Table of Content

10 April 2024, Volume 32 Issue 4

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Professional Forum

New concepts of complementary feeding in infants and toddlers

WANG Zhixu

2024, 32(4):  362-367.  DOI: 10.11852/zgetbjzz2024-0250

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Infants go through a transition period before fully adapting to a diversified balanced diet after being breastfed, during which foods introduced other than milk, aimed at supplementing energy and nutrients, are referred to as complementary foods. The process of introducing complementary foods is called complementary feeding (CF). The purpose and significance of adding complementary foods include not only supplementing energy and nutrients, but also promoting the development of eating skills and fine motor functions, establishing healthy eating and food-related psychological behaviors, preventing food allergies and other allergic diseases, and materializing diversity of children's gut flora. The feeding suggestions of introducing red meat paste first other than iron-fortified baby rice flour at the age of 6 months, and rapidly achieving diversified food exposure, is comply with the above principles. This article analyzes the purpose of infant CF, reviews the historical development of CF, and interprets relevant feeding recommendations based on new concepts of CF.

Nutrition and brain development in early life

SHAO Jie, GAO Jiaying

2024, 32(4):  368-371.  DOI: 10.11852/zgetbjzz2024-0273

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The early life period is a rapid period, as well as a critical/sensitive period for brain development. Proteins, long-chain polyunsaturated fatty acids (LCPUFAs), iron, zinc, iodine, folate, choline, vitamins A, D, B₆, and B₁₂, all play a role in key neural development processes and thus influence brain development. Different brain regions or circuits have specific critical periods during different stages of development that depend on specific nutrients. Any nutrient deficiency during this period, even if corrected with supplementation, may still affect the trajectory of brain development and result in long-term cognitive and behavioral impairment. This article elucidates the effects of major nutrient deficiencies during early life on brain development, the possible sensitive/critical timing, and the impacts on long-term cognitive and behavioral development, providing insights for the prevention and intervention of nutritional diseases and psychiatric developmental disorders, and the promotion of early childhood development.

Original Articles

Characteristics of sensory integration in static balance of 4 - to 5-year-old children

LIU Ruqiang, XU Zichun, ZHANG Rulei, LIU Yang, MAO Lijuan

2024, 32(4):  372-376.  DOI: 10.11852/zgetbjzz2023-0806

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Objective To analyze the sensory integration characteristics of 4- to 5-year-old preschool children while maintaining static balance, in order to provide reference for promoting the development of motor development. Methods A total of 128 preschool children were randomly selected in this study from a public kindergarten in Suzhou. Wearable sensor were worn at the center of mass(COM) position for four tests: T1 standing with eyes open, T2 standing with eyes closed, T3 standing with eyes open on a sponge pad, and T4 standing with eyes closed on a sponge pad. The angular velocity modulus(ω) of COM shaking was extracted, the Romberg quotient(RQ), vestibular Romberg quotient(VRQ), and the rate of increase in body stability when integrating different sensations were calculated. The contribution weights and sensory integration characteristics of visual, proprioceptive, and vestibular sensations to static balance were analyzed. Independent sample t-test was used to analyze the differences between different gender and age groups. Results The RQ was 1.20, and the VRQ was 1.58. The contribution rates of visual, proprioceptive, and vestibular senses to body balance were approximately 9.28%, 28.19% and 62.53%, respectively. The difference in the rate of increase in body stability between integrated vision and integrated proprioception with normal vestibular perception was statistically significant(P<0.001, Cohen's d＝-1.14),while the difference in the rate of increase in body stability between integrated proprioception and vestibular perception with normal vestibular perception and integrated vision with normal proprioception was statistically significant(P<0.001, Cohen's d=2.30). The difference in the rate of increased body stability between the sum of vestibular and proprioceptive integration and the simultaneous integration of visual and proprioceptive integration was statistically significant(P<0.001, Cohen's d＝-0.86). The gender differences in RQ, VRQ, and the rate of increased body stability when integrating different sensations(P>0.05) and the difference in half year old age was not statistically significant(P>0.05). Conclusions When preschool children aged 4 - 5 maintain static balance, the contribution of vestibular integration proprioception to body stability is greater than that of vestibular integrate vision. The contribution of vestibular and visual integrate proprioception to body stability is greater than that of vestibular and proprioception integrate vision. The sensory integration characteristics between boys and girls, as well as half year old children, are basically the same.

