Evidence-based systematic review on the association between food advertising with childhood obesity
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摘要:
目的 通过检索国内外相关文献，综合评价食品广告对儿童肥胖发生的影响，为中国儿童肥胖防控政策的制定提供证据支持。 方法 采用系统评价方法，检索中国知网(CNKI)、维普网(VIP)、万方数据知识服务平台(Wanfang Data)、PubMed、Medline、SpringerLink、Web of Science、Science Direct等8个中外文献数据库至2020年11月30日国内外公开发表的有关研究文献，2016年及之后的高质量系统评价研究文献直接采纳，2016年之前的高质量系统评价文献与之后的相关文献进行合并后分析。 结果 共13篇文献被纳入综合评价，包括系统综述、队列研究、随机对照试验研究和横断面研究。儿童接触食品广告暴露，可增加其能量摄入。食品电视广告可影响儿童食物选择，增加儿童对甜食、含糖饮料等不健康食品的选择。儿童接触不健康食品广告，可增加其肥胖发生风险。 结论 规范儿童食品广告播放，有利于降低儿童肥胖的发生风险。 Abstract:Objective To evaluate the impact of food advertising on childhood obesity by reviewing relevant literatures, and to provide evidence support for childhood obesity prevention and control strategies in China. Methods A systematic review method was used to search relevant literatures published to November 30, 2020 from 8 databases including CNKI, VIP, Wanfang Data, PubMed, Medline, SpringerLink, Web of Science, Science Direct. The high-quality systematic reviews published since 2016 were included directly, and those published before 2016 were rereviewed after combined with other literatures. Results A total of 13 articles were included for evaluation, including systematic reviews, cohort studies, randomized controlled trials and cross-sectional studies. Children's exposure to food advertisements could increase energy intake. Television food advertising could influence children's food choices and increase the consumption of unhealthy foods such as sweets and sugary drinks. Children's exposure to unhealthy food advertisements could increase the risk of obesity. Conclusion Regulating the food advertisement can help reduce the risk of childhood obesity. -
Key words:
- Food /
- Advertisements /
- Obesity /
- Child /
- Evidence-based medicine
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表 1 食品广告对儿童肥胖发生影响的系统评价分析
Table 1. The systematic review analysis of food advertising on childhood obesity
第一作者 研究类型 样本量 年龄/岁 研究内容 结果 Russell[7] 系统综述与Meta分析 60 078(含1980—2018年发表的39项研究) 2~18 广告对膳食摄入影响 电视食品广告接触可使儿童膳食能量增加60.0(95%CI=3.1~116.9)kcal；食品游戏广告接触可使儿童膳食能量增加53.2(95%CI=31.5~74.9)kcal；电视食品广告与膳食摄入增加呈正相关(r=0.30，95%CI=0.16~0.45)。 Sadeghirad[8] 系统综述与Meta分析 5 966(含2015年1月之前发表的29项研究) 2~18 广告对膳食摄入及膳食选择影响 不健康膳食宣传广告可使儿童食物增加4.8(95%CI=0.8~8.8)g，膳食能量增加30.4(95%CI=2.9~57.9)kcal，增加饮料摄入风险(RR=1.1，95%CI=1.0~1.2)。 Boyland[9] 系统综述与Meta分析 2 463(含2015年3月之前发表的22项研究) 5~54 广告对膳食摄入影响 以膳食摄入标准均差(SMD)计，SMD=0.37; 95%CI=0.09~0.65;I2=98%，其中儿童SMD=0.56，P=0.003，95%CI=0.18~0.94，I2= 98%。 Hidalgo[10] 综述 — — 电视食品广告对儿童肥胖的影响 需要规范食品广告播放，尤其电视食品广告播放，以便预防儿童肥胖的发生。 Boyland[11] 综述 — — 电视食品广告对儿童饮食影响 尽管不同研究方法和样本特征不尽相同，但均表明，食品广告越来越多，并助推了不健康食品的流行，短期接触即可导致儿童消费增加。 Norman[4] RCT 160 7~16 广告对膳食摄入影响 接触多媒体食品广告后，其父母限制其饮食的儿童与不限制其饮食的儿童，零食摄入分别增加356，209 kJ；接触非多媒体食品广告，仅父母限制其饮食的学生午餐膳食摄入增加240 kJ。 Halford[12] RCT 37 11~13 广告对食物选择影响 正常体重儿童进行食品广告干预后，对商品或非商品属性食物的选择增加，超重肥胖儿童对商品食物选择多于正常体重儿童，并且存在食品广告与食物选择的显著正相关。 Tarabashkina[13] RCT 354 7~13 广告对食物选择影响 营养知识欠缺儿童，按照广告宣传选择零食的可能性更大。 Emond[14] 队列研究(2014—2015年) 624 3~5 电视食品广告对快餐摄入影响 广告对儿童西式快餐消费影响，受父母消费频率而异，其父母消费较少儿童受广告营影响消费增加的风险是父母消费较多的2倍。 Liu[15] 横断面研究 452 9~11 电视食品广告对食物选择的影响 儿童选择电视广告营销的甜食和饮料的可能性分别为其1.13，1.23倍，尤其泡芙和糖饮料更是分别达到1.31，1.45倍。 Buijzen[5] 横断面研究 234 4~12 电视食品广告对食物选择的影响 儿童接触食品广告暴露后，与广告品牌食品选择(b=0.21)及高能量密度食品选择(b=0.19)存在正相关。 Lobstein[16] 横断面研究 10个国家 6~15 电视食品广告对儿童超重的影响 儿童超重率与不健康食品广告数量呈正相关(r=0.81，P < 0.01)；与健康饮食推荐广告呈负相关(r=-0.56，P < 0.10)。 
横断面研究 347 3~8 电视食品广告对儿童食物选择的影响 超过50%的电视食品广告中食品为高脂高糖食品，49.2%的儿童在观看电视或是购物时，会要求父母购买电视广告食品，电视食品广告会增加儿童对不健康食品消费。 
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