 등이었다. 개별 연구는 체계적 문헌고찰의 질 평가도구인 AMSTAR를 이용하여 평가하였다. 임상 및 연구에 적용할 점, 연구의 장점 및 제한점에 대한정성분석을 시행하였다. 결과: 최종적으로 35편의 논문이 연구에 포함되었고, 15 편은 체계적 고찰, 20편은 메타분석에 해당하였다. 포함된35편의 논문 중 24편(69%)에서 소아청소년 비만 예방 중재의 효과에 대해 긍정적으로 보고하였다. 식사, 운동, 좌식생활, 환경 등 다양한 분야에 대한 중재를 포함하는 다면적접근이 효과적이었고, 학교를 중심으로 가정, 지역사회 등다양한 환경에서 중재를 하였을 때 긍정적인 결과를 나타내었다. 부모의 높은 참여도 또한 긍정적인 중재 결과에 영향을 주었다. 대상자의 나이, 성별, 지역, 사회경제적 특성에 따라 중재 효과가 다양하게 나타남을 보였다. 결론: 소아ㆍ청소년을 대상으로 한 비만 예방 중재는 작지만 체질량지수의 개선을 보였으며, 비만에 영향을 주는식사, 운동, 행동변수 및 임상변수에도 긍정적인 효과를 나타내었다. 효과적인 소아ㆍ청소년 비만 예방을 위해서는학교를 중심으로 가족 및 지역사회의 포괄적인 참여가 이루어지는 환경에서, 다양한 중재 방법을 활용한 프로그램의 개발 및 보급을 위한 노력이 필요하다.

Abstract

Background:Pediatric obesity is an important global issue in public health. However, previous efforts for childhood obesity prevention have sporadically been implemented in Korea, neither evidence-based nor with proper evaluation. We aimed to investigate the characteristics of an effective intervention for prevention of pediatric obesity by reviewing previous systematic reviews and Meta-analyses. Methods:PubMed was searched for articles published frombetween January 2005 to November 2015. Inclusion criteria were as follows: (1) articles published in English; (2) child and/or adolescents (between 2 and 18 years of age) as subjects; and (3) systematic reviews or meta-analyses concerning the preventive intervention of pediatric/adolescent obesity. Each study was evaluated via the Assessment of Multiple Systematic Reviews for quality assessment. We conducted a quantitative analysis to evaluate the implications, strengths, and limitations of each study. Results:Our final analysis included 35 articles, of which 15 were systematic reviews and 20 were meta-analyses. Among these, 24 studies (69%) advocated the efficacy of preventive intervention for pediatric obesity. Multidimensional approach including diet, exercise, and environmental factors conducted in schools with a parent and community involvement wasis more effective at preventing obesity. The efficacy of intervention varied depending on the age, sex, region, and socioeconomic characteristics of participantssubjects. Conclusions:Preventive intervention of pediatric obesity demonstrated smallminor improvements in body mass index and had positive effects on behavioral and clinical variables, which are associated with obesity. For the efficient prevention of pediatric obesity, it is necessary to consider efforts for developing various intervention programs, with active as well as the participation of school, family, and social community groups.

참고문헌 (46)