Differences in exosome miRNAs in human breast milk between preterm and full-term infants

WANG Yinfei, YIN Qin, ZENG Sijie, SUN Lei, YAN Qinhui, SHENG Xiaojing

2024, 32(4):  377-383.  DOI: 10.11852/zgetbjzz2023-0390

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Objective To evaluate the differential miRNA expression of breast milk exosome in premature and full-term groups, and to analyze the regulatory pathways by bioinformatics, so as to provide guidance and scientific basis for the growth and development of premature infants and the prevention and treatment of related diseases. Methods From August 2020 to June 2021, breast milk samples from 13 premature(premate group)and 9 full-term infants(full-term group)in the Department of Child Health Care of the Second Affiliated Hospital of Nanjing Medical University were collected to extract exosomes. The miRNAs of two groups of breast milk exosomes were sequenced by high-throughput sequencing. According to the sequencing results, miRNA expression profiles of milk exosome were analyzed. Biological function software was used to carry out GO and KEGG pathway analysis of differential miRNA. Results The expression of miRNA in human milk exosomes was rich, especially hsa-miR-148a-3p,hsa-let-7b-5p, hsa-let-7g-5p, hsa-miR-22-3p, hsa-miR-99a-5p, hsa-miR-200, hsa-miR-146b-5p and hsa-miR-26a-5p were relatively high expressed in preterm group and full-term group. Differential expression analysis showed that compared with full-term infant breast milk, 7 miRNAs were up-regulated(log₂|fold change|=2.803, 2.714, 1.632, 2.360, 1.350, 3.387, 2.137, respectively), and 5 miRNAs were down-regulated(log₂|fold change|＝-2.553,-2.197,-2.771,-1.395,-1.136, respectively)(|fold change>2|, P<0.05) in breast milk for preterm infants. In these differential expressed miRNAs, down-regulated miR-29b(P=0.001) and up-regulated miR-133a-3p(P=0.004) were associated with inflammation, and up-regulated miR-126-5p(P=0.021) and miR-126-3p(P=0.041) were associated with lipid metabolism. The fatty acid biosynthesis pathway was obviously enriched in preterm group. MiR-7-5p, miR-29b-3p and miR-100-5p played a role in the fatty acid synthesis pathway. Conclusions Exosomal miRNAs are rich in breast milk, and have significant differences between preterm and full-term infants' mothers. The differentially expressed miRNA in preterm infants treast milk may be related to inflammation and promote the growth and development of preterm infants through the fatty acid biosynthesis pathway.

Status quo of overweight, obesity and elevated blood pressure among children and adolescents aged 7 - 17 years in Mengzi City

JIN Cai'e, LI Gaoqiang, YANG Qingwei, YANG Shunling, WANG Yimin

2024, 32(4):  384-388.  DOI: 10.11852/zgetbjzz2023-0717

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Objective To analyze the association of overweight and obesity with elevated blood pressure(BP) among children and adolescents in Mengzi City, in order to provide reference for making effective interventions. Methods A total of 30 classes of students in 14 schools were selected into this study by a stratified random cluster sampling method from October 2020 to September 2021. The paticipants completed a questionnaire survey, and had their height, weight and BP measured. Logistic regression analysis was used to evaluate the association of overweight and obesity with elevated BP. Results A total of 4 015 children and adolescents aged 7 - 17 years were involved in the study. The detection rate of overweight, obesity and elevated BP was 12.53%, 10.01% and 12.38%, respectively. The detection rate of elevated BP was 9.96%, 19.48% and 25.62% in normal weight, overweight and obese groups, respectively. The risk of elevated BP in the overweight and obese groups was 2.190 times(95%CI: 1.696 - 2.926, P<0.001) and 3.243 times(95%CI: 2.501 - 4.204, P<0.001) as high as that in normal weight groups. The dietary and exercise behaviors of 1 604 adolescents were analyzed, it was found that the detection rate of obesity was significntly higher in non-boarding students(15.09%) and those who consumed fresh fruits at least once a day(13.49%)(χ²=18.012, 7.225, P<0.05), the detection rate of elevated BP was significantly higher in among those who did not consume sugary beverages(16.88%), and performed moderate-to-high intensity physical exercise of 60 minutes or more ≤ 2 days per week(16.88%)(χ²=9.403, 14.921,P<0.01). Conclusions The risk of developing hypertension increases with the high prevalence of overweight and obesity and is strongly associated with multiple factors. Therefore, it is essential to conduct effective weight control and behavioral lifestyle interventions among children and adolescents.

