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Medical Home Access Among Children with Obesity: The Role of Family-Centered Communication. 肥胖症儿童的家庭医疗:以家庭为中心的沟通的作用。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-01 Epub Date: 2024-09-20 DOI: 10.1089/chi.2024.0303
Coleman R Hayes, Olasunkanmi Kehinde, Dmitry Tumin, Shaundreal D Jamison

Objective: The American Academy of Pediatrics recommends all children receive care in a patient-centered medical home. With weight stigma potentially hampering family-centered communication in the care of children with overweight or obesity, we aimed to determine how children's weight status was associated with access to a medical home and its components. Methods: We analyzed 2016-2021 data on children age 10-17 years in the National Survey of Children's Health. Children's weight status was classified as underweight/normal weight, overweight, or obese, based on caregiver-reported height and weight. Outcomes included receiving care in a medical home and each category of the medical home definition (personal health care provider, usual source of health care, family/patient-centered care, care coordination, and assistance with referrals). Results: Based on the study sample (n = 105,111), we estimated that 16% of children were overweight and 16% were obese, while 42% had access to a patient-centered medical home. On multivariable analysis, obesity compared to normal weight was associated with lower access to a medical home (odds ratio: 0.87; 95% confidence intervals: 0.80, 0.95; p = 0.003) and, specifically, with lower access to family-centered care and assistance with care coordination. Conclusions: Children with obesity encounter barriers to accessing care meeting medical home criteria, with one plausible mechanism being that weight stigma disrupts family-centered communication. Lower access to care coordination among children with obesity may also indicate a need to improve the integration of obesity-related specialty care with pediatric primary care services.

目的:美国儿科学会建议所有儿童在以患者为中心的医疗之家接受治疗。由于体重污名化可能会阻碍在对超重或肥胖儿童进行护理时以家庭为中心的沟通,我们旨在确定儿童的体重状况与获得医疗之家及其组成部分之间的关系。方法:我们分析了 2016-2021 年全国儿童健康调查中 10-17 岁儿童的数据。根据护理人员报告的身高和体重,将儿童的体重状况分为体重不足/正常体重、超重或肥胖。结果包括在医疗之家接受护理以及医疗之家定义的每个类别(个人医疗保健提供者、通常的医疗保健来源、家庭/以患者为中心的护理、护理协调以及转诊协助)。研究结果根据研究样本(n = 105,111),我们估计有 16% 的儿童超重,16% 的儿童肥胖,而 42% 的儿童获得了以患者为中心的医疗之家服务。在多变量分析中,与正常体重相比,肥胖与较低的医疗之家就诊率相关(几率比:0.87;95% 置信区间:0.80,0.95;P = 0.003),特别是与较低的以家庭为中心的护理和护理协调协助就诊率相关。结论肥胖症儿童在获得符合医疗之家标准的护理服务时会遇到障碍,其中一个合理的机制是体重成见破坏了以家庭为中心的沟通。肥胖症儿童获得护理协调的机会较少,这也表明有必要改善肥胖症相关专科护理与儿科初级护理服务的整合。
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引用次数: 0
Moving Beyond Research to Public Health Practice: Spread And Scale of Interventions that Support Healthy Childhood Growth. 从研究转向公共卫生实践:支持儿童健康成长的干预措施的推广和规模。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-01 Epub Date: 2024-08-30 DOI: 10.1089/chi.2024.0255
Alyson B Goodman, Eileen Bosso, Ruth Petersen, Heidi M Blanck

Equitable access to affordable, effective, and safe obesity prevention and treatment remains a problem for many children and families in the U.S. In 2023, the American Academy of Pediatrics (AAP) published its first Clinical Practice Guideline (CPG) for pediatric obesity evaluation and treatment, aiding the field's awareness of effective approaches. CDC has supported the adapting and packaging of existing, effective Family Healthy Weight Programs that deliver CPG-recommended intensive behavioral treatment for kids. Currently, at least six family-centered programs are recognized by CDC and can be implemented in clinical and community settings to support child health. CDC and other national partners are coordinating the movement of these research-tested FHWPs into public health practice. This work includes implementing FHWPs in over 60 US communities and supporting national-level infrastructure improvements. CDC is committed to engaging with stakeholders to help scale proven strategies that ensure all children receive the care they need to thrive.