  1. "Population-based prevention strategies for childhood obesity : report of a WHO forum and technical meeting" (2010)[URL]
  2. "Trends in obesity and comprehensive policy strategy to prevent obesity in Korea" (2009)[URL]
  3. 이효영, "메타분석을 이용한 비만관리 프로그램의 효과분석", 보건교육건강증진학회지, 24(5), pp.131~146 (2007), 한국보건교육건강증진학회
  4. 성경숙, "국내 비만아동의 비만관리프로그램의 효과에 대한 메타분석", Child Health Nursing Research, 19(4), pp.262~269 (2013), 한국아동간호학회[DOI]
  5. Shea BJ, "AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews", J Clin Epidemiol, 62(10), pp.1013~1020 (2009)
  6. NECA's guidance for undertaking systematic reviews and meta-analyses for intervention, "Kim SY", Korea Institute for Health and Social Affairs, ~ (2011)
  7. Liberati A, "The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration", BMJ, 339, pp.b2700~ (2009)
  8. Budd GM, "School-based obesity prevention: research, challenges, and recommendations", J Sch Health, 76(10), pp.485~495 (2006)
  9. Cook-Cottone C, "A meta-analytic review of obesity prevention in the schools: 1997–2008", Psychol Sch, 46(8), pp.695~719 (2009)
  10. Katz DL, "Strategies for the prevention and control of obesity in the school setting: systematic review and meta-analysis", Int J Obes (Lond), 32(12), pp.1780~1789 (2008)
  11. Lavelle HV, "Systematic review and meta-analysis of school-based interventions to reduce body mass index", J Public Health (Oxf), 34(3), pp.360~369 (2012)
  12. Luckner H, "Effectiveness of interventions to promote healthy weight in general populations of children and adults: a meta-analysis", Eur J Public Health, 22(4), pp.491~497 (2012)
  13. Marsh S, "Family-based interventions for reducing sedentary time in youth: a systematic review of randomized controlled trials", Obes Rev, 15(2), pp.117~133 (2014)
  14. Stice E, "A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work", Psychol Bull, 132(5), pp.667~691 (2006)
  15. van Grieken A, "Primary prevention of overweight in children and adolescents:a meta-analysis of the effectiveness of interventions aiming to decrease sedentary behaviour", Int J Behav Nutr Phys Act, 9, pp.61~ (2012)
  16. Wahi G, "Effectiveness of interventions aimed at reducing screen time in children: a systematic review and meta-analysis of randomized controlled trials", Arch Pediatr Adolesc Med, 165(11), pp.979~986 (2011)
  17. Chen JL, "Efficacy of technology-based interventions for obesity prevention in adolescents: a systematic review", Adolesc Health Med Ther, 5, pp.159~170 (2014)
  18. Williams AJ, "Systematic review and meta-analysis of the association between childhood overweight and obesity and primary school diet and physical activity policies", Int J Behav Nutr Phys Act, 10, pp.101~ (2013)
  19. Osei-Assibey G, "The influence of the food environment on overweight and obesity in young children: a systematic review", BMJ Open, 2(6), pp.e001538~ (2012)
  20. Brown T, "Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence", Obes Rev, 10(1), pp.110~141 (2009)
  21. Branscum P, "After-school based obesity prevention interventions: a comprehensive review of the literature", Int J Environ Res Public Health, 9(4), pp.1438~1457 (2012)
  22. Connelly JB, "A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: a realistic synthesis of the evidence", Public Health, 121(7), pp.510~517 (2007)
  23. Doak CM, "The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes", Obes Rev, 7(1), pp.111~136 (2006)
  24. Gonzalez-Suarez C, "School-based interventions on childhood obesity: a meta-analysis", Am J Prev Med, 37(5), pp.418~427 (2009)
  25. Harris KC, "Effect of school-based physical activity interventions on body mass index in children: a meta-analysis", CMAJ, 180(7), pp.719~726 (2009)
  26. Kamath CC, "Clinical review: behavioral interventions to prevent childhood obesity: a systematic review and metaanalyses of randomized trials", J Clin Endocrinol Metab, 93(12), pp.4606~4615 (2008)