Epidemiological survey and influencing factors of overweight and obesity among preschool children in Suzhou

DENG Shasha, MENG Yumei, SUN Rongbo, SHEN Lingling, KONG Rui

2024, 32(4):  389-394.  DOI: 10.11852/zgetbjzz2023-0632

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Objective To investigate the prevalence and influencing factors of overweight and obesity among preschool children in Suzhou. Methods A stratified cluster random sampling method was used to select 24 452 children aged 3 - 6 years in different districts of Suzhou from December 2021 to June 2022. Then the prevalence rate of overweight and obesity was determined by physical measurements. A case-control study was conducted with a questionnaire survey of 3 786 children(1 893 in the obesity group and 1 893 in the control group) to analyze the factors influencing preschool obesity. Results 1) The overall detection rates of overweight among preschool children in Suzhou was 14.8%(boys 14.6%, girls 15.0%). The overall detection rates of obesity was 7.9%(boys 8.7%, girls 7.1%), with a statistically significant difference between boys and girls(χ²=19.828, P<0.01). 2) There was statistically significant difference in the detection rates of obesity among different age groups(χ²=98.415, P<0.01), with the lowest rate in the 3 - 4 years old group(5.8%) and the highest rate in the 6 - 7 years old group(11.8%). 3) The overall detection rates of mild, moderate and severe obesity was 4.8%, 2.6% and 0.5%, respectively. The proportion of moderate and severe obesity significantly increased with age(χ²=57.275,P<0.01). 4) Risk factors for preschool obesity included birth weight >4 000g, cesarean section, parental overweight/obesity, strong appetite of children, eating speed <10min/meal, high frequency of fried food consumption(>1time/week), eating while watching television, sedentary behavior >2h/d, insufficient exercise endurance, screen time >1h/d, and late bedtime(after 21∶30)(P<0.05). Protective factors for preschool obesity included larger breakfast consumption, fruits and vegetables as regular snacks, and physical activity after meals(P<0.05). 5) Factors influencing the degree of preschool obesity included paternal overweight(OR=1.33, 95%CI:1.06 - 1.65), paternal obesity(OR=1.91, 95%CI:1.46 - 2.49), maternal overweight(OR=1.25, 95%CI:1.01 - 1.54), maternal obesity(OR=1.94, 95%CI:1.40 - 2.69), low education level of father(junior high school or below)(OR=1.57, 95%CI:1.25 - 1.96), strong appetite of children(OR=1.72, 95%CI:1.41 - 2.11), eating speed <10min/meal(OR=1.29, 95%CI:1.05 - 1.57), sedentary behavior >2h/d(OR=1.51, 95%CI:1.24 - 1.85), insufficient exercise endurance(OR=1.56, 95%CI:1.12 - 2.19), and screen time>1h/d(OR=1.42, 95%CI:1.16 - 1.75). Conclusions The detection rates of overweight and obesity among preschool children in Suzhou are relatively high, and the detection rate and severity of obesity increase with age. In addition to genetic factors, preschool obesity are also associated with pregnancy and birth history, as well as unhealthy lifestyle after birth.

