① 小児期の肥満,その他の心血管リスクファクター,そして早期死亡 ② 炭酸飲料消費量の減量による小児期の肥満予防:クラスターランダム化試験

- 文献名 -
① Paul W. Franks, Ph.D., Robert L. Hanson, M.D., M.P.H., William C. Knowler, M.D., Dr.P.H., Maurice L. Sievers, M.D., Peter H. Bennett, M.B., F.R.C.P., and Helen C. Looker, M.B., B.S., 
Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death, 
N Engl J Med 362;6 nejm.org February 11, 2010
② Janet James, Peter Thomas, David Cavan, David Kerr, Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial, BMJ. 2004 May 22; 328(7450): 1236.

 - この文献を選んだ背景 -
上川町の保健師さんとの定例会議で小学生の肥満が話題になり,北海道ブロック支部の地方会でも別海町における小児の肥満対策の発表があったので,小児期の肥満について自分なりに調べてみた.まず,小児期の肥満が介入すべき問題なのか?ということと,介入する方略として論文にまとめられているものを調べてみた.研究デザインとしても興味深かったので,今回は2つの文献を取り上げた.

 - 要約 -
① Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death
BACKGROUND
The effect of childhood risk factors for cardiovascular disease on adult mortality is poorly understood.

METHODS
In a cohort of 4857 American Indian children without diabetes (mean age, 11.3 years; 12,659 examinations) who were born between 1945 and 1984, we assessed whether body-mass index (BMI), glucose tolerance, and blood pressure and cholesterol levels predicted premature death. Risk factors were standardized according to sex and age. Proportional-hazards models were used to assess whether each risk factor was associated with time to death occurring before 55 years of age. Models were adjusted for baseline age, sex, birth cohort, and Pima or Tohono O’odham Indian heritage.

RESULTS
There were 166 deaths from endogenous causes (3.4% of the cohort) during a median follow-up period of 23.9 years. Rates of death from endogenous causes among children in the highest quartile of BMI were more than double those among children in the lowest BMI quartile (incidence-rate ratio, 2.30; 95% confidence interval [CI], 1.46 to 3.62). Rates of death from endogenous causes among children in the highest quartile of glucose intolerance were 73% higher than those among children in the lowest quartile (incidence-rate ratio, 1.73; 95% CI, 1.09 to 2.74). No significant associations were seen between rates of death from endogenous or external causes and childhood cholesterol levels or systolic or diastolic blood-pressure levels on a continuous scale, although childhood hypertension was significantly associated with premature death from endogenous causes (incidence-rate ratio, 1.57; 95% CI, 1.10 to 2.24).

CONCLUSIONS
Obesity, glucose intolerance, and hypertension in childhood were strongly associated with increased rates of premature death from endogenous causes in this population. In contrast, childhood hypercholesterolemia was not a major predictor of premature death from endogenous causes.


② Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial
OBJECTIVE
To determine if a school based educational programme aimed at reducing consumption of carbonated drinks can prevent excessive weight gain in children.

DESIGN
Cluster randomised controlled trial.

SETTING
Six primary schools in southwest England.

PARTICIPANTS
644 children aged 7-11 years.

INTERVENTION
Focused educational programme on nutrition over one school year.

MAIN OUTCOME MEASURES
Drink consumption and number of overweight and obese children.

RESULTS
Consumption of carbonated drinks over three days decreased by 0.6 glasses (average glass size 250 ml) in the intervention group but increased by 0.2 glasses in the control group (mean difference 0.7, 95% confidence interval 0.1 to 1.3). At 12 months the percentage of overweight and obese children
increased in the control group by 7.5%, compared with a decrease in the intervention group of 0.2% (mean difference 7.7%, 2.2% to 13.1%).

CONCLUSION
A targeted, school based education programme produced a modest reduction in the number of carbonated drinks consumed, which was associated with a reduction in the number of overweight and obese children. 

 - 考察とディスカッション -
①の文献では,対象が限定されたコホート研究であり,一概に日本人の小児に適応することはできないが,人種の系統としては近いと考えられるため,小児期の肥満は介入すべき問題と考えられた.②の文献は,フェローで行う研究のヒントになりそうな研究デザインで,地域コミュニティケアの取り組みとしても興味深く感じられた.
そこで,各サイトでの小児期の肥満に対する取り組みなどについて,共有やディスカッションをしたいと思った.

開催日:平成25年12月18日












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