2至12岁儿童肥胖：综述

文献信息

中文摘要

重要性： 在美国，肥胖影响15%的2至5岁儿童和22%的6至11岁儿童。儿童肥胖与血脂异常、高血压、代谢功能障碍相关脂肪性肝病以及阻塞性睡眠呼吸暂停相关。与正常体重同龄人相比，肥胖儿童的生活质量较低，并且成年后患肥胖的可能性高出5倍。
观察： 体重指数（BMI；按体重千克除以身高米平方计算）用于识别有过度脂肪蓄积风险的儿童，指南建议临床医生从2岁开始使用BMI筛查肥胖。在儿童中，肥胖使用标准化的年龄和性别特异性生长曲线图来定义，肥胖定义为BMI处于第95百分位或更高，重度肥胖定义为BMI达到第95百分位的120%或以上。儿童肥胖治疗包括强化健康行为和生活方式治疗，由至少26个接触小时的面对面小组或家庭为基础的活动组成，这些活动在3至12个月期间向儿童和照护者提供营养、身体活动和行为改变教育。与未参加强化健康行为和生活方式治疗的儿童相比，强化健康行为和生活方式治疗使BMI降低0.7。目前美国食品药品监督管理局（FDA）批准用于12岁以下儿童的唯一肥胖药物治疗是setmelanotide，一种黑皮质素-4受体激动剂，适用于3种罕见单基因肥胖（LEPR、POMC和PCSK1基因变异）、Bardet-Biedl综合征和获得性下丘脑性肥胖。利拉鲁肽目前仅获FDA批准用于12岁及以上青少年；然而，一项在6岁至12岁以下儿童中进行的随机临床试验表明，与安慰剂相比，利拉鲁肽使BMI降低7.4%。代谢和减重手术很少用于12岁以下儿童，支持其在该人群中使用证据有限。儿童期肥胖的早期识别和治疗可能降低成年期2型糖尿病、血脂异常、高血压和死亡风险。
结论与意义： 儿童肥胖与慢性疾病（如高血压）以及较差的生活质量相关。儿童肥胖的循证治疗包括强化健康行为和生活方式治疗，药物治疗可能提供额外获益，尽管短期和长期安全性和有效性数据有限。儿童期肥胖的早期识别和治疗可能降低成年期2型糖尿病、血脂异常、高血压和死亡风险。

英文摘要

IMPORTANCE: Obesity affects 15% of children aged 2 to 5 years and 22% of children aged 6 to 11 years in the US. Obesity in children is associated with dyslipidemia, hypertension, metabolic dysfunction-associated steatotic liver disease, and obstructive sleep apnea. Compared with normal-weight peers, children with obesity have lower quality of life and are 5 times more likely to have obesity in adulthood.
OBSERVATIONS: Body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is used to identify children at risk for excess adiposity, and guidelines recommend that clinicians screen for obesity using BMI starting at age 2 years. Among children, obesity is defined using standardized age- and sex-specific growth charts, with obesity defined as BMI in the 95th or higher percentile and severe obesity as BMI of 120% or greater of the 95th percentile. Obesity treatment in children includes intensive health behavior and lifestyle treatment, consisting of at least 26 contact hours of face-to-face group or family-based activities that incorporate nutrition, physical activity, and behavior change education delivered to the child and caregivers over a 3- to 12-month period. Intensive health behavior and lifestyle treatment reduces BMI by 0.7 compared with children who do not participate in intensive health behavior and lifestyle treatment. The only obesity pharmacotherapy currently approved by the US Food and Drug Administration (FDA) for children younger than 12 years is setmelanotide, a melanocortin-4 receptor agonist, which is indicated for 3 forms of rare monogenic obesity (LEPR, POMC, and PCSK1 genetic variants), Bardet-Biedl syndrome, and acquired hypothalamic obesity. Liraglutide is currently only FDA approved for youth aged 12 years or older; however, a randomized clinical trial among children aged 6 to younger than 12 years demonstrated that, compared with placebo, liraglutide reduced BMI by 7.4%. Metabolic and bariatric surgery is rarely used in children younger than age 12 years and evidence supporting its use in children is limited. Early identification and treatment of obesity during childhood may reduce risk of type 2 diabetes, dyslipidemia, hypertension, and mortality in adulthood.
CONCLUSIONS AND RELEVANCE: Obesity in children is associated with chronic disease, such as hypertension, and with poor quality of life. Evidence-based treatment for obesity in children includes intensive health behavior and lifestyle treatment, and pharmacotherapy may provide additional benefit, although short- and long-term safety and efficacy data are limited. Early identification and treatment of obesity during childhood may reduce risk of type 2 diabetes, dyslipidemia, hypertension, and mortality in adulthood.