Nutrition-related influencing factors of myopia among adolescents in Zhengding County, Shijiazhuang City

YOU Yi, LIU Fangfang, QIN Hongyu, XU Lamei, JING Ran, GAO Shuqing

2024, 32(4):  395-400.  DOI: 10.11852/zgetbjzz2023-0902

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Objective To analyze nutrition-related factors that affect the prevalence of myopia in adolescents, in order to provide reference for primary prevention of myopia. Methods A stratified sampling method was used to select 385 adolescents from Zhengding County in October 2021. Adolescents in this study took vision testing, physical examination and completed a questionnaire survey. One-way analysis of variance and lasso regression were used to screen the variables, and Logistic regression was used to determine the possible influencing factors of myopia. Factor analysis was adopted to extract the dietary patterns of adolescents in Zhengding County, then the association between dietary patterns and myopia was analyzed. Results A total of 385 adolescents were surveyed, with the prevalence rate of myopia of about 68.6%. Multivariate analysis revealed that fried food(OR=8.480, 95%CI:1.058 - 67.971) was a risk factor for myopia, while intake of milk and dairy products(OR=0.994, 95%CI:0.991 - 0.999), soybeans and nuts(OR=0.997, 95%CI:0.994 - 0.999), no myopia in either parent(OR=0.312, 95%CI:0.115 - 0.845), physical education class 4 times per week(OR=0.269, 95%CI:0.074 - 0.984) were statistically associated with a lower risk of myopia(P＜0.05). Three dietary patterns was extracted through factor analysis, including diversified dietary pattern, soy-hybrid dietary pattern, and snack and beverage dietary pattern. Logistic analysis results indicated that soy-hybrid dietary pattern(OR=0.85, 95%CI:0.73 - 0.99,P<0.05) was statistically associated with myopia. Conclusions The problem of myopia among adolescents in Zhengding County is more serious. Increasing the intake of milk and dairy products, soybeans and nuts, reducing the intake of fried foods, and adjusting the overall dietary structure should be recommended in order to prevent the development of myopia in adolescents.

Effect of intervention on the perception of body weight among parents of preschool children

CHEN Yanlin, WAN Zihao, HOU Fang, LI Li

2024, 32(4):  401-404.  DOI: 10.11852/zgetbjzz2023-0873

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Objective To explore the effect of health education intervention measures on improving parents' perception of their children's weight, so as to provide scientific basis for intervention in preschool obese children. Methods Children from 7 kindergartens in Luohu district were randomly selected in this study in October 2020, and were divided into intervention group and control group. The intervention group consisted of 1 318 children and parents from 3 kindergartens, and the control group consisted of 1 546 children and parents from 4 kindergartens. Parents in the intervention group received combination of online and offline health education intervention measures for 2 months, while parents in the control group received no intervention measures. Logistic regression analysis was used to evaluate the effect of parents' perception of their children's weight in intervention group and control group. Results After controlling for imbalanced variables such as parents' education level, total monthly family income, and parents' perception of their children's weight, there was a statistically significant difference in the improvement of parents' perception of their children's weight status between two groups after intervention(OR=2.175,95%CI:1.536 - 3.080,P<0.05). After intervention, the improvement of parents' perception of boys' weight status in intervention group was better than that in control group(OR=2.985, 95%CI: 1.878 - 4.745, P<0.05). There was no statistically significant difference in the degree of improvement in perceived weight status among girls' parents after intervention(P＞0.05). Regardless of whether the child's weight status was normal or not, parents in the intervention group showed better improvement in their perception of their children's weight status than the control group(OR=1.558, 6.111, 95%CI:1.025 - 2.368, 2.811 - 13.287, P<0.05). Conclusion Health education measures can improve the perception bias of parents towards their preschool children's weight, and the intervention effect varies among children of different genders and weight states.

Basic Experimental Article

Effects of early postnatal immune activation on autism-likebehaviors and glial cells in mice

ZHANG Bei, WANG Minnan, NI Luopa, Gulijianati ABULAKEMU, Keriman PAERHATI, HE Yanhong, Amanguli KADEER, Rena MAIMAITI

