手术干预对控制儿童和青少年肥胖症的效果：根据 GRADE 指南，使用最小重要差异估算进行系统回顾和荟萃分析，为临床实践指南提供信息。

IF 2.7 3区医学 Q1 PEDIATRICS Pediatric Obesity Pub Date : 2024-10-03 DOI:10.1111/ijpo.13119

Krista Oei, Bradley C. Johnston, Geoff D. C. Ball, Donna Fitzpatrick-Lewis, Ali Usman, Diana Sherifali, Zahra Esmaeilinezhad, Roah Merdad, Elizabeth Dettmer, Julius Erdstein, Jacob C. Langer, Catherine Birken, Mélanie Henderson, Sarah A. Moore, Katherine M. Morrison, Jill Hamilton, the Steering Committee for Updating the Canadian Clinical Practice Guideline for Managing Pediatric Obesity

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引用次数: 0

摘要

目的总结有关减肥手术治疗小儿肥胖症的文献，包括改善患者报告结果指标（PROMs）、心脏代谢风险因素、人体测量和评估不良事件（AEs）的干预效果：符合条件的研究发表于 2012 年 1 月至 2022 年 1 月期间，包括手术前后的随机对照试验 (RCT) 和观察性（对照和非对照）研究，平均年龄为 24 岁：共有 63 篇文献（43 项原创研究）符合我们的纳入标准（n = 6128 名参与者；66% 为女性）。研究报告了六种不同的手术技术，分别采用非对照单臂观察法（n = 49）、对照观察法（n = 13）和 RCT（n = 1）设计进行评估。大多数研究都进行了短期随访（结论：减肥手术的效果主要为中度和重度：尽管证据的确定性为低度到中度，但减肥手术在不同的结果方面主要表现出中度到非常大的改善，而AEs的证据有限。

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Effectiveness of surgical interventions for managing obesity in children and adolescents: A systematic review and meta-analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline

Objective

To summarize the literature on bariatric surgery for managing pediatric obesity, including intervention effects to improve patient-reported outcome measures (PROMs), cardiometabolic risk factors, anthropometry, and assess adverse events (AEs).

Methods

Eligible studies were published between January 2012 and January 2022 and included randomized controlled trials (RCTs) and observational (controlled and uncontrolled) studies before and after surgery with a mean age <18 years old. Outcomes and subgroups were selected a priori by stakeholders; estimates of effect for outcomes were presented relative to minimal important differences (MIDs) and GRADE certainty of evidence. We examined data on PROMs, cardiometabolic risk factors, anthropometry, and AEs. Subgroup analyses examined outcomes by follow-up duration and surgical technique, when possible.

Results

Overall, 63 publications (43 original studies) met our inclusion criteria (n = 6128 participants; 66% female). Studies reported six different surgical techniques that were evaluated using uncontrolled single arm observational (n = 49), controlled observational (n = 13), and RCT (n = 1) designs. Most studies included short-term follow-up (<18 months) only. PROMs were measured in 12 (28%) studies. Surgery led to large improvements in health-related quality of life compared to baseline and control groups, and moderate to very large improvements in cardiometabolic risk factors compared to baseline. Large to very large improvements in BMIz were noted compared to baseline across all follow-up periods. There was limited evidence of AEs with most reporting mild or non-specific AEs; serious AEs were uncommon.

Conclusion

Bariatric surgery demonstrated primarily moderate to very large improvements across diverse outcomes with limited evidence of AEs, albeit with low to moderate certainty of evidence.

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来源期刊

Pediatric Obesity PEDIATRICS-

CiteScore

7.30

自引率

5.30%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Pediatric Obesity is a peer-reviewed, monthly journal devoted to research into obesity during childhood and adolescence. The topic is currently at the centre of intense interest in the scientific community, and is of increasing concern to health policy-makers and the public at large. Pediatric Obesity has established itself as the leading journal for high quality papers in this field, including, but not limited to, the following: Genetic, molecular, biochemical and physiological aspects of obesity – basic, applied and clinical studies relating to mechanisms of the development of obesity throughout the life course and the consequent effects of obesity on health outcomes Metabolic consequences of child and adolescent obesity Epidemiological and population-based studies of child and adolescent overweight and obesity Measurement and diagnostic issues in assessing child and adolescent adiposity, physical activity and nutrition Clinical management of children and adolescents with obesity including studies of treatment and prevention Co-morbidities linked to child and adolescent obesity – mechanisms, assessment, and treatment Life-cycle factors eg familial, intrauterine and developmental aspects of child and adolescent obesity Nutrition security and the "double burden" of obesity and malnutrition Health promotion strategies around the issues of obesity, nutrition and physical activity in children and adolescents Community and public health measures to prevent overweight and obesity in children and adolescents.