ImportanceAdolescent obesity requires effective and accessible treatment. Intensive dietary interventions have the potential to be used as adjunctive therapy for behavioral weight management.ObjectiveTo examine the effectiveness of 2 diet therapies, delivered as part of an intensive behavioral weight management intervention, in adolescents with metabolic complications associated with obesity.Design, Setting, and ParticipantsThis multisite, 52-week randomized clinical trial was conducted from January 31, 2018, to March 31, 2023, at 2 tertiary pediatric centers in Australia. Adolescents (aged 13-17 years) with obesity and 1 or more associated complications were included.InterventionsIntensive behavioral interventions, delivered by a multidisciplinary team, comparing intermittent energy restriction (IER) or continuous energy restriction (CER), with 3 phases: very low-energy diet (weeks 0-4), intensive intervention (weeks 5-16), and continued intervention and/or maintenance (weeks 17-52).Main Outcomes and MeasuresThe primary outcome was body mass index (BMI) z score at 52 weeks in the IER vs CER group. Anthropometry, body composition, and cardiometabolic health were assessed at baseline and 52 weeks. The BMI z score and percentiles were determined using Centers for Disease Control and Prevention growth charts. Insulin resistance, dyslipidemia, and elevated hepatic function were assessed.ResultsA total of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) were enrolled, 71 in the IER group and 70 in the CER group, and 97 (68.8%) completed the intervention, 43 in the IER group and 54 in the CER group. At week 52, both groups had reduced BMI z scores (estimated marginal mean change, −0.28 [95% CI, −0.37 to −0.20] for IER and −0.28 [95% CI, −0.36 to −0.20] for CER) and reduced BMI expressed as a percentage of the 95th percentile (estimated marginal mean change, −9.56 [95% CI, −12.36 to −6.83] for IER and −9.23 [95% CI, −11.82 to −6.64] for CER). No differences were found in body composition or cardiometabolic outcomes between the groups. Both groups had a reduction in the occurrence of insulin resistance (from 52 of 68 [76.5%] to 32 of 56 [57.1%] in the IER group and from 59 of 68 [86.8%] to 31 of 60 [57.1%] in the CER group) at week 16; however, at week 52, this effect was observed in the CER group only (from 59 of 68 [86.7%] to 30 of 49 [61.2%]). The occurrence of dyslipidemia was unchanged between baseline and week 52 (60 of 137 [42.6%] and 37 of 87 [42.5%], respectively), with a small improvement in occurrence of impaired hepatic function tests (37 of 139 [27.0%] and 15 of 87 [17.2%], respectively). No differences were found in dyslipidemia or hepatic function between groups.Conclusions and RelevanceThese findings suggest that for adolescents with obesity-associated complications, IER can be incorporated into a behavioral weight management program, providing an option in addition to CER and offering participants more choice.Trial Registrationhttp://anzctr.org.au Identifier: ACTRN12617001630303

中文翻译：

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肥胖青少年的间歇性能量限制


重要性青少年肥胖需要有效且容易获得的治疗。强化饮食干预有可能用作行为体重管理的辅助疗法。目的检查作为强化行为体重管理干预的一部分提供的 2 种饮食疗法对患有与肥胖相关的代谢并发症的青少年的有效性。设计、设置、这项多中心、为期 52 周的随机临床试验于 2018 年 1 月 31 日至 2023 年 3 月 31 日在澳大利亚 2 个三级儿科中心进行。包括患有肥胖症和 1 种或多种相关并发症的青少年（13-17 岁）。干预措施由多学科团队实施的强化行为干预措施，比较间歇性能量限制 (IER) 或连续性能量限制 (CER)，分为 3 个阶段：非常低-能量饮食（第0-4周），强化干预（第5-16周），以及持续干预和/或维持（第17-52周）。主要结果和措施主要结果是体重指数（BMI）z评分为52 IER 与 CER 组的周数。在基线和 52 周时对人体测量、身体成分和心脏代谢健康进行评估。 BMI z 分数和百分位数是使用疾病控制和预防中心生长图确定的。评估了胰岛素抵抗、血脂异常和肝功能升高。 结果 共有 141 名青少年（中位 [IQR] 年龄，14.8 [12.9-17.9] 岁；71 名男性 [50.4%]）入组，其中 IER 组 71 名，IER 组 70 名。 CER 组中有 97 人（68.8%）完成了干预，其中 IER 组有 43 人，CER 组有 54 人。第 52 周时，两组的 BMI z 分数均降低（估计边际平均变化，IER 为 -0.28 [95% CI，-0.37 至 -0.20]，IER 为 -0.28 [95% CI，-0.36 至 -0]。20]对于CER）和降低的BMI表示为第95个百分位的百分比（估计边际平均变化，IER为-9.56 [95% CI，-12.36至-6.83]和-9.23 [95% CI，-11.82至-6.64] ] 对于 CER）。各组之间的身体成分或心脏代谢结果没有发现差异。两组胰岛素抵抗的发生率均有所下降（IER 组从 68 例中的 52 例 [76.5%] 降至 56 例中的 32 例 [57.1%]，而 IER 组则从 68 例中的 59 例 [86.8%] 降至 60 例中的​​ 31 例 [57.1%]。 CER 组）在第 16 周；然而，在第 52 周，这种效应仅在 CER 组中观察到（从 68 例中的 59 例 [86.7%] 到 49 例中的 30 例 [61.2%]）。从基线到第 52 周，血脂异常的发生率没有变化（分别为 137 例中的 60 例 [42.6%] 和 87 例中的 37 例 [42.5%]），肝功能检查受损的发生率略有改善（139 例中的 37 例 [27.0%]）和 87 个中的 15 个 [17.2%]）。各组之间的血脂异常或肝功能没有发现差异。结论和相关性这些研究结果表明，对于患有肥胖相关并发症的青少年，IER 可以纳入行为体重管理计划，为 CER 之外提供一个选择，并为参与者提供更多选择。试用注册http://anzctr.org。au 标识符: ACTRN12617001630303