Parent-focused behavioural interventions for the prevention of early childhood obesity (TOPCHILD): a systematic review and individual participant data meta-analysis.
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Hunter Kylie E, Nguyen David, Libesman Sol, Williams Jonathan G, Aberoumand Mason, Aagerup Jannik, Johnson Brittany J, Golley Rebecca K, Barba Angie, Sotiropoulos James X, Shrestha Nipun, Palacios Talia, Pryde Samantha J, Wolfenden Luke, Taylor Rachael W, Godolphin Peter J, Matvienko-Sikar Karen, Sanders Lee M, Robledo Kristy P, Brown Vicki, Wood Charles T, Taki Sarah, Yin H Shonna, Hayes Alison J, O'Connor Denise A, Smith Wendy, Espinoza David E, Askie Lisa, Chadwick Paul M, Rissel Chris, Webster Angela C, Hesketh Kylie D, Bryant Maria, Thomson Jessica L, Lakshman Rajalakshmi, Fiks Alexander G, Helle Christine, Odar Stough Cathleen, Ong Ken K, Perrin Eliana M, Karssen Levie, Larsen Junilla K, Linares Ana M, Messito Mary Jo, Wen Li Ming, Oken Emily, Øverby Nina Cecilie, Palacios Cristina, Paul Ian M, Rasmussen Finn E, Reifsnider Elizabeth A, Rothman Russell L, Byrne Rebecca A, Rybak Tiffany M, Salvy Sarah-Jeanne, Wasser Heather M, Thompson Amanda L, Ghaderi Ata, Taylor Barry J, Maffeis Claudio, Xu Huilan, Savage Jennifer S, Joshipura Kaumudi J, de la Haye Kayla, Røed Margrethe, Copsey Bethan, Golova Natalia, Gross Rachel S, Anzman-Frasca Stephanie, Banna Jinan, Baur Louise A, Seidler Anna Lene, TOPCHILD Collaboration
Аннотация
METHODS: We did a systematic review and individual participant data meta-analysis. We searched databases and trial registries (MEDLINE, Embase, CENTRAL, CINAHL, PsycInfo, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform) from inception until Sept 30, 2024, for randomised controlled trials commencing before 12 months of age examining parent-focused behavioural interventions to prevent obesity in children, compared with usual care, no intervention, or attention control. Individual participant data were checked, harmonised, and assessed for integrity and risk of bias. We excluded trials that were quasi-randomised, investigated pregnancy-only interventions, or did not collect any child weight-related outcomes. The primary outcome was BMI Z score at age 24 months (±6 months). We did an intention-to-treat, two-stage, random effects meta-analysis to examine effects overall and for prespecified subgroups. We assessed certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation. This study is registered with PROSPERO, CRD42020177408.
FINDINGS: Of 19 990 identified records, 47 (0·24%) trials were completed and eligible. Of these, 18 (38%) assessed our primary outcome, BMI Z score. We obtained individual participant data for 17 (94%; n=9128) of these 18 trials (n=9383), representing 97% of eligible participants. Of these 9128 participants, 4549 (50%) were boys, 4415 (48%) were girls, and 164 (2%) had unknown sex. We found no evidence of an effect of interventions on BMI Z score at age 24 months (±6 months; mean difference -0·01 [95% CI -0·08 to 0·05]; high certainty evidence, τ2=0·01; n=6505; 2623 missing). Findings were robust to prespecified sensitivity analyses (eg, different analysis methods and missing data), and we found no evidence of differential intervention effects for prespecified subgroups including priority populations and trial-level factors.
INTERPRETATION: These findings indicate that examined parent-focused behavioural interventions are insufficient to prevent obesity at age 24 months (±6 months). This evidence highlights a need to re-think childhood obesity prevention approaches.
FUNDING: Australian National Health and Medical Research Council.