2023 年,美国儿科学会 (AAP) 发布了第一份儿科肥胖症评估和治疗临床实践指南 (CPG),提高了该领域对有效方法的认识。疾病预防控制中心支持对现有的有效家庭健康体重计划进行调整和包装,为儿童提供 CPG 推荐的强化行为治疗。目前,至少有六项以家庭为中心的计划得到了疾病预防控制中心的认可,可在临床和社区环境中实施,以支持儿童健康。疾病预防控制中心和其他国家合作伙伴正在协调将这些经过研究检验的家庭健康和体重计划推广到公共卫生实践中。这项工作包括在美国 60 多个社区实施 FHWP,并支持国家级基础设施的改善。疾病预防控制中心致力于与利益相关者合作,帮助推广经过验证的战略,确保所有儿童都能获得茁壮成长所需的护理。
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引用次数: 0
High BMI z-Scores from Different Growth References Are Not Comparable: An Example from a Weight Management Trial with an Anti-Obesity Medication in Pubertal Adolescents with Obesity. 不同生长参照的高 BMI z 值不具可比性:以青春期青少年肥胖症患者使用抗肥胖药物进行体重管理试验为例。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-01 Epub Date: 2024-07-12 DOI: 10.1089/chi.2024.0248
Craig M Hales, Cynthia L Ogden, David S Freedman, Kushal Sahu, Paula M Hale, Rashmi K Mamadi, Aaron S Kelly

Background: The BMI z-score is a standardized measure of weight status and weight change in children and adolescents. BMI z-scores from various growth references are often considered comparable, and differences among them are underappreciated. Methods: This study reanalyzed data from a weight management clinical study of liraglutide in pubertal adolescents with obesity using growth references from CDC 2000, CDC Extended, World Health Organization (WHO), and International Obesity Task Force. Results: BMI z-score treatment differences varied 2-fold from -0.13 (CDC 2000) to -0.26 (WHO) overall and varied almost 4-fold from -0.05 (CDC 2000) to -0.19 (WHO) among adolescents with high baseline BMI z-score. Conclusions: Depending upon the growth reference used, BMI z-score endpoints can produce highly variable treatment estimates and alter interpretations of clinical meaningfulness. BMI z-scores cited without the associated growth reference cannot be accurately interpreted.

背景:体重指数 z 值是衡量儿童和青少年体重状况和体重变化的标准化指标。来自不同生长参照标准的 BMI z 分数通常被认为具有可比性,而它们之间的差异却未得到足够重视。研究方法本研究重新分析了利拉鲁肽对青春期肥胖症青少年进行体重管理临床研究的数据,使用的生长参考数据来自中国疾病预防控制中心 2000 年版、中国疾病预防控制中心扩展版、世界卫生组织(WHO)和国际肥胖问题工作组。研究结果总体而言,BMI z-score治疗差异从-0.13(美国疾病预防控制中心,2000年)到-0.26(世界卫生组织)相差2倍,在基线BMI z-score较高的青少年中,差异从-0.05(美国疾病预防控制中心,2000年)到-0.19(世界卫生组织)相差近4倍。结论:根据所使用的生长参考值,BMI z-分数终点可产生差异很大的治疗估计值,并改变对临床意义的解释。在没有相关生长参考值的情况下,无法准确解释 BMI z 分数。
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引用次数: 0
A Scoping Review of Tailoring in Pediatric Obesity Interventions. 小儿肥胖症干预措施中的量身定制范围审查。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-01 Epub Date: 2024-07-15 DOI: 10.1089/chi.2024.0214
Emily S Fu, Cady Berkel, James L Merle, Sara M St George, Andrea K Graham, Justin D Smith

