Энергетическая ценность и диетическая структура рациона в терапии детского ожирения: сравнительный анализ национальных моделей (систематический обзор)

Введение. Детское ожирение остается одной из наиболее актуальных медико-социальных проблем, сопряженных с риском метаболических и сердечно-сосудистых осложнений. Несмотря на общность базовых принципов диетотерапии, подходы к регулированию энергетической ценности и структуры рациона существенно различаются между странами.

Цель — провести сравнительный анализ современных подходов к диетотерапии детского ожирения в России и Китае, определить их концептуальные различия, эффективность и перспективы унификации.

Материалы и методы. Выполнен целевой обзор литературы в базах данных PubMed, Scopus, Cochrane Library, eLibrary.ru и CNKI за 2017–2025 гг. с использованием методологии PRISMA 2020. В анализ включено 46 публикаций, включая национальные клинические рекомендации, экспертные консенсусы, систематические обзоры и оригинальные исследования.

Результаты. В России диетотерапия рассматривается как основной немедикаментозный метод лечения и основана на нормокалорийном рационе, направленном на физиологическую нормализацию питания и сохранение темпов роста без ограничения калорийности. Вмешательство реализуется преимущественно в рамках семейной модели, предусматривающей совместное участие врача и родителей в изменении питания, физической активности и поведенческих привычек ребенка. В Китае, согласно экспертному консенсусу, диетотерапия строится на контролируемом постепенном снижении энергетической плотности рациона до достижения рекомендованного уровня и включает интеграцию медицинского, семейного и школьного уровней: участие родителей и педагогов рассматривается как обязательный компонент коррекции пищевого и двигательного поведения. Основные различия касаются степени энергокоррекции и механизмов реализации — от индивидуально-семейного подхода в России до социально интегрированного, школьно-ориентированного в Китае.

Заключение. Оптимальная степень ограничения энергетической ценности при детском ожирении остается недостаточно изученной. Для повышения эффективности и безопасности диетических вмешательств необходимы многоцентровые исследования и унификация критериев оценки результатов.

1. Dang J, Zhang Y, Liu Y, Shi D, Cai S, Chen Z, et al. Spatial-temporal analysis and spatial drivers of childhood obesity in China from 1985 to 2019. Obesity. 2025;33(7):1344–1354. DOI: https://doi.org/10.1002/oby.24303.

2. Hong Y, Ullah R, Wang JB, Fu JF. Trends of obesity and overweight among children and adolescents in China. World Journal of Pediatrics. 2023;19(12):1115–1126. DOI: https://doi.org/10.1007/s12519-023-00709-7.

3. Martinchik AN, Laikam KE, Kozyreva NA, Mikhailov NA, Keshabyants EE, Baturin AK, et al. Prevalence of overweight and obesity in children. Voprosy pitaniia. 2022;91(3):64–72. (In Russ.). DOI: https://doi.org/10.33029/0042-8833-2022-91-3-64-72.

4. Gepstein V, Weiss R. Obesity as the main risk factor for metabolic syndrome in children. Frontiers in Endocrinology. 2019;10:568. DOI: https://doi.org/10.3389/fendo.2019.00568.

5. Chung ST, Krenek A, Magge SN. Childhood obesity and cardiovascular disease risk. Current Atherosclerosis Reports. 2023;25(7):405–415. DOI: https://doi.org/10.1007/s11883-023-01111-4.

6. Tian J, Blizzard L, Campbell JA, Gall S, Dwyer T, Venn A. Association of body mass index from childhood to mid-adulthood with health-related quality of life in mid-adulthood. Quality of Life Research. 2023; 32(12):3349–3358. DOI: https://doi.org/10.1007/s11136-023-03497-9.

7. Rozga M, Handu D. Nutrition interventions for pediatric obesity prevention: an umbrella review of systematic reviews. Nutrients. 2023;15(24):5097. DOI: https://doi.org/10.3390/nu15245097.

