A Digital Health Behavior Intervention to Prevent Childhood Obesity: The Greenlight Plus Randomized Clinical Trial.

Autor:	Heerman WJ; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee., Rothman RL; Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee., Sanders LM; Departments of Pediatrics and Health Policy, Stanford University School of Medicine, Stanford, California., Schildcrout JS; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee., Flower KB; Department of Pediatrics, UNC School of Medicine, University of North Carolina at Chapel Hill., Delamater AM; Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida., Kay MC; Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina., Wood CT; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina., Gross RS; Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York., Bian A; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee., Adams LE; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee., Sommer EC; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee., Yin HS; Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York., Perrin EM; Department of Pediatrics, Johns Hopkins University School of Medicine and School of Nursing, Baltimore, Maryland., de la Barrera B; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.; Now with Evidenze Health Spain S.L.U., Bility M; Department of Pediatrics, UNC School of Medicine, University of North Carolina at Chapel Hill., Cruz Jimenez Smith M; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Cruzatte EF; Department of Pediatrics, New York University Grossman School of Medicine, New York, New York., Guevara G; Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida., Howard JB; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina., Lampkin J; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee., Orr CJ; Department of Pediatrics, UNC School of Medicine, University of North Carolina at Chapel Hill., Pilotos McBride J; Department of Pediatrics, UNC School of Medicine, University of North Carolina at Chapel Hill., Quintana Forster L; Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida., Ramirez KS; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Rodriguez J; Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina., Schilling S; Department of Pediatrics, UNC School of Medicine, University of North Carolina at Chapel Hill., Shepard WE; Department of Pediatrics, Stanford University School of Medicine, Stanford, California., Soto A; Department of Pediatrics, New York University Grossman School of Medicine, New York, New York., Velazquez JJ; Department of Pediatrics, New York University Grossman School of Medicine, New York, New York., Wallace S; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Jazyk:	angličtina
Zdroj:	JAMA [JAMA] 2024 Nov 03. Date of Electronic Publication: 2024 Nov 03.
DOI:	10.1001/jama.2024.22362
Abstrakt:	Importance: Infant growth predicts long-term obesity and cardiovascular disease. Previous interventions designed to prevent obesity in the first 2 years of life have been largely unsuccessful. Obesity prevalence is high among traditional racial and ethnic minority groups. Objective: To compare the effectiveness of adding a digital childhood obesity prevention intervention to health behavior counseling delivered by pediatric primary care clinicians. Design, Setting, and Participants: Individually randomized, parallel-group trial conducted at 6 US medical centers and enrolling patients shortly after birth. To be eligible, parents spoke English or Spanish, and children were born after 34 weeks' gestational age. Study enrollment occurred between October 2019 and January 2022, with follow-up through January 2024. Interventions: In the clinic-based health behavior counseling (clinic-only) group, pediatric clinicians used health literacy-informed booklets at well-child visits to promote healthy behaviors (n = 451). In the clinic + digital intervention group, families also received health literacy-informed, individually tailored, responsive text messages to support health behavior goals and a web-based dashboard (n = 449). Main Outcomes and Measures: The primary outcome was child weight-for-length trajectory over 24 months. Secondary outcomes included weight-for-length z score, body mass index (BMI) z score, and the percentage of children with overweight or obesity. Results: Of 900 randomized children, 86.3% had primary outcome data at the 24-month follow-up time point; 143 (15.9%) were Black, non-Hispanic; 405 (45.0%) were Hispanic; 185 (20.6%) were White, non-Hispanic; and 165 (18.3%) identified as other or multiple races and ethnicities. Children in the clinic + digital intervention group had a lower mean weight-for-length trajectory, with an estimated reduction of 0.33 kg/m (95% CI, 0.09 to 0.57) at 24 months. There was also an adjusted mean difference of -0.19 (95% CI, -0.37 to -0.02) for weight-for-length z score and -0.19 (95% CI, -0.36 to -0.01) for BMI z score. At age 24 months, 23.2% of the clinic + digital intervention group compared with 24.5% of the clinic-only group had overweight or obesity (adjusted risk ratio, 0.91 [95% CI, 0.70 to 1.17]) based on the Centers for Disease Control and Prevention criteria of BMI 85th percentile or greater. At that age, 7.4% of the clinic + digital intervention group compared with 12.7% of the clinic-only group had obesity (adjusted risk ratio, 0.56 [95% CI, 0.36 to 0.88]). Conclusions and Relevance: A health literacy-informed digital intervention improved child weight-for-length trajectory across the first 24 months of life and reduced childhood obesity at 24 months. The intervention was effective in a racially and ethnically diverse population that included groups at elevated risk for childhood obesity. Trial Registration: ClinicalTrials.gov Identifier: NCT04042467.
Databáze:	MEDLINE
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