Background: Families with children who have or are at risk for obesity have differing needs and a one-size-fits-all approach can negatively impact program retention, engagement, and outcomes. Individually tailored interventions could engage families and children through identifying and prioritizing desired areas of focus. Despite literature defining tailoring as individualized treatment informed by assessment of behaviors, intervention application varies. This review aims to exhibit the use of the term "tailor" in pediatric obesity interventions and propose a uniform definition. Methods: We conducted a scoping review following PRISMA-ScR guidelines among peer-reviewed pediatric obesity prevention and management interventions published between 1995 and 2021. We categorized 69 studies into 6 groups: (1) individually tailored interventions, (2) computer-tailored interventions/tailored health messaging, (3) a protocolized group intervention with a tailored component, (4) only using the term tailor in the title, abstract, introduction, or discussion, e) using the term tailor to describe another term, and (5) interventions described as culturally tailored. Results: The scoping review exhibited a range of uses and lack of explicit definitions of tailoring in pediatric obesity interventions including some that deviate from individualized designs. Effective tailored interventions incorporated validated assessments for behaviors and multilevel determinants, and recipient-informed choice of target behavior(s) and programming. Conclusions: We urge interventionists to use tailoring to describe individualized, assessment-driven interventions and to clearly define how an intervention is tailored. This can elucidate the role of tailoring and its potential for addressing the heterogeneity of behavioral and social determinants for the prevention and management of pediatric obesity.

背景:有肥胖儿童或有肥胖风险儿童的家庭有不同的需求,一刀切的方法可能会对计划的保留率、参与度和成果产生负面影响。量身定制的干预措施可以通过确定和优先考虑所需的重点领域来吸引家庭和儿童。尽管有文献将 "量身定制 "定义为以行为评估为依据的个性化治疗,但干预措施的应用却各不相同。本综述旨在展示 "量身定制 "一词在儿科肥胖干预中的应用,并提出统一的定义。方法:我们按照 PRISMA-ScR 指南,对 1995 年至 2021 年间发表的经同行评审的儿科肥胖症预防和管理干预措施进行了范围界定综述。我们将 69 项研究分为 6 组:(1) 单独定制的干预措施;(2) 计算机定制的干预措施/定制的健康信息;(3) 含有定制内容的协议化团体干预措施;(4) 仅在标题、摘要、引言或讨论中使用 "定制 "一词;(5) 使用 "定制 "一词来描述其他术语;(6) 描述为文化定制的干预措施。结果范围界定审查显示,在儿科肥胖症干预措施中,包括一些偏离个性化设计的干预措施在内,量身定制的使用范围很广,且缺乏明确的定义。有效的定制干预措施包含对行为和多层次决定因素的有效评估,以及受助者对目标行为和方案的知情选择。结论:我们敦促干预者使用 "量身定制 "来描述个性化、以评估为导向的干预,并明确定义干预是如何量身定制的。这可以阐明 "量身定制 "的作用及其在解决行为和社会决定因素的异质性以预防和管理小儿肥胖症方面的潜力。
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引用次数: 0
Reliability of Anthropometric Measurement of Young Children with Parent Involvement. 有家长参与的幼儿人体测量的可靠性。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-01 Epub Date: 2024-08-22 DOI: 10.1089/chi.2023.0065
Sarah Rae, Eleanor Pullenayegum, Frank Ong, Cindy-Lee Dennis, Jill Hamilton, Jonathon Maguire, Catherine Birken

