Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: protocol for a systematic review with individual participant data meta-analysis of behavioural interventions for the prevention of early childhood obesity
Authors: Hunter Kylie E , Johnson Brittany J , Askie Lisa , Golley Rebecca K , Baur Louise A , Marschner Ian C , Taylor Rachael W , Wolfenden Luke , Wood Charles T , Mihrshahi Seema , Hayes Alison J , Rissel Chris , Robledo Kristy P , O’Connor Denise A , Espinoza David , Staub Lukas P , Chadwick Paul , Taki Sarah , Barba Angie , Libesman Sol , Aberoumand Mason , Smith Wendy A , Sue-See Michelle , Hesketh Kylie D , Thomson Jessica L , Bryant Maria , Paul Ian M , Verbestel Vera , Stough Cathleen Odar , Wen Li Ming , Larsen Junilla K , O’Reilly Sharleen L , Wasser Heather M , Savage Jennifer S , Ong Ken K , Salvy Sarah-Jeanne , Messito Mary Jo , Gross Rachel S , Karssen Levie T , Rasmussen Finn E , Campbell Karen , Linares Ana Maria , Øverby Nina Cecilie , Palacios Cristina , Joshipura Kaumudi J , González Acero Carolina , Lakshman Rajalakshmi , Thompson Amanda L , Maffeis Claudio , Oken Emily , Ghaderi Ata , Rivera Maribel Campos , Perez-Exposito Ana B , Banna Jinan C , de la Haye Kayla , Goran Michael , Røed Margrethe , Anzman-Frasca Stephanie , Seidler Anna Lene 
Published: December 2020

Introduction

Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of intervention-covariate interactions. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups.

Methods and analysis

Systematic searches of Medline, Embase, CENTRAL, CINAHL, PsycInfo, and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2020 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis (PMA) will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index (BMI) z-score at age 24 +/- 6 months using World Health Organisation Growth Standards, and effect differences will be explored among pre-specified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events.

Ethics and dissemination

Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations, and media releases.

Registration

Prospectively registered on PROSPERO: CRD42020177408

STRENGTHS AND LIMITATIONS OF THIS STUDY

This will be the largest individual participant data (IPD) meta-analysis evaluating behavioural interventions for the prevention of early childhood obesity to date, and will provide the most reliable and precise estimates of early intervention effects to inform future decision-making.

IPD meta-analysis methodology will enable unprecedented exploration of important individual and trial-level characteristics that may be associated with childhood obesity or that may be effect modifiers.

The proposed innovative methodologies are feasible and have been successfully piloted by members of our group.

It may not be possible to obtain IPD from all eligible trials; in this instance, aggregate data will be used where available, and sensitivity analyses will be conducted to assess inclusion bias.

Outcome measures may be collected and reported differently across included trials, potentially increasing imprecision; however, we will harmonise available data where possible, and encourage those planning or conducting ongoing trials to collect common core outcomes following prospective meta-analysis methodology.