2024, 32(4):  405-411.  DOI: 10.11852/zgetbjzz2023-1149

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Objective To observe the effects of early postnatal immune activation (EPIA) on social behaviors of male and female mice, and to explore the possible role of the functional state of astrocytes and microglia in this process. Methods Using lipopolysaccharide (LPS) induced EPIA mice as study subjects, mice were divided into the male-control, male-model, female-control, and female-model groups, each containing 10 mice (n=10). Behavioral tests were performed at 25 - 32 days of age, and the social behavior ability of mice was evaluated by open field test, three-chamber sociability test, and marble burying test. The expression levels of GFAP, IBA-1, TLR4, and NFκB p65 in the cortex and hippocampus were detected by Western blot (n=3). Results In behavioral tests, social index significantly decreased in LPS treatment group (F=14.907, P＜0.05). The interaction effect between treatment and sex was significant in the residence time (F =5.260, P<0.05) and the number of buried marbles (F=7.788, P<0.05). LPS treatment decreased the retention time of the central region in male mice (F=4.261, P<0.05), and increased the number of buried marbles in males (F=20.645, P<0.05). Western blot results showed that LPS treatment increased the expression of GFAP protein in the hippocampus (F=50.443, P<0.05) and cortex (F=30.116, P<0.05), as well as the expression of IBA-1 protein (F=21.844. P<0.05) and TLR4 protein (F=6.215, P<0.05) in the cortex. The results of NFκB p65 showed a significant interaction between treatment and sex in the cortex (F=6.558, P<0.05), and LPS increased the expression of NFκB p65 protein in the cortex in female mice (F=16.317, P<0.05). Conclusions EPIA is sufficient to induce sex-specific autism spectrum disorder (ASD)-like behavior and enhance astroglial and microglial reactivity in mice. ASD-like behavior induced by EPIA may be related to the TLR4/NFκB signaling pathway in the cortex.

Review

Risk factors of non-alcoholic fatty liver disease in children

GENG Zuotao, ZHANG Dan, ZHU Xiaotong, LI Lanyi, LI Xuehai, YANG Yongli

2024, 32(4):  412-418.  DOI: 10.11852/zgetbjzz2023-0676

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Non-alcoholic fatty liver disease(NAFLD) has become the main cause of chronic liver disease in children worldwide, and the incidence of NAFLD shows an increasing trend year by year. The risk factors leading to the onset of NAFLD in children are diversified and different from those in adults. At present, most medical institutions still pay little attention to NAFLD in children. This paper summarizes the risk factors and mechanisms for NAFLD in children, including gene polymorphism, maternal and fetal conditions, diet and living habits, environmental exposure, metabolic syndrome, endocrine-related mechanisms and intestinal microecology, in order to provide reference for the prevention and management of childhood NAFLD.

Research progress of growth hormone in the treatment of small for gestational age infants

LIN Kunhong, CHEN Dijia, XING Yan, WANG Xinli

2024, 32(4):  419-423.  DOI: 10.11852/zgetbjzz2023-0634

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Generally, small for gestational age(SGA) infants will catch up with growth after birth, but some SGAs fail to show enough catch-up growth, leading to physical growth backwardness, and the risk of metabolic diseases in adult offspring increases. The application of exogenous growth hormone replacement therapy can ensure and promote the occurrence of SGA catching up with growth. However, as growth hormone exerts therapeutic effects in related clinical diseases, clinical attention is gradually being paid to whether growth hormone may bring long-term risks. This article aims to review the efficacy and potential risks of growth hormone treatment for SGA.

Research progress in the effects of the main active ingredients of breast milk on the intestinal and immune functions of infants

LYU Lina, ZHU Bingquan

2024, 32(4):  424-428.  DOI: 10.11852/zgetbjzz2023-0907

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Gut microbiome plays an important role in maintaining lifelong health. Infancy is a critical period for the establishment of gut microbiota, which is influenced by many factors, including delivery methods, antibiotics, and feeding mode. Human milk contains a variety of bioactive factors, such as human milk oligosaccharide, secretory immunoglobulin, and human milk microbiota, which play important roles in the establishment and stability of newborn microbiota. This article presents the latest research progress on the effects of the aforementioned bioactive factors in breast milk on the colonization and development of infant microbiota, and explains how these substances affect immune function through intestinal bacteria.

Research progress of breast-feeding in infants with congenital heart disease

ZHENG Yan, SI Zaixia, ZHAO Liping, ZHANG Jin

2024, 32(4):  429-432.  DOI: 10.11852/zgetbjzz2023-0881

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Breastfeeding is the best natural food for infants. In infants with congenital heart disease(CHD), breast milk can reduce the incidence of necrotizing enterocolitis, feeding intolerance and growth failure, and improve the overall prognosis. However, there are many obstacles to breastfeeding in infants with CHD as well as lack of related domestic research. This study mainly focuses on breastfeeding status, influencing factors, assessment, implementation and solutions for the infants with CHD, and proposed the future research recommendations on clinical practices, in order to provide reference for the breastfeeding management of infants with CHD in China.