Background: The purpose of this study was to determine the reliability of anthropometric measurements between two trained anthropometrists working in a team and one trained anthropometrist working with a child's parent/caregiver in a primary health care setting. Study Design: An observational study to determine measurement reliability was conducted in a primary care child research network in Canada. In total, 120 children 0-5 years old had their anthropometric measurement taken twice by two trained anthropometrists working in a team and twice by one trained anthropometrist working with a child's parent/caregiver. Inter- and intra-observer reliability was calculated using the technical error of measurement (TEM), relative TEM (%TEM), and the coefficient of reliability (R). Results: The %TEM values for length/height and weight were <2%, and the R coefficient values were >0.99, indicating a high degree of inter- and intra-observer reliability. The TEM values demonstrated a high degree of reliability for inter- and intra-observer measurement of length/height in comparison with other anthropometric measurement parameters. However, there was greater variation seen in the length measurement for children 0 to <2 years of age and in arm circumference measurement across both age-groups. Conclusion(s): This study suggests that anthropometric measurement taken by one trained anthropometrist with the assistance of a parent/caregiver is reliable. These findings provide evidence to support inclusion of a child's parent/caregiver with anthropometric measurement collection in clinical setting(s) to enhance feasibility and efficiency and reduce the research costs of including a second trained anthropometrist.

背景:本研究的目的是确定在初级卫生保健机构中,两名训练有素的人体测量师以团队形式工作,以及一名训练有素的人体测量师与儿童的父母/看护人一起工作时所进行的人体测量的可靠性。研究设计:在加拿大的一个初级保健儿童研究网络中开展了一项观察性研究,以确定测量的可靠性。共有 120 名 0-5 岁儿童接受了由两名训练有素的人体测量师组成的团队进行的两次人体测量,以及由一名训练有素的人体测量师与儿童家长/看护人共同进行的两次人体测量。使用测量技术误差(TEM)、相对 TEM(%TEM)和可靠性系数(R)计算观察者之间和观察者内部的可靠性。结果:身长/身高和体重的 TEM 百分比值均为 0.99,表明观察者之间和观察者内部的可靠性很高。与其他人体测量参数相比,身长/身高的 TEM 值显示出观察者之间和观察者内部测量的高度可靠性。不过,0 到结论(s)年龄段儿童的身长测量结果差异较大:这项研究表明,由一名训练有素的人体测量师在家长/护理人员的协助下进行人体测量是可靠的。这些研究结果提供了证据,支持在临床环境中让儿童的父母/看护人参与人体测量收集工作,以提高可行性和效率,并降低包括第二名训练有素的人体测量师在内的研究成本。
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引用次数: 0
Acknowledgment of Reviewers 2024. 审稿人致谢
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-01 DOI: 10.1089/chi.2024.04562.revack
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引用次数: 0
Percent Body Fat and Weight Status of Youth Participating in Pediatric Weight Management Programs in the Pediatric Obesity Weight Evaluation Registry. 儿科肥胖症体重评估登记中参加儿科体重管理计划的青少年的体脂百分比和体重状况。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-01 Epub Date: 2024-08-26 DOI: 10.1089/chi.2023.0201
Maheen Quadri, Adolfo J Ariza, Jared M Tucker, Jennifer W Bea, Eileen C King, Shelley Kirk, Brooke R Sweeney, Melissa Santos, Lucie Silver, Karyn J Roberts, Helen J Binns

Factors associated with change in percent body fat (%BF) of children in pediatric weight management (PWM) care may differ from those associated with change in weight status. Objective: To describe %BF and weight status at initial visits to 14 PWM sites, identify differences by sex, and evaluate factors associated with change over 6 months. Methods: Initial visits of 2496 males and 2821 females aged 5-18 years were evaluated. %BF was measured using bioelectrical impedance analysis. Results: Sex-specific logistic regressions [806 males (32.3%), 837 females (29.7%)] identified associations with primary outcomes: lower %BF and metabolically impactful ≥5-point drop in percent of the 95th BMI percentile (%BMIp95) over 6 months. At the initial visit, males had lower %BF and higher %BMIp95 than females. Over 6 months, males had significantly (p < 0.001) greater median drop in %BF (-1.4% vs. -0.4%) and %BMIp95 (-3.0% vs. -1.9%) and a higher frequency of decreased %BF (68.9% vs. 57.8%), but similar percentage with ≥5-point %BMIp95 drop (36.5% vs. 32.4%; p = 0.080). For males, factors significantly associated with decreased %BF (older age, ≥6 visits, lack of developmental or depression/anxiety concerns) were not related to having a ≥5-point %BMIp95 drop. For females, lack of depression/anxiety concern was significantly associated with decreased %BF but was not associated with ≥5-point %BMIp95 drop. Conclusions: There are differences by sex in initial visit %BF and %BMIp95 and in characteristics associated with changes in these measures. PWM interventions should consider evaluating body composition and sex-stratifying outcomes.