8. Hoelscher DM, Brann LS, O’Brien S, Handu D, Rozga M. Prevention of pediatric overweight and obesity: Position of the Academy of Nutrition and Dietetics based on an umbrella review of systematic reviews. Journal of the Academy of Nutrition and Dietetics. 2022;122(2):410–423.e6. DOI: https://doi.org/10.1016/j.jand.2021.11.003. Erratum in: Journal of the Academy of Nutrition and Dietetics. 2022;122(4):882. DOI: https://doi.org/10.1016/j.jand.2022.01.013.

9. Alman KL, Lister NB, Garnett SP, Gow ML, Aldwell K, Jebeile H. Dietetic management of obesity and severe obesity in children and adolescents: A scoping review of guidelines. Obesity Reviews. 2021;22(1):e13132. DOI: https://doi.org/10.1111/obr.13132.

10. Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, et al. Pediatric obesity — assessment, treatment, and prevention: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 2017;102(3):709–757. DOI: https://doi.org/10.1210/jc.2016-2573.

11. Semlitsch T, Stigler FL, Jeitler K, Horvath K, Siebenhofer A. Management of overweight and obesity in primary care — a systematic overview of international evidence‐based guidelines. Obesity Reviews. 2019; 20(9):1218–1230. DOI: https://doi.org/10.1111/obr.12889.

12. Mazur A, Zachurzok A, Baran J, et al. Childhood obesity: Position statement of Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes, the College of Family Physicians in Poland and Polish Association for Study on Obesity. Nutrients. 2022;14(18):3806. DOI: https://doi.org/10.3390/nu14183806.

13. Pfeiffié S, Pellegrino F, Kruseman M, Pijollet C, Volery M, Soguel L, et al. Current recommendations for nutritional management of overweight and obesity in children and adolescents: A structured framework. Nutrients. 2019;11(2):362. DOI: https://doi.org/10.3390/nu11020362.

14. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71.

15. Gooey M, Skouteris H, Betts J, Hatzikiriakidis K, Sturgiss E, Bergmeier H, et al. Clinical practice guidelines for the prevention of childhood obesity: A systematic review of quality and content. Obesity Reviews. 2022; 23(10):e13492. DOI: https://doi.org/10.1111/obr.13492.

16. Flynn AC, Suleiman F, Windsor-Aubrey H, Wolfe I, O’Keeffe M, Poston L, et al. Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting. Maternal & Child Nutrition. 2022;18(3):e13354. DOI: https://doi.org/10.1111/mcn.13354.

17. Motevalli M, Drenowatz C, Tanous DR, Khan NA, Wirnitzer K. Management of childhood obesity — time to shift from generalized to personalized intervention strategies. Nutrients. 2021;13(4):1200. DOI: https://doi.org/10.3390/nu13041200.

18. Denova-Gutiérrez E, González-Rocha A, Méndez-Sánchez L, Araiza-Nava B, Balderas N, López G, et al. Overview of systematic reviews of health interventions for the prevention and treatment of overweight and obesity in children. Nutrients. 2023;15(3):773. DOI: https://doi.org/10.3390/nu15030773.

19. Pereira AR, Oliveira A. Dietary interventions to prevent childhood obesity: A literature review. Nutrients. 2021;13(10):3447. DOI: https://doi.org/10.3390/nu13103447.

20. Tomayko EJ, Tovar A, Fitzgerald N, Howe CL, Hingle MD, Murphy MP, et al. Parent involvement in diet or physical activity interventions to treat or prevent childhood obesity: An umbrella review. Nutrients. 2021; 13(9):3227. DOI: https://doi.org/10.3390/nu13093227.

21. Epstein LH, Wilfley DE, Kilanowski C, Quattrin T, Cook SR, Eneli IU, et al. Family-based behavioral treatment for childhood obesity implemented in pediatric primary care: A randomized clinical trial. JAMA. 2023;329(22):1947–1956. DOI: https://doi.org/10.1001/jama.2023.8061.

