Intermittent Energy Restriction for Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial.

IF 24.7 1区 医学 Q1 PEDIATRICS
Natalie B Lister, Louise A Baur, Eve T House, Shirley Alexander, Justin Brown, Clare E Collins, Christopher T Cowell, Kaitlin Day, Sarah P Garnett, Megan L Gow, Alicia M Grunseit, Maddison Henderson, Mary-Kate Inkster, Cathy Kwok, Sarah Lang, Susan J Paxton, Helen Truby, Krista A Varady, Hiba Jebeile
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引用次数: 0

Abstract

Importance: Adolescent obesity requires effective and accessible treatment. Intensive dietary interventions have the potential to be used as adjunctive therapy for behavioral weight management.

Objective: To examine the effectiveness of 2 diet therapies, delivered as part of an intensive behavioral weight management intervention, in adolescents with metabolic complications associated with obesity.

Design, setting, and participants: This multisite, 52-week randomized clinical trial was conducted from January 31, 2018, to March 31, 2023, at 2 tertiary pediatric centers in Australia. Adolescents (aged 13-17 years) with obesity and 1 or more associated complications were included.

Interventions: Intensive behavioral interventions, delivered by a multidisciplinary team, comparing intermittent energy restriction (IER) or continuous energy restriction (CER), with 3 phases: very low-energy diet (weeks 0-4), intensive intervention (weeks 5-16), and continued intervention and/or maintenance (weeks 17-52).

Main outcomes and measures: The primary outcome was body mass index (BMI) z score at 52 weeks in the IER vs CER group. Anthropometry, body composition, and cardiometabolic health were assessed at baseline and 52 weeks. The BMI z score and percentiles were determined using Centers for Disease Control and Prevention growth charts. Insulin resistance, dyslipidemia, and elevated hepatic function were assessed.

Results: A total of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) were enrolled, 71 in the IER group and 70 in the CER group, and 97 (68.8%) completed the intervention, 43 in the IER group and 54 in the CER group. At week 52, both groups had reduced BMI z scores (estimated marginal mean change, -0.28 [95% CI, -0.37 to -0.20] for IER and -0.28 [95% CI, -0.36 to -0.20] for CER) and reduced BMI expressed as a percentage of the 95th percentile (estimated marginal mean change, -9.56 [95% CI, -12.36 to -6.83] for IER and -9.23 [95% CI, -11.82 to -6.64] for CER). No differences were found in body composition or cardiometabolic outcomes between the groups. Both groups had a reduction in the occurrence of insulin resistance (from 52 of 68 [76.5%] to 32 of 56 [57.1%] in the IER group and from 59 of 68 [86.8%] to 31 of 60 [57.1%] in the CER group) at week 16; however, at week 52, this effect was observed in the CER group only (from 59 of 68 [86.7%] to 30 of 49 [61.2%]). The occurrence of dyslipidemia was unchanged between baseline and week 52 (60 of 137 [42.6%] and 37 of 87 [42.5%], respectively), with a small improvement in occurrence of impaired hepatic function tests (37 of 139 [27.0%] and 15 of 87 [17.2%], respectively). No differences were found in dyslipidemia or hepatic function between groups.

Conclusions and relevance: These findings suggest that for adolescents with obesity-associated complications, IER can be incorporated into a behavioral weight management program, providing an option in addition to CER and offering participants more choice.

Trial registration: http://anzctr.org.au Identifier: ACTRN12617001630303.

针对青少年肥胖症的间歇性能量限制:健康快车道随机临床试验》。
重要性:青少年肥胖症需要有效且方便的治疗。强化饮食干预有可能作为行为体重管理的辅助疗法:目的:研究作为强化行为体重管理干预措施一部分的两种饮食疗法对患有肥胖相关代谢并发症的青少年的有效性:这项多地点、为期 52 周的随机临床试验于 2018 年 1 月 31 日至 2023 年 3 月 31 日在澳大利亚的 2 家三级儿科中心进行。研究对象包括患有肥胖症和一种或多种相关并发症的青少年(13-17 岁):由多学科团队提供强化行为干预,比较间歇性能量限制(IER)或持续性能量限制(CER),分为3个阶段:极低能量饮食(0-4周)、强化干预(5-16周)、持续干预和/或维持(17-52周):主要结果:IER 组与 CER 组的主要结果是 52 周时的体重指数(BMI)Z 值。在基线和 52 周时对人体测量、身体成分和心脏代谢健康进行评估。BMI z 分数和百分位数是根据美国疾病控制和预防中心的生长图表确定的。对胰岛素抵抗、血脂异常和肝功能升高进行了评估:共有 141 名青少年(中位数[IQR]年龄,14.8 [12.9-17.9] 岁;71 名男性[50.4%])参加了干预活动,其中 71 人参加了 IER 组,70 人参加了 CER 组,97 人(68.8%)完成了干预活动,其中 43 人参加了 IER 组,54 人参加了 CER 组。第52周时,两组的BMI z得分均有所下降(估计边际平均变化,IER为-0.28 [95% CI, -0.37 to -0.20],CER为-0.28 [95% CI, -0.36 to -0.20]),BMI占第95百分位数的百分比也有所下降(估计边际平均变化,IER为-9.56 [95% CI, -12.36 to -6.83],CER为-9.23 [95% CI, -11.82 to -6.64])。两组在身体成分或心脏代谢结果方面没有差异。在第16周时,两组的胰岛素抵抗发生率都有所下降(IER组从68人中的52人[76.5%]降至56人中的32人[57.1%],CER组从68人中的59人[86.8%]降至60人中的31人[57.1%]);但在第52周时,只有CER组观察到了这种效果(从68人中的59人[86.7%]降至49人中的30人[61.2%])。血脂异常的发生率在基线和第 52 周之间没有变化(分别为 137 例中的 60 例[42.6%]和 87 例中的 37 例[42.5%]),肝功能检测受损的发生率略有改善(分别为 139 例中的 37 例[27.0%]和 87 例中的 15 例[17.2%])。各组之间在血脂异常或肝功能方面没有发现差异:这些研究结果表明,对于患有肥胖相关并发症的青少年,IER可被纳入行为体重管理计划中,提供CER之外的另一种选择,并为参与者提供更多选择。试验注册:http://anzctr.org.au Identifier:ACTRN12617001630303。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAMA Pediatrics
JAMA Pediatrics PEDIATRICS-
CiteScore
31.60
自引率
1.90%
发文量
357
期刊介绍: JAMA Pediatrics, the oldest continuously published pediatric journal in the US since 1911, is an international peer-reviewed publication and a part of the JAMA Network. Published weekly online and in 12 issues annually, it garners over 8.4 million article views and downloads yearly. All research articles become freely accessible online after 12 months without any author fees, and through the WHO's HINARI program, the online version is accessible to institutions in developing countries. With a focus on advancing the health of infants, children, and adolescents, JAMA Pediatrics serves as a platform for discussing crucial issues and policies in child and adolescent health care. Leveraging the latest technology, it ensures timely access to information for its readers worldwide.
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