儿科体重管理(PWM)护理中儿童体脂率(%BF)变化的相关因素可能不同于体重状态变化的相关因素。目的:描述 14 个体重管理中心初诊时的体脂百分比和体重状况,确定性别差异,并评估与 6 个月内变化相关的因素。方法: 对 2496 名男性和 2496 名女性进行初次访问:对 2496 名男性和 2821 名女性(5-18 岁)的初次就诊情况进行评估。采用生物电阻抗分析法测量了%BF。结果性别特异性逻辑回归[806 名男性(32.3%),837 名女性(29.7%)]确定了与主要结果的关联:较低的 BF 百分比和 6 个月内 BMI 第 95 百分位数百分比(%BMIp95)下降≥5 点的代谢影响。与女性相比,男性在初次就诊时的肺活量百分比较低,而体重指数 p95 百分比较高。在 6 个月内,男性的 BF%(-1.4% vs. -0.4%)和 BMIp95%(-3.0% vs. -1.9% )的中位数下降幅度明显更大(p < 0.001),BF%下降的频率更高(68.9% vs. 57.8%),但 BMIp95%下降≥5%的比例相似(36.5% vs. 32.4%; p = 0.080)。就男性而言,与 BF 百分比下降明显相关的因素(年龄较大、就诊次数≥6 次、缺乏发育或抑郁/焦虑问题)与 BMIp95 百分比下降≥5 点无关。就女性而言,缺乏抑郁/焦虑问题与%BF下降显著相关,但与%BMIp95下降≥5点无关。结论:初次就诊时,BF%和BMIp95%以及与这些指标变化相关的特征存在性别差异。PWM干预措施应考虑评估身体成分和性别分层结果。
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引用次数: 0
Associations of Longitudinal BMI-Percentile Classification Patterns in Early Childhood with Neighborhood-Level Social Determinants of Health. 幼儿期纵向 BMI 百分位数分类模式与邻里层面健康社会决定因素的关联。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-01 Epub Date: 2024-08-26 DOI: 10.1089/chi.2023.0157
Mehak Gupta, Thao-Ly T Phan, Félice Lê-Scherban, Daniel Eckrich, H Timothy Bunnell, Rahmatollah Beheshti

Background: Understanding social determinants of health (SDOH) that may be risk factors for childhood obesity is important to developing targeted interventions to prevent obesity. Prior studies have examined these risk factors, mostly examining obesity as a static outcome variable. Methods: We extracted electronic health record data from 2012 to 2019 for a children's health system that includes two hospitals and wide network of outpatient clinics spanning five East Coast states in the United States. Using data-driven and algorithmic clustering, we have identified distinct BMI-percentile classification groups in children from 0 to 7 years of age. We used two separate algorithmic clustering methods to confirm the robustness of the identified clusters. We used multinomial logistic regression to examine the associations between clusters and 27 neighborhood SDOHs and compared positive and negative SDOH characteristics separately. Results: From the cohort of 36,910 children, five BMI-percentile classification groups emerged: always having obesity (n = 429; 1.16%), overweight most of the time (n = 15,006; 40.65%), increasing BMI percentile (n = 9,060; 24.54%), decreasing BMI percentile (n = 5,058; 13.70%), and always normal weight (n = 7,357; 19.89%). Compared to children in the decreasing BMI percentile and always normal weight groups, children in the other three groups were more likely to live in neighborhoods with higher poverty, unemployment, crowded households, single-parent households, and lower preschool enrollment. Conclusions: Neighborhood-level SDOH factors have significant associations with children's BMI-percentile classification and changes in classification. This highlights the need to develop tailored obesity interventions for different groups to address the barriers faced by communities that can impact the weight and health of children living within them.