Meta Analysis

Hotspots and trends of nutrition research in global preschool children from 2012 to 2022 based on Citespace visual analysis

ZHANG Jiawen, ZHAO Ziling, CHEN Shiqi, ZHOU Tianjin, LI Yanlin, LIU Yuci, LUO Min

2024, 32(4):  433-439.  DOI: 10.11852/zgetbjzz2023-0355

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Objective To review the scientific research advances in the field of preschool children's nutrition from 2012 to 2022, in order to provide reference for relevant policy formulation and further scientific exploration in this area. Methods High-quality literature published both domestically and internationally between 2012 and 2022 was retrieved through Web of Science (WOS) and China National Knowledge Infrastructure (CNKI) database. Excel and CiteSpace software were applied to visualize the research hotspots and frontier trends. Results A total of 1 816 English articles and 110 Chinese articles were included in the analysis. The cooperation network density of research institutions and authors was found to be low. Excluding the search terms, the top three English keywords were vitamin A (0.74), intervention (0.67), obesity prevention (0.55); the top three Chinese keywords were "anemia" (0.41), "obesity" (0.38), and "nutritional status" (0.18). In Chinese and English clusters, "anemia" and "physical activity" ranked first, respectively. The latest burst words identified were "dietary pattern" and "diet quality". Conclusions The number of English literature published in the field of preschool children's nutrition is increasing, but it has shown a downward trend in the past three years in China. There are few studies in this field in China. The research hotspots primarily focus on the nutritional status of preschool children, with less attention paid to intervention research and methodological exploration. Further research in the field of preschool children's nutrition in China may need to focus on the external determinants of preschool children's nutrition, such as parental education, diet and food supply.

Clinical Research

Characteristics of foot development in children under 3 years old in Xi'an City

FENG Shuang, WANG Zhaohui, WANG Dong, REN Jiaojiao, LI Hongjuan, GE Shasha

2024, 32(4):  440-444.  DOI: 10.11852/zgetbjzz2023-0971

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Objective To measure and analyze foot development indicators of children under 3 years old, in order to provide basis for the correct clinical assessment of children foot development. Methods A total of 5 894 children under 3 years old who took physical examination in the Child Health Care Department of Xi'an People's Hospital from August 2022 to March 2023 were randomly selected. Foot length, foot width, the ratio of foot width to length and arch index were measured by image processing system, and were compared among different age groups and sex groups. Results 1) Foot length, foot width and arch index of children under 3 years old increased significantly with age, while the ratio of foot width to length decreased significantly with age(F=1 345.23, 396.21,184.65, 287.03, P＜0.05). 2) There was no statistical significance in foot length, foot width and arch index between left and right foot of children under 3 years old(P＞0.05). 3) Foot length and foot width of boys were greater than those of girls in all age groups, and the difference was statistically significant(t_{foot length}:3.45 - 10.19,t_{foot width}: 3.77 - 9.21, P＜0.05). There was no significant difference in arch index between boys and girls in all age groups(P＞0.05). Conclusion Foot shape of children under 3 years old changes with age, there are differences in foot length and width between boys and girls.

Serum vitamin D level of children aged 0 to 3 years and its correlation with nutritional knowledge, attitude and behavior of caregivers in Yibin