22. Kemps E, Goossens L, Petersen J, Verbeken S, Vervoort L, Braet C. Evidence for enhancing childhood obesity treatment from a dual-process perspective: A systematic literature review. Clinical Psychology Review. 2020;77:101840. DOI: https://doi.org/10.1016/j.cpr.2020.101840.

23. Murimi MW, Moyeda-Carabaza AF, Nguyen B, Saha S, Amin R, Njike V. Factors that contribute to effective nutrition education interventions in children: A systematic review. Nutrition Reviews. 2018;76(8):553–580. DOI: https://doi.org/10.1093/nutrit/nuy020.

24. Russian Association of Endocrinologists; Society of Bariatric Surgeons. Obesity in children: Clinical recommendations of the Ministry of Health of the Russian Federation. Moscow; 2024. (In Russ.). Available from: https://clck.ru/3Q2Bpp (accessed 18 October 2025).

25. Pavlovskaya EV, Surkov AG, Shilina NM, Zubovich AI, Strokova TV. Modern approaches to diet therapy for obesity in children. Pediatric Nutrition. 2016;14(1):41–46. (In Russ.). DOI: https://doi.org/10.20953/1727-5784-2016-1-41-46.

26. Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database of Systematic Reviews. 2017;6(6):CD012651. DOI: https://doi.org/10.1002/14651858.CD012651.

27. Holm JC, Gamborg M, Bille DS, Grønbæk HN, Ward LC, Faerk J. Chronic care treatment of obese children and adolescents. International Journal of Pediatric Obesity. 2011;6(3–4):188–196. DOI: https://doi.org/10.3109/17477166.2011.575157.

28. Subspecialty Group of Endocrinologic, Hereditary and Metabolic Diseases, the Society of Pediatrics, Chinese Medical Association; Subspecialty Group of Child Health Care, the Society of Pediatrics, Chinese Medical Association; Subspecialty Group of Clinical Nutrition, the Society of Pediatrics, Chinese Medical Association; Editorial Board, Chinese Journal of Pediatrics. Expert consensus on diagnosis, assessment, and management of obesity in Chinese children. Zhonghua er ke za zhi = Chinese Journal of Pediatrics. 2022;60(6):507–515. (In Chinese). DOI: https://doi.org/10.3760/cma.j.cn112140-20220112-00043.

29. Ma GS. Report on childhood obesity in China. Beijing: People’s Medical Publishing House; 2017. (In Chinese).

30. Wang SS, Lay S, Yu HN, Shen SR. Dietary Guidelines for Chinese Residents (2016): Comments and comparisons. Journal of Zhejiang University-SCIENCE B. 2016;17(9):649–656. DOI: https://doi.org/10.1631/jzus.B1600341.

31. Chen P, Wang D, Shen H, Yu L, Gao Q, Mao L, et al. Physical activity and health in Chinese children and adolescents: Expert consensus statement (2020). British Journal of Sports Medicine. 2020;54(22):1321–1331. DOI: https://doi.org/10.1136/bjsports-2020-102261.

32. Zhang Y, Ma S, Chen C, Liu S, Zhang C, Cao Z, et al. Physical activity guide for Chinese children and adolescents. Chinese Journal of Evidence-Based Pediatrics. 2017;12(6):401–409. (In Chinese). DOI: https://doi.org/10.3969/j.issn.1673-5501.2017.06.001.

33. Deng X, He M, He D, Zhu Y, Zhang Z, Niu W. Sleep duration and obesity in children and adolescents: Evidence from an updated and dose — response meta-analysis. Sleep Medicine. 2021;78:169–181. DOI: https://doi.org/10.1016/j.sleep.2020.12.027.

34. Fatima Y, D o i SAR, Mamun AA. Longitudinal impact of sleep on overweight and obesity in children and adolescents: A systematic review and bias‐adjusted meta‐analysis. Obesity Reviews. 2015;16(2):137–149. DOI: https://doi.org/10.1111/obr.12245.