背景:了解可能成为儿童肥胖症风险因素的健康社会决定因素(SDOH)对于制定有针对性的干预措施来预防肥胖症非常重要。之前的研究对这些风险因素进行了研究,但大多将肥胖作为一个静态结果变量进行研究。研究方法我们提取了一个儿童医疗系统从 2012 年到 2019 年的电子健康记录数据,该系统包括两家医院和广泛的门诊网络,横跨美国东海岸五个州。通过数据驱动和算法聚类,我们确定了 0 至 7 岁儿童中不同的 BMI 百分位数分类群体。我们使用了两种不同的算法聚类方法来确认所识别聚类的稳健性。我们使用多叉逻辑回归法研究了聚类与 27 个邻里 SDOH 之间的关联,并分别比较了积极和消极 SDOH 特征。研究结果在 36,910 名儿童的队列中,出现了五个 BMI 百分位数分类组:始终肥胖(n = 429;1.16%)、大部分时间超重(n = 15,006; 40.65%)、BMI 百分位数增加(n = 9,060; 24.54%)、BMI 百分位数减少(n = 5,058; 13.70%)和始终体重正常(n = 7,357; 19.89%)。与 BMI 百分位数下降组和体重始终正常组的儿童相比,其他三组的儿童更有可能生活在贫困率较高、失业率较高、家庭拥挤、单亲家庭和学前教育入学率较低的社区。结论邻里层面的 SDOH 因素与儿童的 BMI 百分位数分级和分级变化有显著关联。这突出表明,有必要针对不同群体制定有针对性的肥胖干预措施,以解决社区面临的可能影响社区内儿童体重和健康的障碍。
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引用次数: 0
Enactment, Evaluation, and Expansion of a Healthy Living Club in an Out of School Setting: A Community-Academic Partnership. 校外健康生活俱乐部的建立、评估和扩展:社区与学术界的合作。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2025-01-01 Epub Date: 2024-07-30 DOI: 10.1089/chi.2024.0237
Brianna Roche, Stephanie Victor, Janice Holden, Shui Yu, Dale Seamans, Markus Fischer, Cara B Ebbeling

Interventions in community settings, where children spend substantial out of school time, may enhance access to evidence-based lifestyle interventions. The Boys and Girls Club of Lawrence (BGCL) and New Balance Foundation Obesity Prevention Center at Boston Children's Hospital partnered to revise, enact, and evaluate BGCL's existing Healthy Living Club and then flexibly expand the program to increase access. The BGCL is within walking distance of three public housing communities and easily accessible to members, of whom 90% identify as Hispanic. The interventions comprised nutrition sessions and either fitness activity sessions (N+FA Cycle 1, n = 63, 26 hours; N+FA Cycle 2, n = 94, 27 hours) or academic basketball practices (N+AB Cycle 2, n = 99, 72-80 hours), leveraging time already in the schedule where fitness could be intentionally promoted by coaches. Among children aged 8-15 years, mean [95% confidence interval (CI)] changes (beginning to end) in percentage above the BMI median were significant [N+FA Cycle 1: -2.4 (-4.1, -0.8); N+FA Cycle 2: -4.3 (-5.4, -3.1); N+AB Cycle 2: -5.5 (-6.9, -4.1)]. Lifestyle interventions, implemented with flexibility in existing programs, had beneficial impact, indicating potential of community-academic partnerships.

