Hsin-Hui Lu, Duan-Rung Chen, An-Kuo Chou
The school environment and bullying victimization among seventh graders with autism spectrum disorder: a cohort study
Child and adolescent psychiatry and mental health
prevention childhood obesity international public health priority given significant impact obesity acute chronic diseases general health development wellbeing international evidence base strategies prevent obesity large accumulating rapidly update previous reviewto determine effectiveness range interventions include diet physical activity components designed prevent obesity childrenwe searched central medline embase psychinfo cinahl june 2015 reran search june 2015 january 2018 included search trial registersrandomised controlled trials rcts diet physical activity interventions combined diet physical activity interventions preventing overweight obesity children 017 years reported outcomes minimum 12 weeks baselinetwo authors independently extracted data assessed riskofbias evaluated overall certainty evidence using grade extracted data adiposity outcomes sociodemographic characteristics adverse events intervention process costs metaanalysed data guided cochrane handbook systematic reviews interventions presented separate metaanalyses age group child 0 5 years 6 12 years 13 18 years zbmi bmiwe included 153 rcts mostly usa europe thirteen studies based uppermiddleincome countries umic brazil ecuador lebanon mexico thailand turkey usmexico border one based lower middleincome country lmic egypt majority 85 targeted children aged 6 12 yearschildren aged 05 years moderatecertainty evidence 16 rcts n 6261 diet combined physical activity interventions compared control reduced bmi mean difference md 007 kgm2 95 confidence interval ci 014 001 similar effect 11 rcts n 5536 zbmi md 011 95 ci 021 001 neither diet moderatecertainty evidence physical activity interventions alone highcertainty evidence compared control reduced bmi physical activity alone md 022 kgm2 95 ci 044 001 zbmi diet alone md 014 95 ci 032 004 physical activity alone md 001 95 ci 010 013 children aged 05 yearschildren aged 6 12 years moderatecertainty evidence 14 rcts n 16410 physical activity interventions compared control reduced bmi md 010 kgm2 95 ci 014 005 however moderatecertainty evidence little effect zbmi md 002 95 ci 006 002 lowcertainty evidence 20 rcts n 24043 diet combined physical activity interventions compared control reduced zbmi md 005 kgm2 95 ci 010 001 highcertainty evidence diet interventions compared control little impact zbmi md 003 95 ci 006 001 bmi 002 kgm2 95 ci 011 006children aged 13 18 years lowcertainty evidence physical activity interventions compared control reduced bmi md 153 kgm2 95 ci 267 039 4 rcts n 720 lowcertainty evidence reduction zbmi md 02 95 ci 03 01 1 rct n 100 lowcertainty evidence eight rcts n 16583 diet combined physical activity interventions compared control effect bmi md 002 kgm2 95 ci 010 005 zbmi md 001 95 ci 005 007 6 rcts n 16543 evidence two rcts lowcertainty evidence n 294 found effect diet interventions bmidirect comparisons interventions two rcts reported data directly comparing diet either physical activity diet combined physical activity interventions children aged 6 12 years reported differencesheterogeneity apparent results three age groups could entirely explained setting duration interventions reported interventions appear result adverse effects 16 rcts increase health inequalities gender 30 rcts socioeconomic status 18 rcts although relatively studies examined factorsrerunning searches january 2018 identified 315 records potential relevance review synthesised next updateinterventions include diet combined physical activity interventions reduce risk obesity zbmi bmi young children aged 0 5 years weaker evidence single study dietary interventions may beneficialhowever interventions focus physical activity appear effective children age contrast interventions focus physical activity reduce risk obesity bmi children aged 6 12 years adolescents aged 13 18 years age groups evidence interventions focus diet effective evidence diet combined physical activity interventions may effective importantly updated review also suggests interventions prevent childhood obesity appear result adverse effects health inequalitiesthe review updated current form manage growth rcts child obesity prevention interventions future review split three separate reviews based child age