TIAN Xue, WANG Lin, LYU Dan

2024, 32(4):  445-450.  DOI: 10.11852/zgetbjzz2023-0370

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Objective To explore the correlation of serum vitamin D level of children aged 0 to 3 years with their caregivers' nutritional knowledge, attitude and practice (KAP) in Yibin, in order to provide reference for the prevention of vitamin D deficiency in children. Methods A total of 783 children aged 0 to 3 years who underwent child health care at the First People's Hospital of Yibin from January to December 2020 were selected into this study. Children's general conditions (feeding, growth and development, lifestyle, etc.) were collected, and venous blood samples were taken to detect serum 25-(OH)D concentration using the chemiluminescence method. The caregivers' nutritional KAP was investigated using a self-designed knowledge-attitude-practice questionnaire. The relationship between the children's vitamin D nutritional status and their caregivers' nutritional KAP was analyzed using pearson correlation analysis. Results 1) The exclusive breastfeeding rate of children aged 0 to 3 years was about 62.2%. Significant differences were found in outdoor activity time and average vitamin D supplementation among different age groups (t=9.030, 10.260, P<0.05). 2) The average concentration of serum 25-(OH)D was (36.8±8.7)ng/mL, and the incidence of vitamin D deficiency was 21.84%. Significant differences were found in serum 25-(OH)D level and the incidence of vitamin D deficiency among children of different ages, body shapes, outdoor activities, and vitamin D supplementation (t/F:2.220 - 6.302, χ²:5.346 - 33.134, P<0.05). 3) The caregivers' nutritional KAP scores were 78.9±9.9, 88.1±8.3, and 78.3±11.8, respectively, with parents scoring higher than other caregivers (P<0.05). 4) Serum 25-(OH)D level was positively correlated with the nutritional knowledge, attitude, and behavior scores of caregivers (r=0.805, 0.650, 0.831, P<0.05). The caregivers' nutritional KAP grade was correlated with vitamin D deficiency (P<0.05). 5) Overweight/obesity was a possible risk factor for vitamin D deficiency in children (OR=2.126, 95%CI: 1.162 - 3.887). Outdoor activity duration ≥2h/d (OR=0.592, 95%CI: 0.392 - 0.895), regular vitamin D supplementation (OR=0.618, 95%CI: 0.456 - 0.838), and good nutritional behavior of caregivers(OR=0.725, 95%CI: 0.563 - 0.933) were protective factors for vitamin D deficiency in children (P<0.05). Conclusions The prevalence of vitamin D deficiency is high among children aged 0 to 3 years in Yibin, and it is related to the nutritional KAP of their caregivers. Improving the nutritional KAP of caregivers can help prevent and manage vitamin D deficiency in children.

Correlation of body mass index with family status and feeding conditions among preschool children in Jingzhou City

WANG Tiantian, ZHAO Bing

2024, 32(4):  451-455.  DOI: 10.11852/zgetbjzz2023-0491

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Objective To investigate the distribution of body mass index(BMI) among preschool children in Jingzhou City and its correlation with family conditions and feeding practices, so as to provide scientific basis for the health management of overweight and obesity in children. Methods In August 2022, a cross-sectional study was conducted in Jingzhou City using stratified cluster random sampling. Data on the height, weight, family conditions and feeding practices of children aged 3 - 6 years attending kindergartens were collected. Then BMI was calculated, and multivariate linear regression analysis was performed for data analysis. Results A total of 14 237 preschool children were surveyed. The overall average BMI was (16.40±3.40) kg/m². Among them, the porpotion of children whose BMI were in lower, lower-middle, middle, upper-middle and upper range was 0.05%, 1.95%, 86.49%, 4.83% and 6.67%, respectively. Multivariate linear regression analysis revealed that factors such as cesarean birth(β=0.17), paternal smoking(β=0.13), maternal smoking(β=0.39), being female(β＝-0.22), total pre-tax family income(β＝-0.13), private kindergartens (β=0.22)and a diet pattern primarily consisting of fried chicken, burgers, fries, carbonated drinks, and fruit juices (β=0.46) were linearly correlated with children's BMI(P<0.05). Conclusions Overweight and obesity are prevalent among preschool children in Jingzhou City, with a higher proportion of BMI in the upper-middle and upper ranges. Parents and society should collaborate and take appropriate measures to ensure the healthy growth of children.