35. Lister NB, Baur LA, House ET, Alexander S, Brown J, Collins CE, et al. Intermittent energy restriction for adolescents with obesity: The fast track to health randomized clinical trial. JAMA Pediatrics. 2024; 178(10):1006–1016. DOI: https://doi.org/10.1001/jamapediatrics.2024.2869.

36. Jebeile H, Gow ML, Lister NB, Mosalman Haghighi M, Ayer J, Cowell CT, et al. Intermittent energy restriction is a feasible, effective, and acceptable intervention to treat adolescents with obesity. The Journal of Nutrition. 2019;149(7):1189–1197. DOI: https://doi.org/10.1093/jn/nxz049.

37. Hoare JK, Jebeile H, Garnett SP, Lister NB. Novel dietary interventions for adolescents with obesity: A narrative review. Pediatric Obesity. 2021;16(9):e12798. DOI: https://doi.org/10.1111/ijpo.12798.

38. Koh P, Chua J, Chan P, Shorey S. Effectiveness of universal community engagement childhood obesity interventions at improving weight-related and behavioral outcomes among children and adolescents: A systematic review and meta-analysis. Nutrients. 2024;16(20):3465. DOI: https://doi.org/10.3390/nu16203465.

39. Torstensson T, Bohlin A, Almqvist-Tangen G, Roswall J, Kindblom JM, Sjogren L. Family meals on prescription as treatment for childhood obesity — a randomized controlled trial. European Journal of Pediatrics. 2024;183(11):4857–4866. DOI: https://doi.org/10.1007/s00431-024-05744-8.

40. Kerr JA, Loughman A, Knox A, Koplin JJ, Allen KJ, Wake M. Nutrition‐related interventions targeting childhood overweight and obesity: A narrative review. Obesity Reviews. 2019;20(S1):45–60. DOI: https://doi.org/10.1111/obr.12768.

41. Liu Z, Gao P, Gao AY, Lin Y, Feng XX, Zhang F, et al. Effectiveness of a multifaceted intervention for prevention of obesity in primary school children in China: A cluster randomized clinical trial. JAMA Pediatrics. 2022;176(1):e214375. DOI: https://doi.org/10.1001/jamapediatrics.2021.4375.

42. Xu H, Ecker O, Zhang Q, Du S, Liu A, Li Y, et al. The effect of comprehensive intervention for childhood obesity on dietary diversity among younger children: Evidence from a school-based randomized controlled trial in China. PLoS One. 2020;15(7):e0235951. DOI: https://doi.org/10.1371/journal.pone.0235951.

43. Brown V, Moodie M, Sultana M, Hunter KE, Byrne R, Zarnowiecki D, et al. A scoping review of outcomes commonly reported in obesity prevention interventions aiming to improve obesity‐related health behaviors in children to age 5 years. Obesity Reviews. 2022;23(5):e13427. DOI: https://doi.org/10.1111/obr.13427.

44. Griffiths LA, Douglas SM, Raynor HA. The role of structure in dietary approaches for the treatment of pediatric overweight and obesity: A critical review. Obesity Reviews. 2021;22(9):e13266. DOI: https://doi.org/10.1111/obr.13266.

45. Durá-Travé T, Gallinas-Victoriano F, Urretavizcaya-Martinez M, Ahmed-Mohamed L, Chueca-Guindulain MJ, Berrade-Zubiri S. Effects of the application of a prolonged combined intervention on body composition in adolescents with obesity. Nutrition Journal. 2020;19(1):49. DOI: https://doi.org/10.1186/s12937-020-00570-8.

46. Heerman WJ, JaKa MM, Berge JM, Trapl ES, Sommer EC, Samuels LR, et al. The dose of behavioral interventions to prevent and treat childhood obesity: a systematic review and meta-regression. International Journal of Behavioral Nutrition and Physical Activity. 2017;14(1):157. DOI: https://doi.org/10.1186/s12966-017-0615-7.