| ?Objective? Part one(1)To observe the effects of comprehensive intervention on anthropometric parameters in outpatient obese children and analyze whether the reductions of anthropometric parameters was closely with the time of intervention.(2)To evaluate clinical efficiency of two definitions of metabolic syndrome(MetS)and relevant individual components developed by the Society of Pediatrics,Chinese Medical Association in 2012(MetS-CHN-2012)and by International Diabetes Federation in 2007(MetS-IDF-2007).Part two To observe the effects of communityschool-family based intervention on changes in anthropometric parameters in school obese children.?Methods? Part one(1)A retrospective study was conducted in 640 obese children aged 6-18 years old in the outpatient of Department of Clinical Nutrition,Renji Hospital,School of Medicine,Shanghai Jiao Tong University from 2000 to 2016.Three hundred and forty obese children receiving intervention for more than 4 weeks and with complete anthropometric indices(height,weight,waist circumference and hip circmference)were enrolled.All participants were divided into 3 groups according to intervention time: 164 children were assigned into group I(intervention time<3 months),77 in group II(intervention time between 3 to 6 months)and 99 in group III(intervention time?6 months).Overall difference was tested by Kruskal-Wallis H test and Wilcoxon test among the three groups.The relationship between the changes in anthropometric parameters and intervention time was tested using Spearman partial correlation.(2)A retrospective study was conducted in outpatient obese children aged 10-18 years old from 2010 to 2016.95 obese children with complete anthropometric indices(height,weight,WC,HC),blood pressure and biological indices(serum lipid,transaminase,uric acid,fasting blood glucose,fasting insulin,CRP and serum ferritin)were enrolled.Insulin resistance(IR)was evaluated by homeostasis model assessment(HOMA).The consistency of two definitions for MetS criteria and relevant individual components was analyzed using Kappa test.Subjects were divided into two groups according to MetS-CHN-2012,including 64 in simple obesity children(SOC)group and 31 in obesity plus MetS group.Wilcoxon test was used to test the difference between groups.The risk factors for MetS among obese chidren were analyzed by binary logistic regression.Part Two A cross-sectional survey was performed with a sample size of 2676 primary school students aged 7-13 years,which were randomly selected from five schools in Gao Hang Town,Shanghai.Overweight and obese children(n=576)were further selected to receive a 2-year intervention program based community,school and family.Normal-weighted children(n=1067)were served as the control group.The differences in changes of anthropometric parameters were tested by non-paired t test or Wilcoxon test according to the distribution of the data.?Results? Part One(1)BMI Z-score and WC Z-score decreased significantly in group III and group II than those in group I(P<0.001).BMI Z-score in group III also decreased greater than that in group II(P=0.010),while there was no significant difference in WC Z-score(P=0.482).After controlling for age,sex,the baseline BMI Z score and WC Z-score,the changes of BMI Z-score and WC Z-score were still positively correlated with intervention time(r=0.407,P<0.001;r=0.170,P=0.002).(2)The concordance between the two definitions for MetS criteria was 83.2%(Kappa=0.558,P<0.001).The concordance was 84.2% and 78.9% for detecting the individual components(dyslipidemia and hypertension)(Kappa=0.632,P<0.001;Kappa=0.473,P =0.001).Anthropometric and biological indices(BMI Z-score,WC Z-score,WHtR,ALT,AST,UA,HOMA-IR)were significantly higher in obese plus MetS group according to MetS-CHN-2012(P=0.002;P=0.001;P=0.003;P=0.013;P=0.010;P=0.002;P=0.003).HOMA-IR was a risk factor for MetS in obese children by the binary regression.Part Two(1)BMI Z-score increased by 0.15 at the end of the first year and 0.10(P<0.001)at the end of the second year;WC Z-score also increased by 0.29 and 0.06 respectively(P<0.001;P=0.001)in normal-weighted group.(2)At the end of the first and second year of intervention,obese group showed significant decrease in BMI Z-score of 0.07 and 0.25(P <0.001),overweight group showed increase in BMI Z-score of 0.03 and decrease in BMI Z-score of 0.15(P=0.286;P=0.009).BMI Z-score decreased by 0.02 and 0.15(P=0.236;P<0.001)at the end of the first and second year of intervention in all overweight and obese children.(3)WC Z-score increased by 0.04 and decreased by 0.03(P<0.001;P=0.431)at the end of the first and second year of intervention in all overweight and obese children.WC Z-score increased by 0.10 and decreased by 0.05(P <0.001;P=0.086)at the end of the first and second year of intervention in obese children.WC Z-score increased by 0.02 and 0.01(P<0.001;P=0.778)at the end of the first and second year of intervention in overweight children.?Conclusion? Part One(1)The decrease of BMI Z-score after comprehensive intervention for more than one month was 0.25.The effects of intervention were positively correlated with intervention time in overweight and obese children in outpatient.(2)The prevalence of MetS diagnosed by MetS-CHN-2012 was higher than that by MetS-IDF-2007.The concordance between the two criteria for MetS was moderate because the different screening criteria of individual components(mainly cholesterol abnormality and hypertension).Anthropometric and biochemical indices were significantly higher in obese plus MetS group according to MetS-CHN-2012.HOMA-IR was a risk factor for MetS in obese children.Part Two Normal-weighted group showed significant increase in BMI Z-score and WC Z-score at the end of the first and second year follow-up without intervention.Overweight and obese children together,obese children,overweight children all showed significant decrease in BMI Z-score after intervention.Better intervention effects were found in obese children and after the second year of intervention.Overweight and obese children together,obese children,overweight children all showed no significant decrease in WC Z-score after intervention. |
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