Experience Exchange

Effectiveness of extensively hydrolyzed formula in treating feeding intolerance in preterm infants

YU Hanshu, SUN Ruizhen, YANG Yanling, SU Yuehua, FU Zhongying

2024, 32(4):  456-459.  DOI: 10.11852/zgetbjzz2023-0545

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Objective To analyze the effect of extensively hydrolyzed formula(eHF) in the treatment of feeding intolerance in preterm infants and the effect on hospital infection, in order to provide reference for the clinical treatment of feeding intolerance in preterm infants. Methods A total of 208 cases of preterm infants with feeding intolerance diagnosed and treated in Shandong Heze Municipal Hospital from April 2017 to February 2020 were selected into the clinical trial for eligibility assessment, then were randomly assigned into study group(n=100) and control group(n=100) after screening and exclusion. Children in the control group were fed with standard preterm formula, while children in the study group were fed with eHF. Feeding tolerance indicators, including daily milk intake, time to meconium evacuation, time to full gastrointestinal nutrition, total gastric residual counts(GRV1) in the 7-d period after resumption of breastfeeding, ratio of all-day gastric residual counts/all-day estimated milk intake after resumption of breastfeeding(GRV2) were compared between the two groups, and growth indicators(body weight growth rate, head dimension growth rate), complication incidence [necrotizing enterocolitis(NEC), pathological jaundice, positive fecal occult blood or blood in stool] and incidence of hospital-acquired infections. Results The daily milk intake(t=5.037) of the study group was higher than that of the control group, and the time of foetal excretion(t=9.217), the time to reach full gastrointestinal nutrition(t=15.833), GRV1(t=6.737), GRV2(t=9.956) were lower than those of the control group, and the differences were all statistically significant(P<0.05). The rate of weight gain(t=2.454) and head dimension growth(t=5.469) in the study group was significantly higher than those of the control group(P<0.05). The incidence of the three complications of NEC, pathological jaundice and positive fecal occult blood or blood in stool(χ²=4.310) and the incidence of hospital infections(χ²=4.688) were significantly lower in the study group than in the control group(P<0.05). Conclusions Compared with the standard formula milk for preterm infants, eHF can significantly improve the feeding intolerance of preterm infants, promote growth and development, and reduce the occurrence of hospital-acquired infections. Therefore, eHF can be widely used in clinic for preterm infants with feeding intolerance.

Association between caregiver feeding style and dinner diet quality in children with nutritional problems

WANG Wenxian, WANG Haining, GAO Jingjing, HUO Yanyan, YANG Fan, CHEN Jinjin

2024, 32(4):  460-464.  DOI: 10.11852/zgetbjzz2023-1291

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Objective To explore the correlation between different feeding styles of caregivers and diet quality of children with nutritional problems, in order to provide reference for making effective feeding guidance and intervention strategy. Methods From January 2022 to August 2023, 2- to 6-year-old children who had been enrolled in kindergartens or nurseries and their caregivers from the combined outpatient department of Child Healthcare and Nutrition in Shanghai Children's Hospital were selected into this study.The amount of dinner served and consumed was obtained through the three-day dinner intake survey, and the Chinese Healthy Eating Index (CHEI) was calculated.Feeding styles were divided into four groups through the Caregiver Feeding Style Questionnaire.Pearson correlation analysis was used to determine the correlation between served and consumed CHEI score.Chi-square test, t-test and ANOVA were used to compare the differences in CHEI score for dinner consumed in children with different feeding styles. Results 1) Totally 133 parent-child pairs were included in this study.There were 68 boys (51.1%) and 65 girls (48.9%), with an average age of (4.6±0.6) years.2) CHEI scores for dinner served was highly correlated with that for dinner consumed (r=0.90, P<0.05).There was statistically significant difference between the CHEI score for dinner served and consumed by authoritative and authoritarian feeding styles (t=2.538, 1.732, P＜0.05).3) After adjusting body shape, children in the authoritative feeding style actually completed a significantly higher diet quality CHEI score than those in the authoritarian feeding style (P＜0.05).4)Authoritative and indulgent feeding styles had statistical differences in the distribution of children's body size (χ²=13.587, P=0.035). Conclusions Parents with authoritarian feeding style and indulgent feeding style have worse control over their children's dietary completion.Children with authoritative feeding style have higher dietary quality than those with authoritarian feeding style.Children with indulgent feeding style may have a higher proportion of non-low weight than those with authoritative feeding style.Although feeding style could not reverse the outcome of body shape deviation in children with disease, it may have some positive effects.