在社区环境中进行干预(儿童在社区环境中度过了大量的校外时间),可以增加获得循证生活方式干预措施的机会。劳伦斯男孩女孩俱乐部(BGCL)与波士顿儿童医院的新百伦基金会肥胖预防中心合作,对 BGCL 现有的健康生活俱乐部进行了修订、颁布和评估,然后灵活地扩展该计划,以增加参与机会。BGCL 位于三个公共住房社区的步行范围内,便于会员使用,其中 90% 的会员为西班牙裔。干预措施包括营养课程和健身活动课程(N+FA 周期 1,n=63,26 小时;N+FA 周期 2,n=94,27 小时)或学术篮球练习(N+AB 周期 2,n=99,72-80 小时),利用时间表中已有的时间,由教练有意识地促进健身。在 8-15 岁的儿童中,BMI 中位数以上百分比的平均值[95% 置信区间 (CI)]变化(从开始到结束)显著[N+FA 循环 1:-2.4 (-4.1, -0.8);N+FA 循环 2:-4.3 (-5.4, -3.1);N+AB 循环 2:-5.5 (-6.9, -4.1)]。在现有计划中灵活实施的生活方式干预措施产生了有益的影响,表明社区与学术界的合作具有潜力。
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引用次数: 0
Household Income Moderates Longitudinal Relations Between Neighborhood Child Opportunity Index and BMI Growth. 家庭收入调节邻里儿童机会指数与BMI增长的纵向关系。
IF 1.5 4区 医学 Q2 PEDIATRICS Pub Date : 2024-12-20 DOI: 10.1089/chi.2024.0322
Alexandra Ursache, Brandi Y Rollins

Background: To examine longitudinal associations of early neighborhood Child Opportunity Index 2.0 (COI) with children's BMI trajectories and identify whether household economic resources moderate relations of COI in infancy/toddlerhood and the preschool years to longitudinal BMI growth between 2 and 12 years. Methods: Family data (n = 1091) were drawn from the Family Life Project, a longitudinal study of families residing in rural high-poverty areas. Neighborhood COI was obtained for each developmental period: infancy/toddlerhood (2-15 months) and the preschool years (2-5 years). BMIs were created from anthropometrics collected at six time points. Results: Higher neighborhood COIs during the infancy/toddlerhood (β = -0.0130, p < 0.01) and preschool years (β = -0.0093, p < 0.05) were associated with lower BMI at 5 years of age; although the latter became nonsignificant after adjusting for infancy/toddlerhood COI. Both household income and time spent in poverty moderated associations of infancy/toddlerhood exposure to neighborhood COI with BMI change. Among children residing in not poor households, higher neighborhood level child opportunity was associated with a slower increase in BMI from 2 to 12 years (β = -0.0369, p < 0.05), and a lower BMI at 12 years (β = -0.0395, p < 0.05). Conclusions: Neighborhood COI during the infant and toddler years is longitudinally associated with child growth, and long-term associations are evident among children residing in not poor households. Future work is needed to better understand how family and neighborhood-level resources interact to influence obesity risk, particularly for those at high risk.

背景:研究早期邻里儿童机会指数2.0 (COI)与儿童BMI轨迹的纵向关联,并确定家庭经济资源是否调节婴幼儿期和学龄前儿童机会指数2.0与2 - 12岁儿童BMI纵向增长的关系。方法:家庭数据(n = 1091)来自家庭生活项目,这是一项对农村高贫困地区家庭的纵向研究。每个发育阶段的邻里COI:婴儿期/幼儿期(2-15个月)和学龄前(2-5岁)。bmi是根据在六个时间点收集的人体测量数据创建的。结果:婴幼儿期(β = -0.0130, p < 0.01)和学龄前(β = -0.0093, p < 0.05)较高的邻里COIs与5岁时较低的BMI相关;尽管后者在调整了婴儿期/幼儿期COI后变得不显著。家庭收入和贫困时间都调节了婴幼儿暴露于社区COI与BMI变化的关系。在非贫困家庭的儿童中,较高的邻里儿童机会与2至12岁时BMI增长缓慢相关(β = -0.0369, p < 0.05),与12岁时较低的BMI相关(β = -0.0395, p < 0.05)。结论:婴幼儿时期的邻里COI与儿童的成长有纵向关系,而在非贫困家庭的儿童中,这种长期关系也很明显。未来的工作需要更好地了解家庭和社区资源如何相互作用来影响肥胖风险,特别是对于那些高风险的人。
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Childhood Obesity
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