  27. Kropski JA, "School-based obesity prevention programs: an evidence-based review", Obesity (Silver Spring), 16(5), pp.1009~1018 (2008)
  28. Lissau I, "Prevention of overweight in the school arena", Acta Paediatr, 96(454), pp.12~18 (2007)
  29. Niemeier BS, "Parent participation in weight-related health interventions for children and adolescents:a systematic review and meta-analysis", Prev Med, 55(1), pp.3~13 (2012)
  30. Peirson L, "Prevention of overweight and obesity in children and youth: a systematic review and meta-analysis", CMAJ Open, 3(1), pp.E23~E33 (2015)
  31. Sbruzzi G, "Educational interventions in childhood obesity:a systematic review with meta-analysis of randomized clinical trials", Prev Med, 56(5), pp.254~264 (2013)
  32. Silveira JA, "The effect of participation in school-based nutrition education interventions on body mass index: a meta-analysis of randomized controlled community trials", Prev Med, 56(3-4), pp.237~243 (2013)
  33. Sobol-Goldberg S, "School-based obesity prevention programs: a meta-analysis of randomized controlled trials", Obesity (Silver Spring), 21(12), pp.2422~2428 (2013)
  34. Vasques C, "Effects of intervention programs on child and adolescent BMI: a meta-analysis study", J Phys Act Health, 11(2), pp.426~444 (2014)
  35. Wang Y, "What childhood obesity prevention programmes work? A systematic review and meta-analysis", Obes Rev, 16(7), pp.547~565 (2015)
  36. Waters E, "Interventions for preventing obesity in children", Cochrane Database Syst Rev, (12), pp.CD001871~ (2011)
  37. Zenzen W, "Integrative review of school-based childhood obesity prevention programs", J Pediatr Health Care, 23(4), pp.242~258 (2009)
  38. Langford R, "The WHO health promoting school framework for improving the health and well-being of students and their academic achievement", Cochrane Database Syst Rev, (4), pp.CD008958~ (2014)
  39. Bleich SN, "Systematic review of community-based childhood obesity prevention studies", Pediatrics, 132(1), pp.e201~e210 (2013)
  40. Showell NN, "A systematic review of home-based childhood obesity prevention studies", Pediatrics, 132(1), pp.e193~e200 (2013)
  41. Li M, "A systematic review of school-based intervention studies for the prevention or reduction of excess weight among Chinese children and adolescents", Obes Rev, 9(6), pp.548~559 (2008)
  42. Friedrich RR, "Effect of interventions on the body mass index of school-age students", Rev Saude Publica, 46(3), pp.551~560 (2012)
  43. Brown HE, "Family-based interventions to increase physical activity in children: a meta-analysis and realist synthesis protocol", BMJ Open, 4(8), pp.e005439~ (2014)
  44. Swinburn B, "Obesity prevention: a proposed framework for translating evidence into action", Obes Rev, 6(1), pp.23~33 (2005)
  45. Hoffmann TC, "Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide", BMJ, 348, pp.g1687~ (2014)
  46. Moore GF, "Process evaluation of complex interventions: Medical Research Council guidance", BMJ, 350, pp.h1258~ (2015)

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소아, 청소년 비만 예방을 위한 학교 및 지역사회 중재박경희대한가정의학회 · Korean Journal of Family Medicine2004 · 제25권 제7호소아청소년 비만의 포괄적인 예방 전략문경래대한소아소화기영양학회 · Pediatric Gastroenterology, Hepatology & Nutrition2011 · 제14권 제4호국내 비만아동의 비만관리프로그램의 효과에 대한 메타분석김은주, 성경숙, 윤영미한국아동간호학회 · Child Health Nursing Research2013 · 제19권 제4호국내 아동비만 중재연구의 동향 분석오희, 마현희, 박지영, 이유나한국아동간호학회 · Child Health Nursing Research2017 · 제23권 제1호Physical Activity Component Should be Included when Designing National Child-Obesity Program: The Rapid Review of Multi-Component Child Obesity Intervention Programs이돈형대한운동학회 · 아시아 운동학 학술지2020 · 제22권 제3호아동·청소년 비만 예방을 위한 인구기반 예방 전략 개발: WHO 모형의 적용김기랑, 김혜련, 이은영한국보건교육건강증진학회 · 보건교육건강증진학회지2011 · 제28권 제3호

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